46 year old man with history of non-ischemic cardiomyopathy, previous PE on anticoagulation, and recent syncope referred for cardiac MRI to evaluate for etiology of his cardiomyopathy. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 13%, the LV end diastolic volume index is 343 ml/m2 (normal range: 74+/-15), the LVEDV is 708 ml (normal range 142+/-34), the LV end systolic volume index is 299 ml/m2 (normal range 25+/-9), the LVESV is 617 ml (normal range 47+/-19). There is global hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of myocardial iron overload.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced function. The overall RV ejection fraction is 13%, the RV end diastolic volume index is 173 ml/m2 (normal range 82+/-16), the RVEDV is 357 ml (normal range 142+/-31), the RV end systolic volume index is 150 ml/m2 (normal range 31+/-9), and the RVESV is 310 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is tethering of the mitral valve leaflets with probable severe mitral regurgitation, which is eccentric.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated (34mm).Venous AnatomyThe SVC and IVC normally into the right atrium. There is a catheter in the SVC.PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThere is a small right pleural effusion. There is mediastinal lymphadenopathy consistent with the previous chest imaging. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.
1. Severely dilated left ventricle with severely reduced function (EF 13%). There is global hypokinesis with regional variation.2. Severely dilated right ventricle with severely reduced function (EF 13%). 3. Biatrial dilatation4. Severe mitral regurgitation, eccentric jet is posteriorly directed5. At least moderate tricuspid regurgitation6. No late gadolinium enhancement to suggest an infiltrative, inflammatory or fibrosive process. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.