A 49 year old male with alcohol abuse and recently diagnosed biventricular heart failure (LVEF 10% by echo). An apical clot was suspected and anticoagulant treatment was started. Normal coronary arteries by left heart catheterization. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 15%, the LV end diastolic volume index is 177 ml/m2 (normal range: 74+/-15), the LVEDV is 398 ml (normal range 142+/-34), the LV end systolic volume index is 151 ml/m2 (normal range 25+/-9), the LVESV is 340 ml (normal range 47+/-19), the LV mass index is 89 g/m2 (normal range 85+/-15), and the LV mass is 200 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying focal replacement fibrosing, infiltrative, or inflammatory process.Native myocardial T1 times are mildly increased (~1100ms), suggesting the presence of mild, diffuse, interstitial fibrosis. No intracavitary thrombus was noted.No myocardial iron overload was noted.Left AtriumThe left atrium is severely dilated (166ml). Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 29%, the RV end diastolic volume index is 123 ml/m2 (normal range 82+/-16), the RVEDV is 277 ml (normal range 142+/-31), the RV end systolic volume index is 88 ml/m2 (normal range 31+/-9), and the RVESV is 198 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation (functional).Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is upper normal size (37 X 38mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (32mm).Venous AnatomyThe SVC and IVC drain into the right atrium. There is a catheter on the right subclavian vein. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere is a large right pleural effusion with likely associated compressionn atelectasis. There is a small left pleural effusion. 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. The left ventricle is severely dilated with severely reduced systolic function, the LVEF 15%. 2. There is no late gadolinium enhancement to suggest the presence of an underlying focal replacement fibrosing, infiltrative, or inflammatory process. However, native myocardial T1 times are mildly increased, suggesting the presence of mild interstitial fibrosis.3. No intracavitary thrombus was noted.4. No myocardial iron overload was noted.5. The right ventricle is mildly dilated with severely reduced systolic function, the RVEF is 29%. 6. The left atrium is severely dilated and the right atrium is mildly dilated7. There is mild to moderate mitral regurgitation (functional).8. The main pulmonary artery is mildly dilated.9. There is a small pericardial effusion.10. See extracardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.