55 year old man on dialysis referred for assessment of LV size and function, given abnormal echo. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 35.3%, the LV end diastolic volume index is 135 ml/m2 (normal range: 74+/-15), the LVEDV is 203 ml (normal range 142+/-34), the LV end systolic volume index is 87 ml/m2 (normal range 25+/-9), the LVESV is 131 ml (normal range 47+/-19), the LV mass index is 120 g/m2 (normal range 85+/-15), and the LV mass is 178 g (normal range 164+/-36). There is thinning and hypokinesis of the basal to mid inferior and inferolateral wall, consider prior myocardial infarction. There is otherwise circumferential mild left ventricular hypertrophy (IVSd=11mm). Based on SSFP scout imaging (not T2-star), there is probably no myocardial iron overload.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 83 ml/m2 (normal range 82+/-16), the RVEDV is 125 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 55 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant 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 normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is likely significant hepatic and splenic iron overload. Thyroid enlargement is noted. Esophageal dilation is noted. 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. Severe LV dilation, mild LVH, and moderately reduced systolic function (LVEF 35.2%). There is thinning and hypokinesis of the basal to mid inferior and inferolateral wall, consider prior myocardial infarction or hibernating myocardium. 2. Normal RV size and systolic function (RVEF 56%).3. Severe left atrial dilation.4. See extra-cardiac findings.