40 year old with new onset heart failure presenting for evaluation of etiology. Left VentricleThe left ventricle is severely dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 42%, the LV end diastolic volume index is 183 ml/m2 (normal range: 74+/-15), the LVEDV is 310 ml (normal range 142+/-34), the LV end systolic volume index is 106 ml/m2 (normal range 25+/-9), the LVESV is 180 ml (normal range 47+/-19), the LV mass index is 85 g/m2 (normal range 85+/-15), and the LV mass is 144 g (normal range 164+/-36). The left ventricular systolic dysfunction is global with regional variation. There is mid myocardial interventricular septal late gadolinium ("mid-wall stripe") enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This finding has been described in nonischemic cardiomyopathy and is atypical for prior myocardial infarction. Native T1 times are normal at 1025 ms. No evidence of iron overload. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 155 ml/m2 (normal range 82+/-16), the RVEDV is 264 ml (normal range 142+/-31), the RV end systolic volume index is 85 ml/m2 (normal range 31+/-9), and the RVESV is 145 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 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 mildly dilated (30 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis 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 with mild to moderately reduced systolic function (LVEF 42%) with evidence of late gadolinium enhancement involving the mid-wall of the septum. The pattern most likely represents myocardial fibrosis and is commonly described in dilated cardiomyopathy. The pattern is not typical for prior myocardial infarction.2. Severe RV dilation with mildly reduced systolic function (RVEF 45%).3. Mild biatrial dilation.4. Mild dilation of the main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.