59 year old man with history of non-ischemic cardiomyopathy, paroxysmal atrial fibrillation and syncope with no inducible VT/SVT on EP study, referred for cardiac MRI. Left VentricleThe left ventricle is moderately-severely dilated with normal systolic function. The LV is dilated even after adjusting for BSA; however, normal ranges are not at all well defined in individuals of his height. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 130 ml/m2 (normal range: 74+/-15), the LVEDV is 319 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 141 ml (normal range 47+/-19), the LV mass index is 32 g/m2 (normal range 85+/-15), and the LV mass is 78 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a transmural area of late gadolinium enhancement in the basal inferolateral wall which is unlikely to represent myocardial infarction because it is within a region of myocardium that has normal wall thickness. The finding suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of myocardial iron overload. Left AtriumThe left atrium is moderately enlarged. The interatrial septum appears aneurysmal.Right VentricleThe right ventricle is moderately dilated with normal systolic function. The RV is dilated even after adjusting for BSA; however, normal ranges are not at all well defined in individuals of his height. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 136 ml/m2 (normal range 82+/-16), the RVEDV is 332 ml (normal range 142+/-31), the RV end systolic volume index is 59 ml/m2 (normal range 31+/-9), and the RVESV is 144 ml (normal range 54+/-17). While the indexed diastolic volume is elevated, there are no regional wall motion abnormalities of the right ventricle to suggest underlying ARVC.Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial 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. Normal origin of the coronary arteries. 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 a trivial pericardial effusion.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. Moderate-severely dilated left ventricle with normal systolic function (EF 56%). The LV is dilated even after adjusting for BSA; however, normal ranges are not at all well defined in individuals of his height. 2. There is a small transmural area of late gadolinium enhancement in the basal inferolateral wall which is unlikely to represent myocardial infarction because it is within a region of myocardium that has normal wall thickness. The finding suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. Moderately dilated right ventricle with normal systolic function (EF 57%) and no regional wall motion abnormalities. The RV is dilated even after adjusting for BSA; however, normal ranges are not at all well defined in individuals of his height. 4. Biatrial dilation. 5. Aneurysmal interatrial septum. 6. Normal origin of the coronary arteries. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.