24 year old man with history of polysubstance abuse, found to have new biventricular failure and referred for cardiac MRI to evaluate for possible etiologies of his cardiomyopathy. Left VentricleThe left ventricle is severely dilated with severely reduced function. The overall LV ejection fraction is 16%, the LV end diastolic volume index is 181 ml/m2 (normal range: 74+/-15), the LVEDV is 301 ml (normal range 142+/-34), the LV end systolic volume index is 152 ml/m2 (normal range 25+/-9), the LVESV is 254 ml (normal range 47+/-19). There is global hypokinesis with regional variation. There is no evidence of LV thrombus seen. There is significant late gadolinium enhancement present as a mid myocardial stripe in the septum, and patchy, non-transmural involvement in the basal-mid anterolateral and basal inferolateral wall. Pattern is atypical for ischemic disease.Left AtriumThe left atrium is dilated. Right VentricleThe right ventricle is severely dilated. The overall RV ejection fraction is 32%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 59 ml/m2 (normal range 31+/-9), and the RVESV is 98 ml (normal range 54+/-17).Right AtriumThe right atrium is dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings . 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 systolic dysfunction with significant delayed enhancement in a mid-wall and patchy pattern which spares the endocardium.3. RV systolic dysfunction3. No LV thrombus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.