59 year old male with a history of heart failure with preserved ejection fraction, hypertension, coronary artery disease, atrial arrhythmias, and COPD who was recently discharged after decompensated heart failure. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 146 ml (normal range 142+/-34), the LV end systolic volume index is 21 ml/m2 (normal range 25+/-9), the LVESV is 53 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 138 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is asymmetric severe left ventricular hypertrophy (basal to mid anteroseptal wall 17mm and posterior wall 7 mm). There is no LVOT gradient or flow acceleration noted. There is a significant amount of late gadolinium enhancement which involves much of the basal to mid left ventricular endocardial surface. The pattern of late gadolinium enhancement is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native T1 myocardial relaxation time is mildly elevated (1120 ms). The morphological features of the left ventricle are suggestive of hypertrophic cardiomyopathy; however, the late gadolinium enhancement pattern is fairly suggestive of the diagnosis of cardiac amyloidosis. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 65 ml (normal range 54+/-17).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 no significant mitral regurgitation. No systolic anterior motion of the mitral leaflets. 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 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. The left ventricle is normal in size and systolic function (LVEF 64%). There is asymmetric severe left ventricular hypertrophy which is worst in the basal anteroseptum. There is also a significant amount of late gadolinium enhancement which nearly circumferentially involves much of the basal to mid left ventricular endocardial surface. The pattern of late gadolinium enhancement is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The morphological features of the left ventricle are suggestive of hypertrophic cardiomyopathy; however, the late gadolinium enhancement pattern is fairly suggestive of the diagnosis of cardiac amyloidosis. 2. The right ventricle is normal in size and systolic function (RVEF 54%).3. Moderate biatrial enlargement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.