56 year old male with history if ischemic heart disease, s/p orthotopic heart transplant, with shortness of breath recent back pain, leg pain and diabetic keto-acidosis associated with decreased LVEF to 31%. Evaluation for infection vs graft rejection. Left VentricleThe left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 22%. The LVEDV is 231 ml (normal range 142+/-34), the LV end diastolic volume index is 119 ml/m2 (normal range: 74+/-15), the LVESV is 180 ml (normal range 47+/-19) and the LV end systolic volume index is 93 ml/m2 (normal range 25+/-9). The LV mass is 248 g (normal range 164+/-36) and the LV mass index is 128 g/m2 (normal range 85+/-15). There is global hypokinesis. The T2-ratio and global relative enhancement ratios are both within normal range. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no LV thrombus. Left AtriumThe left atrium has transplant morphology. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 32%. The RVEDV is 143 ml (normal range 142+/-31), RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVESV is 97 ml (normal range 54+/-17), and the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9).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 mild 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. Mild left ventricular dilation with severely reduced systolic function (LVEF 22%). No evidence of elevated T2-ratio, global relative enhancement, or late gadolinium enhancement which suggest the absence of myocardial inflammation, infiltration, or fibrosis. Unfortunately, T1-mapping was not available during today's scan because of a scanner software upgrade. If clinically indicated, patient can be brought back for T1-mapping at no cost to the patient after the upgrade is completed next week .2. Normal right ventricular size with moderate systolic dysfunction (RVEF 32%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.