64Yrs male with a history of AL amyloidosis with cardiac and renal involvement. History of by bilateral pulmonary emboli. His other cardiovascular risk factors include hypertension, hyperlipidemia, and obstructive sleep apnea. MRI evaluation for cardiac diagnosis of cardiac amyloidosis and burden. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. There is mild to moderate concentric left ventricular hypertrophy (IVSd=14mm and PWd=10mm). There are slightly thickened chordal attachments of the anterior mitral valve leaflet causing some flow acceleration of blood through these into the LV outflow tract (i.e. chordal SAM). The overall LV ejection fraction is 69%. The LVEDV is 149 ml (normal range 142+/-34), the LV end diastolic volume index is 67 ml/m2 (normal range: 74+/-15), the LVESV is 46 ml (normal range 47+/-19) and the LV end systolic volume index is 21 ml/m2 (normal range 25+/-9). The LV mass is 155 g (normal range 164+/-36) and the LV mass index is 70 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is diffuse subendocardial, circumferential late gadolinium enhancement involving much of the left ventricle. The pattern is not consistent with prior myocardial infarction and is consistent with the diagnosis of cardiac amyloidosis. The native T1 myocardial relaxation time is 1076 ms in the septum which is on the high end of normal. It is 1184 ms in the lateral and inferolateral left ventricular walls which is moderately elevated. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. There is mild right ventricular hypertrophy. The overall RV ejection fraction is 61%. The RVEDV is 133 ml (normal range 142+/-31), RV end diastolic volume index is 60 ml/m2 (normal range 82+/-16), the RVESV is 52 ml (normal range 54+/-17), and the RV end systolic volume index is 23 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThere are thickened anterior mitral valve leaflet and chordal attachments causing some flow acceleration of blood through these into the LV outflow tract (i.e. chordal SAM). The mitral valve opens widely and there is mild to moderate 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 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.Normal sized LV with normal systolic function (LVEF 69%) with evidence of circumferential, endocardial late gadolinium enhancement. The pattern of late gadolinium enhancement is consistent with the diagnosis of cardiac amyloidosis. 2.Normal sized RV with normal systolic function (RVEF 61%)3.Mild to moderate mitral regurgitation with evidence of LVOT flow acceleration due to chordal SAM.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.