37 year old male with hypertrophic cardiomyopathy, referred for cardiovascular MRI to evaluate function, hypertrophy, and scar. Left VentricleThe left ventricle has severe asymmetric hypertrophy involving the mid and distal ventricular septum, anterior, and anterolateral walls with sparing of the basal-mid inferior and lateral walls. There is mid-cavitary obstruction. The overall systolic function is normal, The apex is akinetic. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 85 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 37 ml/m2 (normal range 25+/-9), the LVESV is 86 ml (normal range 47+/-19), the LV mass index is 117 g/m2 (normal range 85+/-15), and the LV mass is 273 g (normal range 164+/-36). There is extensive late gadolinium enhancement in the mid and distal anterior and anterolateral walls and basal anterior wall. There is transmural circumferential enhancement in the apex and distal lateral wall. Left AtriumThe left atrium is normal in moderately dilated.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 143 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 65 ml (normal range 54+/-17).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 no significant mitral regurgitation. No obvious SAM.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 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 has severe asymmetric hypertrophy involving the mid and distal ventricular septum, anterior, and anterolateral walls with sparing of the basal-mid inferior and lateral walls. Maximal wall thickness (anterior wall) was 21-22 mm.2. The overall LV systolic function is normal.3. The apex is akinetic. 4. There is extensive late gadolinium enhancement in the mid and distal anterior and anterolateral walls and basal anterior wall. ALthough the endocardium is more heavily involved, the pattern of enhancement is clearly more than endocardial and in many segments diffuse.5. There is transmural circumferential enhancement in the apex and distal lateral wall. These segments are also thinned suggestive of infarction.6. Normal RV systolic function.