A 68 year old male with exertional chest pain with an echocardiography that showed a normal left ventricular function, hypertrophied septum, normal left ventricular thickness and a mid-cavity gradient. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 57 ml/m2 (normal range: 74+/-15), the LVEDV is 116 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 41 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 82 g (normal range 164+/-36). There is mild basal anteroseptal hypertrophy (13mm), and the rest of the myocardium has a normal wall thickness (8mm). There is septal anterior motion of the anterior leaflet of the mitral valve (SAM) with resulting mild flow acceleration in the left ventricular outflow tract. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Additionally, the native myocardial T1 relaxation times are within normal limits. No myocardial iron overload.No intracavitary thrombus.Left AtriumThe left atrium is normal in size (61ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 71 ml/m2 (normal range 82+/-16), the RVEDV is 145 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 69 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. The aortic valve is trileaflet. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is septal anterior motion of the anterior leaflet of the mitral valve (SAM) with resulting mild flow acceleration in the left ventricular outflow tract.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 is normal size with normal systolic function (LVEF is 64%). There is asymmetric hypertrophy of the left ventricle; however, strict MRI criteria for the diagnosis of hypertrophic cardiomyopathy are not met. However, early stage of hypertrophic cardiomyopathy should still be considered given the clear asymmetry and the presence of systolic anterior motion of the mitral valve (SAM) with mild LVOT flow acceleration. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Additionally, native myocardial T1 relaxation times are within normal limits. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 53%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.