A 55 year old female with Chronic kidney disease, hyperlipidemia, non-obstructive coronary artery disease, LBBB, chronic heart failure with a 2013 cardiac MRI that showed LVEF of 35% with late gadolinium enhancement in the inferoseptal wall. Referred now to cardiac MRI for further evaluation with concerns about cardiac amyloid. Left VentricleThe left ventricle is severely dilated with severe systolic dysfunction. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 117 ml/m2 (normal range: 65+/-11), the LVEDV is 216 ml (normal range 109+/-23), the LV end systolic volume index is 86 ml/m2 (normal range 18+/-5), the LVESV is 159 ml (normal range 31+/-10), the LV mass index is 89 g/m2 (normal range 67+/-11), and the LV mass is 167 g (normal range 114+/-24). There is mild left ventricular hypertrophy of the basal inferolateral wall (13mm wall thickness); the remainder of the myocardium has normal wall thickness (10mm wall thickness). There is global left ventricular dysfunction with regional variation. Abnormal septal motion compatible with LBBB. There are two regions of late gadolinium enhancement. The first is a focal region of transmural late gadolinium enhancement in the mid-inferior wall, and the second is a patch of late gadolinium enhancement in the basal infero-lateral wall. These findings are atypical for prior myocardial infarction. Also, given the normal "Gadolinium Kinetics ons the TI scout," the findings are also not typical for the diagnosis of cardiac amyloidosis. The native myocardial T1 time is moderately increased suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Compared side by side with cardiac MRI of 4/25/2013: no significant change in the LGE pattern was noted.No intracardiac thrombus is noted.No myocardial iron overload.Left AtriumThe left atrium is normal in size. The LA volume is 76 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 53 ml/m2 (normal range 69+/-14), the RVEDV is 98 ml (normal range 110+/-24), the RV end systolic volume index is 18 ml/m2 (normal range 22+/-8), and the RVESV is 34 ml (normal range 35+/-13). 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.Pulmonic ValveThe pulmonic valve opens widely. There is mild 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 (26 x 26 mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (24mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.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 severely dilated with severe systolic dysfunction, the LVEF is 26%. The basal inferolateral wall is mildly hypertrophied and has evidence of a patch of late gadolinium enhancement within it. There is a second region of focal, transmural late gadolinium enhancement in the mid-inferior wall. Overall, these patterns of late gadolinium enhancement are not typical for either prior myocardial infarction or cardiac amyloidosis. However, they do suggest the presence of some form of myocardial fibrosis, inflammation, or infiltration. Compared side by side with cardiac MRI of 4/25/2013: no significant change in the LGE pattern was noted.2. The right ventricle is normal in size with normal systolic function, the RVEF is 65%. 3. Small pericardial effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.