A 63 year old male with known severe left ventricular dysfunction and no coronary artery disease, referred to cardiac MRI for evaluation of etiology and degree of fibrosis. Left VentricleThe left ventricle is severely dilated with severe systolic dysfunction. The overall LV ejection fraction is 18%, the LV end diastolic volume index is 135 ml/m2 (normal range: 74+/-15), the LVEDV is 229 ml (normal range 142+/-34), the LV end systolic volume index is 111 ml/m2 (normal range 25+/-9), the LVESV is 187 ml (normal range 47+/-19), the LV mass index is 88 g/m2 (normal range 85+/-15), and the LV mass is 149 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is mid-myocardial late gadolinium enhancement of the basal interventricular septum. The finding is atypical for prior myocardial infarction and likely represents myocardial fibrosis. This pattern of late gadolinium enhancement is most commonly seen in dilated cardiomyopathy. No evidence of myocardial iron overload. Findings unlikely to represent amyloidosis. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severe systolic dysfunction. The overall RV ejection fraction is 14%, the RV end diastolic volume index is 170 ml/m2 (normal range 82+/-16), the RVEDV is 188 ml (normal range 142+/-31), the RV end systolic volume index is 146 ml/m2 (normal range 31+/-9), and the RVESV is 246 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.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 moderate to severe 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. There is mild atherosclerosis of the aortic arch and descending aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is mild pericardial effusion.Extracardiac FindingsThere is mild bilateral pleural effusion. This 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. Severe LV dilation with severely reduced systolic function (LVEF 18%). 2. There is mid-myocardial late gadolinium enhancement of the basal interventricular septum. The finding is atypical for prior myocardial infarction and likely represents myocardial fibrosis. This pattern of late gadolinium enhancement is most commonly seen in dilated cardiomyopathy. 3. Severe RV dilation with severely reduced systolic function (RVEF 14%).4. Severe biatrial dilation.5 Moderate to severe mitral regurgitation.6. Mild atherosclerosis of thoracic aorta.7. Mild pericardial and pleural effusions.