42 year old man with history of heart failure with reduced ejection fraction, hypertension who presents with new drop in ejection fraction. Cardiac MRI done to evaluate for structure, function, and etiology of cardiomyopathy Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 15%, the LV end diastolic volume index is 222 ml/m2 (normal range: 74+/-15), the LVEDV is 542 ml (normal range 142+/-34), the LV end systolic volume index is 189 ml/m2 (normal range 25+/-9), the LVESV is 462 ml (normal range 47+/-19), the LV mass index is 117 g/m2 (normal range 85+/-15), and the LV mass is 285 g (normal range 164+/-36). There is global hypokinesis. There is a small area of near transmural late gadolinium enhancement in the apical lateral wall in a pattern most consistent with prior myocardial infarction due to an embolic event. No evidence of myocardial iron overload, cardiac amyloidosis, or other infiltrative process.No LV apical thrombus present.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 25 %, the RV end diastolic volume index is 125 ml/m2 (normal range 82+/-16), the RVEDV is 305 ml (normal range 142+/-31), the RV end systolic volume index is 93 ml/m2 (normal range 31+/-9), and the RVESV is 227 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 ValveThere is restricted opening of the mitral valve with 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 moderate dilated and measures 35 mmVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a small right pleural effusion. Evidence of increased interstitial lung markings at bilateral lung bases. 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. The left ventricle is severely dilated with severely reduced systolic function (LVEF 15%)2. The right ventricle is mildly dilated with severely reduced systolic function (RVEF 25%)3. There is a small area of near transmural late gadolinium enhancement in the apical lateral wall in a pattern most consistent with myocardial infarction from an embolic event. No evidence of infiltrative myocardial process such as iron overload, sarcoidosis, or amyloidosis. The extent of LV dysfunction is out of proportion to the size of her myocardial infarction suggesting a predominantly non-ischemic etiology.4. Severe left atrial dilation5. Main pulmonary artery dilation.6. Moderate mitral regurgitation.7. See extra-cardiac findings.