68yo female with history of carcinoma of nasopharynx now with concerns for multiple myeloma presenting for cardiac evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. Normal wall thickness (IVSd=8mm and PWd=8mm). The overall LV ejection fraction is 61%, the LV end diastolic volume index is 45 ml/m2 (normal range: 65+/-11), the LVEDV is 85 ml (normal range 109+/-23), the LV end systolic volume index is 18 ml/m2 (normal range 18+/-5), the LVESV is 34 ml (normal range 31+/-10), the LV mass index is 22 g/m2 (normal range 67+/-11), and the LV mass is 41 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Native myocardial T1 times are ~1075ms, which is in the normal range and does not support the diagnosis of cardiac amyloid. Myocardial T2* time is 39ms, which suggests no myocardial iron overload.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 47 ml/m2 (normal range 69+/-14), the RVEDV is 90 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 40 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. The MV appears thickened. 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 with minimal tortuosity. The aortic root is normal in size. Atherosclerotic plaque is seen in the descending aorta. 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 are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease. Pericardial fat is present.Extracardiac FindingsThere is evidence of significant hepatic iron overload (T2-star=12.8ms). 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. Normal LV size and systolic function (LVEF 61%). Normal wall thickness, normal myocardial T1 times, normal left atrial size all speak against the diagnosis of cardiac amyloidosis. No contrast imaging was performed given the patients decreased renal function.2. Normal RV size and systolic function (RVEF 56%).3. Mild descending aortic atherosclerosis.4. Evidence of hepatic iron overload. 