70 year old man with NICM, referred for further evaluation of underlying etiology. Left VentricleThe left ventricle is mildly dilated with severely reduced systolic function. There is severe concentric left ventricular hypertrophy (IVSd=20ms). The overall LV ejection fraction is 28%, the LV end diastolic volume index is 123 ml/m2 (normal range: 74+/-15), the LVEDV is 254 ml (normal range 142+/-34), the LV end systolic volume index is 88 ml/m2 (normal range 25+/-9), the LVESV is 182 ml (normal range 47+/-19), the LV mass index is 122 g/m2 (normal range 85+/-15), and the LV mass is 251 g (normal range 164+/-36). LV dysfunction is global. The native myocardial T1 time is severely elevated (1202ms), indicative of an underlying infiltrative process. There is diffuse, circumferential, endocardial late gadolinium enhancement which is worst along the base and mid myocardium and a little less at the apex. The TI scout shows nearly simultaneous myocardial and LV cavity nulling. These findings are diagnostic of cardiac amyloidosis. Left AtriumThe left atrium is severely dilated. The atrial wall and interatrial septum are thickened.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 101 ml/m2 (normal range 82+/-16), the RVEDV is 208 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 131 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to 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 normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumA small pericardial effusion is noted. Extracardiac FindingsSmall right pleural effusion is noted. 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 mildly dilated and severely hypertrophied with severely reduced systolic function (LVEF 28%). There is diffuse, circumferential, endocardial late gadolinium enhancement which is worst along the base and mid myocardium and a little less at the apex. The TI scout shows nearly simultaneous myocardial and LV cavity nulling. The native myocardial T1 relaxation time is severely elevated. Together, these findings are diagnostic of cardiac amyloidosis. 2. Normal RV size with moderately reduced systolic function (RVEF 37%).3. Severe biatrial dilation.4. Mild to moderate mitral regurgitation.5. Mild aortic regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.