77 year old woman with recent increasing shortness of breath with exertion and possible diagnosis of hypertrophic cardiomyopathy presents for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. There is asymmetric septal hypertrophy (septal wall thickness: 16 mm, posterior wall 8mm) with flow acceleration in the outflow tract and associated systolic anterior motion of the mitral valve. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 67 ml/m2 (normal range: 74+/-15), the LVEDV is 121 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 43 ml (normal range 47+/-19), the LV mass index is 85 g/m2 (normal range 85+/-15), and the LV mass is 153 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is an atypical pattern of late gadolinium enhancement involving the basal inferior and inferolateral walls and the LV apex which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The overall burden of late gadolinium enhancement is 5-10% of the myocardial mass. Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 112 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 51 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 ValveThe mitral valve opens widely and there is at least mild mitral regurgitation. There is evidence of systolic anterior motion of the mitral valve.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 upper limits of normal in size (29 mm)Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. There is mild amount of pericardial fat present.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 normal in size and systolic function (65%)2. There is asymmetric septal hypertrophy (septal wall thickness: 16 mm, posterior wall: 8mm) with flow acceleration in the outflow tract and associated systolic anterior motion of the mitral valve. 3. There is an atypical pattern of late gadolinium enhancement to suggest the presence of an underlying fibrosing process, which involves only 5-10% of the myocardial mass. 4. The right ventricle is normal in size and systolic function (54%)5. Taken together, these findings support the diagnosis of hypertrophic cardiomyopathy and no high risk features of sudden cardiac death/ adverse cardiac remodeling are identified. Atypical patterns of late gadolinium enhancement are present in approximately two-thirds of individuals with hypertrophic cardiomyopathy. The presence of 15-20% late gadolinium enhancement burden is considered higher risk for sudden cardiac death and adverse cardiac remodeling. 