47 year old female with ESRD on HD, HTN, heroine abuse on methadone, cardiomyopathy with concern for amyloid. Referred for cardiac MRI to assess for cardiac amyloid. Left VentricleThe left ventricle is mildly dilated with reduced systolic function. There is mild global decrease in function without any regional wall motion abnormalities. The overall LV ejection fraction is 47%. The LVEDV is 163 ml (normal range 109+/-23), LV end diastolic volume index is 112 ml/m2 (normal range: 65+/-11), LVESV is 87 ml (normal range 31+/-10), and LV end systolic volume index is 60 ml/m2 (normal range 18+/-5). The LV mass is 110 g (normal range 114+/-24) and the LV mass index is 76 g/m2 (normal range 67+/-11).  The native T1 myocardial relaxation time is <950 ms not suggestive of underlying diffuse fibrosis or infiltration. There is no myocardial iron overload. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RVEDV is 102 ml (normal range 110+/-24), the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVESV is 48 ml (normal range 35+/-13), and the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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 drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsBilateral moderate pleural effusions . Associated passive bilateral lower lobe subsegmental atelectasis. Suggestion of persistent pulmonary edema. 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.Assessment for cardiac amyloidosis is limited in the absence of contrast; unable to assess for areas of myocardial late gadolinium enhancement. The native T1 myocardial relaxation time is <950 ms, not suggestive of underlying diffuse fibrosis or infiltration.2.The left ventricle is mildly dilated with mildly reduced systolic function. LVEF 47% stable from recent TTE. 3.The right ventricle is normal in size with normal systolic function. RVEF 53%.4.Mild mitral regurgitation and mild left atrial dilation.5.Small pericardial effusion.6.Bilateral moderate pleural effusions, multilobar passive atelectasis and suggestion of persistent pulmonary edema.