A 45 year old male with no known medical problems until about one month ago when he was hospitalized because of heart failure and his clinical condition improved with diuretics. The echocardiography showed a severely decreased systolic function of the left ventricle and suspected non-compaction cardiomyopathy. A normal EKG and troponin levels was seen. He suffers from mildly reduced kidney function. Referred now to cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 239 ml/m2 (normal range: 74+/-15), the LVEDV is 510 ml (normal range 142+/-34), the LV end systolic volume index is 191 ml/m2 (normal range 25+/-9), the LVESV is 408 ml (normal range 47+/-19), the LV mass index is 83 g/m2 (normal range 85+/-15), and the LV mass is 177 g (normal range 164+/-36). There is severe global hypokinesis with akinesia of the entire inferior wall. The lateral wall is mildly dyskinetic. There is intermediate signal that is transmural from the base to the apical two thirds of the lateral wall. In addition, there is a high signal, linear epicardial enhancement involving the apex that extends from the apical one third of the septum to the apical one third of the lateral wall. This epicardial enhancement is atypical for myocardial infarct. Given the pattern of enhancement and disproportionate wall abnormality relative to regions of enhancement, a global process such as inflammation may be present. In the presence of wall thinning, this may represent a subacute or chronic myocarditis. Per clinical history, the EKG and troponins were normal; therefore, ischemic etiology is considered much less likely.There is no intracavitary thrombus.There is no iron overload in the myocardium. There is no MRI findings compatible with non-compaction cardiomyopathy.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 36%, the RV end diastolic volume index is 117 ml/m2 (normal range 82+/-16), the RVEDV is 249 ml (normal range 142+/-31), the RV end systolic volume index is 74 ml/m2 (normal range 31+/-9), and the RVESV is 158 ml (normal range 54+/-17). No definite right ventricular wall enhancement is identified; however, this may be limited because a single dose of gadolinium was utilized due to limited renal function.Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least 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.PericardiumThere is mild pericardial effusion.
1. The left ventricle is severely dilated with severely reduced systolic function, the LVEF is 20%. 2. There is no MRI findings compatible with non-compaction cardiomyopathy. There is severe global hypokinesia with areas of akinesia and wall thickening with associated enhancement as described above. The enhancement is not typical of myocardial infarct; therefore, other etiologies such as inflammation may be considered.3. The right ventricle is mildly dilated with moderately reduced systolic function, the RVEF is 36%. 4. The right and left atrium are moderately dilated. 5. There is at least moderate mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.