65 year old male with new diagnosis of heart failure with reduced ejection fraction, atrial fibrillation referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 63 ml/m2 (normal range: 74+/-15), the LVEDV is 135 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 66 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 134 g (normal range 164+/-36). There is mild-moderate left ventricular hypertrophy (mid septum 16-17mm, lateral wall 15 mm). There is global hypokinesis. There is diffuse predominantly mid to based subendocardial late gadolinium enhancement. The pre-contrast native myocardial T1 relaxation time is upper limits of normal 1080 ms. Left AtriumThe left atrium is mildly dilated with suggestion of diffuse late gadolinium enhancement. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 137 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 71 ml (normal range 54+/-17). There is mild right ventricular hypertrophy. Right AtriumThe right atrium is mildly dilated with suggestion of diffuse late gadolinium enhancement.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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.PericardiumSmall circumferential pericardial effusion.Extracardiac FindingsLarge bilateral pleural effusions (right greater than left) with associated passive atelectasis. 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 normal in size with mildly reduced systolic function (LVEF 51%) with global hypokinesis. 2. The right ventricle is normal in size with mildly reduced systolic function (RVEF 48%). 3. Mild-moderate left ventricular hypertrophy and mild right ventricular hypertrophy with diffuse predominantly mid to basilar subendocardial late enhancement. Overall these findings highly suggest cardiac amyloid. 6. See extracardiac findings as above.