67 year old woman with cardiomyopathy, who is referred to assess for etiology.MEDICATIONS: furosemide, glipizide, aspirin, warfarin First Pass PerfusionThere is a global subendocardial perfusion defect present both during hyperemia and during resting conditions.Viability/ Myocardial ScarThere is no evidence of underlying myocardial infarction; however, there is an atypical pattern of late gadolinium enhancement which involves the basal to mid inferior wall and spares the endocardial border. This suggests the presence of underlying myocardial fibrosis.Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. There is global hypokinesis with regional variation. The overall LV ejection fraction is 23%, the LV end diastolic volume index is 134 ml/m2 (normal range: 65+/-11), the LVEDV is 245 ml (normal range 109+/-23), the LV end systolic volume index is 104 ml/m2 (normal range 18+/-5), the LVESV is 190 ml (normal range 31+/-10), the LV mass index is 67 g/m2, and the LV mass is 123 g. No LV thrombus is noted.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVEDV is 170 ml (normal range 110+/-24), the RV end systolic volume index is 64 ml/m2 (normal range 22+/-8), and the RVESV is 118 ml (normal range 35+/-13). 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 drains normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are large bilateral pleural effusions. 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. There is a global circumferential perfusion defect present during hyperemia and resting conditions. This finding could be secondary to severe multi-vessel coronary disease or due to significant congestive heart failure/ increased LVEDP.2. Severe LV dilation with severely reduced systolic function (LVEF 23%) with an atypical (non-myocardial infarction) pattern of late gadolinium enhancement involving the basal and mid inferior walls suggesting the presence of underlying myocardial fibrosis. This finding favors the diagnosis of non-ischemic cardiomyopathy.3. Normal RV size with moderately reduced systolic function (RVEF 31%).4. Severe left atrial dilation. 5. Small pericardial effusion.6. Large bilateral pleural effusions. 