64 year old woman with history of HF with preserved EF, CAD and asthma admitted with heart failure exacerbation, now referred for cardiac MRI to evaluate for possible infiltrative disease. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 95 ml/m2 (normal range: 65+/-11), the LVEDV is 195 ml (normal range 109+/-23), the LV end systolic volume index is 43 ml/m2 (normal range 18+/-5), the LVESV is 88 ml (normal range 31+/-10), the LV mass index is 74 g/m2 (normal range 67+/-11), and the LV mass is 151 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is mild hypertrophy (wall thickness 11-12mm). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. However, the native T1 time is elevated (1080ms in the basal slice, and 1100ms in the mid ventricular slice). The ECV fraction is 42%, which is also elevated. This speaks to a possible early infiltrative (amyloid) process.No intracardiac thrombus. Left AtriumThe left atrium is moderately dilated. The interatrial septum is thickened.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 36 ml/m2 (normal range 69+/-14), the RVEDV is 71 ml (normal range 110+/-24), the RV end systolic volume index is 144 ml/m2 (normal range 22+/-8), and the RVESV is 39 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 are thickened but open widely. There is mild mitral regurgitation which appears eccentric. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial 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 a small pericardial effusion with dimpling of the right atrium during diastole but no frank diastolic collapse of the RA or RV.
1. Mildly dilated LV with normal systolic function (EF 55%)2. No late gadolinium enhancement is seen. However, there is an elevated native T1 relaxation time (1080-1100ms) in the myocardium, and an elevated ECV (42%), which speak to the presence of a possible early infiltrative disease, consider amyloidosis).3. Normal size RV with mildly reduced systolic function (EF 45%).4. Mild mitral regurgitation. 5. Small circumferential pericardial effusion with dimpling of the right atrium during diastole. 