A 49 year old male with personal history of intermittent LBBB and sinus tachycardia, hypertension, hyperlipidemia, overweight, obstructive sleep apnea. Due to chest pain he had a left cardiac catheterization in 2014 that showed non-significant coronary artery disease and a recent echocardiography showed a decrease in left ventricular systolic function from 55 to 45%. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 279 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 153 ml (normal range 47+/-19), the LV mass index is 38 g/m2 (normal range 85+/-15), and the LV mass is 93 g (normal range 164+/-36). The thickness of the myocardium is normal-to-thin. There is global mild hypokinesis with dyssynchrony due to conduction defects. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native myocardial T1-times are mildly and diffusely increased (~1100-1150ms), suggesting interstitial fibrosis.The values of Global Relative enhancement, T2-STIR edema ratio and Extracellular Volume Fraction are all between normal values.No findings to support myocardial edema in T2-STIR sequence.No myocardial iron overload.No intracavitary thrombus.Left AtriumThe left atrium is mildly dilated (103ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 239 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 108 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant 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 mildly dilated (33mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis 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 mildly dilated with mildly reduced systolic function, the LVEF is 45%. The thickness of the myocardium is normal-to-thin. There is global mild hypokinesis with dyssynchrony due to conduction defects. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1-times are mildly and diffusely increased, suggesting interstitial fibrosis. No findings to support myocardial edema. No myocardial iron overload. No intracavitary thrombus.3. The right ventricle is normal in size and systolic function, the RVEF is 55%. 4. There is mild biatrial enlargement. 