A 57 year old female hospitalized because of chest pain, positive troponin, ST segment elevation on the EKG, a left catheterization showed apical ballooning and no coronary artery disease. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function with mild apical hypokinesis. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 124 ml (normal range 109+/-23), the LV end systolic volume index is 44 ml/m2 (normal range 18+/-5), the LVESV is 68 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 90 g (normal range 114+/-24). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native myocardial T1-times are significantly increased (~1100-1150ms). While the global relative enhancement ratio and the T2-STIR edema ratio are increased, the extracellular volume fraction is in the upper normal limit. No myocardial iron overload was seen.No intracavitary thrombus was seenGlobal Relative Enhancement4.1Normal <4T2 STIR Edema Ratio (ER)3.4Normal <2T1 MOLLI Pre contrast myocardium1233Normal <1,050msT1 MOLLI Pre contrast blood pool1668Extracellular volume fraction29.7normal 20-30%Left AtriumThe left atrium is normal in size. The LA volume is 74 ml.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 67 ml/m2 (normal range 69+/-14), the RVEDV is 103 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 52 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 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 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 normal in size with mildly reduced systolic function, the LVEF is 45%. There is mild apical hypokinesis without late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. These findings support the diagnosis of Takotsubo's cardiomyopathy.2. The right ventricle is normal in size and systolic function, the RVEF is 50%. 3. There is mild mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.