A 65 year old male with history of coronary artery disease (myocardial infarction in 1990, left catheterization with stent implantation in 1998), normal left ventricular ejection fraction by a recent echocardiography, COPD, s/p cholecystectomy and primary amyloidosis. Referred to cardiac MRI to evaluate cardiac involvement of amyloidosis. Left VentricleThe left ventricle is normal in size with mild systolic dysfunction. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 67 ml/m2 (normal range: 74+/-15), the LVEDV is 146 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 79 ml (normal range 47+/-19). There is mild hypertrophy of the basal anterior septum (11-12mm). There is hypokinesis of the basal and middle segments of the inferior and infero-lateral walls. There is high signal of late gadolinium enhancement at the basal and middle segments of the inferior and infero-lateral walls. This finding suggest the presence of an underlying fibrosing process compatible with an old myocardial infarction. The involvement of this late gadolinium enhancement is more than 50% suggesting it is non-viable. There is a small area of the basal most infro-lateral segments with < 50% enhancement suggesting viability. In addition, there is a diffuse patchy enhancement in the septum and anteroseptum. Non-contrast T1 time of the IVS was 1212 msec.No evidence of iron overload.No LV thrombus noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 57 ml/m2 (normal range 82+/-16), the RVEDV is 125 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 63 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 trace pulmonic 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.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is trace bilateral pleural effusion. 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 mild systolic dysfunction, the LVEF is 46%. There is mild hypertrophy of the basal anterior septum (11-12mm). There is hypokinesis of the basal and middle segments of the inferior and infero-lateral walls.2. There is high signal of late gadolinium enhancement at the basal and middle segments of the inferior and infero-lateral walls. This finding suggest the presence of an underlying fibrosing process compatible with an old myocardial infarction. The involvement of this late gadolinium enhancement is more than 50% suggesting it is non-viable. There is a small area of the basal most infro-lateral segments with < 50% enhancement suggesting viability. 3. In addition, there is a diffuse patchy enhancement in the septum and anteroseptum. Non-contrast T1 time of the IVS was 1212 msec. This is consistent with cardiac amyloid.4. The right ventricle is normal in size with normal systolic function, the RVEF is 50%.