64 year old woman with CREST variant scleroderma and smoldering myeloma with evidence of left ventricular hypertrophy referred to evaluate for infiltrative heart disease. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The interventricular septum is mildly thickened (12mm). The overall LV ejection fraction is 68%, the LV end diastolic volume index is 104 ml/m2 (normal range: 65+/-11), the LVEDV is 171 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 55 ml (normal range 31+/-10), the LV mass index is 38 g/m2 (normal range 67+/-11), and the LV mass is 63 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native myocardial T1 relaxation time, extracellular volume fraction, global relative enhancement ratio, and T2-ratio are all within normal limits. Left AtriumThe left atrium is mildly dilated. The LA volume is 104 ml.Right VentricleThe right ventricle is normal size and systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 134 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 48 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is at least moderate 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 mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size (36mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (27mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion (previously present but not mentioned).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. Moderate left ventricular dilation with normal systolic function (LVEF 68%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal right ventricular size and systolic function (RVEF 64%).3. Mild left atrial dilation.4. At least moderate aortic regurgitation.5. Mild pericardial effusion.6. Compared to the CMR study from 2/22/2011, the LV is now moderately dilated and there is more aortic regurgitation. 