A 35 year old male with shortness of breath on exertion and recently diagnosed biventricular systolic heart failure by echocardiography. Referred to stress cardiac MRI for further evaluationMEDICATIONS: carvedilol, furosemide First Pass PerfusionDuring hyperemia, no perfusion defects were present and a prominent "dark rim" artifact was noted.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Native myocardial T1 times are diffusely increased (~1100-1200ms). This finding suggest intersitial fibrosis.The calculated extracellular volume (ECV) was in the normal range (29%).Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 154 ml/m2 (normal range: 74+/-15), the LVEDV is 324 ml (normal range 142+/-34), the LV end systolic volume index is 122 ml/m2 (normal range 25+/-9), the LVESV is 258 ml (normal range 47+/-19), the LV mass index is 74 g/m2, and the LV mass is 156 g. There is severe global hypo/akinesis with regional variation. No intracavitary thrombus was noted.No myocardial iron overload was noted.Left AtriumThe left atrium is mildly dilated (105ml). Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 21%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 212 ml (normal range 142+/-31), the RV end systolic volume index is 79 ml/m2 (normal range 31+/-9), and the RVESV is 168 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trivial pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (35mmmm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is trivial pericardial effusion.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. No perfusion defects/ "ischemia" present during hyperemia. A dark rim artifact was noted.2. No prior myocardial infarction. The entire myocardium is viable. However, needed myocardial T1 times are diffusely increased suggestive of an abnormal infiltrative process beyond the resolution of delayed hyperenhancement MRI. The calculated ECV was in the normal range.3. The LV is severely dilated with severely reduced systolic function (LVEF 20%). There is severe global hypo/akinesis with regional variation. 4. The RV is mildly dilated with severely reduced systolic function (RVEF 21%).5. Mild biatrial dilation.6. At least moderate mitral and tricuspid regurgitation. 7. Mild aortic regurgitation.8. The main pulmonary artery is mildly dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.