A 69 years old female with recent diagnosis of heart failure and no coronary artery disease. Echocardiography showed severe biventricular dysfunction. Referred to cardiac MRI to rule out infiltrative heart disease. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 16%, the LV end diastolic volume index is 155 ml/m2 (normal range: 65+/-11), the LVEDV is 330 ml (normal range 109+/-23), the LV end systolic volume index is 131 ml/m2 (normal range 18+/-5), the LVESV is 278 ml (normal range 31+/-10), the LV mass index is 69 g/m2, and the LV mass is 147 g. There is global hypokinesis with dyssynchrony. There is very small, atypical patch of late gadolinium enhancement in the mid inferior wall. The pattern is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.T2-star sequence is negative for myocardial iron deposition. There is no intracardiac thrombus.Left AtriumThe left atrium is severely dilated Right VentricleThe right ventricle is severely dilated with severely reduced systolic function The overall RV ejection fraction is 18%, the RV end diastolic volume index is 148 ml/m2 (normal range 69+/-14), the RVEDV is 315 ml (normal range 110+/-24), the RV end systolic volume index is 121 ml/m2 (normal range 22+/-8), and the RVESV is 258 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation visualized. Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation visualized. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation visualized. Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation visualized. AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.Extracardiac FindingsA small nodule in the right lower lung can not be excluded, suggest correlation with chest x-ray. Small bilateral pleural effusions are noted. 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 severely dilated with severely reduced systolic function (LVEF 16%). There is global hypokinesis with dyssynchrony. 2. There is very small, atypical patch of late gadolinium enhancement in the mid inferior wall. The pattern is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process3. The right ventricle is severely dilated with severely reduced systolic function (RVEF 18%). 4. The left atrium is moderately dilated. 5. There is moderate mitral regurgitation. 6. Mild dilation of the main pulmonary artery. 7. See extra-cardiac findings.