72 year old man with a history of Amyloidosis, diastolic dysfunction, coronary artery disease, hypertension, syncope (vasovagal due to amyloid) undergoing treatment for cardiac amyloidosis. Patient is referred to evaluate progression of disease. Left VentricleThe left ventricle is normal in size and systolic function. There is moderate circumferential left ventricular hypertrophy (IVSd=14mm and PWd=14mm; previously both were 12mm. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 66 ml/m2 (normal range: 74+/-15), the LVEDV is 108 ml (normal range 142+/-34), the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9), the LVESV is 44 ml (normal range 47+/-19), the LV mass index is 72 g/m2 (normal range 85+/-15), and the LV mass is 118 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is circumferential late gadolinium enhancement involving the endocardial surface of the LV. Additionally, gadolinium kinetics are severely abnormal and the native T1 time is prolonged (1215ms, previously 1130ms), consistent with a diagnosis of amyloidosis. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 113 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 62 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLarge right pleural effusion and small left pleural effusion 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. Normal LV size and systolic function, LVEF 59%. Moderate left ventricular hypertrophy with abnormal gadolinium kinetics and late gadolinium enhancement diagnostic of cardiac amyloidosis. LV wall thickness and native myocardial T1 have increased when compared to the previous cardiac MRI of 2013 suggesting progression of disease.3. Normal RV size with mildly reduced systolic function, RVEF 45%.4. Large right pleural effusion. 5. Biatrial dilatation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.