A 57 year old male with personal history of acute leukemia treated with stem cell transplant and chemotherapy (doxorubicin and mitoxantrone) in 2012 who was recently diagnosed with left heart failure and the echocardiography showed a severely decreased systolic function. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 148 ml/m2 (normal range: 74+/-15), the LVEDV is 313 ml (normal range 142+/-34), the LV end systolic volume index is 122 ml/m2 (normal range 25+/-9), the LVESV is 260 ml (normal range 47+/-19), the LV mass index is 83 g/m2 (normal range 85+/-15), and the LV mass is 176 g (normal range 164+/-36). There is a mid-wall stripe pattern of late gadolinium enhancement in the septum most suggestive of underlying myocardial fibrosis. This pattern of late gadolinium enhancement is classically seen in dilated cardiomyopathy. The pattern is atypical for prior myocardial infarction. Native myocardial T1 relaxation values are generally within normal range; however, in the basal to mid inferoseptum, they are mildly elevated consistent with the above described fibrosis. No myocardial iron overload.No intracavitary thrombus was seen.Left AtriumThe left atrium is mildly dilated (115ml). Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 39%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 181 ml (normal range 142+/-31), the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9), and the RVESV is 111 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 no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.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. The left ventricle is severely dilated with severely reduced systolic function, the LVEF is 17%. There is a mid-wall stripe of late gadolinium enhancement in the septum most suggestive of underlying myocardial fibrosis in a pattern that is classically described for dilated cardiomyopathy. No evidence of prior myocardial infarction or infiltrative cardiomyopathy.2. The right ventricle is normal in size with moderately reduced systolic function, the RVEF is 39%. 3. Mild biatrial enlargement. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.