53 yo woman with cardiomyopathy and acute chest pain referred for evaluation of etiology of cardiomyopathy. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 116 ml/m2 (normal range: 65+/-11), the LVEDV is 184 ml (normal range 109+/-23), the LV end systolic volume index is 78 ml/m2 (normal range 18+/-5), the LVESV is 124 ml (normal range 31+/-10), the LV mass index is 82 g/m2 (normal range 67+/-11), and the LV mass is 130 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is a small amount of late gadolinium enhancement (LGE) in the basal anterior wall and mid-wall LGE in the basal anteroseptum to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is not consistent with prior myocardial infarction. There is also a moderate elevation in native myocardial T1 time (1163ms). Theis suggests the presence of diffuse underlying myocardial fibrosis in addition to the focal fibrosis that is represented by the late gadolinium enhancement. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 114 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 46 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. 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 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 normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. Pericardium isThere is no obvious pericardial disease.Extracardiac FindingsThere is a small hiatal hernia 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. Severe LV dilation with moderately reduced systolic function (LVEF 33%) with evidence of underlying myocardial fibrosis inflammation or infiltration involving the basal anterior and anteroseptal.2. The RV is normal in size with normal systolic function (RVEF 60%)3. Left atrium is severely dilated. The