37 year old male with a history of non-ischemic cardiomyopathy following viral illness (first diagnosed in 2011) who was admitted for acute decompensated heart failure and ventricular tachycardia with shock/discharge from Life Vest. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 13%, the LV end diastolic volume index is 307 ml/m2 (normal range: 74+/-15), the LVEDV is 674 ml (normal range 142+/-34), the LV end systolic volume index is 267 ml/m2 (normal range 25+/-9), the LVESV is 586 ml (normal range 47+/-19), the LV mass index is 70 g/m2 (normal range 85+/-15), and the LV mass is 154 g (normal range 164+/-36). There is global hypokinesis with regional variation. Late gadolinium enhancement images were suboptimal due to artifacts and patient breathing. There is a mid-myocardial stripe of late gadolinium enhancement in the septum. Additionally, there appears to be a small area of late gadolinium enhancement confined to the the mid to apical inferolateral and lateral walls which is subendocardial in nature and could be suspicious for old myocardial infarction versus coronary embolic event. The overall quantity of this late gadolinium enhancement in this region is not enough to explain this patient's cardiomyopathy. In addition, there is significant artifact on late gadolinium enhancement images. T1 mapping could not be performed due to technical challenges. Two thrombi noted in the left ventricle - one at the apex and one at the mid septal wall. 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 16%, the RV end diastolic volume index is 170 ml/m2 (normal range 82+/-16), the RVEDV is 373 ml (normal range 142+/-31), the RV end systolic volume index is 144 ml/m2 (normal range 31+/-9), and the RVESV is 316 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is at least mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation. There is bileaflet tethering. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is 41 mm at the sinus of Valsalva.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 FindingsInterstitial changes noted in the lungs of unclear etiology. 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. Significant motion and breathing artifact throughout the scan that impairs diagnostic quality images. 2. The left ventricle is severely dilated with severely reduced systolic function (LVEF 13%). There is global hypokinesis with regional variation. 3. The right ventricle is severely dilated with severely reduced systolic function (RVEF 16%). 4. There is global hypokinesis with regional variation. 5. There is a mid-myocardial stripe of late gadolinium enhancement in the septum. Additionally, there appears to be a small area of late gadolinium enhancement confined to the the mid to apical inferolateral and lateral walls which is subendocardial in nature and could be suspicious for old myocardial infarction versus coronary embolic event. 5. Two thrombi noted in the left ventricle - one at the apex and one at the mid septal wall. 6. There is at least moderate mitral regurgitation. 7. Severe biatrial enlargement.8. Extracardiac findings as described above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.