85 year old with history of atrial fibrillation, hypertension and heart failure presenting for evaluation of etiology of heart failure. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. There is basal septal hypertrophy and concentric left ventricular hypertrophy. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 95 ml/m2 (normal range: 65+/-11), the LVEDV is 157 ml (normal range 109+/-23), the LV end systolic volume index is 53 ml/m2 (normal range 18+/-5), the LVESV is 86 ml (normal range 31+/-10), the LV mass index is 60 g/m2 (normal range 67+/-11), and the LV mass is 99 g (normal range 114+/-24). The left ventricular systolic dysfunction is global.There is late gadolinium enhancement at the basal to mid septum (on right ventricular side), subendocardial basal lateral wall, subendocardial apical septum and transmural at the apex. The differential diagnosis includes prior myocarditis from inflammation or sarcoidosis. This distribution is atypical for amyloidosis. Although the majority of the enhancement is subendocardial, it does consistently follow a pattern for infarct. No intracardiac thrombus.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 114 ml/m2 (normal range 69+/-14), the RVEDV is 187 ml (normal range 110+/-24), the RV end systolic volume index is 78 ml/m2 (normal range 22+/-8), and the RVESV is 129 ml (normal range 35+/-13). No enhancement.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 at least mild mitral regurgitation. There is mild thickening of anterior leaflet of the mitral valve. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate 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 significant pericardial effusion.Extracardiac Findings:There is a trace right pleural effusion and small left pleural effusion.
1. The left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%. Enhancement pattern that is suspicious for prior inflammation from myocarditis or infiltrative process such as sarcoidosis. It is atypical for amyloidosis or embolic infarcts.2. The right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 31% 