59 year old with multiple myeloma s/p stem cell transplant and history of possible amyloidosis. Echo suggests mild diastolic dysfunction but LV walls poorly visualized and wall thickness can not be determined to gain insights into whether there is cardiac amyloidosis. Patient referred to evaluate for possible cardiac amyloid. Left VentricleThe left ventricle is normal in size with normal systolic function. Normal LV wall thickness without evidence of LVH (IVSd=10mm and PWd=9mm). The overall LV ejection fraction is 64%, the LV end diastolic volume index is 47 ml/m2 (normal range: 65+/-11), the LVEDV is 97 ml (normal range 109+/-23), the LV end systolic volume index is 17 ml/m2 (normal range 18+/-5), the LVESV is 35 ml (normal range 31+/-10), the LV mass index is 48 g/m2 (normal range 67+/-11), and the LV mass is 98 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Native myocardial T1 times ranging between 968 to 1185msec; however, image quality limited by respiratory motion.Left AtriumThe left atrium is normal in size. The LA volume is 69 ml. Lipomatous hypertrophy of the interatrial septum is noted.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 55 ml/m2 (normal range 69+/-14), the RVEDV is 112 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 71 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. The SVC catheter tip end in the right atrium.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 are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease. Trace pericardial effusion.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. Normal LV size and systolic function (LVEF 64%) with normal wall thickness. 2. Normal RV size and systolic function (RVEF 64%).3. Normal biatrial size.4. Lipomatous hypertrophy of the interatrial septum. 5. SVC catheter extends mildly into the right atrium .Given normal LV mass, LV wall thickness, and left atrial volumes patient is unlikely to have cardiac amyloidosis. Her diastolic dysfunction is more likely to be secondary to her cardiovascular risk factors. 