36 year old female with a history of poorly controlled hypertension referred for cardiac MRI after new diagnosis of heart failure with reduced ejection fraction.MEDICATIONS: None First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 129 ml/m2 (normal range: 65+/-11), the LVEDV is 326 ml (normal range 109+/-23), the LV end systolic volume index is 80 ml/m2 (normal range 18+/-5), the LVESV is 203 ml (normal range 31+/-10), the LV mass index is 62 g/m2, and the LV mass is 157 g. There is global hypokinesis. Native pre-contrast myocardial T1 relaxation time is upper limits of normal (1072 ms). Normal global relative enhancement ratio. The ECV fraction is within normal limits. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 84 ml/m2 (normal range 69+/-14), the RVEDV is 205 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 107 ml (normal range 35+/-13). 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 mild 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.AortaThe aortic root is normal. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small to moderate sized pericardial effusion. The pericardium has evidence of mild increased T2-signal and also mild late gadolinium enhancement. These findings are consistent with mild pericardial inflammation. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is severely dilated with moderately reduced systolic function (LVEF 38%). There is no evidence of an underlying myocardial infiltrative or fibrosing process. 4. The right ventricle is normal in size with mildly reduced systolic function (RVEF 48%).5. Small to moderate sized pericardial effusion with evidence of mild pericardial inflammation. 6. The main pulmonary artery is moderately dilated. 7. Mild biatrial enlargement. 8. Mild mitral and tricuspid regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.