We discuss a case of seventy-ninth years old Caucasian man,
who underwent CMR on December 2016,
with suspect of cardiomyopathy.
He performed an ECG that showed some alteration of repolarization (T wave inversions in precordial leads) and echocardiography,
which demonstrate a mild wall thickening in the left ventricle.
In order to improve the assessment of patient,
the cardiologist recommended CMR.
We used a 1,5 T scanner (Achieva D-Stream,
Philips,
Best,
The Netherlands) and ECG triggering.
A multi-phase steady-state free precession sequence was applied to obtain 2-chamber,
3-chamber and 4-chamber views in cine mode.
The temporal resolution was 30 frames per RR interval.
We analyzed the images with a post-processing cardiac software (CVI 42,
Circle View,
Calgary,
Canada).
The left ventricle size was normal (EDV 69.2 ml/m2,
ESV 20.5 ml/m2),
with ejection fraction in normal range 70%,
but the mass of ventricle was increased (ED 157.7 g).
In the morphological images,
the apical segments had an end-diastolic wall thickness of 23 mm.
Wall thickness was normal in all other segments.
Fig. 1
The cine sequence showed a small apical aneurysm in the most distal portion of the LV,
with a thin hypokinetic wall,
in the absence of thrombus formation.
A stack of 2D images of the left ventricle were acquired in short-axis 10 minutes after administration of gadolinium,
using a multi-shot turbo field echo breath-hold sequence with a phase-sensitive inversion recovery method,
to evaluate late enhancement.
Late gadolinium enhancement (LGE) was positive in few small areas in apical segment,
more in wall of aneurysm.
Feature tracking CMR analysis of systolic strain was performed in a set of long-axis 2-chamber,
4-chamber and short-axis.
The FT-CMR analysis highlighted significant lower values of longitudinal,
radial and circumferential strain in the apex than other segment,
indicative of systolic dysfunction (Figures 3 – 4 - 5).