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Please Give Advice On Cardiac MRI Results And What To Do Next
So my husband was diagnosed with Hypertrophic Cardiomyopathy 9 years ago and I came on to ask several questions at that time. He of course has been seeing his cardiologist regularly since then and up until recently, everything has been fine. Still is, as far as he's concerned.
Well a recent ECHO is what led him to need a follow up Stress Echo and Also a Cardiac MRI, according to his cardiologist. He also was put on a 2 week Xio heart monitor. Well the results came back from the monitor and they called him immediately saying that it showed a few episodes of Ventricular Tachycardia and wanted him to meet with a Cardiophysiologist. He did.
We actually left there feeling good after being reassured that the episodes were NOT sustained VT, what the differences were, and he, doc, said he did not see anything questionable that we would need to worry about. So he suggested my husband continue on with the stress echo and MRI and we'd go from there.
Well the doc called after the stress echo and he said "everything looks pretty good so we'll just wait for the MRI test and results and I'll call you back then." Husband had that done yesterday and the doc called today and left a message. He didn't say anything in particular about the results just that he was gonna consult with the electrophysiologist that my husband saw a few weeks ago, and the doctor who read the report and the three of them would come up with a plan. That's all he said. My husband wasn't able to speak to him because we was working. Cardiologist said he would call back tomorrow to try and speak to him.
Having said that, it would be nice to get some other opinions before he hears back from them just to be sure things are going in the right direction. I also want to add that my husband has NOT had any worsening symptoms since he was first diagnosed. No increase in medications, no passing out, no unusual dizziness (other than when he bends over which is normal with HOCM), absolutely nothing feels different to him in his opinion which is why this is all a surprise.
Anyway, here are the results of the MRI. If you want to see the results of the Echo, I posted them already in a previous post that you can find by going into my name. Thanks!!!
CARDIOVASCULAR MAGNETIC RESONANCE IMAGING REPORT
SCANNER DETAILS AND TECHNIQUES PERFORMED:
Scanner Tesla: 1.5T Scanner Vendor: Philips Scan Quality: Cine MRI:
Good; LGE: Fair
Artifacts: breathing artifact
Techniques Performed:
Cardiac localization
Steady-state free precession cine imaging in multiple imaging planes
Contrast-enhanced late gadolinium enhancement imaging in multiple
planes
T2-weighted triple-inversion recovery fast-spin echo imaging in
multiple imaging planes
The patient received intravenous Gadavist/Gadovist (gadobutrol) total
- 13.5ml
QUANTITATIVE MEASUREMENTS:
Non-indexed Indexed (m2) Non-indexed Indexed (m2)
Volumetric Measurements
LVEF (%) 67 RVEF (%) 72
LVEDV (ml) 186 87 RVEDV (ml) 130 61
LVESV (ml) 61 29 RVESV (ml) 37 17
LVSV (ml) 125 58 RVSV (ml) 93 43
LVED Mass (g) 154 72 RVED Mass (g)
Cardiac Output (l/min) 8.1 3.8
Linear Measurements
LVEDD (mm) 50 23 RVEDD (mm)
Ant Sep Wall Th (mm) 17 8 Left Atrium (mm) 44 21
Inf Lat Wall Th (mm) 7 3 Aortic Root (mm) 33 15
PERICARDIUM AND PLEURA:
Pericardium Thickness: Normal
QUALITATIVE IMPRESSIONS:
LV Size: Normal RV Size: Normal
LV Global Function: Normal RV Global Function: Normal
LV Regional Function: RV Regional Function: Normal
LV LGE: Abnormal RV LGE: Normal
LA size: Moderately enlarged RA size: Normal
IMPRESSIONS:
1. The left ventricular size is normal. The left ventricular ejection
fraction is 67 % by Simpson's method. Global left ventricular function is
normal. The left ventricular mass is normal. There is moderate to severe
asymmetric septal hypertrophy, maximal thickness 17 mm. There is systolic
anterior motion of the anterior mitral valve with evidence of flow
acceleration at LV outflow tract at rest.
2. There is evidence of myocardial edema by T2 weighted imaging. There is
a medium amount of late gadolinium enhancement (LGE) at the basal
anteroseptum and inferoseptal wall, patchy heterogeneous, consistent with
fibrosis. Unable to quantify degree of fibrosis given inadequate
breath-holding on short axis LGE slices. Collectively findings are
suggestive of hypertrophic obstructive cardiomyopathy.
3. The right ventricular size is normal. Global right ventricular function
is normal. There are no regional wall motion abnormalities of the right
ventricular wall. There is no late gadolinium enhancement of the right
ventricle.
4. Left atrial size is moderately enlarged.
5. Qualitatively, there is mild mitral regurgitation.
Well a recent ECHO is what led him to need a follow up Stress Echo and Also a Cardiac MRI, according to his cardiologist. He also was put on a 2 week Xio heart monitor. Well the results came back from the monitor and they called him immediately saying that it showed a few episodes of Ventricular Tachycardia and wanted him to meet with a Cardiophysiologist. He did.
We actually left there feeling good after being reassured that the episodes were NOT sustained VT, what the differences were, and he, doc, said he did not see anything questionable that we would need to worry about. So he suggested my husband continue on with the stress echo and MRI and we'd go from there.
Well the doc called after the stress echo and he said "everything looks pretty good so we'll just wait for the MRI test and results and I'll call you back then." Husband had that done yesterday and the doc called today and left a message. He didn't say anything in particular about the results just that he was gonna consult with the electrophysiologist that my husband saw a few weeks ago, and the doctor who read the report and the three of them would come up with a plan. That's all he said. My husband wasn't able to speak to him because we was working. Cardiologist said he would call back tomorrow to try and speak to him.
Having said that, it would be nice to get some other opinions before he hears back from them just to be sure things are going in the right direction. I also want to add that my husband has NOT had any worsening symptoms since he was first diagnosed. No increase in medications, no passing out, no unusual dizziness (other than when he bends over which is normal with HOCM), absolutely nothing feels different to him in his opinion which is why this is all a surprise.
Anyway, here are the results of the MRI. If you want to see the results of the Echo, I posted them already in a previous post that you can find by going into my name. Thanks!!!
CARDIOVASCULAR MAGNETIC RESONANCE IMAGING REPORT
SCANNER DETAILS AND TECHNIQUES PERFORMED:
Scanner Tesla: 1.5T Scanner Vendor: Philips Scan Quality: Cine MRI:
Good; LGE: Fair
Artifacts: breathing artifact
Techniques Performed:
Cardiac localization
Steady-state free precession cine imaging in multiple imaging planes
Contrast-enhanced late gadolinium enhancement imaging in multiple
planes
T2-weighted triple-inversion recovery fast-spin echo imaging in
multiple imaging planes
The patient received intravenous Gadavist/Gadovist (gadobutrol) total
- 13.5ml
QUANTITATIVE MEASUREMENTS:
Non-indexed Indexed (m2) Non-indexed Indexed (m2)
Volumetric Measurements
LVEF (%) 67 RVEF (%) 72
LVEDV (ml) 186 87 RVEDV (ml) 130 61
LVESV (ml) 61 29 RVESV (ml) 37 17
LVSV (ml) 125 58 RVSV (ml) 93 43
LVED Mass (g) 154 72 RVED Mass (g)
Cardiac Output (l/min) 8.1 3.8
Linear Measurements
LVEDD (mm) 50 23 RVEDD (mm)
Ant Sep Wall Th (mm) 17 8 Left Atrium (mm) 44 21
Inf Lat Wall Th (mm) 7 3 Aortic Root (mm) 33 15
PERICARDIUM AND PLEURA:
Pericardium Thickness: Normal
QUALITATIVE IMPRESSIONS:
LV Size: Normal RV Size: Normal
LV Global Function: Normal RV Global Function: Normal
LV Regional Function: RV Regional Function: Normal
LV LGE: Abnormal RV LGE: Normal
LA size: Moderately enlarged RA size: Normal
IMPRESSIONS:
1. The left ventricular size is normal. The left ventricular ejection
fraction is 67 % by Simpson's method. Global left ventricular function is
normal. The left ventricular mass is normal. There is moderate to severe
asymmetric septal hypertrophy, maximal thickness 17 mm. There is systolic
anterior motion of the anterior mitral valve with evidence of flow
acceleration at LV outflow tract at rest.
2. There is evidence of myocardial edema by T2 weighted imaging. There is
a medium amount of late gadolinium enhancement (LGE) at the basal
anteroseptum and inferoseptal wall, patchy heterogeneous, consistent with
fibrosis. Unable to quantify degree of fibrosis given inadequate
breath-holding on short axis LGE slices. Collectively findings are
suggestive of hypertrophic obstructive cardiomyopathy.
3. The right ventricular size is normal. Global right ventricular function
is normal. There are no regional wall motion abnormalities of the right
ventricular wall. There is no late gadolinium enhancement of the right
ventricle.
4. Left atrial size is moderately enlarged.
5. Qualitatively, there is mild mitral regurgitation.
We're going to speak to the cardiologist tomorrow about setting up my husbands defibrillator appointment. I wish I could get someone to answer as to whether or not they feel it's really necessary at this point.
So we just got word that, based on bits and pieces of the MRI results and the previous stress echo and heart monitor results, that they suggest a defibrillator be implanted.
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