Fig. 2.

Cardiac magnetic resonance (CMR) imaging. Cine CMR imaging (A) showed severely reduced left ventricular (LV) systolic function without LV dilatation (end-diastolic volume index, 66 ml/m², end-systolic volume index, 53 ml/m²), and ejection fraction of 19%. In addition, the pericardium thickness was up to 3–4 mm (normal range <2–3 mm), and small pericardial and pleural effusion existed. T2 weighted imaging showed no high-intensity lesion which suggests myocardial edema. Late gadolinium enhancement (LGE) images in short-axis view did not show definite enhancement in the LV wall (B). However, extracellular volume (ECV) maps with T1 mapping (C) showed increased ECV of 45% (reference value: 20–30%), in the whole myocardium, which suggested global myocardial fibrosis.