Late-gadolinium enhancement in a subject with normal left ventricular function

A 27-year-old man visited our hospital after experiencing palpitations. His 12-lead electrocardiogram and chest radiograph were unremarkable. Blood test results showed normal plasma brain natriuretic peptide level (<5.8 pg/mL). Transthoracic echocardiography revealed normal left ventricular structure and function by demonstrating left ventricular wall thickness of 10 mm, end-diastolic dimension of 46 mm, end-systolic dimension of 31 mm, and ejection fraction of 64%. Pulsed-wave Doppler echocardiography demonstrated normal E/e' ratio of 7.5. Cardiac magnetic resonance imaging showed normal coronary artery. However, there was massive late-gadolinium enhancement at the mid-layer wall, suggesting massive left ventricular fibrosis. This case reveals that left ventricular function may be normal even in massive late-gadolinium enhancement. Pathophysiology other than fibrosis might have contributed to this specific finding in late-gadolinium enhancement.