Skip to main content
Top
Published in: Journal of Cardiovascular Magnetic Resonance 1/2014

Open Access 01-12-2014 | Research

Patterns of late gadolinium enhancement in Duchenne muscular dystrophy carriers

Authors: Vincenzo Giglio, Paolo Emilio Puddu, Giovanni Camastra, Stefano Sbarbati, Sabino Walter Della Sala, Alessandra Ferlini, Francesca Gualandi, Enzo Ricci, Federico Sciarra, Gerardo Ansalone, Marco Di Gennaro

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2014

Login to get access

Abstract

Background

This study was designed to assess whether cardiovascular magnetic resonance imaging (CMR) in Duchenne muscular dystrophy carriers (DMDc) may index any cell milieu elements of LV dysfunction and whether this cardiac phenotype may be related to genotype. The null hypothesis was that myocardial fibrosis, assessed by late gadolinium enhancement (LGE), might be similarly accounted for in DMDc and gender and age-matched controls.

Methods

Thirty DMDc patients had CMR and genotyping with 37 gender and age-matched controls. Systolic and diastolic LV function was assessed by 2D-echocardiography.

Results

Absolute and percent LGE were higher in muscular symptomatic (sym) than asymptomatic (asy) DMDc (1.77 ± 0.27 vs 0.76 ± 0.17 ml; F = 19.6, p < 0.0001 and 1.86 ± 0.26% vs 0.68 ± 0.17%, F = 22.1, p < 0.0001, respectively). There was no correlation between LGE and age. LGE was seen most frequently in segments 5 and 6; segment 5 was involved in all asy-DMDc. Subepicardial LGE predominated, compared to the mid-myocardial one (11 out of 14 DMDc). LGE was absent in the subendocardium. No correlations were seen between genotyping (type of mutation, gene region and protein domain), confined to the exon’s study, and cardiac phenotype.

Conclusions

A typical myocardial LGE-pattern location (LV segments 5 and 6) was a common finding in DMDc. LGE was more frequently subepicardial plus midmyocardial in sym-DMDc, with normal LV systolic and diastolic function. No genotype-phenothype correlation was found.
Appendix
Available only for authorised users
Literature
1.
go back to reference Martinez HR, Pignatelli R, Belmont JW, Craigen WJ, Jefferies JL: Childhood onset of left ventricular dysfunction in a female manifesting carrier of muscular dystrophy. Am J Med Genet. 2011, 155: 3025-3029.CrossRef Martinez HR, Pignatelli R, Belmont JW, Craigen WJ, Jefferies JL: Childhood onset of left ventricular dysfunction in a female manifesting carrier of muscular dystrophy. Am J Med Genet. 2011, 155: 3025-3029.CrossRef
2.
go back to reference Nolan MA, Jones ODH, Pedersen RL, Johnston HM: Cardiac assessment in childhood carriers of Duchenne and Becker muscular dystrophies. Neuromusc Disord. 2003, 13: 129-132.CrossRefPubMed Nolan MA, Jones ODH, Pedersen RL, Johnston HM: Cardiac assessment in childhood carriers of Duchenne and Becker muscular dystrophies. Neuromusc Disord. 2003, 13: 129-132.CrossRefPubMed
3.
go back to reference Mirabella M, Servidei S, Manfredi G, Ricci E, Frustaci A, Bertini E, Rana M, Tonali P: Cardiomyopathy may be the only clinical manifestation in female carriers of Duchenne muscular dystrophy. Neurology. 1993, 43: 2342-2345.CrossRefPubMed Mirabella M, Servidei S, Manfredi G, Ricci E, Frustaci A, Bertini E, Rana M, Tonali P: Cardiomyopathy may be the only clinical manifestation in female carriers of Duchenne muscular dystrophy. Neurology. 1993, 43: 2342-2345.CrossRefPubMed
4.
go back to reference Kamakura K, Kawai M, Arahata K, Koizumi H, Watanabe K, Sugita H: A manifesting carrier of Duchenne muscular dystrophy with severe myocardial symptoms. J Neurol. 1990, 237: 483-485.CrossRefPubMed Kamakura K, Kawai M, Arahata K, Koizumi H, Watanabe K, Sugita H: A manifesting carrier of Duchenne muscular dystrophy with severe myocardial symptoms. J Neurol. 1990, 237: 483-485.CrossRefPubMed
5.
go back to reference Hoogerwaard EM, van der Wouw PA, Wilde AA, Bakker E, Ippel PF, Oosterwijk JC, Majoor-Krakauer DF, van Essen AJ, Leschot NJ, de Visser M: Cardiac involvement in carriers of Duchenne and Becker muscular dystrophy. Neuromuscul Disord. 1999, 9: 347-351.CrossRefPubMed Hoogerwaard EM, van der Wouw PA, Wilde AA, Bakker E, Ippel PF, Oosterwijk JC, Majoor-Krakauer DF, van Essen AJ, Leschot NJ, de Visser M: Cardiac involvement in carriers of Duchenne and Becker muscular dystrophy. Neuromuscul Disord. 1999, 9: 347-351.CrossRefPubMed
6.
go back to reference Grain L, Cortina-Borja C, Hilton-Jones D, Hopkin J, Burch M: Cardiac abnormalities and skeletal muscle weakness in carriers of Duchenne and Becker muscular dystrophies and controls. Neuromuscul Disord. 2001, 11: 186-191.CrossRefPubMed Grain L, Cortina-Borja C, Hilton-Jones D, Hopkin J, Burch M: Cardiac abnormalities and skeletal muscle weakness in carriers of Duchenne and Becker muscular dystrophies and controls. Neuromuscul Disord. 2001, 11: 186-191.CrossRefPubMed
7.
go back to reference Melacini P, Fanin M, Angelini A, Pegoraro E, Livi U, Danieli GA, Hoffman EP, Thiene G, Dalla Volta S, Angelini C: Cardiac transplantation in a Duchenne muscular dystrophy carrier. Neuromuscul Disord. 1998, 8: 585-590.CrossRefPubMed Melacini P, Fanin M, Angelini A, Pegoraro E, Livi U, Danieli GA, Hoffman EP, Thiene G, Dalla Volta S, Angelini C: Cardiac transplantation in a Duchenne muscular dystrophy carrier. Neuromuscul Disord. 1998, 8: 585-590.CrossRefPubMed
8.
go back to reference Davies JE, Winokur TS, Aaron MF, Benza RL, Foley BA, Holman WL: Cardiomyopathy in a carrier of Duchenne’s muscular dystrophy. J Heart Lung Transplant. 2001, 20: 781-784.CrossRefPubMed Davies JE, Winokur TS, Aaron MF, Benza RL, Foley BA, Holman WL: Cardiomyopathy in a carrier of Duchenne’s muscular dystrophy. J Heart Lung Transplant. 2001, 20: 781-784.CrossRefPubMed
9.
go back to reference O’Hanlon R, Grasso A, Roughton M, Moon JC, Clark S, Wage R, Webb J, Kulkarni M, Dawson D, Sulaibeekh L, Chandrasekaran B, Bucciarelli-Ducci C, Pasquale F, Cowie MR, McKenna WJ, Sheppard MN, Elliott PM, Pennell DJ, Prasad SK: Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2010, 56: 867-874.CrossRefPubMed O’Hanlon R, Grasso A, Roughton M, Moon JC, Clark S, Wage R, Webb J, Kulkarni M, Dawson D, Sulaibeekh L, Chandrasekaran B, Bucciarelli-Ducci C, Pasquale F, Cowie MR, McKenna WJ, Sheppard MN, Elliott PM, Pennell DJ, Prasad SK: Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2010, 56: 867-874.CrossRefPubMed
10.
go back to reference Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM: The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000, 343: 1445-1453.CrossRefPubMed Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM: The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000, 343: 1445-1453.CrossRefPubMed
11.
go back to reference McCrohon JA, Moon JC, Prasad SK, McKenna VJ, Lorenz CH, Coats AJ, Pennell DJ: Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation. 2003, 108: 54-59.CrossRefPubMed McCrohon JA, Moon JC, Prasad SK, McKenna VJ, Lorenz CH, Coats AJ, Pennell DJ: Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation. 2003, 108: 54-59.CrossRefPubMed
12.
go back to reference Yilmaz A, Gdynia H-J, Albert C, Ludolph MD, Karin Klingel MD, Reinhard Kandolf MD, Udo Sechtem MD: Cardiomyopathy in a Duchenne muscular dystrophy carrier and Her diseased Son similar pattern revealed by cardiovascular MRI. Circulation. 2010, 121: 237-239.CrossRef Yilmaz A, Gdynia H-J, Albert C, Ludolph MD, Karin Klingel MD, Reinhard Kandolf MD, Udo Sechtem MD: Cardiomyopathy in a Duchenne muscular dystrophy carrier and Her diseased Son similar pattern revealed by cardiovascular MRI. Circulation. 2010, 121: 237-239.CrossRef
13.
go back to reference Mavrogeni S, Bratis K, Papavassiliou A, Skouteli E, Karanasios E, Georgakopoulos D, Kolovou G, Papadopoulos G: CMR detects subclinical cardiomyopathy in mother-carriers of Duchenne and Becker muscular dystrophy. JACC Cardiovasc Imaging. 2013, 6: 526-528.CrossRefPubMed Mavrogeni S, Bratis K, Papavassiliou A, Skouteli E, Karanasios E, Georgakopoulos D, Kolovou G, Papadopoulos G: CMR detects subclinical cardiomyopathy in mother-carriers of Duchenne and Becker muscular dystrophy. JACC Cardiovasc Imaging. 2013, 6: 526-528.CrossRefPubMed
14.
go back to reference Soltanzadeh P, Friez MJ, Dunn D, von Niederhausern A, Gurvich OL, Swoboda KJ, Sampson JB, Pestronk A, Connolly AM, Florence JM, Finkel RS, Bönnemann CG, Medne L, Mendell JR, Mathews KD, Wong BL, Sussman MD, Zonana J, Kovak K, Gospe SM, Gappmaier E, Taylor LE, Howard MT, Weiss RB, Flanigan KM: Clinical and genetic characterization of manifesting carriers of DMD mutations. Neuromuscul Disord. 2010, 20: 499-504.PubMedCentralCrossRefPubMed Soltanzadeh P, Friez MJ, Dunn D, von Niederhausern A, Gurvich OL, Swoboda KJ, Sampson JB, Pestronk A, Connolly AM, Florence JM, Finkel RS, Bönnemann CG, Medne L, Mendell JR, Mathews KD, Wong BL, Sussman MD, Zonana J, Kovak K, Gospe SM, Gappmaier E, Taylor LE, Howard MT, Weiss RB, Flanigan KM: Clinical and genetic characterization of manifesting carriers of DMD mutations. Neuromuscul Disord. 2010, 20: 499-504.PubMedCentralCrossRefPubMed
15.
go back to reference Nishimura S, Mahmarian JJ, Boyce TM, Verani MS: Quantitative thallium-201 single-photon emission computed tomography during maximal pharmacologic coronary vasodilation with adenosine for assessing coronary artery disease. J Am Coll Cardiol. 1991, 18: 736-745.CrossRefPubMed Nishimura S, Mahmarian JJ, Boyce TM, Verani MS: Quantitative thallium-201 single-photon emission computed tomography during maximal pharmacologic coronary vasodilation with adenosine for assessing coronary artery disease. J Am Coll Cardiol. 1991, 18: 736-745.CrossRefPubMed
16.
go back to reference Nishimura RA, Tajik J: Evaluation of diastolic filling of left ventricle in health and disease:doppler echocardiography is the Clinician’s Rosetta stone. J Am Coll Cardiol. 1991, 30: 8-18.CrossRef Nishimura RA, Tajik J: Evaluation of diastolic filling of left ventricle in health and disease:doppler echocardiography is the Clinician’s Rosetta stone. J Am Coll Cardiol. 1991, 30: 8-18.CrossRef
17.
go back to reference Abbs S, Tuffery-Giraud S, Bakker E, Ferlini A, Sejersen T, Mueller CR: Best practice guidelines on molecular diagnostics in Duchenne/Becker muscular dystrophies. Neuromuscul Disord. 2010, 20: 422-427.CrossRefPubMed Abbs S, Tuffery-Giraud S, Bakker E, Ferlini A, Sejersen T, Mueller CR: Best practice guidelines on molecular diagnostics in Duchenne/Becker muscular dystrophies. Neuromuscul Disord. 2010, 20: 422-427.CrossRefPubMed
18.
go back to reference Brioschi S, Gualandi F, Scotton C, Armaroli A, Bovolenta M, Falzarano MS, Sabatelli P, Selvatici R, D’Amico A, Pane M, Ricci G, Siciliano G, Tedeschi S, Pini A, Vercelli L, de Grandis D, Mercuri E, Bertini E, Merlini L, Mongini T, Ferlini A: Genetic characterisation in symptomatic female DMD carriers: lack of relationship between X-inactivation, transcriptional DMD allele balancing and phenotype. BMC Med Genet. 2012, 13: 73-PubMedCentralCrossRefPubMed Brioschi S, Gualandi F, Scotton C, Armaroli A, Bovolenta M, Falzarano MS, Sabatelli P, Selvatici R, D’Amico A, Pane M, Ricci G, Siciliano G, Tedeschi S, Pini A, Vercelli L, de Grandis D, Mercuri E, Bertini E, Merlini L, Mongini T, Ferlini A: Genetic characterisation in symptomatic female DMD carriers: lack of relationship between X-inactivation, transcriptional DMD allele balancing and phenotype. BMC Med Genet. 2012, 13: 73-PubMedCentralCrossRefPubMed
19.
go back to reference Kim RJ, Ds F, Parrish TB, Harris K, Chen EL, Simonetti O, Bundy J, Finn JP, Klocke FJ, Judd RM: Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age and contractile function. Circulation. 1999, 100: 1992-2002.CrossRefPubMed Kim RJ, Ds F, Parrish TB, Harris K, Chen EL, Simonetti O, Bundy J, Finn JP, Klocke FJ, Judd RM: Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age and contractile function. Circulation. 1999, 100: 1992-2002.CrossRefPubMed
20.
go back to reference Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS: American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002, 105: 539-542.CrossRefPubMed Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS: American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002, 105: 539-542.CrossRefPubMed
21.
go back to reference Maceira AM, Prasad SK, Khan M, Pennell DJ: Reference right ventricular systolic and diastolic function normalized to age, gender and body surface area from steady-state free precession cardiovascular magnetic resonance. Eur Heart J. 2006, 27: 2879-2888.CrossRefPubMed Maceira AM, Prasad SK, Khan M, Pennell DJ: Reference right ventricular systolic and diastolic function normalized to age, gender and body surface area from steady-state free precession cardiovascular magnetic resonance. Eur Heart J. 2006, 27: 2879-2888.CrossRefPubMed
22.
go back to reference Ferlini A, Neri M, Gualandi F: The medical genetics of dystrophinopaties: molecular genetic diagnosis and its impact on the clinical practice. Neuromuscul Disord. 2012, 23: 4-14.CrossRefPubMed Ferlini A, Neri M, Gualandi F: The medical genetics of dystrophinopaties: molecular genetic diagnosis and its impact on the clinical practice. Neuromuscul Disord. 2012, 23: 4-14.CrossRefPubMed
23.
go back to reference Hor KN, Taylor MD, Al-Khalidi HR, Cripe LH, Raman SV, Jefferies JL, O’Donnell R, Benson DW, Mazur W: Prevalence and distribution of late gadolinium enhancement in a large population of patients with Duchenne muscular dystrophy: effect of age and left ventricular systolic function. J Cardiovasc Magn Reson. 2013, 15: 107-115.PubMedCentralCrossRefPubMed Hor KN, Taylor MD, Al-Khalidi HR, Cripe LH, Raman SV, Jefferies JL, O’Donnell R, Benson DW, Mazur W: Prevalence and distribution of late gadolinium enhancement in a large population of patients with Duchenne muscular dystrophy: effect of age and left ventricular systolic function. J Cardiovasc Magn Reson. 2013, 15: 107-115.PubMedCentralCrossRefPubMed
24.
go back to reference Varghese A, Pennell DJ: Late gadolinium enhanced cardiovascular magnetic resonance in Becker muscular dystrophy. Heart. 2004, 90: 59-CrossRef Varghese A, Pennell DJ: Late gadolinium enhanced cardiovascular magnetic resonance in Becker muscular dystrophy. Heart. 2004, 90: 59-CrossRef
25.
go back to reference Mahrholdt H, Goedecke C, Wagner A, Meinhardt G, Athanasiadis A, Vogelsberg H, Fritz P, Klingel K, Kandolf R, Sechtem U: Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation. 2004, 109: 1250-1258.CrossRefPubMed Mahrholdt H, Goedecke C, Wagner A, Meinhardt G, Athanasiadis A, Vogelsberg H, Fritz P, Klingel K, Kandolf R, Sechtem U: Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation. 2004, 109: 1250-1258.CrossRefPubMed
26.
go back to reference Puchalski MD, Williams RV, Askovich B, Sower CT, Hor KH, Su JT, Pack N, Dibella E, Gottliebson WM: Late gadolinium enhancement: precursor to cardiomyopathy in Duchenne muscular dystrophy?. Int J Cardiovasc Imaging. 2009, 25: 57-63.PubMedCentralCrossRefPubMed Puchalski MD, Williams RV, Askovich B, Sower CT, Hor KH, Su JT, Pack N, Dibella E, Gottliebson WM: Late gadolinium enhancement: precursor to cardiomyopathy in Duchenne muscular dystrophy?. Int J Cardiovasc Imaging. 2009, 25: 57-63.PubMedCentralCrossRefPubMed
27.
go back to reference Moon JC: The histologic basis of late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2004, 43: 2260-2264.CrossRefPubMed Moon JC: The histologic basis of late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2004, 43: 2260-2264.CrossRefPubMed
28.
go back to reference Barison A, Aquaro GD, Passino C, Falorni M, Balbarini A, Lombardi M, Pasquali L, Emdin M, Siciliano G: Cardiac magnetic resonance imaging and management of dilated cardiomyopathy in a Duchenne muscular dystrophy manifesting carrier. J Neurol. 2009, 256: 283-284.CrossRefPubMed Barison A, Aquaro GD, Passino C, Falorni M, Balbarini A, Lombardi M, Pasquali L, Emdin M, Siciliano G: Cardiac magnetic resonance imaging and management of dilated cardiomyopathy in a Duchenne muscular dystrophy manifesting carrier. J Neurol. 2009, 256: 283-284.CrossRefPubMed
29.
go back to reference Walcher T, Kunze M, Steinbach P, Sperfeld AD, Burgstahler C, Hombach V, Torzewski J: Cardiac involvement in a female carrier of Duchenne muscular dystrophy. Int J Cardiol. 2010, 138: 302-305.CrossRefPubMed Walcher T, Kunze M, Steinbach P, Sperfeld AD, Burgstahler C, Hombach V, Torzewski J: Cardiac involvement in a female carrier of Duchenne muscular dystrophy. Int J Cardiol. 2010, 138: 302-305.CrossRefPubMed
30.
go back to reference Crilley JG, Boehm EA, Rajagopalan B, Blamire AM, Styles P, Muntoni F, Hilton-Jones D, Clarke K: Magnetic resonance spectroscopy evidence of abnormal cardiac energetics in Xp21 muscular dystrophy. J Am Coll Cardiol. 2000, 36: 1953-1958.CrossRefPubMed Crilley JG, Boehm EA, Rajagopalan B, Blamire AM, Styles P, Muntoni F, Hilton-Jones D, Clarke K: Magnetic resonance spectroscopy evidence of abnormal cardiac energetics in Xp21 muscular dystrophy. J Am Coll Cardiol. 2000, 36: 1953-1958.CrossRefPubMed
31.
go back to reference Walcher T, Steinbach P, Spiess J, Kunze M, Gradinger R, Walcher D, Bernhardt P: Detection of long-term progression of myocardial fibrosis in Duchenne muscular dystrophy in an affected family: a cardiovascular magnetic resonance study. Eur J Radiol. 2011, 80: 115-119.CrossRefPubMed Walcher T, Steinbach P, Spiess J, Kunze M, Gradinger R, Walcher D, Bernhardt P: Detection of long-term progression of myocardial fibrosis in Duchenne muscular dystrophy in an affected family: a cardiovascular magnetic resonance study. Eur J Radiol. 2011, 80: 115-119.CrossRefPubMed
32.
go back to reference Flett AS, Hayward MP, Ashworth MT, Hansen MS, Taylor AM, Elliott PM, McGregor C, Moon JC: Equilibrium contrast cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: preliminary validation in humans. Circulation. 2010, 122: 138-144.CrossRefPubMed Flett AS, Hayward MP, Ashworth MT, Hansen MS, Taylor AM, Elliott PM, McGregor C, Moon JC: Equilibrium contrast cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: preliminary validation in humans. Circulation. 2010, 122: 138-144.CrossRefPubMed
33.
go back to reference Gandjbakhch E, Gackowski A, Tezenas du Montcel S, Isnard R, Amroun A, Richard P, Komaida M, Charron P: Early identification of mutation carriers in familial hypertrophic cardiomyopathy by combined echocardiography and tissue Doppler imaging. Eur Heart J. 2010, 31: 1599-1607.CrossRefPubMed Gandjbakhch E, Gackowski A, Tezenas du Montcel S, Isnard R, Amroun A, Richard P, Komaida M, Charron P: Early identification of mutation carriers in familial hypertrophic cardiomyopathy by combined echocardiography and tissue Doppler imaging. Eur Heart J. 2010, 31: 1599-1607.CrossRefPubMed
Metadata
Title
Patterns of late gadolinium enhancement in Duchenne muscular dystrophy carriers
Authors
Vincenzo Giglio
Paolo Emilio Puddu
Giovanni Camastra
Stefano Sbarbati
Sabino Walter Della Sala
Alessandra Ferlini
Francesca Gualandi
Enzo Ricci
Federico Sciarra
Gerardo Ansalone
Marco Di Gennaro
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2014
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/1532-429X-16-45

Other articles of this Issue 1/2014

Journal of Cardiovascular Magnetic Resonance 1/2014 Go to the issue