title: 59-year-old female with breathlessness.
abstract: A 59-year-old female underwent an electrocardiogram (ECG) and echocardiographic screening. Her brother died at quite a young age of kidney failure. Resting ECG showed borderline voltage criteria for left ventricular hypertrophy (LVH), with marked widespread T-wave inversion. Echocardiogram was normal, but in consideration of exertional breathlessness and abnormal baseline ECG, she underwent a coronary angiogram, which showed unobstructed coronaries. She was then referred to have a cardiac MR (CMR) for further characterisation. CMR images were acquired with a 1.5 T scanner and the imaging protocol included Steady-State Free Precession (SSFP) cine images (Figure 1A) as well as late gadolinium enhancement (LGE) images in the long-axis and short-axis planes covering the whole left ventricle (Figure 1B). In addition, native and postcontrast T1 mapping (Modified Look-Locker (MOLLI)) images were acquired for further tissue characterisation (Figure 1C and D, respectively).
  
  
  
  What is the most likely diagnosis based on CMR findings? Anderson-Fabry's disease (AFD)Cardiac amyloidosisGenotype (+), phenotype (-) hypertrophic cardiomyopathy (HCM)Myocardial iron overloadNormal heart.
authors.affiliation: CMR-unit Bristol Heart Institute, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK Department of Biomedical science, Federico II, University of Naples, Naples, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Scatteia
authors.affiliation: CMR-unit Bristol Heart Institute, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Estefania
authors.initials: E
authors.lastname: De Garate
authors.affiliation: CMR-unit Bristol Heart Institute, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bucciarelli-Ducci
mesh_terms: D015415:Biomarkers / Q000032:analysis; D004417:Dyspnea / Q000175:diagnosis; D000795:Fabry Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000201:enzymology; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008875:Middle Aged; D000519:alpha-Galactosidase / Q000032:analysis
chemical_list: D015415:Biomarkers; C576330:GLA protein, human; D000519:alpha-Galactosidase