Case Report: Twelve-year longitudinal CMR follow-up in Becker muscular dystrophy–associated cardiomyopathy

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Becker muscular dystrophy-associated cardiomyopathy (n=1). Intervention: Serial cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (gadobutrol 0.15 mmol/kg), native T1 mapping, and feature-tracking strain analysis vs. Baseline CMR examination performed 12 years prior. Primary outcome: Longitudinal changes in left ventricular ejection fraction (LVEF), ventricular remodeling, strain, and myocardial fibrosis over 12 years.

Q: What does this research mean for the field?

Becker muscular dystrophy–associated cardiomyopathy can exhibit progressive left ventricular remodeling, worsening systolic function, and expanding myocardial fibrosis across a 12-year interval detectable by serial cardiac magnetic resonance imaging. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mohd Imree Azmi; Masafumi Takafuji; Sven Plein

doi:10.3389/fmed.2026.1969565

October 20, 2026Frontiers in MedicineOpen Access

Case Report: Twelve-year longitudinal CMR follow-up in Becker muscular dystrophy–associated cardiomyopathy

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Key result

Serial CMR tracks a ~12-point LVEF decline and progressive fibrosis over 12 years in BMD cardiomyopathy.

n=1

Why the study?

In Becker muscular dystrophy, myocardial disease may progress despite relatively limited findings on conventional echocardiography, whereas cardiac magnetic resonance provides detailed assessment of ventricular function and myocardial tissue characteristics.

Key Points

To document long-term changes in myocardial tissue characteristics and ventricular function over a 12-year interval in a patient with Becker muscular dystrophy-associated cardiomyopathy using cardiac magnetic resonance (CMR).
Conducted serial CMR examinations 12 years apart (in 2014 and 2026) in a 57-year-old man with genetically confirmed Becker muscular dystrophy.
Evaluated left ventricular volumes and mass, systolic ejection fraction, myocardial strain (GLS, GCS, GRS), late gadolinium enhancement (LGE), and follow-up native T1 mapping.
Left ventricular ejection fraction declined from 49% in 2014 to 37% in 2026, accompanied by an increase in left ventricular end-diastolic volume index from 89 mL/m2 to 123 mL/m2 and left ventricular mass index from 87 g/m2 to 108 g/m2.
Myocardial strain parameters worsened over the 12-year interval: global longitudinal strain decreased from −14.3% to −11.5%, global circumferential strain decreased from −14.9% to −11.4%, and global radial strain decreased from 22.4% to 15.8%.
Imaging revealed interval progression of lateral wall subepicardial fibrosis, new mid-wall septal LGE, an increase in maximum septal wall thickness from 13 mm to 19 mm, and a prolonged native T1 of 1,360 ms on follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 male patient (aged 44 at baseline and 57 at follow-up) with genetically confirmed Becker muscular dystrophy-associated cardiomyopathy followed for 12 years with serial cardiac magnetic resonance imaging.

E

Exposure

Serial cardiac magnetic resonance (CMR) imaging examinations performed 12 years apart (baseline in 2014 on a Philips Ingenia 1.5 T scanner and follow-up in 2026 on a Philips Achieva 3.0 T scanner) using balanced steady-state free precession cine imaging, late gadolinium enhancement (LGE) with intravenous gadobutrol 0.15 mmol/kg, MOLLI native T1 mapping (at follow-up), and feature-tracking strain analysis.

O

Outcome

Interval changes in left ventricular remodelling, systolic function (LVEF and myocardial strain), and distribution and extent of myocardial fibrosis (LGE and native T1) over 12 years.surrogate

Main Result

Absolute Event Rate: 37% vs 49%

This 12-year longitudinal case report demonstrates the utility of serial CMR, including LGE and feature-tracking strain analysis, in characterizing progressive left ventricular remodeling, declining systolic function, and expanding myocardial fibrosis in Becker muscular dystrophy-associated cardiomyopathy.

Limitations

Single-patient case report
CMR examinations were performed at different magnetic field strengths and scanners (1.5 T at baseline vs 3.0 T at follow-up)
Parametric native T1 mapping was not performed at the baseline CMR examination, limiting direct assessment of longitudinal T1 changes
LGE distribution and extent were assessed qualitatively by visual assessment rather than quantitative methods
Temporal association observed in a single case does not establish causality
Single-patient case report including only two CMR time points, precluding assessment of the timing or rate of disease progression
Differences in acquisition protocols (performed at different magnetic field strengths and scanners: 1.5 T in 2014 vs 3.0 T in 2026), clinical events, and treatment changes may have influenced the observed findings
LGE was assessed qualitatively rather than quantitatively
Absence of baseline native T1 mapping precluded longitudinal tissue characterisation comparisons

Implication

Serial CMR may aid monitoring of BMD cardiomyopathy progression; extends sparse longitudinal data but leaves open clinical utility.

Abstract

Cardiac involvement is an important cause of morbidity and mortality in Becker muscular dystrophy. Myocardial disease may progress despite relatively limited findings on conventional echocardiography, while cardiac magnetic resonance (CMR) provides detailed assessment of ventricular function and myocardial tissue characteristics with late gadolinium enhancement (LGE), parametric mapping and strain analysis. We report a case of 57 year-old man with genetically confirmed Becker muscular dystrophy who underwent CMR examinations 12 years apart. Follow-up imaging demonstrated progressive left ventricular remodelling, a decline in left ventricular ejection fraction and interval changes in the distribution and extent of myocardial fibrosis. This case provides a long-term within-patient comparison of Becker muscular dystrophy associated cardiomyopathy and illustrates the additional information provided by serial CMR in documenting progressive myocardial involvement over time.

Discussion

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Cite This Study

Azmi et al. (2026) conducted a case report in Becker muscular dystrophy-associated cardiomyopathy (n=1). Serial cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (gadobutrol 0.15 mmol/kg), native T1 mapping, and feature-tracking strain analysis vs. Baseline CMR examination performed 12 years prior was evaluated on Longitudinal changes in left ventricular ejection fraction (LVEF), ventricular remodeling, strain, and myocardial fibrosis over 12 years. Serial CMR over 12 years in Becker muscular dystrophy cardiomyopathy documented an LVEF decline from 49% to 37%, LVEDV increase from 199 to 258 mL, and progressive lateral and septal fibrosis.

synapsesocial.com/papers/6add4812322f548a006b13d0 https://doi.org/10.3389/fmed.2026.1969565

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Case Report: Twelve-year longitudinal CMR follow-up in Becker muscular dystrophy–associated cardiomyopathy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Case Report: Twelve-year longitudinal CMR follow-up in Becker muscular dystrophy–associated cardiomyopathy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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