For example, some patients may warrant cardioprotective therapy if CMR abnormalities are observed at a time when systolic function is preserved by echocardiography, though this is not current practice in LGMD unlike in Duchenne muscular dystrophy (DMD) where angiotensin-converting enzyme (ACE) inhibitors are often started when EF is normal by echocardiography yet CMR reveals abnormalities in strain and evident myocardial fibrosis[20-22]. This evidence concerns the gene ACE and Myocardial fibrosis.