Chronotropic incompetence: an obscure cause of heart failure symptoms in survivors of critical diseases?

thickening and stiffening [2–4]. In our case, the disease involved predominantly the lungs and airways thus requiring lung transplantation after cardiac evaluation. Since pectus excavatum is common in this pathology, echogenicitymay not be optimalwith difficulty to assess cardiac abnormality. In such case, we think that cardiac MRI is an excellent solution to accurately assess both ventricular function and valvular disease as demonstrated in this case. Interestingly, recent studies also described the ability of cMRI to assess myocardial lipid content by spectroscopy [5,6]. Although late enhancement imagingwas normal in our case, whether cardiac spectrometry could detect cardiac accumulation of glycosaminoglycans and proteoglycans, and could help to detect myocardial involvement in patients with MPS would be of interest. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [7,8]. Supplementary data to this article can be found online at doi:10.1016/j.ijcard.2010.10.089. References