1
|
Sozzi FB, Gnan E, Faggiano A, Giangiacomi F, Iacuzio L, Canetta C, Santangelo G, Pisaniello M, Eker A, Carugo S. Extensive myocardial calcifications: a systematic literature review of a rare pathological phenomenon. Front Cardiovasc Med 2024; 11:1367467. [PMID: 39135615 PMCID: PMC11317411 DOI: 10.3389/fcvm.2024.1367467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/14/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction Myocardial calcifications (MC) represent a relatively rare pathological process, which may accompany different cardiovascular conditions and can be broadly categorized as dystrophic or metastatic. Myocardial infarction (MI) has been traditionally regarded as the main cause of MC overall; however, no updated comprehensive data on the relative incidence of different forms of MC is available. The purpose of this systematic review of the literature is to analyze the currently available evidence on MC in terms of pathophysiology, diagnosis, and clinical presentation. Methods and results A total of 241 studies including a total of 368 patients affected by extensive MC were included in the final review. The majority of patients (69.8%) presented with dystrophic MC. Endomyocardial fibrosis (EMF) represents the single most common etiology of MC (24.2%), while sepsis/acute systemic inflammatory syndrome (SIRS) and chronic kidney disease were identified as the second and third most common causes respectively. The relative incidence of etiologies also varies across the years, with MI being more represented before 1990, and sepsis/SIRS becoming the single most common cause of MC after 1990. Multimodality imaging was used in the work-up of MC in 42.7% of cases. The most commonly employed imaging modality overall was echocardiography (51.9%), while after 1990 computed tomography scan became the most widely used tool (70.1%). Conclusion The present systematic review provides new insights into the pathophysiology of MC. Previously thought to be mainly a consequence of ischemic heart disease, our data indicate that other diseases, namely EMF and sepsis/SIRS, are indeed the main conditions associated with MC. The importance of multimodality imaging in the work-up of MC is also highlighted.
Collapse
Affiliation(s)
- Fabiola B. Sozzi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Gnan
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesco Giangiacomi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Ciro Canetta
- High Care Internal Medicine Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gloria Santangelo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Pisaniello
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Armand Eker
- Centre Cardiothoracique, CCM, Monaco City, Monaco
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
2
|
Sui ML, Wu CJ, Yang YD, Xia DM, Xu TJ, Tang WB. Extensive myocardial calcification in critically ill patients receiving extracorporeal membrane oxygenation: A case report. World J Clin Cases 2022; 10:4214-4219. [PMID: 35665134 PMCID: PMC9131238 DOI: 10.12998/wjcc.v10.i13.4214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/03/2021] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Myocardial calcification is a rare complication in critically ill patients. The prognosis of myocardial calcifications in critically ill patients is very poor if not treated in a timely manner. We describe a rare case of acute extensive myocardial calcifications due to acute myocarditis after receiving extracorporeal membrane oxygenation (ECMO) support.
CASE SUMMARY We report a 17-year-old male patient who developed extensive myocardial calcifications while receiving prolonged ECMO support for severe myocarditis and cardiogenic shock. Extensive myocardial calcifications were confirmed by chest computed tomography (CT). Myocardial calcifications were observed in the left ventricle walls on CT examination 10 days after admission. The patient was then discharged with heart function class II on the NYHA classification. Two years later, the patient was still alive with adequate quality of life. We then included this patient and 7 other cases retrieved from the PubMed, Cochrane Library, EMBASE, and MEDLINE databases in our study, in order to provide a reference for the clinical diagnosis and treatment of this disease.
CONCLUSION Multiple causes including prolonged hemodynamic failure, profound acidosis, high vasopressor doses, and acute renal failure may jointly lead to extensive myocardial calcifications. The precise role of ECMO support in the timing and frequency of acute myocardial calcifications deserves further investigation.
Collapse
Affiliation(s)
- Ming-Liang Sui
- Department ofCritical Care Medicine, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou 215028, Jiangsu Province, China
| | - Chang-Jiang Wu
- Department ofCritical Care Medicine, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou 215028, Jiangsu Province, China
| | - Ya-Di Yang
- Department ofCritical Care Medicine, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou 215028, Jiangsu Province, China
| | - Da-Mei Xia
- Department ofCritical Care Medicine, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou 215028, Jiangsu Province, China
| | - Tian-Jie Xu
- Department ofCritical Care Medicine, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou 215028, Jiangsu Province, China
| | - Wei-Bing Tang
- Department ofCritical Care Medicine, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou 215028, Jiangsu Province, China
| |
Collapse
|
3
|
Li J, Chelala L, Hossain R, Jeudy J, White C. Rapid Onset Development of Myocardial Calcifications in the Setting of Renal Failure and Sepsis. Radiol Cardiothorac Imaging 2021; 3:e200549. [PMID: 33969311 DOI: 10.1148/ryct.2021200549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/27/2020] [Accepted: 01/13/2021] [Indexed: 11/11/2022]
Abstract
Myocardial calcifications can arise following damage to myocardial tissue or in the setting of disturbances in the calcium and phosphorus balance. They are associated with a number of cardiac sequelae, as well as higher mortality. Three cases of rapid-onset myocardial calcifications that developed within the course of 5 to 13 weeks in patients who had a history of sepsis and renal failure while undergoing hemodialysis are described. Baseline imaging from several weeks prior without myocardial calcification are shown for each of the three patients, demonstrating the rapid onset of these calcifications. The clinical significance of these findings is discussed. © RSNA, 2021.
Collapse
Affiliation(s)
- Joy Li
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Lydia Chelala
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Rydhwana Hossain
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Jean Jeudy
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Charles White
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| |
Collapse
|
4
|
Washino M, Tanaka T, Nakase Y, Aoi T, Endo N, Ishikawa H, Morishita Y. A rare case of myocardial calcification secondary to acute myocarditis due to an Escherichia coli infection. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 82:775-781. [PMID: 33311807 PMCID: PMC7719460 DOI: 10.18999/nagjms.82.4.775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Myocardial calcification secondary to acute myocarditis is a rare but possibly life-threatening complication. We report a 43-year-old woman with minimal change nephrotic syndrome who developed sepsis caused by Escherichia coli. We simultaneously detected the complication of acute myocarditis in the patient. Although echocardiography showed hypokinesis of the apical segment when acute myocarditis was diagnosed, no sign of myocardial calcification was observed. After two weeks, a CT showed myocardial calcification in the same area. Although myocardial calcification was still observed 12 months later, the patient’s cardiac function had improved.
Collapse
Affiliation(s)
- Masaya Washino
- Department of Nephrology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Tomoki Tanaka
- Department of Nephrology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Yukiko Nakase
- Department of Nephrology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Tomonori Aoi
- Department of Nephrology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Nobuhide Endo
- Department of Nephrology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Hideaki Ishikawa
- Department of Nephrology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Yoshihiro Morishita
- Department of Cardiology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| |
Collapse
|
5
|
Kimura Y, Seguchi O, K Kono A, Matsumoto M, Kumai Y, Kuroda K, Nakajima S, Watanabe T, Matsumoto Y, Fukushima S, Yanase M, Fujita T, Ishibashi-Ueda H, Kobayashi J, Fukushima N. Massive Biventricular Myocardial Calcification in a Patient with Fulminant Myocarditis Requiring Ventricular Assist Device Support. Intern Med 2019; 58:1283-1286. [PMID: 30568151 PMCID: PMC6543210 DOI: 10.2169/internalmedicine.2039-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The natural course of myocardial calcification is unclear. We herein report a case of massive biventricular myocardial calcification associated with fulminant myocarditis and present its natural course. The patient was a 15-year-old boy. Massive calcification was detected in both ventricles on computed tomography several months after left ventricular assist device placement. Although the calcification gradually regressed, the patient's cardiac function did not recover, and he underwent heart transplantation after a waiting period of 3 years. A histological examination revealed severe fibrosis in both ventricles of the original heart. Myocardial calcification might suggest severe myocardial inflammation and injury in cases of fulminant myocarditis.
Collapse
Affiliation(s)
- Yuki Kimura
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Osamu Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Atsushi K Kono
- Department of Radiology, National Cerebral and Cardiovascular Center, Japan
| | - Manabu Matsumoto
- Department of Pathology, National Cerebral and Cardiovascular Center, Japan
| | - Yuto Kumai
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Kensuke Kuroda
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Seiko Nakajima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Takuya Watanabe
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Yorihiko Matsumoto
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Japan
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Japan
| | - Masanobu Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Japan
| | | | - Junjiro Kobayashi
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Japan
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| |
Collapse
|
6
|
El-Bialy A, Shenoda M, Saleh J, Tilkian A. Myocardial Calcification as a Rare Cause of Congestive Heart Failure: A Case Report. J Cardiovasc Pharmacol Ther 2016; 10:137-43. [PMID: 15965565 DOI: 10.1177/107424840501000208] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Myocardial calcification is a manifestation of either metastatic or dystrophic calcium deposition in the myocardium. Dystrophic calcification of the myocardium is most commonly seen in long-term survivors of substantial myocardial infarctions. Current literature has reported only 3 cases of myocardial calcification with normal coronary arteries. We present a case of an 80-year-old woman with multiple admissions over a 5-year period for congestive heart failure. She was found to have a normal left ventricular ejection fraction and normal coronary arteries on left heart catheterization. A high resolution computed tomography (CT) study of the chest revealed extensive left ventricular myocardial calcifications, which were not present 4 years earlier on CT. The patient’s history and clinical presentation revealed no etiologic factors for her calcified myocardium.
Collapse
Affiliation(s)
- Adel El-Bialy
- Olive View-UCLA Medical Center, Division of Cardiology, Sylmar, CA 91342-1495, USA.
| | | | | | | |
Collapse
|
7
|
Nance JW, Crane GM, Halushka MK, Fishman EK, Zimmerman SL. Myocardial calcifications: Pathophysiology, etiologies, differential diagnoses, and imaging findings. J Cardiovasc Comput Tomogr 2015; 9:58-67. [DOI: 10.1016/j.jcct.2014.10.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/09/2014] [Accepted: 10/12/2014] [Indexed: 01/13/2023]
|
8
|
Avila-Vanzzini N, Trevethan-Cravioto S, Lopez-Mora E, Herrera-Bello H, Soto-Abraham V, Martínez-Rios MA. Heart calcification (idiopathic cardiac osseous metaplasia): a case report. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:140-2. [PMID: 24796527 DOI: 10.1016/j.acmx.2013.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 06/05/2013] [Accepted: 06/07/2013] [Indexed: 10/25/2022] Open
Affiliation(s)
- Nydia Avila-Vanzzini
- Instituto Nacional de Cardiología "Ignacio Chavez", Echocardiography Department, Mexico.
| | | | - Enrique Lopez-Mora
- Instituto Nacional de Cardiología "Ignacio Chavez", Outpatients Clinic Department, Mexico
| | - Héctor Herrera-Bello
- Instituto Nacional de Cardiología "Ignacio Chavez", Intensive Therapy, Medica Sur, Clinic Foundation, Mexico
| | | | | |
Collapse
|
9
|
Oka K, Oohira K, Yatabe Y, Tanaka T, Kurano K, Kosugi R, Murata M, Hakozaki H, Nishikawa T, Tsutsumi Y. Fulminant myocarditis demonstrating uncommon morphology--a report of two autopsy cases. Virchows Arch 2005; 446:259-64. [PMID: 15668804 DOI: 10.1007/s00428-004-1173-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Accepted: 11/03/2004] [Indexed: 12/14/2022]
Abstract
Two autopsy cases of fulminant myocarditis demonstrating uncommon morphology were studied. Subjects included two male patients: a 42-year-old (case 1) and a 39-year-old (case 2). Both cases had fever, chest or epigastric pain, electrocardiographic abnormalities, prominent elevation of serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, lactic dehydrogenase and creatine phosphokinase. They were treated with intra-aortic balloon pumping and percutaneous cardiopulmonary support, and they died at 3 days and 4 days after admission (total course of 10 days and 9 days), respectively. Case 1 showed focal necrosis, severe myocardial dystrophic calcification positive for Kossa stain, inflammatory edema, lymphocyte and macrophage infiltration and extravasation of erythrocytes. Case 2 showed acute inflammation and severe myocardial necrosis with neutrophilic abscess, lymphocyte and macrophage infiltration, cell debris and purulent exudate. Calcified, degenerative and necrotic cardiac myocytes and macrophages were reacted with anti-Enterovirus antibody (clone 5-D8/1), which recognizes an epitope on the VP1 peptide of most Coxsackievirus, echovirus, poliovirus and enterovirus strains. Therefore, the present two cases may be compatible with fulminant enterovirus-associated myocarditis. Using reverse transcriptase-semi-nested polymerase chain reaction, picornaviral RNA was detected in the amplified products extracted from the paraffin-embedded myocardial sample of case 1 but not in case 2.
Collapse
Affiliation(s)
- Kuniyuki Oka
- Pathology, Mito Saiseikai General Hospital, 3-3-10 Futabadai, Mito, 311-4198 Ibaraki, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
In this paper we report a case of 34-year-old man with a severe septic shock. Because of profound hypotension he was given massive amounts of catecholamines for 10 days. After a short recovery the function of his heart started to deteriorate again and clear calcification around the left ventricle was disclosed by computer tomography. Catecholamines are known to induce myocardial injury resulting in a special form of cardiomyopathy with eventual calcification, but there are no previous reports of myocardial calcification to this extent.
Collapse
|
11
|
Itoh E, Saitoh H, Miida T, Oda H, Toeda T, Higuma N, Okazaki E. An autopsied case of acute myocarditis with myocardial calcification. JAPANESE CIRCULATION JOURNAL 1997; 61:798-802. [PMID: 9293412 DOI: 10.1253/jcj.61.798] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 47-year-old woman was admitted with fever, hypotension, an elevated serum creatinine kinase level, and electrocardiographic abnormalities, which led to the diagnosis of acute myocarditis. She was placed on percutaneous cardiopulmonary support because of hemodynamic collapse on the third hospital day. Serial echocardiography showed gradual recovery of profound hypokinesis and edematous thickening of the left ventricle, but she died of sepsis on the 17th day without overt renal insufficiency or electrolytic abnormalities. Autopsy revealed myocardial necrosis with lymphocytic infiltrates and extensive myocardial calcification. Calcification was dense in the area of severe myocardial necrosis, and the distribution of calcium deposits suggested that the calcification was a consequence of significant inflammation of the myocardium. Recovery of regional wall motion was prominent in the area of severe inflammatory change. Dissociation between the pathologic and echocardiographic findings suggested the possibility of functional reversibility of severely damaged myocardium and possible mechanisms of abnormal contractile function other than inflammatory change.
Collapse
Affiliation(s)
- E Itoh
- Department of Cardiology, Niigata City General Hospital, Japan
| | | | | | | | | | | | | |
Collapse
|