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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.
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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
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Deng Y, Li G, Liu J, Wan X, Li L, Lv J, Li Q, Zhou F, Chang D. Case report: Catheter ablation for persistent atrial fibrillation in a patient with heart of stone. Front Cardiovasc Med 2023; 10:1207064. [PMID: 37849940 PMCID: PMC10577284 DOI: 10.3389/fcvm.2023.1207064] [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: 04/17/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023] Open
Abstract
Myocardial calcification is a rare condition, with only a few reports in the literature. For the first time, we report a case of diffuse myocardial calcification who underwent successful catheter ablation for persistent atrial fibrillation (AF). In this case, catheter ablation was recommended due to repeated hospitalization for palpitation and heart failure, but preoperative computed tomography showed massive myocardial calcification. Electroanatomic mapping of the atrium was performed with a Pentaray catheter before ablation, which showed areas of low voltage in the calcified region. As the persistent AF was terminated after circumferential pulmonary vein isolation and posterior wall isolation, and no further ablation was performed. The patient recovered well, with no recurrence of palpitation or heart failure during the one-year follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | - Faguang Zhou
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Dong Chang
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Belkin MN, Dela Cruz M, Nadeem U, Patel AR, Kim G, Grinstein J. Massive Myocardial Calcium Deposition: Hardened Heart. JACC Case Rep 2020; 2:996-1003. [PMID: 34317401 PMCID: PMC8302108 DOI: 10.1016/j.jaccas.2020.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 02/06/2023]
Abstract
A 25-year-old African-American woman with end-stage renal disease presented with new-onset heart failure. Transthoracic echocardiography indicated a significantly hyperechoic myocardium, and computed tomography noted a circumferential hyperattenuated myocardium. Endomyocardial biopsy revealed focal interstitial and intramyocyte calcium deposition in the heart, confirming a rare diagnosis of massive myocardial calcium deposition. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Mark N. Belkin
- Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Mark Dela Cruz
- Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Urooba Nadeem
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Amit R. Patel
- Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Gene Kim
- Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Jonathan Grinstein
- Section of Cardiology, University of Chicago, Chicago, Illinois
- Address for correspondence: Dr. Jonathan Grinstein, University of Chicago, 5841 South Maryland Avenue, A621, Chicago, Illinois 60637.
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Apical Sparing Pattern of Longitudinal Strain and Positive Bone Scintigraphy in Metastatic Myocardial Calcification. JACC Case Rep 2020; 2:809-813. [PMID: 34317352 PMCID: PMC8301688 DOI: 10.1016/j.jaccas.2020.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/04/2020] [Accepted: 02/26/2020] [Indexed: 11/20/2022]
Abstract
An apical sparing pattern of longitudinal strain and positive radionuclide bone scintigraphy are believed to be specific for the diagnosis of transthyretin cardiac amyloidosis. We report on a young woman with apical sparing of longitudinal strain and positive bone scintigraphy who was found to have metastatic myocardial calcification at autopsy. (Level of Difficulty: Intermediate.)
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Joki N, Tanaka Y, Hayashi T. Sudden Death, A Common Cause of Death in Japanese Hemodialysis Patients. J Atheroscler Thromb 2019; 27:303-305. [PMID: 31694988 PMCID: PMC7192818 DOI: 10.5551/jat.ed122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center
| | - Yuri Tanaka
- Division of Nephrology, Toho University Ohashi Medical Center
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Chan YH, Ngai MC, Chen Y, Wu MZ, Yu YJ, Zhen Z, Lai K, Cheung T, Ho LM, Chung HY, Lau CS, Lau CP, Tse HF, Yiu KH. Osteogenic circulating endothelial progenitor cells are linked to electrocardiographic conduction abnormalities in rheumatic patients. Ann Noninvasive Electrocardiol 2019; 24:e12651. [PMID: 31017736 DOI: 10.1111/anec.12651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/02/2019] [Accepted: 03/06/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Osteogenic circulating endothelial progenitor cells (EPC) play a pathogenic role in cardiovascular system degeneration through promulgating vasculature calcification, but its role in conduction disorders as part of the cardiovascular degenerative continuum remained unknown. AIM To investigate the role of osteocalcin (OCN)-expressing circulating EPCs in cardiac conduction disorders in the unique clinical sample of rheumatoid arthritis (RA) susceptible to both abnormal bone metabolism and cardiac conduction disorders. METHODS We performed flow cytometry studies in 134 consecutive asymptomatic patients with rheumatoid arthritis to derive osteogenic circulating OCN-positive (OCN+) CD34+KDR+ vs. CD34+CD133+KDR+ conventional EPC. Study endpoint was the prespecified combined endpoint of electrocardiographic conduction abnormalities. RESULTS Total prevalence of cardiac conduction abnormality was 9% (n = 12). All patients except one had normal sinus rhythm. One patient had atrial fibrillation. No patient had advanced atrioventricular (AV) block. Prevalence of first-degree heart block (>200 ms), widened QRS duration (>120 ms) and right bundle branch block were 6.7%, 2.1%, and 2.2% respectively. Circulating osteogenic OCN+ CD34+ KDR+ EPCs were significantly higher among patients with cardiac conduction abnormalities (p = 0.039). Elevated OCN+ CD34+ KDR+ EPCs> 75th percentile was associated with higher prevalence of cardiac conduction abnormalities (58.3% vs. 20.02%, p = 0.003). Adjusted for potential confounders, elevated OCN+ CD34+ KDR+ EPCs> 75th percentile remained independently associated with increased risk of cardiac conduction abnormalities (OR = 4.4 [95%CI 1.2-16.4], p = 0.028). No significant relation was found between conventional EPCs CD34+CD133+KDR+ and conduction abnormalities (p = 0.36). CONCLUSIONS Elevated osteogenic OCN+ CD34+ KDR+ EPCs are independently associated with the presence of electrocardiographic conduction abnormalities in patients with rheumatoid arthritis, unveiling a potential novel pathophysiological mechanism.
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Affiliation(s)
- Yap-Hang Chan
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Michael Cheong Ngai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Yan Chen
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.,Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Mei-Zhen Wu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Yu-Juan Yu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Zhe Zhen
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Kevin Lai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Tommy Cheung
- Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Lai-Ming Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Ho-Yin Chung
- Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Chak-Sing Lau
- Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Chu-Pak Lau
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.,Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.,Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen, China
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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.
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Affiliation(s)
- Adel El-Bialy
- Olive View-UCLA Medical Center, Division of Cardiology, Sylmar, CA 91342-1495, USA.
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Subcutaneous nerve activity and mechanisms of sudden death in a rat model of chronic kidney disease. Heart Rhythm 2015; 13:1105-1112. [PMID: 26744093 DOI: 10.1016/j.hrthm.2015.12.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The mechanisms of sudden death in chronic kidney disease (CKD) remain unclear. OBJECTIVE The purpose of this study was to test the hypotheses that subcutaneous nerve activity (SCNA) can be used to estimate sympathetic tone in ambulatory rats and that abrupt reduction of SCNA precedes the spontaneous arrhythmic death of Cy/+ rats. METHODS Radiotransmitters were implanted in ambulatory normal (N = 6) and Cy/+ (CKD; N = 6) rats to record electrocardiogram and SCNA. Two additional rats were studied before and after chemical sympathectomy with 6-hydroxydopamine. RESULTS In normal rats, the baseline heart rate (HR) and SCNA were 351 ± 29 bpm and 5.12 ± 2.97 mV·s, respectively. SCNA abruptly increased HR by 4.31% (95% confidence interval 4.15%-4.47%). In comparison, the CKD rats had reduced baseline HR (336 ± 21 bpm, P < .01) and SCNA (4.27 ± 3.19 mV·s, P < .01). When SCNA was observed, HR increased by only 2.48% (confidence interval 2.29%-2.67%, P < .01). All Cy/+ rats died suddenly, preceded by sinus bradycardia, advanced (second- and third-degree) AV block (N = 6), and/or ventricular tachycardia or fibrillation (N = 3). Sudden death was preceded by a further reduction of SCNA (3.22 ± 2.86 mV·s, P < .01) and sinus bradycardia (243 ± 55 bpm, P < .01). Histologic studies in CKD rats showed myocardial calcification that involved the conduction system. Chemical sympathectomy resulted in progressive reduction of SCNA over 7 days. CONCLUSION SCNA can be used to estimate sympathetic tone in ambulatory rats. CKD is associated with reduced HR response to SCNA and conduction system diseases. Abrupt reduction of sympathetic tone precedes AV block, ventricular arrhythmia, and sudden death of CKD rats.
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Ito S, Endo A, Okada T, Nakamura T, Adachi T, Sugamori T, Takahashi N, Yoshitomi H, Tanabe K. Myocardial Calcification with a Latent Risk of Congestive Heart Failure in a Patient with Apical Hypertrophic Cardiomyopathy. Intern Med 2015; 54:1627-31. [PMID: 26134195 DOI: 10.2169/internalmedicine.54.4161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Myocardial calcification is rare. An 88-year-old man who had previously been diagnosed with apical hypertrophic cardiomyopathy exhibited left ventricular asynergy on echocardiography before undergoing cholecystectomy. Computed tomography revealed severe calcification in the apical region of the left ventricular myocardium, although the coronary arteries were intact and the hemodynamics on right heart catheterization were normal. The cause of the left ventricular asynergy appeared to be myocardial calcification, thought to be the result of rheumatic fever based on the patient's past history. Stress echocardiography showed a latent risk for the development of heart failure due to the distensibility of the calcified left ventricular myocardium.
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Affiliation(s)
- Shimpei Ito
- Division of Cardiology, Shimane University Faculty of Medicine, Japan
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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]
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Abstract
Cardiovascular disease is the most common cause of the greatly elevated rates of mortality characteristic of patients undergoing maintenance hemodialysis. This article is an attempt to describe the complex and evolving features of cardiac disease routinely encountered in HD patients. Furthermore, by trying to appreciate the pathophysiological drivers, and the crucial interaction with the HD treatment itself, this article seeks to define cardiac disease in this setting (HD-associated cardiomyopathy) as a unique and complex entity. By understanding the phenotype and basis of HD-associated cardiomyopathy, we can develop an evolved understanding of the dominant processes involved in its development and offer up dialysis-based interventions specifically designed to mitigate the cumulative ischemic insults consequent to conventional HD treatment. This article explores the justification of this approach and recent evidence of its efficacy.
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Genovesi S, Gallieni M. Cardiovascular complications of calcium supplementation in chronic kidney disease: are there arrhythmic risks? Expert Opin Drug Saf 2014; 13:1143-8. [DOI: 10.1517/14740338.2014.937423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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
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Molenaar FM, van Reekum FE, Rookmaaker MB, Abrahams AC, van Jaarsveld BC. Extraosseous calcification in end-stage renal disease: from visceral organs to vasculature. Semin Dial 2014; 27:477-87. [PMID: 24438042 DOI: 10.1111/sdi.12177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In earlier days, periarticular accumulations of calcium phosphate causing tumor-like depositions were considered the result of passive precipitation and referred to as metastatic calcifications. From sophisticated computer tomographic studies and growing insight, we have learned that calcifications in the cardiovascular system are far more threatening and in fact one of the most important sequela of end-stage renal disease. The histologic characteristic of uremia-related calcification is arteriosclerosis of the media. In addition, there is atherosclerosis of the intima, due to the high prevalence of classic cardiovascular risk factors in renal disease. The two vascular features can frequently exist at different sites in the vasculature. Novel diagnostic techniques are helping to elucidate the pathogenetic mechanisms of active conversion of vascular smooth muscle cells to osteochondritic cells. Through this process, extensive calcification of the central and peripheral vasculature ensues, influenced by different promotors and inhibitors. Calciphylaxis is a special form of extraosseous calcification leading to skin necrosis. The factors that trigger the development of calciphylaxis are not completely understood, but this syndrome shares part of the pathophysiologic basis of extraosseous calcification in general. However, the therapeutic approach must be prompt and aggressive, because of the poor prognosis. Frequently, a fatal outcome cannot be avoided in calciphylaxis.
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Takahashi H, Aoki T, Fukumoto Y, Sugimura K, Nochioka K, Miura Y, Tatebe S, Yamamoto S, Shibuya K, Shimokawa H. "Porcelain heart" a case of acute heart failure with massive myocardial calcification complicated with primary hyperparathyroidism. J Cardiol Cases 2013; 8:183-186. [PMID: 30534287 DOI: 10.1016/j.jccase.2013.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/22/2013] [Accepted: 08/12/2013] [Indexed: 11/17/2022] Open
Abstract
A 47-year-old Japanese woman was transported to our hospital due to acute heart failure (AHF). She had been diagnosed with primary hyperparathyroidism (pHPT) and undergone parathyroidectomy 3 months previously. Chest X-ray showed marked cardiomegaly and severe pulmonary congestion, and transthoracic echocardiography indicated both left ventricular (LV) systolic and diastolic dysfunction, complicated with extensive massive myocardial calcification and no LV hypertrophy. Computed tomography also showed massive myocardial calcification in the posterior wall of the LV and the interventricular septum. After treatment with furosemide, olprinone, and carperitide under Swan-Ganz monitoring, LV ejection fraction was almost normalized. However, cardiac catheterization in the chronic phase indicated that LV diastolic dysfunction still existed, which might be affected by myocardial calcification. We followed this patient using spironolactone (25 mg/day), perindopril (8 mg/day), and bisoprolol (1.25 mg/day), with no further episode of heart failure for at least 6 months. Here, we report a rare case of AHF complicated with massive myocardial calcification possibly caused by primary hyperparathyroidism. <Learning objective: This is the first case report of acute heart failure due to left ventricular systolic and diastolic dysfunction, complicated with massive myocardial calcification, "porcelain heart", possibly caused by primary hyperparathyroidism.>.
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Affiliation(s)
- Hidenori Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Tatsuo Aoki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yoshihiro Fukumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Koichiro Sugimura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yutaka Miura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Shunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Saori Yamamoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Kiyotaka Shibuya
- Department of Cardiology, Saka General Hospital, Shiogama, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Lee HU, Youn HJ, Shim BJ, Lee SJ, Park MY, Jeong JU, Gu GM, Jeon HK, Lee JE, Kwon BJ. Porcelain heart: rapid progression of cardiac calcification in a patient with hemodialysis. J Cardiovasc Ultrasound 2012; 20:193-6. [PMID: 23346289 PMCID: PMC3542513 DOI: 10.4250/jcu.2012.20.4.193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 08/18/2012] [Accepted: 11/21/2012] [Indexed: 02/08/2023] Open
Abstract
Cardiac calcification usually occurs in patients with end-stage renal disease. However, rapid progression of cardiac calcification is rarely associated with secondary hyperparathyroidism of end-stage renal disease. We report a patient with end-stage renal disease who showed moderate left ventricular hypertrophy at the first echocardiography, and showed severe myocardial calcification and severe mitral valve stenosis 4 years later. We suspected a rapid progression 'porcelain heart' cardiomyopathy secondary to hyperparathyroidism of end-stage renal disease. The patient underwent parathyroidectomy, and considered mitral valve replacement.
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Affiliation(s)
- Hyeon-Uk Lee
- Division of Cardiology, Department of Internal Medicine, Pohang St. Mary's Hospital, Pohang, Korea
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Segura AM, Radovancevic R, Connelly JH, Loyalka P, Gregoric ID, Buja LM. Endomyocardial nodular calcification as a cause of heart failure. Cardiovasc Pathol 2011; 20:e185-8. [DOI: 10.1016/j.carpath.2010.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 07/21/2010] [Accepted: 08/09/2010] [Indexed: 11/25/2022] Open
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Faridi AB, Weisberg LS. Acid-Base, Electrolyte, and Metabolic Abnormalities. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Toniato A, Boschin IM. Stony heart and severe hyperparathyroidism. ANZ J Surg 2007; 77:802-3. [PMID: 17685970 DOI: 10.1111/j.1445-2197.2007.04239.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Calcification of the cardiovascular system is now well recognized to be a common feature of patients with chronic kidney disease. It is increasingly prevalent in patients with more severe uremia, particularly those receiving dialysis. Furthermore, it is progressive in terms of both severity and associated functional cardiovascular consequences. Although well recognized to be associated with a markedly increased mortality rate, the pathophysiological processes that result in these poor outcomes are less well understood. This article attempts to review calcification of the cardiovascular system as a whole entity and how the structural and functional changes may translate to the observed patterns of disease seen in these patients.
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Affiliation(s)
- Christopher W McIntyre
- Division of Vascular Medicine, School of Medical and Surgical Sciences, University of Nottingham Medical School at Derby , Derby Hospitals NHS Foundation Trust, Derby, United Kingdom.
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21
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Aras D, Topaloglu S, Demirkan B, Deveci B, Ozeke O, Korkmaz S. Porcelain heart: a case of massive myocardial calcification. Int J Cardiovasc Imaging 2005; 22:123-6. [PMID: 16041561 DOI: 10.1007/s10554-005-9006-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2005] [Accepted: 06/13/2005] [Indexed: 11/26/2022]
Abstract
Reports of massive myocardial calcification are limited mainly to case reports and this type intracardiac calcifications have been usually identified postmortem. We present a very interesting case of massive calcification of the left ventricular myocardium, interventricular and interatrial septae causing restrictive physiology and coronary artery obstruction in a 46-year-old Turkish woman. The diagnosis of myocardial calcification was suspected from chest X-ray and confirmed with computerized tomography and cardiac catheterization. The findings of the chest computed tomography were very similar to those previously reported cases of endomyocardial fibrosis (EMF) with massive calcification of the left ventricle.
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Affiliation(s)
- Dursun Aras
- Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ballibaba sokak. No:52/3, Kucukesat, 06700 Ankara, Turkey.
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22
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Alfrey AC. The role of abnormal phosphorus metabolism in the progression of chronic kidney disease and metastatic calcification. Kidney Int 2004:S13-7. [PMID: 15296502 DOI: 10.1111/j.1523-1755.2004.09003.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The role of abnormal phosphorus metabolism in the progression of renal disease and metastatic calcification. Hyperphosphatemia is a common biochemical abnormality in advanced renal failure. The resulting increase serum calcium x phosphorus product results in the deposition of hydroxyapatite crystals. The crystalline properties of these deposits incite an inflammatory response manifested by encapsulated tumoral deposits around joints, acute inflammatory arthritis, and irritative conjunctivitis. These deposits occur in association with marked elevation of serum phosphorus levels, and are prevented and eradicated by normalizing serum phosphorus levels. The calcium-phosphate deposits which occur in heart and lungs are nonapatitic. These deposits were never clearly related to hyperphosphatemia. They are mainly of historic interest because currently they are rarely seen. Their eradication appears to be more of a result of improved dialytic techniques than correction of serum phosphorus levels. The presence, persistence, and progression of vascular calcification are more closely related to patient age and duration of dialysis than hyperphosphatemia. This suggests that these deposits are a result of dystrophic calcification occurring de novo in a diseased or damaged vessel wall. Phosphorous restriction has also been shown to be protective of renal functional deterioration in experimental renal disease. It is unclear whether the protective effect is mediated through phosphate restriction or phosphate depletion. In conclusion, control of serum phosphorus levels in dialyzed uremic patients has clearly decreased morbidity associated with periarticular, articular, and conjunctiva hydroxyapatite deposits. In contrast, phosphorous control has had little effect on the presence or severity of vascular calcification.
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23
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Okada M, Kyakuno M, Imamura J, Nakamura T, Takahara S. An autopsy case of sudden death in renal transplant recipient. Clin Transplant 2003; 16 Suppl 8:58-61. [PMID: 12464134 DOI: 10.1034/j.1399-0012.16.s8.3.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Few autopsy cases of sudden death in renal transplant recipients have been reported in the literature. The present case was a 50-year-old female recipient of a living-related renal transplant, who died suddenly after a good post-transplant course of 14 years. The patient was admitted in December 2000 for detailed investigation for ascites, and died unexpectedly 1 month later. She complained of mild dyspnoea approximately 3 h before death. Detailed clinical and laboratory investigations after admission showed no malignant findings in the abdominal cavity. Postmortem pathological examination also showed no tumour in the abdominal cavity. Both lungs were pneumatized. Histopathological examinations revealed metastatic calcification. Calcification was observed in the heart, lungs, kidney graft and pancreas. Calcification in the heart was found in the central fibrous body surrounding the atrioventricular node and bundle of His, as well as in the origin of bifurcating bundle. In the myocardial fibres, fibre rupture and waviness were observed. Although these findings may indicate agonal changes, they might also be a consequence of sudden cardiac death. This patient was in a state of renal failure, which presumably caused metastatic calcification involving also the cardiac conduction system. This calcification might partially account for the sudden death.
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Affiliation(s)
- Masanao Okada
- Department of Pathology, Osaka Seamen's Insurance Hospital, Osaka, Japan
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24
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Quinn AM, McClatchey KD. Pathologic quiz case: a 38-year-old woman with chronic renal disease and dyspnea. Arch Pathol Lab Med 2003; 127:499-500. [PMID: 12683886 DOI: 10.5858/2003-127-0499-pqcayo] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Adam M Quinn
- Department of Pathology, Loyola University Medical Center, Maywood, Ill 60153, USA.
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