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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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Li B, Liu Q, Chen X, Chen T, Dang W, Zhao J, Cui G, Chen K, Wu Y. A Novel Idiopathic Atrial Calcification: Pathologic Manifestations and Potential Mechanism. Front Cardiovasc Med 2022; 9:788958. [PMID: 35387434 PMCID: PMC8978529 DOI: 10.3389/fcvm.2022.788958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cardiac calcification is a type of ectopic pathologic calcification of unknown etiology and mechanisms. Once diagnosed, the location, extent and morphology of the calcified lesions, as well as their functional significance in the heart, are usually the focus of case reports. Calcification is mostly distributed in myocardium, but rarely reported in atrium. In addition, because of limited sampling and complex pathological mechanisms, the etiology underlying the formation of these calcified lesions also remains unclear. Methods Two cardiac calcifications were found in a patient, died of trauma-induced subarachnoid hemorrhage after slightly drinking, during a standard autopsy. The location and morphological characteristics of the calcified lesions were determined by computed tomography (CT) and CT-based 3D reconstruction. The specific histopathological characteristics of the lesions were determined by multi-staining. The concentration of free calcium and inorganic pyrophosphate (PPi) in plasma reflected the change of calcium metabolism. The expression and membranal localization of the ATP Binding Cassette Subfamily C Member 6 (ABCC6) in hepatocytes were detected by immunofluorescence. The variants of the ABCC6 were detected by Sanger sequencing and potential pathogenic variants were further identified by in silico analysis. Results The present study describes a patient with idiopathic calcification with two pear-shaped and irregularly hollow lesions symmetrically distributed in the patient's atrium. Massive accumulation of calcium salts was identified by multi-staining. For this patient, the plasma concentration of free calcium was higher than the control, indicating that calcium metabolism was disturbed. Furthermore, the plasma PPi of the patient was lower than the normal. By using immunofluorescence, the expression and membranal localization of ABCC6 was decreased and impaired in hepatocytes, respectively. Combined with Sanger sequencing and in silico analysis, 7 variants were identified. Conclusions This study described a novel patient with symmetrically distributed idiopathic atrial calcifications. Furthermore, all the results indicated that these pathologic calcifications may be secondary to reduced plasma PPi content due to ABCC6 dysfunction in hepatocytes. Moreover, these findings provided novel clues to the pathogenesis, clinical diagnosis and treatment of idiopathic atrial calcification in future.
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Affiliation(s)
- Bowen Li
- Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Qingbo Liu
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Xihui Chen
- Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Tangdong Chen
- Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Wenhui Dang
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Jing Zhao
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Guangbin Cui
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University, Xi'an, China
- Guangbin Cui
| | - Kun Chen
- Department of Anatomy, Histology and Embryology and K.K. Leung Brain Research Centre, Air Force Medical University, Xi'an, China
- Kun Chen
| | - Yuanming Wu
- Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
- *Correspondence: Yuanming Wu
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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.
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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
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Deguchi K, Ueno T, Matsuura R, Yamanaka H, Nara K, Uehara S, Tazuke Y, Bessho K, Okuyama H. Disseminated Metastatic Tissue Calcification After Orthotopic Liver Transplantation: A Case Report. Transplant Proc 2016; 48:251-4. [PMID: 26915877 DOI: 10.1016/j.transproceed.2015.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hypercalcemia has been observed in patients after liver transplantation. However, it is rare that the hypercalcemia induced disseminated tissue calcification and heart failure. CASE REPORT We report a rare case of heart failure caused by disseminated metastatic tissue calcification that involved extensive progressive myocardial calcification after liver transplantation. A 20-year-old man with end-stage liver disease due to biliary atresia underwent ABO-incompatible living donor liver transplantation. After successful transplantation, he suffered from antibody-mediated rejection. Subsequently, ABO-matched cadaveric liver retransplantation was successfully performed. Hypercalcemia developed gradually following the second transplantation. His serum calcium level increased to 18.3 mg/dL with sudden onset of ventricular tachycardia. Although he was resuscitated with a cardiopulmonary support device, he died of heart and liver failure. Histopathologic examination revealed systemic disseminated metastatic tissue calcification, including massive myocardial calcification. CONCLUSION Progressive worsening of hypercalcemia resulted in disseminated metastatic tissue calcification and massive metastatic myocardial calcification, which led to heart failure after liver transplantation. Because hypercalcemia after liver transplantation can cause fatal tissue calcification, early intervention for hypercalcemia should be considered.
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Affiliation(s)
- K Deguchi
- Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan
| | - T Ueno
- Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan.
| | - R Matsuura
- Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan
| | - H Yamanaka
- Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan
| | - K Nara
- Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan
| | - S Uehara
- Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan
| | - Y Tazuke
- Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan
| | - K Bessho
- Department of Pediatrics, Osaka University, Postgraduate School of Medicine, Osaka, Japan
| | - H Okuyama
- Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan
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Panduranga P. Porcelain Heart and Lung. Sultan Qaboos Univ Med J 2015; 15:e299-e300. [PMID: 26052467 PMCID: PMC4450797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/27/2014] [Indexed: 06/04/2023] Open
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Gan XT, Taniai S, Zhao G, Huang CX, Velenosi TJ, Xue J, Urquhart BL, Karmazyn M. CD73-TNAP crosstalk regulates the hypertrophic response and cardiomyocyte calcification due to α1 adrenoceptor activation. Mol Cell Biochem 2014; 394:237-46. [PMID: 24894822 DOI: 10.1007/s11010-014-2100-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Abstract
Cluster of differentiation 73 (CD73) is an ecto-5' nucleotidase which catalyzes the conversion of AMP to adenosine. One of the many functions of adenosine is to suppress the activity of tissue nonspecific alkaline phosphatase (TNAP), an enzyme important in regulating intracellular calcification. Since myocardial calcification is associated with various cardiac disease states, we studied the individual roles and crosstalk between CD73 and TNAP in regulating myocyte responses to the α1 adrenoceptor agonist phenylephrine in terms of calcification and hypertrophy. Cultured neonatal rat cardiomyocytes were treated with 10 µM phenylephrine for 24 h in the absence or presence of the stable adenosine analog 2-chloro-adenosine, the TNAP inhibitor tetramisole or the CD73 inhibitor α,β-methylene ADP. Phenylephrine produced marked hypertrophy as evidenced by significant increases in myocyte surface area and ANP gene expression, as well as calcification determined by Alizarin Red S staining. These responses were associated with reduced CD73 gene and protein expression and CD73 activity. Conversely, TNAP expression and activity were significantly increased although both were suppressed by 2-chloro-adenosine. CD73 inhibition alone significantly reduced myocyte-derived adenosine levels by >50 %, and directly induced hypertrophy and calcification in the absence of phenylephrine. These responses and those to phenylephrine were abrogated by TNAP inhibition. We conclude that TNAP contributes to the hypertrophic effect of phenylephrine, as well as its ability to produce cardiomyocyte calcification. These responses are minimized by CD73-dependent endogenously produced adenosine.
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Affiliation(s)
- Xiaohong Tracey Gan
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada
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Jones C, Lodhi AM, Cao LB, Chagarlamudi AK, Movahed A. Atrium of stone: A case of confined left atrial calcification without hemodynamic compromise. World J Clin Cases 2014; 2:142-145. [PMID: 24868514 PMCID: PMC4023308 DOI: 10.12998/wjcc.v2.i5.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 04/29/2014] [Indexed: 02/05/2023] Open
Abstract
Dystrophic cardiac calcification is often associated with conditions causing systemic inflammation and when present, is usually extensive, often encompassing multiple cardiac chambers and valves. We present an unusual case of dystrophic left atrial calcification in the setting of end stage renal disease on hemodialysis diagnosed by echocardiography and computed tomography. Significant calcium deposition is confined within the walls of the left atrium with no involvement of the mitral valve, and no hemodynamic effects.
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