Cardiac Multimodality Imaging Assessment of Dystrophic Myocardial Calcification in a Human Immunodeficiency Virus-Infected Patient With Dilated Cardiomyopathy

Abstract

Dystrophic myocardial calcification represents the sequelae of local tissue damage and cellular necrosis. We present the case of a 72-year-old man who presented with exertional chest pain. He had a medical history of human immunodeficiency virus (HIV) infection and chronic dilated cardiomyopathy with severe left ventricular (LV) systolic dysfunction and wall motion abnormalities at the inferior and lateral LV walls. A cardiac magnetic resonance (CMR) examination from 16 years ago showed a subendocardial late gadolinium enhancement (LGE) distribution consistent with prior myocardial infarction (MI). Recently, a pharmacological stress myocardial perfusion imaging by CMR had been positive for myocardial ischemia in the left descending coronary artery (LAD) territory. A cardiac CT angiography (CCTA) showed nonsignificant LAD obstruction <50% consistent with microvascular ischemia and the presence of dystrophic myocardial calcification as an unusual progression of a prior MI. Conservative approach and optimal medical therapy were employed in our patient, and there was no symptom progression during the two-month followup period.

An Autopsy Case of Fulminant Myocarditis with Massive Left Ventricular Calcification

“…Metastatic calcification results from a systemic process (hypercalcemia and/or abnormalities of calcium homeostasis) in patients with chronic renal failure on hemodialysis, primary or secondary hyperparathyroidism, and dietary calcium and vitamin D deficiency ( 3 ). However, dystrophic calcification occurs where necrosis or damage to myocardial cells has occurred, such as in myocardial infarction, cardiac surgery, or systemic disorders, such as sepsis, irrespective of serum calcium concentration ( 1 , 2 ). Few reports of myocardial calcification caused by myocarditis exist, and the mechanism is yet to be described ( 5 ).…”

“…Myocardial calcification occurs following myocardial injury or necrosis, including myocardial infarction, cardiac surgery, and myocarditis (1)(2)(3)(4). We herein report a case of fulminant myocarditis with diffuse myocardial calcification and its pathological autopsy results.…”