Myocardial Calcification with a Latent Risk of Congestive Heart Failure in a Patient with Apical Hypertrophic Cardiomyopathy

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.

Massive Biventricular Myocardial Calcification in a Patient with Fulminant Myocarditis Requiring Ventricular Assist Device Support

“…Myocardial calcification can cause focal wall motion abnormalities, diastolic dysfunction, arrhythmia, and congestive heart failure (3,6,7). Additionally, myocardial calcification with pediatric myocarditis has been reported to be a predictor of poor outcomes (8).…”

Apical hypertrophic cardiomyopathy with apical endomyocardial fibrosis and calcification

“…The reduced distensibility of the calcified LV myocardium could lead to heart failure. [16] Earlier myocardial mechanical analyses showed that the apical myocardium was inversely related to the motion of the myocardium in other segments, and the global strain in the longitudinal and circumferential directions and the radial area were lower than those in normal people. [17,18] As can be seen in Figure 2F, the strain in the other segments was relatively enhanced, which suggests that the systolic function of the apex in our 2 patients was impaired.…”

A proposed role for sepsis in the pathogenesis of myocardial calcification

“…The effect of myocardial calcification on cardiac function is not clear 1 and the possibility of it existing at a subclinical level in some septic patients, therefore being more common than the literature suggests, cannot be ruled out. However, case reports of myocardial calcification in non-septic patients tend to have a diagnosis made at post-mortem in patients who presented with intractable heart failure 34 , although Ito et al report on a case of apical myocardial calcification in a stable patient 1 . Intuitively the damaged myofibrils and widespread calcification must have contributed to cardiac failure.…”

“…Myocardial calcification is a rare and life-threatening condition that is a recognised complication of ischaemic heart disease, cardiac surgery, rheumatic fever and myocarditis. It is distinct from coronary artery or valvular calcification, and can be seen in patients with abnormal calcium metabolism 1 . Its presence in the context of sepsis is less well recognised and the mechanisms responsible are poorly understood.…”