Intramyocardial Calcification in a Patient with Apical Hypertrophic Cardiomyopathy

Kaimoto, Satoshi; Kawasaki, Tatsuya; Yamano, Michiyo; Miki, Shigeyuki; Kamitani, Takeshi; Sugihara, Hiroki

doi:10.2169/internalmedicine.51.7323

Cited by 8 publications

(3 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous reports [ 5 , 6 ] had described apical calcification in ApHCM. Myocardial calcification can be caused by several etiologies.…”

Section: Discussionmentioning

confidence: 95%

Endomyocardial fibrosis and apical calcification: A case report with unusual presentations of apical hypertrophic cardiomyopathy

Gao,

Zhang,

Xie

et al. 2023

Medicine

View full text Add to dashboard Cite

Rationale: Apical hypertrophic cardiomyopathy (ApHCM) is a phenotypic variant of hypertrophic cardiomyopathy. Endomyocardial fibrosis and endocardial calcification are especially rare in ApHCM. Patient concerns: The main symptoms was chest tightness, palpitation, shortness of breath, and fatigue. Echocardiography and imaging examinations found apical hypertrophy along with endocardial calcification and endomyocardial fibrosis. Abnormal structural changes led to thrombosis and made the left ventricle a flat shape resembling an “apple.” Diagnoses: The typical presentations, hypertrophic apex on echocardiography and an elevated N-terminal pro-brain natriuretic peptide level indicated the diagnosis of ApHCM and heart failure with preserved ejection fraction. Interventions: Optimal medical therapy including the administration of ApHCM, heart failure and atrial fibrillation to improve symptoms and life quality. Outcomes: Since discharge, the patient could perform normal daily activities and had no discomfort based on the optimal medical therapy. Lessons: We report a ApHCM patients with unusual presentations of endomyocardial fibrosis and apical calcification. This case highlights the importance of understanding the specific pathological changes of ApHCM for treatment and prognosis.

show abstract

“…Previous reports [ 5 , 6 ] had described apical calcification in ApHCM. Myocardial calcification can be caused by several etiologies.…”

Section: Discussionmentioning

confidence: 95%

Endomyocardial fibrosis and apical calcification: A case report with unusual presentations of apical hypertrophic cardiomyopathy

Gao,

Zhang,

Xie

et al. 2023

Medicine

View full text Add to dashboard Cite

show abstract

“…However, in clinical practice, it is evident as only a minority of ApHCM patients develops EMF and calcifications. Actually, in literature only, seven cases of EMF in ApHCM patients are described in six different papers, 7 , 8 , 9 , 10 , 11 , 12 so our clinical series is the largest one.…”

Section: Discussionmentioning

confidence: 99%

Intramyocardial calcification in apical hypertrophic cardiomyopathy assessed using multimodality imaging: a case series

Radano,

Mabritto,

Luceri

et al. 2024

ESC Heart Failure

View full text Add to dashboard Cite

Apical hypertrophic cardiomyopathy (ApHCM) is an HCM variant, affecting frequently males in midlife. It is characterized by apical obliteration and persistent diastolic contraction, often resulting in microvascular ischaemia. We report five cases of ApHCM, with evidence of intramyocardial calcification on echocardiogram. On cardiac magnetic imaging (MRI), a hypointense component at early gadolinium enhancement (EGE) sequences, compatible with calcium, and a deep layer, with hyperintensity at late gadolinium enhancement (LGE) sequences, referable to fibrosis, suggest an endomyocardial fibrosis (EMF) diagnosis. EMF pathologic hallmark is endocardium and myocardium scarring, evolving to dystrophic calcification. It is found only in few ApHCM patients. Our series is the largest one described until now. Analysing patients' history, coexistent inflammatory triggers were evident in all of them, so their co‐morbidities could represent a further cause of small vessel disease, in the context of ischaemic microvascular stress due to hypertrophy, leading to fibrosis and dystrophic calcification. This series could demonstrate the relation between apical fibrosis/calcification and microvascular ischaemia due to hypertrophy and inflammatory triggers.

show abstract

“…These overall cardiac CT findings demonstrate the potential hemodynamic sequelae of apical hypertrophic cardiomyopathy. 1,2 Prior reports describe cases of apical hypertrophic cardiomyopathy with calcified myocardium 3 ; however, the mechanism remains unknown. We postulate that increased left ventricular filling pressure in the setting of known microvascular disease associated with hypertrophic cardiomyopathy 4 leads to decreased microvascular perfusion pressure.…”

Section: Discussionmentioning

confidence: 99%

Histologic Sequelae of Apical Hypertrophic Cardiomyopathy: Dystrophic Calcification

Saba

Makaryus

Rahmani

et al. 2017

Clin Med Insights Cardiol

View full text Add to dashboard Cite

We present cardiac computed tomography (CT) findings demonstrating apical hypertrophic cardiomyopathy with dystrophic calcification of the left ventricular apex. The absence of significant epicardial coronary artery disease demonstrated by coronary CT angiography suggests that increased wall tension and decreased microvascular perfusion over time account for the dyskinetic apical myocardium, rather than myocardial infarction secondary to atherosclerotic plaque rupture. These observations support CT as the imaging modality of choice to visualize the deposition of calcium in injured myocardial tissue, a recognized occurrence in chronically infarcted myocardium.

show abstract

Intramyocardial Calcification in a Patient with Apical Hypertrophic Cardiomyopathy

Cited by 8 publications

References 9 publications

Endomyocardial fibrosis and apical calcification: A case report with unusual presentations of apical hypertrophic cardiomyopathy

Endomyocardial fibrosis and apical calcification: A case report with unusual presentations of apical hypertrophic cardiomyopathy

Intramyocardial calcification in apical hypertrophic cardiomyopathy assessed using multimodality imaging: a case series

Histologic Sequelae of Apical Hypertrophic Cardiomyopathy: Dystrophic Calcification

Contact Info

Product

Resources

About