Left ventricular myocardial calcifications and its impact on cardiovascular prognosis
Objective To report frequency, etiology and severity of left ventricle (LV) myocardial calcifications (MC) and its impact on prognosis. Methods We retrospectively analyzed 47,042 CT scanners between 2009 and 2017, 3D multiplanar reconstructions used to determine the location and extension of MC. Detailed clinical, echocardiogram and coronary angiography data were recorded. Clinical follow up was obtained at a mean of 91 months. Results 44 (0.09%) patients had MC, aged 67±15y; 25 (56.8%) had previous history of MI (I-MC) and 19 (43.2%) non-ischemic origin (NI-MC): 3 renal failure, 3 valvular cardiomyopathy, 1 traumatic, 2 post-cardiac surgery, 1 post-radiotherapy, 2 sarcoidosis, 1 myocarditis, 1 hydatid cyst, 1 endomyocardial fibrosis and 3 idiopathic MC. Apical wall and sub-endocardial topography of MC was more frequent I-MC compared to NI-MC (16 vs. 3, P = 0.002; 10 vs. 2, P = 0.03). None of I-MC were associated with cardiac extra-LV MC (0 vs. 6, P = 0.003). I-MC had lower LVEF, higher LV volume and LV fat metaplasia than NI-MC (20 vs. 6, P = 0.001; 10 vs. 1, P = 0.02; 10 vs. 0, P = 0.001). At follow-up, the widespread of LV MC was associated cardiac death and ventricular arrhythmia ( r = 0.58, P = 0.0001; r = 0.35, P = 0.01). Altered LVEF was more frequent in the I-MC vs. NI-MC (80% vs. 31%, P = 0.001). Conclusion Left ventricle MC is very rare. The dystrophic MC from ischemic origin is the most frequent. At long-term follow-up, 59% of MC had altered LVEF, it is more frequent (80%) in I-MC. The extent of LV MC was associated with high risk of cardiac death and ventricular arrhythmia.
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