THE CLINICAL IMPORTANCE OF CARDIAC CALCIFICATIONS



Gregg S. Pressman, M.D., Einstein Medical Center, Philadelphia, PA, USA

Cardiac calcifications are frequently noted on routine clinical echocardiography. They’re particularly common in older patients and those with renal disease. They can involve the aortic root and valve, the mitral valve and annulus, and the sub-mitral apparatus. When severe aortic and/or mitral valve function can be affected. Otherwise they tend to garner little attention. However, they share risk factors with atherosclerosis and have been associated with cardiovascular disease, particularly stroke.

Calcium deposition in cardiac structures and vessels is the result of an inflammatory process that shares many similarities with atherosclerosis and is accelerated by the presence of renal dysfunction. The enzymatic processes involved are highly regulated and, in valvular tissue, can result in lamellar bone formation. While there are currently no effective treatments animal studies suggest possible methods of prevention.

There is no standard way to score echocardiographic calcifications but several semi-quantitative measures have been proposed. These have clinical utility in predicting cardiovascular events and mortality. They can also alert the clinician to the likely presence of chronic kidney disease, conduction disease, and atherosclerosis.

Aside from effects on valvular function calcification of the mitral annulus can be a nidus for infection. Multiple case reports and two case series have documented vegetations arising from the calcified mitral annulus, including an unusual type of large vegetation with a distinctive speckled appearance.

Finally, the distribution, size, and bulk of calcifications have important implications for structural heart procedures. Pre-procedure planning for TAVR and percutaneous mitral valve replacement needs to include careful assessment of calcium deposits in the aortic valve and mitral annulus.