From the Guidelines
Calcium deposition in the left ventricular myocardium is primarily associated with conditions such as hypertrophic cardiomyopathy (HCM), where calcium accumulation can occur in the mitral annulus, and other cardiac conditions like myocardial infarction, chronic kidney disease, and severe hyperparathyroidism.
Conditions Associated with Calcium Deposition
The conditions associated with calcium deposition in the left ventricular myocardium include:
- Hypertrophic cardiomyopathy (HCM), as noted in the american college of cardiology/european society of cardiology clinical expert consensus document on HCM 1
- Myocardial infarction (heart attack), where dead heart tissue becomes calcified during the healing process
- Chronic kidney disease, which contributes to calcium dysregulation throughout the body, including the heart, as failing kidneys cannot properly regulate calcium and phosphate levels
- Severe hyperparathyroidism, leading to elevated calcium levels in the blood that can deposit in cardiac tissue
- Certain infections like tuberculosis or parasitic diseases, which may cause inflammatory responses leading to calcification
- Autoimmune disorders such as systemic lupus erythematosus, which can trigger inflammation in the heart muscle
- Radiation therapy to the chest area, which may cause tissue damage that eventually calcifies
- Genetic disorders like Fabry disease, which can also lead to calcium deposits in heart tissue
Clinical Implications
These calcifications typically develop over time as a response to injury or metabolic disturbances, and they can impair heart function by reducing muscle elasticity and contractility, potentially leading to heart failure or arrhythmias if extensive, as discussed in the acc/aha guidelines for the evaluation and management of chronic heart failure in the adult 1.
Management Considerations
The management of conditions associated with calcium deposition in the left ventricular myocardium should be tailored to the underlying cause, with consideration of the potential impact on heart function and the need for ongoing monitoring and treatment to prevent complications, as noted in the american college of cardiology/european society of cardiology clinical expert consensus document on HCM 1.
From the Research
Conditions Associated with Calcium Deposition
The following conditions are associated with calcium deposition in the left ventricular myocardium:
- Chronic kidney disease (CKD) at hemodialysis initiation, where coronary artery calcification (CAC), cardiac valve calcification (CVC), and left ventricular hypertrophy (LVH) are frequently observed 2
- Iron overload cardiomyopathy, which can lead to disturbances in cardiac calcium regulation and left ventricular dysfunction 3
- Subclinical coronary atherosclerotic disease burden, as evidenced by an abnormal coronary artery calcium score (CAC score) in patients with left ventricular diastolic dysfunction 4
- Hypertension, which can lead to left ventricular hypertrophy and increased risk of cardiovascular complications 5, 6
Key Findings
Key findings from the studies include:
- A significant association between cardiac calcification and left ventricular hypertrophy in CKD patients 2
- The effects of iron overload on cardiac calcium regulation, including alteration in intracellular calcium levels and voltage-gated calcium channel function 3
- The association between left ventricular diastolic dysfunction and an abnormal CAC score, even after adjusting for clinical risk factors 4
- The complementary effects of ACE inhibitors and calcium antagonists in reducing hypertensive target organ disease and cardiovascular complications 5, 6