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[Media calcinosis from the viewpoint of the cardiologist]
1Klinik für Kardiologie und Angiologie, Herzzentrum Coswig. Lanzer@hcc-hurrle.de
Insights
Medial calcification (MC) is a progressive arterial disease, often affecting lower limbs but potentially systemic. While primary MC has a good prognosis, secondary MC linked to diabetes is a cardiovascular risk factor.
Area of Science:
- Vascular Biology
- Medical Imaging
- Pathophysiology
Context:
- Medial calcification (MC) affects muscular arteries, primarily in lower extremities, but can extend to pelvic arteries, abdominal aorta, and rarely coronary arteries.
- MC occurs in primary (isolated) and secondary forms, often associated with type II diabetes mellitus and chronic renal insufficiency with secondary hyperparathyroidism.
Purpose:
- To summarize the current understanding of medial calcification (MC), including its presentation, associations, diagnostic methods, and implications.
- To highlight the ongoing research into the etiopathogenesis of MC, suggesting an active ossification process and potential genetic factors.
Summary:
- Diagnosis traditionally uses X-ray, with computed tomography and high-resolution ultrasonography as advanced imaging tools.
- Coronary MC diagnosis relies on intracoronary ultrasonography (IVUS) for specific arterial wall calcium detection.
- While primary MC prognosis is favorable, secondary MC in diabetics is an independent cardiovascular risk factor; causal therapy remains unknown.
Impact:
- MC serves as a differential diagnosis for atherosclerosis in clinical cardiology.
- MC provides a valuable in vivo model for studying arterial wall ossification and aging processes for scientific research.
Abstract:
Mediacalcinosis (MC) represents a disease of the muscular type arteries characterized by progredient calcification of the media. MC involves most frequently the arteries of the lower extremities. However, a more extensive disease involving the arteries of the pelvis and the abdominal aorta is common. A systemic extension of MC with the involvement of the coronary arteries has been reported, but is however, according to the present opinion, rather rare. MC occurs isolated (primary MC) as well as associated with other diseases (secondary MC). The secondary forms are most frequently due to diabetes mellitus type II and to chronic renal insufficiency and accompanying secondary hyperparathyroidism. The etiopathogenesis of MC has not yet been clarified. The recent evidence based on molecular-biologic investigations suggests an active pathomechanism of an ectopic arterial wall ossification. Genetic predisposition appears possible. The diagnosis of MC is traditionally established by conventional x-ray radiography of the pelvis-lower extremity-region. Among the newer imaging modalities, the computed tomography and the high resolution B-mode ultrasonography are of special importance. The diagnostics of coronary calcification are in descending order of importance relevant the intracoronary ultrasonography (IVUS), the electron beam computed tomography (EBT), the thorax-fluoroscopy and the thorax-radiography. For the diagnosis of coronary MC necessary arterial wall layer specific calcium detection is currently possible only with the IVUS methodology. The prognosis of the primary MC is quoad vitam good. However, the mechanic and biological effects of MC on cardiacal and vascular function have not yet been determined. The secondary MC in type II diabetics represents an independent cardiovascular risk factor. A causal therapy of MC is not known. For the clinical cardiologists, MC is of primary interest as a differential diagnosis to atherosclerosis. For the scientists, MC offers an excellent in vivo model to study processes associated with arterial wall ossifications and ageing.