Datasheet1_Extensive myocardial calcifications: a systematic literature review of a rare pathological phenomenon.docx

IntroductionMyocardial calcifications (MC) represent a relatively rare pathological process, which may accompany different cardiovascular conditions and can be broadly categorized as dystrophic or metastatic. Myocardial infarction (MI) has been traditionally regarded as the main cause of MC overall; however, no updated comprehensive data on the relative incidence of different forms of MC is available. The purpose of this systematic review of the literature is to analyze the currently available evidence on MC in terms of pathophysiology, diagnosis, and clinical presentation.
Methods and resultsA total of 241 studies including a total of 368 patients affected by extensive MC were included in the final review. The majority of patients (69.8%) presented with dystrophic MC. Endomyocardial fibrosis (EMF) represents the single most common etiology of MC (24.2%), while sepsis/acute systemic inflammatory syndrome (SIRS) and chronic kidney disease were identified as the second and third most common causes respectively. The relative incidence of etiologies also varies across the years, with MI being more represented before 1990, and sepsis/SIRS becoming the single most common cause of MC after 1990. Multimodality imaging was used in the work-up of MC in 42.7% of cases. The most commonly employed imaging modality overall was echocardiography (51.9%), while after 1990 computed tomography scan became the most widely used tool (70.1%).
ConclusionThe present systematic review provides new insights into the pathophysiology of MC. Previously thought to be mainly a consequence of ischemic heart disease, our data indicate that other diseases, namely EMF and sepsis/SIRS, are indeed the main conditions associated with MC. The importance of multimodality imaging in the work-up of MC is also highlighted.

## 引言
心肌钙化（Myocardial calcifications, MC）是一种相对少见的病理过程，可伴随多种心血管疾病，大致可分为营养不良性钙化与转移性钙化两大类。长期以来，心肌梗死（Myocardial infarction, MI）被视为总体上引发MC的主要病因，但目前尚无针对不同类型MC相对发病率的最新综合研究数据。本文献系统综述旨在从病理生理学、诊断方法及临床表现三方面，对当前已有的MC相关研究证据展开分析。

## 方法与结果
本最终综述共纳入241项研究，涉及368例确诊为广泛性MC的患者。其中多数患者（69.8%）表现为营养不良性MC。心内膜心肌纤维化（Endomyocardial fibrosis, EMF）是引发MC最为常见的单一病因（24.2%），而脓毒症/急性全身炎症反应综合征（Sepsis/acute systemic inflammatory syndrome, SIRS）与慢性肾脏病则分别位列第二、第三大常见病因。不同病因的相对发病率随时间发生变化：1990年以前，MI占比更高；1990年之后，脓毒症/SIRS成为MC最主要的单一病因。在42.7%的MC病例诊疗评估中，采用了多模态成像技术。总体而言，最常用的成像手段为超声心动图（51.9%）；而1990年以后，计算机断层扫描（Computed tomography scan, CT）成为应用最广泛的检查工具（70.1%）。

## 结论
本系统综述为MC的病理生理学机制提供了全新的研究视角。既往学界普遍认为MC主要由缺血性心脏病引发，但本研究数据显示，其他疾病——尤其是EMF与脓毒症/SIRS——才是与MC相关的主要病症。本综述同时强调了多模态成像在MC诊疗评估中的重要价值。