Mitral and Thoracic Aorta Calcifications

[nih_radioguy]

My wife (51 y.o.) suffers from limited systemic scleroderma (formerly known as the CREST variety).  She is currently being worked up for possible pulmonary hypertension (she is short of breath on exertion, has had chest pressure, and a pulmonary function test showed diffusing capacity 60 percent of predicted value, with normal vital capacity and total lung capacity).  On echocardiogram, her estimated pulmonary artery systolic pressure was 32 mmHg.  The echo also showed mild mitral annular calcium and mild mitral regurgitation, trace tricuspid regurgitation, and trivial posterior pericardial effusion.  A chest CT was normal, except for "evidence of calcifications within the thoracic aorta."

My question -- yes, there is one in here -- given her diagnosis of scleroderma and the potential for pulmonary hypertension, does the presence of calcifications in the mitral valve and thoracic aorta lend suspicion to more extensive heart damage, such as coronary artery disease?

Thank you for this service.

[Cleveland Clinic]

nih

The findings on the cardiac echo are within what we see in the general population.  It sounds like she may have intrisic lung fibrosis without significant pulmonary hypertension at this point. The 2 processes are different but can occur in the same person over time. While rarely some people with scleroderma develop significant intrinsic cardiac disease, it is not common.

The changes are probably due to the normal atherosclerotic process, which can be accelerated in immunocompromised people, especially those on steroids. They are markers for atheosclerotic disease and she should have appropriate screening and risk factor modification to prevent development or progression of significant disease.  I would have to sit down with her to really recommend specific test and therapies.

good luck

[nih_radioguy]

BTW:  Thank you for answering a question I had a few weeks ago.  I've had a nuclear stress test and passed with flying colors.  I still have the pitting edema in the legs and shortness of breath, but at least it doesn't seem cardiac-related.