Myocardial bridging assessed by multidetector computed tomography: likely cause of chest pain in younger patients with low prevalence of dyslipidemia

Angiographic description of the anatomy and clinical aspects of the anterior interventricular artery in a group of Colombians individuals

Introduction

The anterior interventricular artery originates from the left coronary artery and irrigates the anterior surface of the ventricles, apex, and interventricular septum, making it the second most relevant artery of the heart.

Objective

To describe the anatomical and clinical aspects of the anterior interventricular artery through angiography.

Materials and methods

A descriptive study was conducted using 200 angiographic reports of Colombian individuals. The anterior interventricular artery's origin, course, patency, and coronary dominance were evaluated. Data related to chest pain, acute myocardial infarction, dyslipidemia, and electrocardiographic abnormalities were included. Statistical tests could not be performed due to this artery's low prevalence of anatomical variations.

Results

One anterior interventricular artery was found to have originated from the left coronary sinus without a myocardial bridge, with no alteration in permeability, and with left dominance. The frequency of bridges was 2%, and the most frequent dominance was right in 86%; permeability alterations occurred in 43% mainly affecting S13. Twentyfive per cent presented chest pain; 40%, echocardiographic alterations; 5%, ischemic heart disease, and 59%, electrocardiographic alterations.

Conclusions

Variations of origin of the anterior interventricular artery have a low prevalence according to reports from Chile, Colombia, and Spain. anterior interventricular artery myocardial bridges were scarce compared to other studies, suggesting better specificity of computed tomography angiography or direct dissection for these findings. The assessment of coronary permeability is graded with the thrombolysis in myocardial infarction scale; values 0 and 1 indicate occlusive lesion associated with ischemic heart disease. According to various techniques, the most frequent coronary dominance the right, followed by the left in men and balanced circulation in women.

Cardiovascular consequences of myocardial bridging: A meta-analysis and meta-regression

Myocardial bridging, a congenital abnormality in which a coronary artery tunnels through the myocardial fibres was usually considered a benign condition. Many studies suggested a potential hemodynamic significance of myocardial bridging and some, usually case reports, implied a possible correlation between it and various cardiovascular pathologies like acute myocardial infarction, ventricular rupture, life-threatening arrhythmias, hypertrophic cardiomyopathy, apical ballooning syndrome or sudden death. The main objective of this article is to evaluate whether myocardial bridging may be associated with significant cardiac effects or if it is strictly a benign anatomical variation. To this purpose, we performed a meta-analysis (performed using the inverse variance heterogeneity model) and meta-regression, on scientific articles selected from three main databases (Scopus, Web of Science, Pubmed). The study included 21 articles. MB was associated with major adverse cardiac events - OR = 1.52 (1.01–2.30), and myocardial ischemia OR = 3.00 (1.02–8.82) but not with acute myocardial infarction, cardiovascular death, ischemia identified using imaging techniques, or positive exercise stress testing. Overall, myocardial bridging may have significant cardiovascular consequences (MACE, myocardial ischemia). More studies are needed to reveal/refute a clear association with MI, sudden death or other cardiovascular pathologies.

Measurements of myocardial bridges on computed tomography predict presence of clinical symptoms and outcomes of adverse heart events: a retrospective study in a large population from China

Background Clinical-radiological correlation of myocardial bridge (MB) remains unclear. Purpose To correlate clinical symptoms and outcomes of MBs with computed tomography (CT) coronary angiography findings. Material and Methods A total of 2092 patients with CT coronary angiography were collected. Patients were divided into symptomatic and asymptomatic groups, adverse heart events (AHE) and non-AHE groups, MB and non-MB groups, as well as left anterior descending (LAD)-MB and non-LAD-MB groups. Statistical analyses were performed to identify inter-group differences, and clinical-radiological correlations of MBs or mural coronary arteries (MCAs). Results The prevalence of MB, the MCA stenosis either in systole or in diastole, and the ratio of LAD-MB were significantly higher in the symptomatic group than in the asymptomatic group, and higher in the AHE group than in the non-AHE group ( P all <0.05). MB thickness, systolic MCA stenosis, and diastolic MCA stenosis were independent variables predicting clinical symptoms ( P < 0.05), with diastolic MCA stenosis having the highest diagnostic performance, when cutting at 24.6%. The corresponding sensitivity and specificity were 87.8% and 90.6%, respectively. Diastolic MCA stenosis independently indicated outcome of AHE (odds ratio, 1.047; P < 0.001). Conclusion Measurements of MB-MCA by CT predict the presence of clinical symptoms and outcomes of AHE, with diastolic MCA stenosis possessing the greatest performance.

Myocardial bridging analysis by coronary computed tomographic angiography in a Saudi population

AIM: To assess the incidence, location, morphology and clinical association of myocardial bridging in a Saudi population using coronary computed tomographic angiography (CCTA).

METHODS: A total of 350 CCTA of Saudi patients were included in this study (236 men, 114 women) with a mean age of 56.3 years. All patients were examined for appropriateness criteria of CCTA indications (typical chest pain, recent onset cardiomyopathy, left bundle branch block, etc.). The scans were retrospectively reviewed for the presence of myocardial bridging and any other pathological association.

RESULTS: Myocardial bridging was found in 89 of 350 (22.5%) patients. Most of the intramuscular segments were of the superficial type and found in the mid left anterior descending (LAD) (24.6%), followed by distal LAD (3.7%), diagonal branches (2%), ramus intermedius artery (1.4%) and obtuse marginal artery (0.8%). No myocardial bridging was detected in the right coronary or circumflex arteries. No significant differences were found between males and females (P = 0.14). Coronary artery atherosclerosis was found in 51 of 89 (57.3%) patients with MB. Atherosclerotic plaques were not detected in the intramuscular or distal segment of bridging arteries. Dynamic compression was observed in 35 (94.5%) patients with full encasement. No evidence of myocardial hypoperfusion was found in the territories supplied by the bridging arteries.

CONCLUSION: CCTA is excellent in analyzing myocardial bridging in a Saudi population and the results are comparable to other populations. However, finding the real incidence may need a large multicenter study.