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Sakamoto T, Usui E, Hoshino M, Hada M, Nagamine T, Hanyu Y, Nogami K, Ueno H, Setoguchi M, Tahara T, Matsuda K, Mineo T, Wakasa N, Sugiyama T, Yonetsu T, Sasano T, Kakuta T. Association of Coronary Computed Tomography-Defined Myocardial Bridge With Pre- and Post-Procedural Fractional Flow Reserve in Patients Undergoing Elective Percutaneous Coronary Intervention. Circ J 2024:CJ-23-0934. [PMID: 38763754 DOI: 10.1253/circj.cj-23-0934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Myocardial bridge (MB) is a common coronary anomaly characterized by a tunneled course through the myocardium. Coronary computed tomography angiography (CCTA) can identify MB. The impact of MB detected by CCTA on coronary physiological parameters before and after percutaneous coronary intervention (PCI) is unknown.Methods and Results: We investigated 141 consecutive patients who underwent pre-PCI CCTA and fractional flow reserve (FFR)-guided elective PCI for de novo single proximal lesions in the left anterior descending artery (LAD). We compared clinical demographics and physiological parameters between patients with and without CCTA-defined MB. MB was identified in 46 (32.6%) patients using pre-PCI CCTA. The prevalence of diabetes was higher among patients with MB. Median post-PCI FFR values were significantly lower among patients with than without MB (0.82 [interquartile range 0.79-0.85] vs. 0.85 [interquartile range 0.82-0.89]; P=0.003), whereas pre-PCI FFR values were similar between the 2 groups. Multivariable linear regression analysis revealed that the presence of MB and greater left ventricular mass volume in the LAD territory were independently associated with lower post-PCI FFR values. Multivariable logistic regression analysis also revealed that the presence of MB and lower pre-PCI FFR values were independent predictors of post-PCI FFR values ≤0.80. CONCLUSIONS CCTA-defined MB independently predicted both lower post-PCI FFR as a continuous variable and ischemic FFR as a categorical variable in patients undergoing elective PCI for LAD.
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Affiliation(s)
- Tatsuya Sakamoto
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | - Yoshihiro Hanyu
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Kai Nogami
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Hiroki Ueno
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Mirei Setoguchi
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Tomohiro Tahara
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Kazuki Matsuda
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Takashi Mineo
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Nobutaka Wakasa
- Department of Clinical Laboratory, Tsuchiura Kyodo General Hospital
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
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2
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Kurisu S, Fujiwara H. A Super-elderly Case of Suspected New-onset Vasospastic Angina Complicated by Myocardial Bridge. Intern Med 2024; 63:1377-1380. [PMID: 37813615 DOI: 10.2169/internalmedicine.2413-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
A 90-year-old man experienced chest oppressive sensation at 12:30 AM for the first time. Electrocardiography showed a newly developed inversion of the terminal T-wave in the V2-5 leads. A left coronary angiogram showed no significant atherosclerotic stenosis. A myocardial bridge was found in the mid-left anterior descending artery (LAD). Myocardial scintigraphy with 123I beta-methyl 15-para-iodophenyl 3(R,S)-methylpentadecanoic acid revealed a reduced uptake in the apical and septal areas. Based on these findings, we suspected new-onset vasospastic angina complicated by a myocardial bridge in the territory of the LAD. He remained in good condition without recurrent anginal attacks after nifedipine was started before bedtime.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiology, NHO Hiroshimanishi Medical Center, Japan
| | - Hitoshi Fujiwara
- Department of Cardiology, NHO Hiroshimanishi Medical Center, Japan
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3
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Gannon MP, Cerci RJ, Valdiviezo C, Ostovaneh MR, Vavere AL, de Vasconcellos HD, Matheson MB, Cox C, Miller JM, di Carli M, Arbab-Zadeh A, George RT, Lima JAC, Chen MY. Combined Computed Tomography Angiography-Computed Tomography Perfusion in the Identification and Prognostic Assessment of Myocardial Bridging from the CORE320 Study: 5-Year Follow-Up. Am J Cardiol 2023; 207:314-321. [PMID: 37774472 DOI: 10.1016/j.amjcard.2023.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 10/01/2023]
Abstract
Our objective is to use computed tomography angiography (CTA) and computed tomography perfusion (CTP) to identify the ischemic significance of myocardial bridging (MB). We also seek to determine the long-term prognostication of MB in the presence or absence of obstructive coronary artery disease (CAD). The CORE320, a prospective, multicenter study including 381 patients with known or suspected CAD clinically referred for invasive coronary angiography who underwent combined (CTA-CTP) and single-photon emission computed tomography before conventional coronary angiography. The incidence of MB was identified in 135 patients (35.4%) with 93.9% identified in the left anterior descending artery. MB were divided as partially encased versus fully encased. There was no difference in ischemia identified between partially encased MB and fully encased MB (37 [40%] vs 25 [35%], p = 0.54]. Ischemia was identified at similar rates in partially versus fully encased MB by single-photon emission computed tomography at (8 [9%] vs 8 [11%], p = 0.57] and CTP (34 [37%] vs 21 [30%], p = 0.33]. There was no difference in the primary outcome of 5-year outcome of combined incidence of myocardial infarction or death. The restricted mean survival time in patients with CTA with <50% stenosis with or without a MB was 4.906 years (95% confidence interval 4.759 to 5.000) and 4.891 years (95% confidence interval 4.718 to 5.000), respectively (p = 0.824). Cardiac computed tomography perfusion imaging can assess both anatomic and functional significance of myocardial bridging with diagnostic accuracy similar to current standard imaging. Furthermore, 5-year cardiovascular events were not different with the presence of MB in both obstructive and non-obstructive CAD.
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Affiliation(s)
- Michael P Gannon
- Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania; National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, Maryland.
| | | | - Carolina Valdiviezo
- Medstar Heart and Vascular Institute, Georgetown University, Washington, District of Columbia
| | | | - Andrea L Vavere
- Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland
| | | | - Matthew B Matheson
- Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christopher Cox
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Julie M Miller
- Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland
| | | | | | - Richard T George
- Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland
| | - João A C Lima
- Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland
| | - Marcus Y Chen
- National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, Maryland
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4
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Narayanan S, Joseph S, Varghese AC, Nair RG, Mohan H, Edger D, Sudhakar A. Plaque morphology and distribution in patients with and without myocardial bridge - an intravascular ultrasound study. Acta Cardiol 2023; 78:894-900. [PMID: 36939314 DOI: 10.1080/00015385.2023.2187117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/22/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Myocardial bridging (MB) is a common congenital cardiovascular anomaly. There are reported associations of MB with different clinical presentations like effort angina, acute coronary syndromes (ACS) and sudden cardiac death. Acceleration of atherosclerosis in proximal vessel is reported in patients with MB, while bridged segments are reported to be free of atherosclerosis. METHODS We assessed patients who underwent intravascular ultrasound (IVUS) guided percutaneous intervention (PCI) of left anterior descending (LAD) artery. Plaque characteristics derived from IVUS analysis were compared between those who displayed myocardial bridge versus those who did not harbour the anomaly. RESULTS One hundred and forty-seven (147) patients underwent IVUS guided PCI. Incidence of MB was 44/147 (29.9%). Mean age of patients who had MB {+} was higher (62.1 ± 10.3 vs. 57.8 ± 11.2 (p = .03). 142/147 (96.6%) patients presented with ACS. ST elevation myocardial infarction (STEMI) was the most common presenting diagnosis (110/147 to 74.8%). There were no differences in qualitative plaque characteristics - attenuated plaque, calcification or calcium score between two groups. Plaque burden and length of the lesion in the proximal vessel were not different. Among patients with MB {+}, atheromatous extension to segments underlying the bridge was seen in 31/44 (70.5%) cases. CONCLUSIONS In a series of patients who presented with advanced clinical atherosclerosis, plaque characteristics were not different in patients who harboured myocardial bridge vs. those who did not have the anomaly. Atheromatous involvement was seen extending into bridged segment contrary to previous reports.
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Affiliation(s)
- Sajan Narayanan
- Little Flower Hospital & Research Institute, Angamaly, India
| | - Stigi Joseph
- Little Flower Hospital & Research Institute, Angamaly, India
| | | | | | - Hareesh Mohan
- Little Flower Hospital & Research Institute, Angamaly, India
| | - Denim Edger
- Little Flower Hospital & Research Institute, Angamaly, India
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Rinaldi R, Princi G, La Vecchia G, Bonanni A, Chiariello GA, Candreva A, Gragnano F, Calabrò P, Crea F, Montone RA. MINOCA Associated with a Myocardial Bridge: Pathogenesis, Diagnosis and Treatment. J Clin Med 2023; 12:jcm12113799. [PMID: 37297993 DOI: 10.3390/jcm12113799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Myocardial bridging (MB) is the most frequent congenital coronary anomaly characterized by a segment of an epicardial coronary artery that passes through the myocardium. MB is an important cause of myocardial ischemia and is also emerging as a possible cause of myocardial infarction with non-obstructed coronary arteries (MINOCA). There are multiple mechanisms underlying MINOCA in patients with MB (i.e., MB-mediated increased risk of epicardial or microvascular coronary spasm, atherosclerotic plaque disruption and spontaneous coronary artery dissection). The identification of the exact pathogenetic mechanism is crucial in order to establish a patient-tailored therapy. This review provides the most up-to-date evidence regarding the pathophysiology of MINOCA in patients with MB. Moreover, it focuses on the available diagnostic tools that could be implemented at the time of coronary angiography to achieve a pathophysiologic diagnosis. Finally, it focuses on the therapeutic implications associated with the different pathogenetic mechanisms of MINOCA in patients with MB.
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Affiliation(s)
- Riccardo Rinaldi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giulia La Vecchia
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Alice Bonanni
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Alfonso Chiariello
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alessandro Candreva
- Department of Cardiology, Zurich University Hospital, 8091 Zurich, Switzerland
| | - Felice Gragnano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80133 Naples, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80133 Naples, Italy
- Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano", 81100 Caserta, Italy
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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6
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Hashikata T, Kameda R, Ako J. Clinical Implication and Optimal Management of Myocardial Bridging: Role of Cardiovascular Imaging. Interv Cardiol Clin 2023; 12:281-288. [PMID: 36922068 DOI: 10.1016/j.iccl.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Myocardial bridging (MB) was historically considered a benign structure as most people with MB are clinically asymptomatic. Recently, however, mounting evidence indicates that MB can cause adverse cardiac events owing to arterial systolic compression/diastolic restriction, atherosclerotic plaque progression upstream from MB, and/or vasospastic angina. In MB patients with refractory angina, the optimal treatment strategy should be determined individually based on versatile anatomic and hemodynamical assessments that often require multidisciplinary diagnostic approaches. The present review summarizes the clinical implication and management of MB, highlighting the role of imaging modalities currently available in this arena.
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Affiliation(s)
- Takehiro Hashikata
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan.
| | - Ryo Kameda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
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7
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Lu Y, Liu H, Zhu Z, Wang S, Liu Q, Qiu J, Xing W. Assessment of myocardial bridging and the pericoronary fat attenuation index on coronary computed tomography angiography: predicting coronary artery disease risk. BMC Cardiovasc Disord 2023; 23:145. [PMID: 36949394 PMCID: PMC10035163 DOI: 10.1186/s12872-023-03146-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/24/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND The fat attenuation index (FAI) is a radiological parameter that represents pericoronary adipose tissue (PCAT) inflammation, along with myocardial bridging (MB), which leads to pathological shear stress in the coronary vessels; both are associated with coronary atherosclerosis. In the present study, we assessed the predictive value of FAI values and MB parameters through coronary computed tomography angiography (CCTA) for predicting the risk of coronary atherosclerosis and vulnerable plaque in patients with MB. METHODS We included 428 patients who underwent CCTA and were diagnosed with MB. FAI values, MB parameters, and high-risk coronary plaque (HRP) characteristics were recorded. The subjects were classified into two groups (A and B) according to the absence or presence of coronary plaque in the segment proximal to the MB. Group B was further divided into Groups B1 (HRP-positive) and B2 (HRP-negative) according to the HRP characteristic classification method. The differences among the groups were analysed. Multiple logistic regression analysis was performed to determine the independent correlation between FAI values and MB parameters and coronary atherosclerosis and vulnerable plaque risk. RESULTS Compared to the subjects in Group A, those in Group B presented greater MB lengths, MB depths and muscle index values, more severe MB systolic stenosis and higher FAIlesion values (all P < 0.05). In multivariate logistic analysis, age (OR 1.076, P < 0.001), MB systolic stenosis (OR 1.102, P < 0.001) and FAIlesion values (OR 1.502, P < 0.001) were independent risk factors for the occurrence of coronary atherosclerosis. Compared to subjects in Group B2, those in Group B1 presented greater MB lengths and higher FAI values (both P < 0.05). However, only the FAIlesion value was an independent factor for predicting HRP (OR 1.641, P < 0.001). CONCLUSION In patients with MB, MB systolic stenosis was associated with coronary plaque occurrence in the segment proximal to the MB. The FAI value was not only closely related to coronary atherosclerosis occurrence but also associated with plaque vulnerability. FAI values may provide more significant value in the prediction of coronary atherosclerosis than MB parameters in CCTA.
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Affiliation(s)
- Yang Lu
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, 213000, China
| | - Haifeng Liu
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, 213000, China
| | - Zuhui Zhu
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, 213000, China
| | - Siqi Wang
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, 213000, China
| | - Qi Liu
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, 213000, China
| | - Jianguo Qiu
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, 213000, China
| | - Wei Xing
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, 213000, China.
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8
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A spatiotemporal analysis of the left coronary artery biomechanics using fluid-structure interaction models. Med Biol Eng Comput 2023; 61:1533-1548. [PMID: 36790640 DOI: 10.1007/s11517-023-02791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023]
Abstract
Biomechanics plays a critical role in coronary artery disease development. FSI simulation is commonly used to understand the hemodynamics and mechanical environment associated with atherosclerosis pathology. To provide a comprehensive characterization of patient-specific coronary biomechanics, an analysis of FSI simulation in the spatial and temporal domains was performed. In the current study, a three-dimensional FSI model of the LAD coronary artery was built based on a patient-specific geometry using COMSOL Multiphysics. The effect of myocardial bridging was simulated. Wall shear stress and its derivatives including time-averaged wall shear stress, wall shear stress gradient, and OSI were calculated across the cardiac cycle in multiple locations. Arterial wall strain (radial, circumferential, and longitudinal) and von Mises stress were calculated. To assess perfusion, vFFR was calculated. The results demonstrated the FSI model could identify regional and transient differences in biomechanical parameters within the coronary artery. The addition of myocardial bridging caused a notable change in von Mises stress and an increase in arterial strain during systole. The analysis performed in this manner takes greater advantage of the information provided in the space and time domains and can potentially assist clinical evaluation.
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Çetin N, Özlek B, Özdemir İH, Yıldız BS, Yavuz V, Tıkız H. Comparison of Framingham risk score and atherogenic indices as a predictor of atherosclerosis in patients with myocardial bridge in left anterior descending artery. Acta Cardiol 2022; 77:342-349. [PMID: 34210253 DOI: 10.1080/00015385.2021.1945763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Myocardial bridge (MB) is generally considered as a benign condition, but it may trigger atherosclerosis, especially in the adjacent proximal coronary artery segment. In this study, we aimed to investigate whether the Framingham risk score (FRS) or atherogenic indices are risk factors for coronary atherosclerosis in patients with MB in the left anterior descending coronary artery (LAD). METHODS We performed a retrospective study evaluating 155 patients who have MB in LAD. The patients were evaluated in two groups according to the presence of atherosclerosis (74 patients in atherosclerotic group vs. 81 patients in non-atherosclerotic group). Baseline characteristics, FRS and atherogenic indices were reviewed between groups. Significant independent risk factors for coronary atherosclerosis were investigated by logistic regression analysis. RESULTS Patients in atherosclerotic group were significantly older (58.15 ± 10.04 vs. 50.22 ± 9.27 years, p < .001) and 74.3% of the patients were male. While the mean FRS in the atherosclerotic group was 21.20 ± 8.81, it was 12.79 ± 8.61 in the non-atherosclerotic group (p < .001). Among the atherogenic indices, only LDL-c/HDL-c ratio was significantly higher in the atherosclerotic group (3.49 ± 1.2 vs. 3.11 ± 0.98, p:.033). Multivariable analysis showed that age (OR: 1.08, 95% CI 1.03-1.13, p < .001) and FRS (OR: 1.06, 95% CI 1.01-1.11, p:.012) were independently associated with the presence of atherosclerotic lesion. CONCLUSIONS FRS is an easily applicable predictor in clinical practice that indicates the presence of coronary atherosclerosis in patients with MB in LAD.
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Affiliation(s)
- Nurullah Çetin
- Department of Cardiology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Bülent Özlek
- Department of Cardiology, Training and Research Hospital, Mugla Sitki Kocman University, Mugla, Turkey
| | | | - Bekir Serhat Yıldız
- Department of Cardiology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Veysel Yavuz
- Department of Cardiology, Akhisar Mustafa Kirazoglu State Hospital, Manisa, Turkey
| | - Hakan Tıkız
- Department of Cardiology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
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Darabont RO, Vișoiu IS, Magda ȘL, Stoicescu C, Vintilă VD, Udroiu C, Vinereanu D. Implications of Myocardial Bridge on Coronary Atherosclerosis and Survival. Diagnostics (Basel) 2022; 12:diagnostics12040948. [PMID: 35453995 PMCID: PMC9026775 DOI: 10.3390/diagnostics12040948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 12/04/2022] Open
Abstract
Background: In this study, we aimed to describe the impact of MBs on atherosclerosis and survival, in patients with coronary artery disease (CAD). Methods: We retrospectively studied 1920 consecutive patients who underwent conventional coronary angiography for suspected CAD. Atherosclerotic load (AL), defined as the sum of degrees of stenosis, and general atherosclerotic load (GAL), representing the sum of AL, were compared between patients with MB and a control group without MB; patients in these groups were similar in age and sex. We assessed survival at 10 years after the last enrolled patient. Results: Prevalence of MB was 3.96%, predominantly in the mid-segment of left anterior descendent artery (LAD). In the presence of MB, GAL was lower (158.1 ± 93.7 vs. 205.3 ± 117.9, p = 0.004) with a lesser AL in the proximal (30.3 ± 39.9 vs. 42.9 ± 41.1, p = 0.038) and mid-segments (8.1 ± 20.0 vs. 25.3 ± 35.9, p < 0.001) of LAD. Based on a Multinominal Logistic Regression, we found that the presence of MB on LAD (regardless of its location on this artery) is a protective factor against atherosclerotic lesions, decreasing the probability of significant stenosis, especially of those ≥70%, on the entire artery (B −1.539, OR 4660; 95% CI = 1.873−11.595, p = 0.001) and on each of its segments as well: proximal LAD (B −1.275, OR 0.280; 95% CI = 0.015−5.073; p = 0.038), mid-LAD (B −1.879, OR 6.545; 95% CI = 1.492−28.712; p = 0.013) and distal LAD (B −0.900, OR 2.459, 95% CI = 2.459−2.459, p = 0.032). However, 10-year survival was similar between groups (76.70% vs. 74.30%, p = 0.740). Conclusion: The presence of MB on LAD proved to be a protective factor against atherosclerosis for the entire artery and for each of its segments, but it does not influence long-term survival in patients with CAD.
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Affiliation(s)
- Roxana Oana Darabont
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu, 030167 Bucharest, Romania; (Ș.L.M.); (C.S.); (V.D.V.); (D.V.)
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independenței, 050098 Bucharest, Romania; (I.S.V.); (C.U.)
- Correspondence: ; Tel.: +40-723-441-315
| | - Ionela Simona Vișoiu
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independenței, 050098 Bucharest, Romania; (I.S.V.); (C.U.)
| | - Ștefania Lucia Magda
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu, 030167 Bucharest, Romania; (Ș.L.M.); (C.S.); (V.D.V.); (D.V.)
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independenței, 050098 Bucharest, Romania; (I.S.V.); (C.U.)
| | - Claudiu Stoicescu
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu, 030167 Bucharest, Romania; (Ș.L.M.); (C.S.); (V.D.V.); (D.V.)
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independenței, 050098 Bucharest, Romania; (I.S.V.); (C.U.)
| | - Vlad Damian Vintilă
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu, 030167 Bucharest, Romania; (Ș.L.M.); (C.S.); (V.D.V.); (D.V.)
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independenței, 050098 Bucharest, Romania; (I.S.V.); (C.U.)
| | - Cristian Udroiu
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independenței, 050098 Bucharest, Romania; (I.S.V.); (C.U.)
| | - Dragoș Vinereanu
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu, 030167 Bucharest, Romania; (Ș.L.M.); (C.S.); (V.D.V.); (D.V.)
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independenței, 050098 Bucharest, Romania; (I.S.V.); (C.U.)
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Okamura A, Okura H, Iwai S, Kyodo A, Kamon D, Hashimoto Y, Ueda T, Soeda T, Watanabe M, Saito Y. Detection of myocardial bridge by optical coherence tomography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:10.1007/s10554-021-02497-5. [PMID: 35015165 DOI: 10.1007/s10554-021-02497-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022]
Abstract
Myocardial bridge (MB) is less commonly documented by angiography than autopsy. Optical coherence tomography (OCT) may be useful to detect angiographically undetectable MB. To investigate OCT characteristics of MB, 86 LAD vessels were imaged by OCT. MB was defined as presence of intermediate optical intensity, "fine" layer surrounding coronary artery by OCT. Frequency and characteristics of the angio-detectable and angio-undetectable but OCT-detectable MB were investigated. In a subset of patients with angio-detectable MB, cyclic changes in coronary arterial dimensions were analyzed. OCT detected MB in 44 of 86 (51%). Arc of the MB was significantly larger (334.8 ± 58.5° vs. 268.4 ± 92.1°, P = 0.008) and length was significantly longer (22.6 ± 11.7 mm vs. 14.5 ± 8.1 mm, P = 0.014) in angio-detectable MB than OCT-detectable but angio-undetectable MB. Both vessel (6.8 ± 1.5 to 5.3 ± 1.0 mm2, P = 0.035) and lumen area (4.4 ± 1.5 to 3.1 ± 0.7 mm2, P = 0.040) decreased significantly from diastole to systole. Adventitial (0.08 ± 0.03 to 0.08 ± 0.02 mm, P = 0.828) and intima + plaque thickness (0.12 ± 0.05 to 0.10 ± 0.03 mm, P = 0.398) did not change significantly during cardiac cycle. On the other hand, medial thickness increased significantly from diastole to systole (0.08 ± 0.03 to 0.12 ± 0.03 mm, P = 0.022). In conclusion, MB is frequently detected as intermediate intensity, fine layer by OCT. During systole, vessel and lumen size decrease with increased medial thickness. Therefore, we should be careful for OCT interpretation of the coronary arteries with MB.
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Affiliation(s)
- Akihiko Okamura
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Hiroyuki Okura
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan.
- Department of Cardiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Saki Iwai
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Atsushi Kyodo
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Daisuke Kamon
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
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12
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Sternheim D, Power DA, Samtani R, Kini A, Fuster V, Sharma S. Myocardial Bridging: Diagnosis, Functional Assessment, and Management: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:2196-2212. [PMID: 34823663 DOI: 10.1016/j.jacc.2021.09.859] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 02/08/2023]
Abstract
Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of the epicardial coronary artery traverses through the myocardium for a portion of its length. The muscle overlying the artery is termed a myocardial bridge, and the intramyocardial segment is referred to as a tunneled artery. MB can occur in any coronary artery, although is most commonly seen in the left anterior descending artery. Although traditionally considered benign in nature, increasing attention is being given to specific subsets of MB associated with ischemic symptomatology. The advent of contemporary functional and anatomic imaging modalities, both invasive and noninvasive, have dramatically improved our understanding of dynamic pathophysiology associated with MBs. This review provides a contemporary overview of epidemiology, pathobiology, diagnosis, functional assessment, and management of MBs.
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Affiliation(s)
- David Sternheim
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David A Power
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. https://twitter.com/rowpower
| | - Rajeev Samtani
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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13
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Aleksandric SB, Djordjevic-Dikic AD, Dobric MR, Giga VL, Soldatovic IA, Vukcevic V, Tomasevic MV, Stojkovic SM, Orlic DN, Saponjski JD, Tesic MB, Banovic MD, Petrovic MT, Juricic SA, Nedeljkovic MA, Stankovic G, Ostojic MC, Beleslin BD. Functional Assessment of Myocardial Bridging With Conventional and Diastolic Fractional Flow Reserve: Vasodilator Versus Inotropic Provocation. J Am Heart Assoc 2021; 10:e020597. [PMID: 34151580 PMCID: PMC8403296 DOI: 10.1161/jaha.120.020597] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Functional assessment of myocardial bridging (MB) remains clinically challenging because of the dynamic nature of the extravascular coronary compression with a certain degree of intraluminal coronary reduction. The aim of our study was to assess performance and diagnostic value of diastolic‐fractional flow reserve (d‐FFR) during dobutamine provocation versus conventional‐FFR during adenosine provocation with exercise‐induced myocardial ischemia as reference. Methods and Results This prospective study includes 60 symptomatic patients (45 men, mean age 57±9 years) with MB on the left anterior descending artery and systolic compression ≥50% diameter stenosis. Patients were evaluated by exercise stress‐echocardiography test, and both conventional‐FFR and d‐FFR in the distal segment of left anterior descending artery during intravenous infusion of adenosine (140 μg/kg per minute) and dobutamine (10–50 μg/kg per minute), separately. Exercise–stress‐echocardiography test was positive for myocardial ischemia in 19/60 patients (32%). Conventional‐FFR during adenosine and peak dobutamine had similar values (0.84±0.04 versus 0.84±0.06, P=0.852), but d‐FFR during peak dobutamine was significantly lower than d‐FFR during adenosine (0.76±0.08 versus 0.79±0.08, P=0.018). Diastolic‐FFR during peak dobutamine was significantly lower in the exercise‐stress‐echocardiography test –positive group compared with the exercise‐ stress‐echocardiography test –negative group (0.70±0.07 versus 0.79±0.06, P<0.001), but not during adenosine (0.79±0.07 versus 0.78±0.09, P=0.613). Among physiological indices, d‐FFR during peak dobutamine was the only independent predictor of functionally significant MB (odds ratio, 0.870; 95% CI, 0.767–0.986, P=0.03). Receiver‐operating characteristics curve analysis identifies the optimal d‐FFR during peak dobutamine cut‐off ≤0.76 (area under curve, 0.927; 95% CI, 0.833–1.000; P<0.001) with a sensitivity, specificity, and positive and negative predictive value of 95%, 95%, 90%, and 98%, respectively, for identifying MB associated with stress‐induced ischemia. Conclusions Diastolic‐FFR, but not conventional‐FFR, during inotropic stimulation with high‐dose dobutamine, in comparison to vasodilatation with adenosine, provides more reliable functional significance of MB in relation to stress‐induced myocardial ischemia.
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Affiliation(s)
- Srdjan B Aleksandric
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Ana D Djordjevic-Dikic
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Milan R Dobric
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Vojislav L Giga
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Ivan A Soldatovic
- Faculty of Medicine University of Belgrade Serbia.,Institute of Medical Statistics and Informatics Faculty of Medicine University of Belgrade Serbia
| | - Vladan Vukcevic
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Miloje V Tomasevic
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia.,Department of Internal Medicine Faculty of Medical Sciences University of Kragujevac Serbia
| | - Sinisa M Stojkovic
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Dejan N Orlic
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Jovica D Saponjski
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Milorad B Tesic
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Marko D Banovic
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Marija T Petrovic
- Mount Sinai HeartIcahn School of Medicine at Mount Sinai Hospital New York NY.,James J. Peters Veterans Administration Medical Center Bronx NY
| | - Stefan A Juricic
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia
| | - Milan A Nedeljkovic
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Goran Stankovic
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Miodrag C Ostojic
- Faculty of Medicine University of Belgrade Serbia.,Institute for Cardiovascular Diseases Dedinje Belgrade Serbia
| | - Branko D Beleslin
- Cardiology Clinic University Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
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14
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Gulmez N, Sah H. The relationships between the myocardial bridge and ramus interventricularis paraconalis characteristics in lamb and sheep. Anat Histol Embryol 2020; 50:260-265. [PMID: 33009861 DOI: 10.1111/ahe.12623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 08/12/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
The myocardial bridge (MB) is an anomaly that the myocardial fibres cover on a segment of the subepicardial coronary arteries or their branches in domestic animals and humans. The aim of the present study was to determine the relationships between the characteristics of the MB and ramus interventricularis paraconalis at three levels in lambs and adult sheep. Thirty-three hearts (16 lambs and 17 sheep) were used to determine the MB (length, angle and thickness) and vessel (vessel diameter and thicknesses of tunica intima et media of ramus interventricularis paraconalis) characteristics. Independent-samples t test was applied to compare variables between lambs and sheep. Spearman's correlation analysis was conducted to evaluate the relationships between bridge and vessel characteristics at three bridge levels. Length, angle and thickness of myocardial bridges were not significantly different between the lambs and sheep (p > .05). The mean length, angle and thickness were 24.9 ± 16.1 mm, 113.7 ± 11.2° and 1,098 ± 555 µm in 33 hearts, respectively. In lambs, the mean vessel diameters were 1,930 ± 742 µm (1,534-2,325 µm), 1,247 ± 665 µm (893-1,601 µm) and 865 ± 172 µm (774-957 µm) at the pre-bridge, bridge and post-bridge levels, respectively. In sheep, the mean vessel diameters in the same order were 1,861 ± 1,068 µm, 1,337 ± 308 µm and 1,287 ± 549 µm. The bridge prevalence was 100% in the samples examined. In conclusion, coronary arterial diseases related to myocardial bridge should not be expected in sheep for veterinary cardiology practice. It may also be concluded that the cross-breeds of the Awassi and Chios sheep may be useful in experimental studies related to myocardial bridge surgery.
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Affiliation(s)
- Nurhayat Gulmez
- Department of Histology and Embryology, Faculty of Veterinary Medicine, Near East University, Nicosia, Cyprus
| | - Huseyin Sah
- Department of Histology and Embryology, Faculty of Veterinary Medicine, Near East University, Nicosia, Cyprus
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15
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Gao W, Zhang J, Duan F, Guo S, Chen C, Du L, Zhao J, Zhou Z. Clinical characteristics and factors associated with coronary stenosis proximal to a myocardial bridge: a retrospective study. BMC Cardiovasc Disord 2020; 20:371. [PMID: 32795253 PMCID: PMC7427715 DOI: 10.1186/s12872-020-01655-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/04/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The association of myocardial bridge (MB) with cardiovascular risk and the possible cardiovascular risk factors remain unclear. This study aimed to explore the clinical characteristics and related factors of coronary stenosis proximal to an MB. METHODS This was a retrospective study of patients with symptoms of coronary atherosclerotic heart disease admitted between 10/2011 and 12/2014 to the Emergency and Cardiology Department of Bayannur Hospital, who underwent selective coronary angiography (SCAG). The patients were assigned to the non-stenosis and stenosis groups according to whether coronary stenosis was proximal to the MB. RESULTS Among 244 patients with MB and cardiovascular symptoms, 91 (37.3%) had stenosis proximal to the MB. Compared with the non-stenosis group, there were more males (80.2% vs. 55.6%, P < 0.001) and smokers (including those who had quit smoking) (P < 0.001) in the stenosis group. There were no significant differences in blood lipid-related indexes (TG, TC, HDL-C, LDL-C, and VLDL-C) between the two groups. Multivariable analysis suggested that MB location in the middle distal or distal segment of the left anterior descending artery (LAD) increased the odds of coronary stenosis proximal to the MB (OR = 0.439, 95% CI: 1.57-7.532, P = 0.002), which was then considered an independent factor associated with coronary stenosis proximal to the MB. CONCLUSIONS In patients diagnosed with an MB by SCAG, only MB located in the middle distal or distal segment of the LAD is independently associated with coronary stenosis proximal to the MB.
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Affiliation(s)
- Wen Gao
- First Department of Cardiology, Bayannaoer City Hospital, No. 98 Wulan Buhe Road, Linhe District, Bayannaoer City, 015000 Inner Mongolia Autonomous Region China
| | - Jiaxi Zhang
- Department of Cardiac Rehabilitation, Bayannaoer City Hospital, Bayannaoer City, Inner Mongolia Autonomous Region China
| | - Fei Duan
- Department of Vascular Abdominal Wall Hernia Surgery, Bayannaoer City Hospital, Bayannaoer City, Inner Mongolia Autonomous Region China
| | - Shujun Guo
- First Department of Cardiology, Bayannaoer City Hospital, No. 98 Wulan Buhe Road, Linhe District, Bayannaoer City, 015000 Inner Mongolia Autonomous Region China
| | - Chun Chen
- Department of Cardiac Rehabilitation, Bayannaoer City Hospital, Bayannaoer City, Inner Mongolia Autonomous Region China
| | - Liping Du
- First Department of Cardiology, Bayannaoer City Hospital, No. 98 Wulan Buhe Road, Linhe District, Bayannaoer City, 015000 Inner Mongolia Autonomous Region China
| | - Jianquan Zhao
- First Department of Cardiology, Bayannaoer City Hospital, No. 98 Wulan Buhe Road, Linhe District, Bayannaoer City, 015000 Inner Mongolia Autonomous Region China
| | - Zhihong Zhou
- First Department of Cardiology, Bayannaoer City Hospital, No. 98 Wulan Buhe Road, Linhe District, Bayannaoer City, 015000 Inner Mongolia Autonomous Region China
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16
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Al-Musawi M, Marsh A, Yi S, AlOmaishi S, Rubay D. Combined Myocardial Bridge and Coronary Vessel Disease Requiring Coronary Artery Bypass Grafting and Myotomy of the Myocardial Bridge. Cureus 2019; 11:e6486. [PMID: 31903314 PMCID: PMC6935739 DOI: 10.7759/cureus.6486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Myocardial bridging (MB) describes a band of myocardium that covers the epicardial surface of the coronary artery. This band can vary both in thickness and distance to which it covers the artery. It is broadly classified as superficial or deep, depending on the thickness of the covering muscle layer. It can be asymptomatic, or it could present with different complications. Reported complications have included ischemia and acute coronary syndromes, coronary spasm, ventricular septal rupture, and arrhythmias. MB is most commonly found in the middle segment of the left anterior descending (LAD) coronary artery. There is controversy with regard to therapy for symptomatic patients who are refractory to medical management. Percutaneous coronary intervention and surgical myotomy (unroofing) have been proposed; yet, each one has its pros and cons. MB can be associated with the development of atherosclerosis proximal to the MB segment in the involved coronary artery, and patients can present having both pathologies. We present a case series of six patients with atherosclerotic coronary lesions requiring coronary artery bypass grafting (CABG) with an accidental perioperative finding of MB, which required myotomy.
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Affiliation(s)
| | - Amanda Marsh
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Slee Yi
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Suhad AlOmaishi
- Internal Medicine, Life Alliance Organ Recovery Agency, University of Miami, Miami, USA
| | - David Rubay
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
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17
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Eftekhar-Vaghefi SH, Pourhoseini S, Movahedi M, Hooshmand S, Ostovan MA, Dehghani P, Ostovan N. Comparison of detection percentage and morphology of myocardial bridge between conventional coronary angiography and coronary CT angiography. J Cardiovasc Thorac Res 2019; 11:203-208. [PMID: 31579460 PMCID: PMC6759614 DOI: 10.15171/jcvtr.2019.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 08/02/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction: Myocardial bridge (MB) is a congenital anomaly in which a segment of a coronary artery is surrounded by myocardium. In our study, we want to use conventional coronary angiography (CCA) to describe morphologic characteristics of MB (unidentified or identified) in the patients with documented evidence of MB in coronary computed tomography angiography (CCTA). Methods: The present study was designed as cross-sectional and was conducted on 47 patients with documented evidence of MB in CCTA, who were referred to Nemazee and Faghihi hospitals for performing coronary angiography during a one year period. We compared the morphologic characteristics of tunneled segments, which were missed at CCA (unidentified), and the tunneled segments which were identified with CCA. Results: In sum, MB was found in 16 (34%) patients at CCA (identified), and it was not found in 31 (66%) patients (unidentified) based on compression sign. No significant correlation was found between the percentage of systolic compression and the length and depth of the tunneled segment in identified group (r=0.73, P = 0.18; r=1.09, P = 0.15; respectively). Degree of atherosclerotic plaque formation (diameter stenosis, percentage) (mean, 0.25 (25%) ±0.29; range, 0-0.98) of the tunneled segments in unidentified group was significantly more than the same degree (mean, 0.07 (7%) ±0.13; range, 0-0.41) of the identified group (P = 0.03). The measurement of the trapezoid area under the tunneled segment with this formula [(MB length+ intramyocardial segment) ×depth/2] had significant relation with systolic compression (r=0.304, P = 0.03) and defined the cut-off value of 250 mm2 as the value of significant difference in detecting myocardial bridging with CCA. Conclusion: Our results showed that in most of identified MBs in CCA the tunneled segment area was equal and more than 250 mm2. In addition, the degree of atherosclerotic plaque of the tunneled segments at CCA was significantly more in unidentified group.
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Affiliation(s)
| | - Somayeh Pourhoseini
- Department of Anatomy, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Movahedi
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shohre Hooshmand
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Ostovan
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooyan Dehghani
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nikan Ostovan
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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18
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Spontaneous coronary artery dissection and associated myocardial bridging: Current evidence from cohort study and case reports. Med Hypotheses 2019; 128:50-53. [PMID: 31203908 DOI: 10.1016/j.mehy.2019.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/05/2019] [Accepted: 05/12/2019] [Indexed: 01/10/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) is a relatively uncommon and under-diagnosed disease characterized by the dissociation of intima and media of coronary artery wall due to an intimal tear or intramural hemorrhage. The exact pathophysiology of SCAD remains elusive and may involve multiple predisposing or precipitating factors including genetic abnormalities, inherited or acquired vasculopathies, hormonal influences, inflammation, intense exercise, emotional stress, and recreational drugs. Accruing reports, including five case reports and one cohort study, have recently addressed the concurrence of SCAD and myocardial bridging (MB), an anatomic variant in which a segment of the epicardial coronary descends and traverses in the myocardium. Among the patients with coexisting MB and SCAD, the left anterior descending artery was the only artery that harbors both pathologies, with SCAD locating either within the tunneled segment or distal to the MB. No other predisposing factors or precipitating stressors for SCAD were noted. It is hypothesized that the predilection for vasospasm, impaired endothelial function, and disturbed coronary flow dynamics associated with MB bridging could collectively contribute to the development of SCAD. Future studies are warranted to explore the mechanistic implications of MB in patients with SCAD.
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19
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Teragawa H, Oshita C, Ueda T. The Myocardial Bridge: Potential Influences on the Coronary Artery Vasculature. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819846493. [PMID: 31068756 PMCID: PMC6495429 DOI: 10.1177/1179546819846493] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 04/03/2019] [Indexed: 12/18/2022]
Abstract
A myocardial bridge (MB) is an anatomical abnormality of the coronary artery and is characterized by the systolic narrowing of the epicardial coronary artery caused by myocardial compression during systole. An MB is frequently observed on cardiac computed tomography or coronary angiography and generally appears to be harmless in the majority of patients. However, the presence of MB is reportedly associated with abnormalities of the cardiovascular system, including coronary artery diseases, arrhythmia, certain types of cardiomyopathy, and cardiac death, indicating that MB serves a pivotal role in the occurrence and/or development of such cardiovascular events. Recently, there has been an increasing interest in the coexistence of MB and coronary spasm in research due to opposing aspects regarding their treatments. For example, monotherapy using β-blockers, which are effective in patients with MB, may worsen symptoms in patients with coronary spasm. By contrast, nitroglycerin, which is an effective treatment option for coronary spasm, may worsen symptoms in patients with MB. This review focuses on the pathophysiology and diagnosis of MB and MB-related cardiovascular diseases, including coronary spasm, and on the treatment strategies for MB.
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Affiliation(s)
- Hiroki Teragawa
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan
| | - Chikage Oshita
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan
| | - Tomohiro Ueda
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan
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20
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Javadzadegan A, Moshfegh A, Hassanzadeh Afrouzi H. Relationship between myocardial bridge compression severity and haemodynamic perturbations. Comput Methods Biomech Biomed Engin 2019; 22:752-763. [DOI: 10.1080/10255842.2019.1589458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ashkan Javadzadegan
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
- ANZAC Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Abouzar Moshfegh
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
- ANZAC Research Institute, The University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Hamid Hassanzadeh Afrouzi
- Faculty of Mechanical Engineering, Babol Noshirvani University of Technology, Babol, Iran
- Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
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21
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Akishima-Fukasawa Y, Ishikawa Y, Mikami T, Akasaka Y, Ishii T. Settlement of Stenotic Site and Enhancement of Risk Factor Load for Atherosclerosis in Left Anterior Descending Coronary Artery by Myocardial Bridge. Arterioscler Thromb Vasc Biol 2018; 38:1407-1414. [DOI: 10.1161/atvbaha.118.310933] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/07/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Yuri Akishima-Fukasawa
- From the Department of Pathology, Toho University School of Medicine, Tokyo, Japan (Y.A-F., Y.I., T.M., Y.A.)
| | - Yukio Ishikawa
- From the Department of Pathology, Toho University School of Medicine, Tokyo, Japan (Y.A-F., Y.I., T.M., Y.A.)
| | - Tetuo Mikami
- From the Department of Pathology, Toho University School of Medicine, Tokyo, Japan (Y.A-F., Y.I., T.M., Y.A.)
| | - Yoshikiyo Akasaka
- From the Department of Pathology, Toho University School of Medicine, Tokyo, Japan (Y.A-F., Y.I., T.M., Y.A.)
| | - Toshiharu Ishii
- Department of Pathology, Saiseikai Yokohamashi Tobu Hospital, Japan (T.I.)
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22
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Impact of spatial characteristics in the left stenotic coronary artery on the hemodynamics and visualization of 3D replica models. Sci Rep 2017; 7:15452. [PMID: 29133915 PMCID: PMC5684364 DOI: 10.1038/s41598-017-15620-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 10/25/2017] [Indexed: 12/31/2022] Open
Abstract
Cardiovascular disease has been the major cause of death worldwide. Although the initiation and progression mechanism of the atherosclerosis are similar, the stenotic characteristics and the corresponding medical decisions are different between individuals. In the present study, we performed anatomic and hemodynamic analysis on 8 left coronary arterial trees with 10 identified stenoses. A novel boundary condition method had been implemented for fast computational fluid dynamics simulations and patient-specific three-dimensional printed models had been built for visualizations. Our results suggested that the multiple spatial characteristics (curvature of the culprit vessel multiplied by an angle of the culprit's vessel to the upstream parent branch) could be an index of hemodynamics significance (r = -0.673, P-value = 0.033). and reduction of the maximum velocity from stenosis to downstream was found correlated to the FFRCT (r = 0.480, p = 0.160). In addition, 3D printed models could provide accurate replicas of the patient-specific left coronary arterial trees compare to virtual 3D models (r = 0.987, P-value < 0.001). Therefore, the visualization of the 3D printed models could help understand the spatial distribution of the stenoses and the hand-held experience could potentially benefit the educating and preparing of medical strategies.
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Hostiuc S, Rusu MC, Hostiuc M, Negoi RI, Negoi I. Cardiovascular consequences of myocardial bridging: A meta-analysis and meta-regression. Sci Rep 2017; 7:14644. [PMID: 29116137 PMCID: PMC5677117 DOI: 10.1038/s41598-017-13958-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/02/2017] [Indexed: 01/18/2023] Open
Abstract
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.
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Affiliation(s)
- Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Department 2 Morphological Sciences, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - Mugurel Constantin Rusu
- Division of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,MEDCENTER, Centre of Excellence in Laboratory Medicine and Pathology, Bucharest, Romania
| | - Mihaela Hostiuc
- Department of Internal Medicine and Gastroenterology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ruxandra Irina Negoi
- Department of Anatomy, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ionuț Negoi
- Department of Surgery, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Wang Y, Qiu J, Luo S, Xie X, Zheng Y, Zhang K, Ye Z, Liu W, Gregersen H, Wang G. High shear stress induces atherosclerotic vulnerable plaque formation through angiogenesis. Regen Biomater 2016; 3:257-67. [PMID: 27482467 PMCID: PMC4966293 DOI: 10.1093/rb/rbw021] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/15/2016] [Accepted: 05/19/2016] [Indexed: 12/12/2022] Open
Abstract
Rupture of atherosclerotic plaques causing thrombosis is the main cause of acute coronary syndrome and ischemic strokes. Inhibition of thrombosis is one of the important tasks developing biomedical materials such as intravascular stents and vascular grafts. Shear stress (SS) influences the formation and development of atherosclerosis. The current review focuses on the vulnerable plaques observed in the high shear stress (HSS) regions, which localizes at the proximal region of the plaque intruding into the lumen. The vascular outward remodelling occurs in the HSS region for vascular compensation and that angiogenesis is a critical factor for HSS which induces atherosclerotic vulnerable plaque formation. These results greatly challenge the established belief that low shear stress is important for expansive remodelling, which provides a new perspective for preventing the transition of stable plaques to high-risk atherosclerotic lesions.
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Affiliation(s)
- Yi Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China; Taiji Group Co, Ltd, Chongqing, 401147, China
| | - Juhui Qiu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China; Taiji Group Co, Ltd, Chongqing, 401147, China
| | - Shisui Luo
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China; Taiji Group Co, Ltd, Chongqing, 401147, China
| | - Xiang Xie
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China; Taiji Group Co, Ltd, Chongqing, 401147, China
| | - Yiming Zheng
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China; Taiji Group Co, Ltd, Chongqing, 401147, China
| | - Kang Zhang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China; Taiji Group Co, Ltd, Chongqing, 401147, China
| | - Zhiyi Ye
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China; Taiji Group Co, Ltd, Chongqing, 401147, China
| | - Wanqian Liu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China; Taiji Group Co, Ltd, Chongqing, 401147, China
| | - Hans Gregersen
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China; Taiji Group Co, Ltd, Chongqing, 401147, China
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China; Taiji Group Co, Ltd, Chongqing, 401147, China
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Yamada R, Tremmel JA, Tanaka S, Lin S, Kobayashi Y, Hollak MB, Yock PG, Fitzgerald PJ, Schnittger I, Honda Y. Functional Versus Anatomic Assessment of Myocardial Bridging by Intravascular Ultrasound: Impact of Arterial Compression on Proximal Atherosclerotic Plaque. J Am Heart Assoc 2016; 5:e001735. [PMID: 27098967 PMCID: PMC4843493 DOI: 10.1161/jaha.114.001735] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The presence of a myocardial bridge (MB) has been shown to promote atherosclerotic plaque formation proximal to the MB, presumably because of hemodynamic disturbances provoked by retrograde blood flow toward this segment in cardiac systole. We aimed to determine the anatomic and functional properties of an MB related to the extent of atherosclerosis assessed by intravascular ultrasound. Methods and Results We enrolled 100 patients with angina but no significant obstructive coronary artery disease who had an intravascular ultrasound–detected MB in the left anterior descending artery (median age 54 years, 36% male). The MB was identified with intravascular ultrasound by the presence of an echolucent band (halo). Anatomically, the MB length was 22±13 mm, and halo thickness was 0.7±0.6 mm. Functionally, systolic arterial compression was 23±12%. The maximum plaque burden up to 20 mm proximal to the MB entrance was significantly greater than the maximum plaque burden within the MB segment. Among the intravascular ultrasound–defined MB properties, arterial compression was the sole MB parameter that demonstrated a significant positive correlation with maximum plaque burden up to 20 mm proximal to the MB entrance (r=0.254, P=0.011 overall; r=0.545, P<0.001 low coronary risk). In multivariate analysis, adjusting for clinical characteristics and coronary risk factors, arterial compression was independently associated with maximum plaque burden up to 20 mm proximal to the MB entrance. Conclusions In patients with an MB in the left anterior descending artery, the percentage of arterial compression is related directly to the burden of atherosclerotic plaque located proximally to the MB, particularly in patients who otherwise have low coronary risk. This may prove helpful in identifying high‐risk MB patients.
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Affiliation(s)
- Ryotaro Yamada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Shin Lin
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - M Brooke Hollak
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
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26
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Aksan G, Nar G, İnci S, Yanık A, Kılıçkesmez KO, Aksoy O, Soylu K. Exercise-Induced Repolarization Changes in Patients with Isolated Myocardial Bridging. Med Sci Monit 2015; 21:2116-24. [PMID: 26198682 PMCID: PMC4515937 DOI: 10.12659/msm.893632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/13/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although myocardial bridging (MB) is defined as an angiographic phenomenon with a benign course, it has also been associated with adverse cardiovascular events. The effects of exercise on myocardial repolarization in patients with MB were tested in this study, with Tp-e and Tp-e/QT repolarization indexes. MATERIAL AND METHODS A total of 50 patients in whom isolated MB was diagnosed at coronary angiography (CAG) (Group I) and 48 patients with normal CAG results (Group II) were included in this study. The participants underwent treadmill exercise stress testing according to the Bruce protocol. QT dispersion (QTd) was defined as the minimum QT interval subtracted from the maximum. The Tp-e interval was defined as the difference between the QT and the QT peak time period. QTd and Tp-e intervals were calculated for all patients before and after exercise testing and differences between groups were compared. RESULTS At peak exercise, QTd and cQTd showed a significant increase in comparison to baseline values in the group of patients with myocardial bridges. Significant increases were also found with exercise in the Tp-e, cTp-e durations and Tp-e/QT ratio of the MB patient group in comparison to the baseline values. On the other hand, significant differences in QTd, cQTd, Tp-e, cTp-e intervals, and Tp-e/QT ratio during peak exercise in comparison with baseline values were not detected in the control group (p>0.05). CONCLUSIONS Significant increases in QTd, cQTd, Tp-e and cTp-e intervals and Tp-e/QT ratio were detected in the MB patients during exercise testing.
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Affiliation(s)
- Gökhan Aksan
- Deparment of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Gökay Nar
- Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey
| | - Sinan İnci
- Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey
| | - Ahmet Yanık
- Department of Cardiology, Samsun Training and Research Hospital, Samsun, Turkey
| | | | - Olcay Aksoy
- Department of Cardiology, University of California, Los Angeles, CA, U.S.A
| | - Korhan Soylu
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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27
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Ding H, Shang K, Lan H, Lei Y, Sheng L, Liu Z, Zeng Y. In vitro simulation research on the hoop stress of myocardial bridge--coronary artery. J Cardiothorac Surg 2015; 10:60. [PMID: 25907099 PMCID: PMC4415239 DOI: 10.1186/s13019-015-0261-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 04/17/2015] [Indexed: 01/30/2023] Open
Abstract
Aims The aim of this study is to investigate how the myocardial bridge oppression affects the hoop stress of mural coronary artery. Methods The “myocardial bridge – coronary artery” simulative device records the hoop stress which is changed by adjusting the external pressure of the simulated coronary artery and the oppression degree of the respectively. Results Simulation experiment in vitro indicates that the abnormal hoop stress mainly occurs in the proximal end of mural coronary artery. As the oppression degree of myocardial bridge increases, the mean and the oscillatory value (maximum-minimum) of hoop stress in the proximal end increase markedly. Conclusions The “myocardial bridge – coronary artery” simulation device can provide an experiment method of studying the hoop stress influence on mural coronary artery in vitro.
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Affiliation(s)
- Hao Ding
- Shanghai Medical Instrumentation College, Shanghai, 200093, China. .,School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China.
| | - Kun Shang
- Shanghai Medical Instrumentation College, Shanghai, 200093, China. .,School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China.
| | - Hailian Lan
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China.
| | - Yanan Lei
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China.
| | - Lixing Sheng
- Shanghai Medical Instrumentation College, Shanghai, 200093, China. .,School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China.
| | - Zhilin Liu
- Shanghai General Hospital, Shanghai, 200080, China.
| | - Yanjun Zeng
- Biomechanics & Medical Information Institute, Beijing University of Technology, No. 100 PingLeYuan, Beijing, 100022, China.
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28
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Impact of Myocardial Bridging on the Long-term Clinical Outcomes of Patients with Left Anterior Descending Coronary Artery Disease Treated with a Drug-Eluting Stent. Heart Lung Circ 2014; 23:758-63. [DOI: 10.1016/j.hlc.2014.02.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 02/21/2014] [Accepted: 02/22/2014] [Indexed: 11/22/2022]
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29
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Ishii T, Ishikawa Y, Akasaka Y. Myocardial bridge as a structure of "double-edged sword" for the coronary artery. Ann Vasc Dis 2014; 7:99-108. [PMID: 24995053 DOI: 10.3400/avd.ra.14-00037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/15/2014] [Indexed: 01/06/2023] Open
Abstract
Myocardial bridge (MB) is a chance anatomical structure, comprised of the myocardial tissue, with which the coronary artery running in epicardial adipose tissue is partly covered. It is predominantly present in the left anterior descending artery (LAD) and recognizable through imaging techniques as changes in blood flow within the LAD that arises from MB contraction at cardiac systole. Such changes in blood flow influence the pathophysiology of coronary circulation and atherosclerosis development, thus generating controversy as to whether MB predisposes individual to myocardial infarction (MI). However, recent histomorphometric studies have shown that the individual anatomic properties of MB, such as location, length and thickness, consistently play a critical role in the occurrence of MI. This review article comprehensively addresses the pathophysiological mechanisms of MI occurrence together with the benign suppressive effect of coronary atherosclerosis by MB.
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Affiliation(s)
- Toshiharu Ishii
- Department of Pathology, Saiseikai Yokohama-city Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Yukio Ishikawa
- Department of Pathology, Itabashi Chuo Hospital, Tokyo, Japan
| | - Yoshikiyo Akasaka
- Department of Pathology, School of Medicine, Toho University, Tokyo, Japan
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30
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Corban MT, Hung OY, Eshtehardi P, Rasoul-Arzrumly E, McDaniel M, Mekonnen G, Timmins LH, Lutz J, Guyton RA, Samady H. Myocardial bridging: contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies. J Am Coll Cardiol 2014; 63:2346-2355. [PMID: 24583304 DOI: 10.1016/j.jacc.2014.01.049] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/24/2014] [Accepted: 01/28/2014] [Indexed: 12/30/2022]
Abstract
Patients with myocardial bridging are often asymptomatic, but this anomaly may be associated with exertional angina, acute coronary syndromes, cardiac arrhythmias, syncope, or even sudden cardiac death. This review presents our understanding of the pathophysiology of myocardial bridging and describes prevailing diagnostic modalities and therapeutic options for this challenging clinical entity.
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Affiliation(s)
- Michel T Corban
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Olivia Y Hung
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Parham Eshtehardi
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Emad Rasoul-Arzrumly
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael McDaniel
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Girum Mekonnen
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Lucas H Timmins
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Jerre Lutz
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Robert A Guyton
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Habib Samady
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
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31
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Nakaura T, Nagayoshi Y, Awai K, Utsunomiya D, Kawano H, Ogawa H, Yamashita Y. Myocardial bridging is associated with coronary atherosclerosis in the segment proximal to the site of bridging. J Cardiol 2014; 63:134-9. [DOI: 10.1016/j.jjcc.2013.07.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 06/15/2013] [Accepted: 07/13/2013] [Indexed: 11/26/2022]
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32
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Lluri G, Aboulhosn J. Coronary arterial development: a review of normal and congenitally anomalous patterns. Clin Cardiol 2014; 37:126-30. [PMID: 24399787 DOI: 10.1002/clc.22237] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/07/2013] [Indexed: 01/20/2023] Open
Abstract
Coronary artery development is a delicate, complex, and finely tuned process that includes multiple interactions among many pathways, especially in the pericardium and the developing myocardium. There still exists some controversy on the exact origin of certain cellular components. Nevertheless, an understanding of this extremely important developmental process is paramount in identifying some of the causes of anomalous coronary development. There are different patterns of anomalous coronary arteries, with variable risk of myocardial ischemia, malignant arrhythmias, and sudden cardiac death. These anomalies can be broadly categorized into 2 basic anatomic subsets: those with origin of the anomalous coronary artery from the opposite aortic sinus, and those with origin of the anomalous coronary artery from the pulmonary artery. Diagnosis and management of such patterns continues to be challenging. A good knowledge of the normal and abnormal coronary artery development could potentially help us explore new avenues in the treatment of ischemic heart disease as well as anomalous coronary arteries.
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Affiliation(s)
- Gentian Lluri
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
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33
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Wang Y, Lv B, Chen J, Zhang Y, Luo F, Lu N, Sun K, Hou Z, Cao H, Zeb I, Budoff M, Hui R. Intramural Coronary Arterial Course Is Associated With Coronary Arterial Stenosis and Prognosis of Major Cardiac Events. Arterioscler Thromb Vasc Biol 2013; 33:439-44. [DOI: 10.1161/atvbaha.112.300717] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yibo Wang
- From the Sino-German Laboratory for Molecular Medicine, State Key Laboratory of Cardiovascular Disease (Y.W., J.C., Y.Z., K.S., R.H.), Department of Radiology (B.L., Z.H., H.C.), and Department of Cardiology (F.L., R.H.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Bethune First Hospital of Jilin University, Changchun, China (N.L.); and Department of Medicine, Los Angeles
| | - Bin Lv
- From the Sino-German Laboratory for Molecular Medicine, State Key Laboratory of Cardiovascular Disease (Y.W., J.C., Y.Z., K.S., R.H.), Department of Radiology (B.L., Z.H., H.C.), and Department of Cardiology (F.L., R.H.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Bethune First Hospital of Jilin University, Changchun, China (N.L.); and Department of Medicine, Los Angeles
| | - Jinxing Chen
- From the Sino-German Laboratory for Molecular Medicine, State Key Laboratory of Cardiovascular Disease (Y.W., J.C., Y.Z., K.S., R.H.), Department of Radiology (B.L., Z.H., H.C.), and Department of Cardiology (F.L., R.H.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Bethune First Hospital of Jilin University, Changchun, China (N.L.); and Department of Medicine, Los Angeles
| | - Yu Zhang
- From the Sino-German Laboratory for Molecular Medicine, State Key Laboratory of Cardiovascular Disease (Y.W., J.C., Y.Z., K.S., R.H.), Department of Radiology (B.L., Z.H., H.C.), and Department of Cardiology (F.L., R.H.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Bethune First Hospital of Jilin University, Changchun, China (N.L.); and Department of Medicine, Los Angeles
| | - Fang Luo
- From the Sino-German Laboratory for Molecular Medicine, State Key Laboratory of Cardiovascular Disease (Y.W., J.C., Y.Z., K.S., R.H.), Department of Radiology (B.L., Z.H., H.C.), and Department of Cardiology (F.L., R.H.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Bethune First Hospital of Jilin University, Changchun, China (N.L.); and Department of Medicine, Los Angeles
| | - Na Lu
- From the Sino-German Laboratory for Molecular Medicine, State Key Laboratory of Cardiovascular Disease (Y.W., J.C., Y.Z., K.S., R.H.), Department of Radiology (B.L., Z.H., H.C.), and Department of Cardiology (F.L., R.H.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Bethune First Hospital of Jilin University, Changchun, China (N.L.); and Department of Medicine, Los Angeles
| | - Kai Sun
- From the Sino-German Laboratory for Molecular Medicine, State Key Laboratory of Cardiovascular Disease (Y.W., J.C., Y.Z., K.S., R.H.), Department of Radiology (B.L., Z.H., H.C.), and Department of Cardiology (F.L., R.H.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Bethune First Hospital of Jilin University, Changchun, China (N.L.); and Department of Medicine, Los Angeles
| | - Zhihui Hou
- From the Sino-German Laboratory for Molecular Medicine, State Key Laboratory of Cardiovascular Disease (Y.W., J.C., Y.Z., K.S., R.H.), Department of Radiology (B.L., Z.H., H.C.), and Department of Cardiology (F.L., R.H.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Bethune First Hospital of Jilin University, Changchun, China (N.L.); and Department of Medicine, Los Angeles
| | - Huili Cao
- From the Sino-German Laboratory for Molecular Medicine, State Key Laboratory of Cardiovascular Disease (Y.W., J.C., Y.Z., K.S., R.H.), Department of Radiology (B.L., Z.H., H.C.), and Department of Cardiology (F.L., R.H.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Bethune First Hospital of Jilin University, Changchun, China (N.L.); and Department of Medicine, Los Angeles
| | - Irfan Zeb
- From the Sino-German Laboratory for Molecular Medicine, State Key Laboratory of Cardiovascular Disease (Y.W., J.C., Y.Z., K.S., R.H.), Department of Radiology (B.L., Z.H., H.C.), and Department of Cardiology (F.L., R.H.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Bethune First Hospital of Jilin University, Changchun, China (N.L.); and Department of Medicine, Los Angeles
| | - Matthew Budoff
- From the Sino-German Laboratory for Molecular Medicine, State Key Laboratory of Cardiovascular Disease (Y.W., J.C., Y.Z., K.S., R.H.), Department of Radiology (B.L., Z.H., H.C.), and Department of Cardiology (F.L., R.H.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Bethune First Hospital of Jilin University, Changchun, China (N.L.); and Department of Medicine, Los Angeles
| | - Rutai Hui
- From the Sino-German Laboratory for Molecular Medicine, State Key Laboratory of Cardiovascular Disease (Y.W., J.C., Y.Z., K.S., R.H.), Department of Radiology (B.L., Z.H., H.C.), and Department of Cardiology (F.L., R.H.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Bethune First Hospital of Jilin University, Changchun, China (N.L.); and Department of Medicine, Los Angeles
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Rubinshtein R, Gaspar T, Lewis BS, Prasad A, Peled N, Halon DA. Long-term prognosis and outcome in patients with a chest pain syndrome and myocardial bridging: a 64-slice coronary computed tomography angiography study. Eur Heart J Cardiovasc Imaging 2013; 14:579-85. [DOI: 10.1093/ehjci/jet010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Zóka A, Andréka P, Becker D, Fontos G, Merkely B, Szabó G, Szatmári A, Bárczi G. Ventricular septal rupture caused by myocardial bridge, solved by interventional closure device. Croat Med J 2013; 53:627-30. [PMID: 23275329 PMCID: PMC3541589 DOI: 10.3325/cmj.2012.53.627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Myocardial bridging is a common coronary anomaly, which is generally described as a benign phenomenon. However, a growing number of studies consider this anomaly a relevant pathophysiological phenomenon with serious pathological consequences. Here we report on the case of an 88-year-old woman suffering from myocardial infarction and ventricular septal rupture, lacking any recognizable coronary disease except for a myocardial bridge causing the systolic compression of the left anterior descending coronary artery. A wide range of diagnostic procedures, including coronarography, echocardiography, and magnetic resonance imaging were used. The septal rupture was finally closed by using a percutaneous closure device. This event indicates that myocardial bridges - at least in some cases - may have notable clinical relevance.
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Affiliation(s)
- András Zóka
- Semmelweis University Heart Center, Budapest, Hungary.
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36
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Kurisu S, Iwasaki T, Ishibashi K, Mitsuba N, Dohi Y, Nishioka K, Kihara Y. Measurement of fractional flow reserve in a patient with combined myocardial bridging and coronary fixed stenosis. J Cardiol Cases 2012; 6:e163-e165. [DOI: 10.1016/j.jccase.2012.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 05/22/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022] Open
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Cai W, Dong Y, Zhou X, Chen SB, Zhao JH, Jiang TM, Li YM. Left ventricular systolic dyssynchrony in patients with isolated symptomatic myocardial bridge. SCAND CARDIOVASC J 2012; 47:11-9. [PMID: 23036109 DOI: 10.3109/14017431.2012.736635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The impact of myocardial bridge (MB) on left ventricular (LV) systolic synchrony is insufficiently understood. DESIGN Thirty-five subjects with isolated mid-left, anterior, descending artery (LAD) MB, preserved LV ejection fraction (LVEF > 50%), and otherwise, normal coronary angiogram were identified from 3607 patients who underwent diagnostic coronary angiography and were evaluated by tissue Doppler imaging and real-time three-dimensional echocardiography (RT3DE). Control subjects consisted of 26 age and sex-matched coronary angiographically "normal" subjects. RESULTS MB patients were characterized by reduced, early, diastolic strain rate in LAD-supplied apical segments (lateral and anterior), with prevalence of LV systolic dyssynchrony of 25.7% (9/35). MB patients were further classified by the medians of MB stenosis and length. For MB stenosis < 52.5%, Class I: length < 17 mm (n = 7), Class II: length ≥ 17 mm (n = 10); for stenosis ≥ 52.5%, Class III: length < 17 mm (n = 10), Class IV: length ≥ 17 mm (n = 8). Binary Logistic regression model revealed that higher MB lesion classification (odds ratio: 4.944, 95%CI 1.174-20.82, P < 0.05) and hypertension (odds ratio: 15.32, 95%CI: 1.252-187.6, P < 0.05) are statistically associated with LV systolic dyssynchrony, which was independent of LV mass. CONCLUSIONS MB in the mid LAD is associated with myocardial dyssynchrony. Hypertensive individuals and those with more severe bridging (determined by length and stenosis) tend to have an increased incidence of dyssynchrony.
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Affiliation(s)
- Wei Cai
- Institute of Cardiovascular Disease and Heart Center, Pingjin Hospital, Logistics University of Chinese People's Armed Police Forces, Tianjin, PR China
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38
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Verhagen SN, Rutten A, Meijs MF, Isgum I, Cramer MJ, van der Graaf Y, Visseren FLJ. Relationship between myocardial bridges and reduced coronary atherosclerosis in patients with angina pectoris. Int J Cardiol 2012; 167:883-8. [PMID: 22386701 DOI: 10.1016/j.ijcard.2012.01.091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/28/2011] [Accepted: 01/28/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND A myocardial bridge (MB) is a band of myocardium covering a coronary artery segment, typically located in the left anterior descending coronary artery (LAD). Bridged segments of the coronary artery are isolated from the influence of perivascular adipose tissue. The aims of this study were to investigate the relationship between MBs and atherosclerosis in bridged LAD segments and to evaluate whether perivascular adipose tissue is involved in this relationship. METHODS MBs were identified in the coronary arteries of patients referred for diagnostic cardiac CT. The calcium score of MBs of the LAD or, in patients without LAD-MBs, of a corresponding LAD segment at the same distance from its origin and over the same length was measured. RESULTS Of 128 patients, 56 (44%) had in total 73 MBs. The mean MB length was 22 ± 14 mm and the median MB thickness was 0.8mm (interquartile range 0.3-2.1mm). MBs in the LAD were present in 40 patients (31%). The calcium score was 0 in 95% of the LAD segments with MBs compared with 52% of the corresponding LAD segments without MBs. The association between LAD-MBs and calcium score (OR 0.06, 95% CI 0.01-0.25) was not influenced by age and gender, but was attenuated by local perivascular adipose tissue thickness (OR 0.35, 95% CI 0.04-2.70). CONCLUSIONS Coronary artery segments covered with an MB have a lower calcium score than segments without an MB. The association between MBs and calcium scores was influenced by local perivascular adipose tissue thickness.
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Affiliation(s)
- Sandra N Verhagen
- Department of Vascular Medicine, University Medical Center Utrecht, The Netherlands
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Bilen E, Tanboga IH, Kurt M, Kocak U, Ayhan H, Keles T, Bozkurt E. Increase in mean platelet volume in patients with myocardial bridge. Clin Appl Thromb Hemost 2012; 19:437-40. [PMID: 22387585 DOI: 10.1177/1076029612439342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIM Myocardial bridge is associated with atherosclerosis altered in shear stress and endothelial dysfunction. Mean platelet volume (MPV), a determinant of platelet activation, is shown to be related with atherosclerosis and endothelial dysfunction. In this study, we aimed to evaluate platelet function assessed by MPV in patients with myocardial bridge. METHODS Forty-two patients with myocardial bridge in the left anterior descending artery (LAD) and 43 age- and gender-matched healthy participants were included in the study. Myocardial bridging was defined as an intramyocardial systolic compression or milking of a segment of an epicardial coronary artery on angiography. For the entire study population, MPV was measured using an automatic blood counter. RESULTS The study population consisted of 42 patients with myocardial bridge (52.7 ± 10.2, 76.2% male) and 43 age- and sex-matched healthy control participants (52.1 ± 10.4, 74.4% male). Compared to the control group, MPV value was significantly higher in patients with myocardial bridge (8.9 ± 1.24 vs 8.3 ± 0.78; P = .01). Further, there were no significant differences between groups regarding hemoglobin level, platelet count, fasting blood glucose, and creatinine levels. CONCLUSIONS Our study findings indicated that myocardial bridge is associated with elevated MPV values. Our results might partly explain the increased cardiovascular events in patients with myocardial bridge.
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Affiliation(s)
- Emine Bilen
- Ankara Ataturk Education and Research Hospital, Ankara, Turkey
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40
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Jhi JH, Cho KI, Ha JK, Jung CW, kim BJ, Park SO, Jo AR, Kim SM, Lee HG, Kim TI. Alteration of left ventricular function with dobutamine challenge in patients with myocardial bridge. Korean J Intern Med 2011; 26:410-20. [PMID: 22205841 PMCID: PMC3245389 DOI: 10.3904/kjim.2011.26.4.410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 05/18/2011] [Accepted: 06/17/2011] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND/AIMS The aim of this study was to identify changes in left ventricular (LV) performance in patients with a myocardial bridge (MB) in the left anterior descending coronary artery during resting and in an inotropic state. METHODS Myocardial strain measurement by speckle-tracking echocardiography and conventional LV wall-motion scoring was performed in 18 patients with MB (mean age, 48.1 ± 1.7 years, eight female) during resting and intravenous dobutamine challenge (10 and 20 µg/kg/min). RESULTS Conventional LV wall-motion scoring was normal in all patients during resting and in an inotropic state. Peak regional circumferential strain increased dose dependently upon dobutamine challenge. Longitudinal strains of the anterior and anteroseptal segments were, however, reduced at 20 µg/kg/min and showed a dyssynchronous pattern at 20 µg/kg/min. Although there were no significant differences in radial strain and displacement of all segments at rest compared with under 10 µg/kg/min challenge, radial strain and displacement of anterior segments at 20 µg/kg/min were significantly reduced compared with posterior segments at the papillary muscle level (44.8 ± 14.9% vs. 78.4 ± 20.1% and 5.3 ± 2.3 mm vs. 8.5 ± 1.8 mm, respectively; all p < 0.001), and showed plateau (40%) or biphasic (62%) patterns. CONCLUSIONS Reduced LV strain of patients with MB after inotropic stimulation was identified. Speckle-tracking strain echocardiography identified a LV myocardial dyssynchrony that was not demonstrated by conventional echocardiography in patients with MB.
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Affiliation(s)
- Joon-Hyung Jhi
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Kyoung-Im Cho
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Jong-kun Ha
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Chan-Woo Jung
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Bong-Jae kim
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Seong-Oh Park
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - A-Ra Jo
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Seong-Man Kim
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Hyeon-Gook Lee
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Tae-Ik Kim
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
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41
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Myocardial bridging on coronary CTA: an innocent bystander or a culprit in myocardial infarction? J Cardiovasc Comput Tomogr 2011; 6:3-13. [PMID: 22264630 DOI: 10.1016/j.jcct.2011.10.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 08/24/2011] [Accepted: 10/20/2011] [Indexed: 12/28/2022]
Abstract
Myocardial bridging describes the clinical entity whereby a segment of coronary artery is either partially or completely covered by surrounding myocardium. It represents the most frequent congenital coronary anomaly and has an estimated prevalence of ≤13% on angiographic series. With the emergence of cardiac computed tomography and its ability to simultaneously image the coronary arteries and also the myocardium, there has been an apparent increase in the detection rates of myocardial bridges (prevalence as high as 44%). It has now become important to evaluate their clinical significance. Myocardial bridging is generally considered a benign entity with survival rates of 97% at 5 years; however, there is now emerging evidence that certain myocardial bridge characteristics may be associated with cardiovascular morbidity. The length and depth of myocardial bridges have been associated with increased atherosclerosis, whereas the degree of systolic compression has been associated with ischemia on myocardial perfusion single-photon emission tomography. On the basis of current evidence, it appears that limiting further testing for ischemia to symptomatic patients with long and/or deep myocardial brides would be appropriate.
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42
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Abstract
The authors present a case demonstrating the unusual combination of myocardial bridging with a coronary artery aneurysm complicated by acute transient left ventricular dysfunction due to myocardial stunning. The pathophysiology and current insights into myocardial bridging, coronary aneurysms and myocardial stunning are briefly discussed. The literature reveals only one other reported case of coronary aneurysms associated with myocardial bridging. In addition, although there are several reports of angina and myocardial infarction complicating bridging, there is only 1 other report of myocardial stunning specifically.
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Loukas M, Von Kriegenbergh K, Gilkes M, Tubbs RS, Walker C, Malaiyandi D, Anderson RH. Myocardial bridges: A review. Clin Anat 2011; 24:675-83. [PMID: 21751254 DOI: 10.1002/ca.21150] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 01/16/2011] [Accepted: 01/23/2011] [Indexed: 11/06/2022]
Abstract
Much has been written regarding the potential clinical significance of myocardial bridges. As such bridging is often seen in normal individuals, it is clear that not all arteries bridged by myocardial segments produce clinical symptoms thereby suggesting that this feature may simply be an anatomical variant. However, some authors who have considered these bridges as the cause of cardiac ischemia have suggested two potential mechanisms for their pathophysiology. The first is a phasic systolic compression of the bridged segment with persistent mid-to-late diastolic reduction in arterial diameter and the second proposes a reduction in arterial flow. Both mechanisms may contribute to a reduced reserve in coronary blood flow. In this review, we discuss the evidence that exists regarding myocardial bridging and the potential for bridging to cause myocardial ischemia.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies.
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44
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Takamura K, Fujimoto S, Nanjo S, Nakanishi R, Hisatake S, Namiki A, Ishikawa Y, Ishii T, Yamazaki J. Anatomical characteristics of myocardial bridge in patients with myocardial infarction by multi-detector computed tomography. Circ J 2011; 75:642-8. [PMID: 21282876 DOI: 10.1253/circj.cj-10-0679] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Recent development of multi-detector computed tomography (MDCT) has made the detection of myocardial bridge (MB) easier on the left anterior descending coronary artery (LAD). The LAD segment proximal to the MB is well known to be susceptible to atherosclerosis. Anatomical characteristics of MB on LAD in patients with myocardial infarction (MI) were examined by MDCT. METHODS AND RESULTS Subjects were 43 MI patients who had MB in the LAD and comprised 2 groups: 14 with culprit lesions in the LAD proximal to MB (culprit group) and 29 without culprit lesions in the LAD (non-culprit group). MB length, MB thickness, and the distance from the orifice of left main trunk (LMT) to MB entrance were compared. Age and coronary risk factors showed no significant difference between the 2 groups. MB length (P=0.011), MB thickness (P=0.035), and index of the length multiplied by thickness of MB (P=0.031) were significantly greater in the culprit group. The distance from the orifice of the LMT to MB entrance was significantly shorter in the culprit group (P=0.006). CONCLUSIONS Anatomical properties of MB, such as length and thickness of MB as well as MB location, are associated with the formation of culprit lesions of LAD proximal to MB in MI.
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Affiliation(s)
- Kazuhisa Takamura
- Department of Cardiovascular Medicine, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ohta-ku, Tokyo 143-8541, Japan
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45
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Ishikawa Y, Kawawa Y, Kohda E, Shimada K, Ishii T. Significance of the Anatomical Properties of a Myocardial Bridge in Coronary Heart Disease. Circ J 2011; 75:1559-66. [DOI: 10.1253/circj.cj-10-1278] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yukio Ishikawa
- Department of Pathology, Toho University School of Medicine
| | - Yoko Kawawa
- Division of Diagnostic Radiology, National Cancer Center Hospital
| | - Eiichi Kohda
- Department of Radiology, Toho University Medical Center, Ohashi Hospital
| | - Kazuyuki Shimada
- Department of Neurology, Gross Anatomy Section, Kagoshima University Graduate School of Medical and Dental Sciences
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46
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Saidi H, Ongeti WK, Ogeng'o J. Morphology of human myocardial bridges and association with coronary artery disease. Afr Health Sci 2010; 10:242-247. [PMID: 21327135 PMCID: PMC3035959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND The functional significance of myocardial bridging remains controversial. The bridge morphology and structure of the tunneled vessels may modify its ultimate clinical effects. OBJECTIVE To describe the morphological characteristics of myocardial bridges and their influence on coronary histology. DESIGN A descriptive cross-sectional study. METHODS One hundred and nine formalin-fixed adult hearts were evaluated by dissection for these data: prevalence, site, lengths and depths of myocardial bridges. Vessel segments proximal and distal to the bridged portion were also processed for histology and stained to elaborate smooth muscle, collagen and elastic fibers. Stereology was also employed to compare the relative sizes of the tunica intima and the vessel wall to lumen ratios. RESULTS Myocardial bridges were found in 40.4% of the hearts, most commonly in the left anterior descending artery (LAD). The average length of the bridges was 22.66 +11.94 mm while the depth was 1.83+ 0.98mm, with only 11% being long (34.87mm - 50mm) and 9% of them being deep (3.46mm - 5.00mm). The tunica intima was thickest proximal to and thinnest under the myocardial bridge. The intima of the proximal segment was also more elastic. An elaborate perivascular 'cushion' of adipose tissue intervened between the intramural coronary and the surrounding myocardium. CONCLUSIONS Most myocardial bridges are superficial and short. Tunica intima under myocardial bridges is spared from "atherogenesis". The thick perivascular space around the bridged segment may protect it from extreme compression.
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Affiliation(s)
- H Saidi
- Department of Human anatomy, University of Nairobi, Kenya
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47
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Myocardial bridges of the coronary arteries in the human fetal heart. Anat Sci Int 2009; 85:140-4. [DOI: 10.1007/s12565-009-0069-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 11/26/2009] [Indexed: 10/20/2022]
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48
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Yukio I, Yoko K, Ehiichi K, Toshiharu I. (1) coronary events caused by myocardial bridge. Ann Vasc Dis 2009; 2:79-94. [PMID: 23555365 DOI: 10.3400/avd.avdsasvp09001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2009] [Indexed: 01/25/2023] Open
Abstract
Myocardial bridge (MB), which covers a part of the left anterior descending coronary artery (LAD), is a normal anatomical variant structure (45% in frequency by autopsy) in LAD. MB contraction plays the role of a "double-edged sword" on the coronary events, suppressing coronary atherosclerosis under the MB, yet generating abnormal blood flow associated with coronary heart diseases (CHDs). High shear stress driven by MB compression causes the suppression of vascular permeability and vasoactive protein expression such as e-NOS and endothelin-1, which leads to the suppression of atherosclerosis in the LAD segment under the MB. However, despite the prevalent view of MB as benignancy by conventional coronary angiography (5-6% in frequency), with advance of imaging technique such as multislice spiral computed tomography [(MSCT); 16% in frequency], cardiologists are now frequently aware of symptomatic MB occurring not only in hospitalized patients, but also in young athletes free from atherosclerosis. Moreover, the large mass volume of MB muscle induces atherosclerosis evolution at the settled site in LAD proximal to MB and contributes to the occurrence of myocardial infarction. These events upon the coronary events result from the different pathophysiological mechanisms induced by contractile force of MB, which is solely determined just by the integration of anatomical properties of MB, such as the location, length and thickness of MB in an individual LAD. A recent MSCT provides the objective quantification of the anatomical variables that correlate with the histopathological results in relation to the occurrence of CHD. In this review, we therefore discuss the necessity to explore MB as a inherent chance anatomical risk factor for CHD.
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Affiliation(s)
- Ishikawa Yukio
- Department of Pathology, Toho University School of Medicine, Tokyo, Japan
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49
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Ishikawa Y, Akasaka Y, Suzuki K, Fujiwara M, Ogawa T, Yamazaki K, Niino H, Tanaka M, Ogata K, Morinaga S, Ebihara Y, Kawahara Y, Sugiura H, Takimoto T, Komatsu A, Shinagawa T, Taki K, Satoh H, Yamada K, Yanagida-Iida M, Shimokawa R, Shimada K, Nishimura C, Ito K, Ishii T. Anatomic Properties of Myocardial Bridge Predisposing to Myocardial Infarction. Circulation 2009; 120:376-83. [DOI: 10.1161/circulationaha.108.820720] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background—
A myocardial bridge (MB) that partially covers the course of the left anterior descending coronary artery (LAD) sometimes causes myocardial ischemia, primarily because of hemodynamic deterioration, but without atherosclerosis. However, the mechanism of occurrence of myocardial infarction (MI) as a result of an MB in patients with spontaneously developing atherosclerosis is unclear.
Methods and Results—
One hundred consecutive autopsied MI hearts either with MBs [MI(+)MB(+) group; n=46] or without MBs (n=54) were obtained, as were 200 normal hearts, 100 with MBs [MI(−)MB(+) group] and 100 without MBs. By microscopy on LADs that were consecutively cross-sectioned at 5-mm intervals, the extent and distribution of LAD atherosclerosis were investigated histomorphometrically in conjunction with the anatomic properties of the MB, such as its thickness, length, and location and the MB muscle index (MB thickness multiplied by MB length), according to MI and MB status. In the MI(+)MB(+) group, the MB showed a significantly greater thickness and greater MB muscle index (
P
<0.05) than in the MI(−)MB(+) group. The intima-media ratio (intimal area/medial area) within 1.0 cm of the left coronary ostium was also greater (
P
<0.05) in the MI(+)MB(+) group than in the other groups. In addition, in the MI(+)MB(+) group, the location of the segment that exhibited the greatest intima-media ratio in the LAD proximal to the MB correlated significantly (
P
<0.001) with the location of the MB entrance, and furthermore, atherosclerosis progression in the LAD proximal to the MB was largest at 2.0 cm from the MB entrance.
Conclusions—
In the proximal LAD with an MB, MB muscle index is associated with a shift of coronary disease more proximally, an effect that may increase the risk of MI.
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Affiliation(s)
- Yukio Ishikawa
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Yoshikiyo Akasaka
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Koyu Suzuki
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Mieko Fujiwara
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Takafumi Ogawa
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Kazuto Yamazaki
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Hitoshi Niino
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Michio Tanaka
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Kentaro Ogata
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Shojiroh Morinaga
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Yoshiro Ebihara
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Yutaka Kawahara
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Hitoshi Sugiura
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Toshiro Takimoto
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Akio Komatsu
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Toshihito Shinagawa
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Kazuhiro Taki
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Hideaki Satoh
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Kazuaki Yamada
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Maki Yanagida-Iida
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Reiko Shimokawa
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Kazuyuki Shimada
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Chiaki Nishimura
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Kinji Ito
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
| | - Toshiharu Ishii
- From the Tokyo Study Group on Myocardial Bridge, which consisted of the departments of pathology at Toho University School of Medicine (Y.I., Y.A., K.I., T.I.), Tokyo, Japan; St Luke’s International Hospital (K. Suzuki, M.F., T.O.), Tokyo, Japan; Tokyo Saiseikai Central Hospital (K. Yamazaki), Tokyo, Japan; the National Hospital Organization Yokohama Medical Center (H.N.), Yokohama, Japan; Tokyo Metropolitan Hiroo Hospital (M.T.), Tokyo, Japan; Kyosai Tachikawa Hospital (K.O.), Tachikawa, Japan
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Kersemans M, Van Heuverswyn F, De Pauw M, Gheeraert P, Taeymans Y, Drieghe B. Hemodynamic Effect of Myocardial Bridging. Circ Cardiovasc Interv 2009; 2:361-2. [DOI: 10.1161/circinterventions.109.855395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Michel De Pauw
- From the Heart Center, University Hospital Ghent, Ghent, Belgium
| | - Peter Gheeraert
- From the Heart Center, University Hospital Ghent, Ghent, Belgium
| | - Yves Taeymans
- From the Heart Center, University Hospital Ghent, Ghent, Belgium
| | - Benny Drieghe
- From the Heart Center, University Hospital Ghent, Ghent, Belgium
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