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Song C, Wang S, Guo X, Huang M, Zheng X, Lu J, Ji K, Zhao S, Cui J, Wang S, Huang X. Myocardial bridging in obstructive hypertrophic cardiomyopathy: a risk factor for myocardial fibrosis. BMC Med 2024; 22:86. [PMID: 38413945 PMCID: PMC10900667 DOI: 10.1186/s12916-024-03301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Myocardial bridging (MB) is common in patients with hypertrophic cardiomyopathy (HCM). There are sparse data on the impact of MB on myocardial fibrosis in HCM. This study was designed to evaluate the relationship between MB and myocardial fibrosis in patients with obstructive HCM. METHODS In this cohort study, retrospective data were collected from a high-volume HCM center. Patients with obstructive HCM who underwent septal myectomy and preoperative cardiac magnetic resonance (CMR) were screened from 2011 to 2018. RESULTS Finally, 492 patients were included in this study, with an average age of 45.7 years. Of these patients, 76 patients had MB. MB occurred mostly in the left anterior descending artery (73/76). The global extent of late gadolinium enhancement (LGE) was correlated with the degree of systolic compression (r = 0.33, p = 0.003). Multivariable linear regression analysis revealed that the degree of systolic compression was an independent risk factor for LGE (β = 0.292, p = 0.007). The LGE fraction of basal and mid anteroseptal segments in patients with severe MB (compression ratio ≥ 80%) was significantly greater than that in patients with mild to moderate MB (compression ratio < 80%). During a median follow-up of 28 (IQR: 15-52) months, 15 patients died. Kaplan-Meier analysis did not identify differences in all-cause death (log-rank p = 0.63) or cardiovascular death (log-rank p = 0.72) between patients undergoing MB-related surgery and those without MB. CONCLUSIONS MB with severe systolic compression was significantly associated with a high extent of fibrosis in patients with obstructive HCM. Concomitant myotomy or coronary artery bypass grafting might provide excellent survival similar to that of patients without MB. Identification of patients with severe MB and providing comprehensive management might help improve the prognosis of patients with HCM.
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Affiliation(s)
- Changpeng Song
- Department of Special Medical Treatment Center in Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Shengwei Wang
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, People's Republic of China
| | - Xinli Guo
- Department of Special Medical Treatment Center in Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Manyun Huang
- Department of Special Medical Treatment Center in Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Xinxin Zheng
- Department of Special Medical Treatment Center in Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Jie Lu
- Department of Special Medical Treatment Center in Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Keshan Ji
- Department of Magnetic Resonance Imaging in Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging in Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jingang Cui
- Department of Special Medical Treatment Center in Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China.
| | - Shuiyun Wang
- Department of Cardiovascular Surgery in Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
| | - Xiaohong Huang
- Department of Special Medical Treatment Center in Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China.
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2
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Güner A, Atmaca S, Balaban İ, Türkmen İ, Çeneli D, Türkvatan A, Öner E, Sürgit Ö, Güler A, Uzun F, Babür Güler G, Kahraman S, Pala S, Havan N, Yıldız M, Ertürk M. Relationship between myocardial bridging and fatal ventricular arrhythmias in patients with hypertrophic cardiomyopathy: the HCM-MB study. Herz 2023; 48:399-407. [PMID: 37081129 DOI: 10.1007/s00059-023-05171-9] [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: 12/11/2022] [Revised: 01/31/2023] [Accepted: 03/01/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Myocardial bridging (MB) and hypertrophic cardiomyopathy (HCM) are associated with the risk of fatal ventricular arrhythmias (VAs). The goal of the study was to determine the relationship between MB and fatal VAs in HCM patients with implantable cardiac defibrillators (ICD). METHODS A total of 108 HCM patients (mean age: 46.6 ± 13.6 years; male: 73) were enrolled in this retrospective study. All patients underwent transthoracic echocardiography and coronary computed tomography angiography. Fatal VAs including sustained ventricular tachycardia and ventricular fibrillation were documented in ICD records. RESULTS There were documented fatal VAs in 29 (26.8%) patients during a mean follow-up time of 71.3 ± 30.9 months. Compared with the other groups, the fatal VA group had a higher incidence of the following: presence of MB (82.8 vs. 38%, p < 0.001), deep MB (62.1 vs. 6.3%, p < 0.001), very deep MB (24.1 vs. 0%, p < 0.001), long MB (65.5 vs. 11.4%, p < 0.001), presence of > 1 MB (17.2 vs. 0%, p = 0.001), and MB of the left anterior descending artery (79.3 vs. 17.7%, p < 0.001) . Sudden cardiac death (SCD) risk score (hazard ratio: 1.194; 95% CI: 1.071-1.330; p = 0.001) and presence of MB (hazard ratio: 3.815; 95% CI: 1.41-10.284; p = 0.008) were found to be independent predictors of fatal VAs in HCM patients. CONCLUSIONS The current data suggest that the SCD risk score and presence of MB were independent risk factors for fatal VAs in patients with HCM. In addition to conventional risk factors, the coronary anatomical course can provide clinicians with valuable information when assessing the risk of fatal VAs in HCM patients.
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MESH Headings
- Humans
- Male
- Adult
- Middle Aged
- Retrospective Studies
- Myocardial Bridging/complications
- Myocardial Bridging/diagnostic imaging
- Myocardial Bridging/epidemiology
- Arrhythmias, Cardiac
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/etiology
- Risk Factors
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Defibrillators, Implantable/adverse effects
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Affiliation(s)
- Ahmet Güner
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey.
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Turgut Özal Bulvari No. 11, 34303, Kucukcekmece, Istanbul, Turkey.
| | - Sezgin Atmaca
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - İsmail Balaban
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - İrem Türkmen
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Doğancan Çeneli
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Aysel Türkvatan
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Radiology, University of Health Sciences, Istanbul, Turkey
| | - Ender Öner
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Özgür Sürgit
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Arda Güler
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Fatih Uzun
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Gamze Babür Güler
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Serkan Kahraman
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Selçuk Pala
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Nuri Havan
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Radiology, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Yıldız
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Ertürk
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
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Guo F, Yan J, Xue X. The relationship between CTA performances and cardiac function indicators in myocardial bridge and mural coronary artery. Am J Transl Res 2023; 15:4779-4787. [PMID: 37560240 PMCID: PMC10408538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/26/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To investigate the relationship between computed tomography angiography (CTA) performances and cardiac function indicators in patients with myocardial bridge and mural coronary artery (MB-MCA). METHODS The clinical data of 60 patients with MB-MCA receiving CTA in the First Hospital of Zhangjiakou from January 2021 to February 2022 were analyzed retrospectively. The patients were divided into different groups based on CTA performances, including the degree of stenosis of the left anterior descending (LAD) MCA, whether there was atherosclerosis in the anterior segment of MB of LAD branch, the MB thickness, and the degree of stenosis of the LAD branch. The correlation between these TCA performances and cardiac function indicators including end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV), cardiac output (CO), and left ventricular ejection fraction (LVEF) was analyzed. Besides, the receiver operating characteristic (ROC) curve was used to analyze the predictive performance of cardiac function indicators for the severity of MB-MCA. RESULTS ESV, EDV, SV, CO and LVEF were statistically different between the moderate stenosis group and mild stenosis group (all P < 0.05). EDV, SV, CO, and LVEF were statistically different between the atherosclerosis group and non-atherosclerosis group (all P < 0.05). SV, CO, LVEF in the deep group were lower than that in the superficial group (all P < 0.05). EDV, CO, LVEF were different between the LAD moderate stenosis group and LAD mild stenosis group (all P < 0.05). The AUC (areas under the curve) of combined detection of ESV, EDV, SV, CO, and LVEF in predicting the severity of MB-MCA was 0.907, which was higher than the single indicator predictive effect. CONCLUSIONS Cardiac function indicators, mainly CO and LVEF are correlated with the CTA performance of MB-MCA patients. The combination of cardiac function indicators has a good effect in predicting the severity of MB-MCA.
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Affiliation(s)
- Fuzhen Guo
- Department of Emergency, The First Hospital of ZhangjiakouZhangjiakou 075000, Hebei, China
| | - Junfen Yan
- Department of Gastroenterology, Hebei Huaao HospitalZhangjiakou 075000, Hebei, China
| | - Xiubin Xue
- Department of Radiology, The First Hospital of ZhangjiakouZhangjiakou 075000, Hebei, China
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Bruce C, Ubhi N, McKeegan P, Sanders K. Systematic Review and Meta-Analysis of Cardiovascular Consequences of Myocardial Bridging in Hypertrophic Cardiomyopathy. Am J Cardiol 2023; 188:110-119. [PMID: 36512852 DOI: 10.1016/j.amjcard.2022.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/17/2022] [Accepted: 10/30/2022] [Indexed: 12/14/2022]
Abstract
Myocardial bridging (MB) is a congenital variant in which a segment of a coronary artery follows an atypical intramural course under a "bridge" of myocardium and is notably common in hypertrophic cardiomyopathy (HCM). This systematic review and meta-analysis explored the clinical consequences of MB in patients with HCM. A total of 3 outcome domains were investigated: cardiovascular mortality, nonfatal adverse cardiac events, and investigative indicators of myocardial ischemia. A meta-analysis was performed on 10 observational studies comparing outcomes in patients with HCM with and without MB. Studies were identified through a systematic search of 4 databases (PubMed, Scopus, Medline Complete, and Web of Science). The quality of the studies was assessed using a modified version of the Downs and Black tool, from which studies could score a maximum of 23 points. The mean score was 17.5 ± 1.3 (good). The meta-analysis showed that MB was not associated with cardiovascular mortality (odds ratio [OR] 1.70, 95% confidence interval [CI] 0.56 to 5.15, p = 0.35) or nonfatal adverse cardiac events (OR 1.80, 95% CI 0.98 to 3.28, p = 0.06) but was associated with myocardial ischemia (OR 1.89, 95% CI 1.03 to 3.44, p = 0.04). In conclusion, the potential prognostic implications of MB in HCM, especially in those with hemodynamically significant bridges and/or severe underlying disease, should not be ignored. The focus of future studies should be to establish functional and morphologic thresholds, by which MB may adversely influence prognosis by corroborating imaging findings with clinical outcome data.
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Affiliation(s)
- Callum Bruce
- Center for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom.
| | - Niall Ubhi
- Center for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Paul McKeegan
- Center for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Katherine Sanders
- Center for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
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Nie C, Zhu C, Yang Q, Xiao M, Meng Y, Wang S. Correction to: Myocardial bridging of the left anterior descending coronary artery as a risk factor for atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy: a matched case-control study. BMC Cardiovasc Disord 2021; 21:401. [PMID: 34412577 PMCID: PMC8375129 DOI: 10.1186/s12872-021-02204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Changrong Nie
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing, 100037, China
| | - Changsheng Zhu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing, 100037, China
| | - Qiulan Yang
- Department of Intensive Care Unit, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minghu Xiao
- Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanhai Meng
- Department of Intensive Care Unit, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuiyun Wang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing, 100037, China.
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