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Zhang D, Tian X, Li MY, Zheng WS, Yu Y, Zhang HW, Pan T, Gao BL, Li CY. Quantitative computed tomography angiography evaluation of the coronary fractional flow reserve in patients with left anterior descending artery myocardial bridging. Clin Physiol Funct Imaging 2024; 44:251-259. [PMID: 38356324 DOI: 10.1111/cpf.12872] [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: 06/21/2023] [Revised: 12/28/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE To quantitatively investigate the effect of myocardial bridge (MB) in the left anterior descending artery (LAD) on the fractional flow reserve (FFR). MATERIALS AND METHODS Three-hundred patients with LAD MB who had undergone coronary artery CT angiography (CCTA) were retrospectively enroled, and 104 normal patients were enroled as the control. The CCTA-derived fractional flow reserve (FFRCT) was measured at the LAD 10 mm proximal (FFR1) and 20-40 mm distal (FFR3) to the MB and at the MB location (FFR2). RESULTS FFR2 and FFR3 of the MB (with BM only) and MBLA (with both MB and atherosclerosis) groups were significantly (p < 0.01) lower than those of the control. The FFR3 distal to the MB was significantly lower (p < 0.01) than that of the control. The FFRCT of the whole LAD in the MBLA group was significantly (p < 0.05) lower than that of the MB and control group (p < 0.05). MB length (OR 1.061) and MB muscle index (odds ratio or OR 1.007) were two risk factors for abnormal FFRCT, and MB length was a significant independent risk factor for abnormal FFRCT (OR = 1.077). LAD stenosis degree was a risk factor for abnormal FFRCT values (OR 3.301, 95% confidence interval [CI] 1.441-7.562, p = 0.005) and was also a significant independent risk factor (OR = 3.369, 95% CI: 1.392-8.152; p = 0.007) for abnormal FFRCT. CONCLUSION MB significantly affects the FFRCT of distal coronary artery. For patients with MB without atherosclerosis, the MB length is a risk factor significantly affecting FFRCT, and for patients with MB accompanied by atherosclerosis, LAD stenotic severity is an independent risk factor for FFRCT.
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Affiliation(s)
- Dan Zhang
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xin Tian
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Meng-Ya Li
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Wen-Song Zheng
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yang Yu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Hao-Wen Zhang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Tong Pan
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Bu-Lang Gao
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Cai-Ying Li
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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Zhang D, Tian X, Li MY, Zhang HW, Yu Y, Pan T, Li CY. Quantitative analysis of the relationship between the myocardial bridge and the FAI of pericoronal fat on computed tomography. Sci Rep 2024; 14:5976. [PMID: 38472256 DOI: 10.1038/s41598-024-55005-9] [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: 03/19/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
We performed this cohort study to investigate whether the myocardial bridge (MB) affects the fat attenuation index (FAI) and to determine the optimal cardiac phase to measure the volume and the FAI of pericoronary adipose tissue (PCAT). The data of 300 patients who were diagnosed with MB of the left anterior descending (LAD) coronary artery were retrospectively analyzed. All of patients were divided into the MB group and the MB with atherosclerosis group. In addition, 104 patients with negative CCTA results were enrolled as the control group. There was no significant difference between FAI values measured in systole and diastole (P > 0.05). There was no significant difference in FAI among the MB group, the MB with atherosclerosis group, and the control group (P > 0.05). In MB with atherosclerosis group, LAD stenosis degree (< 50%) (OR = 0.186, 95% CI 0.036-0.960; P = 0.045) and MB located in the distal part of LAD opening (OR = 0.880, 95% CI 0.789-0.980; P = 0.020) were protective factors of FAI value. A distance (from the LAD opening to the proximal point of the MB) of 29.85 mm had the highest predictive value for abnormal FAI [area under the curve (AUC), 0.798], with a sensitivity of 81.1% and a specificity of 74.6%.
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Affiliation(s)
- Dan Zhang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei, China
- Department of Radiology, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050000, Hebei, China
| | - Xin Tian
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei, China
| | - Meng-Ya Li
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei, China
| | - Hao-Wen Zhang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei, China
| | - Yang Yu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei, China
| | - Tong Pan
- Department of Medical Imaging, Hebei General Hospital, Shijiazhuang, 050000, Hebei, China
| | - Cai-Ying Li
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei, China.
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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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Parnell LKS, Tanaka R, Volk SW. Yoshikiyo Akasaka: Impact on wound healing across the globe. Wound Repair Regen 2022; 30:613-616. [DOI: 10.1111/wrr.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/24/2022]
Affiliation(s)
| | - Rica Tanaka
- Division of Regenerative Therapy, Graduate School of Juntendo University, Department of Plastic Surgery and Reconstructive Surgery Medical School of Juntendo University Tokyo Japan
| | - Susan W. Volk
- Department of Clinical Sciences and Advanced Medicine University of Pennsylvania School of Veterinary Medicine Philadelphia Pennsylvania USA
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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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Hashikata T, Honda Y, Wang H, Pargaonkar VS, Nishi T, Hollak MB, Rogers IS, Nieman K, Yock PG, Fitzgerald PJ, Schnittger I, Boyd JH, Tremmel JA. Impact of Diastolic Vessel Restriction on Quality of Life in Symptomatic Myocardial Bridging Patients Treated With Surgical Unroofing: Preoperative Assessments With Intravascular Ultrasound and Coronary Computed Tomography Angiography. Circ Cardiovasc Interv 2021; 14:e011062. [PMID: 34665656 DOI: 10.1161/circinterventions.121.011062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Takehiro Hashikata
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Hanjay Wang
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Vedant S Pargaonkar
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Takeshi Nishi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.).,Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan (T.N.)
| | - M Brooke Hollak
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Ian S Rogers
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Koen Nieman
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.).,Department of Radiology, Stanford University School of Medicine, CA (K.N.)
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Jack H Boyd
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
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Erol N. Challenges in Evaluation and Management of Children with Myocardial Bridging. Cardiology 2021; 146:273-280. [PMID: 33631747 DOI: 10.1159/000513900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 12/10/2020] [Indexed: 11/19/2022]
Abstract
Myocardial bridging (MB) is a congenital anomaly where a coronary artery branch or group of branches extends inside a tunnel consisting of myocardium. Although it is mostly considered "benign," it is reported that MB may lead to significant cardiac problems and sudden cardiac deaths. While it is a congenital anomaly, its symptoms usually arise at further ages rather than childhood. The literature on MB in children is in the form of case reports or small case series. This is why pediatric cases are assessed in the light of information obtained from adults. This review compiled the literature on MB in adults and children and compared it, as well as discussing questions arising regarding the clinic, diagnosis, and treatment of MB.
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Affiliation(s)
- Nurdan Erol
- Pediatric Clinics, Zeynep Kamil Gynecology and Pediatrics Training and Research Hospital, Health Sciences University, Uskudar/Istanbul, Turkey,
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Papp S, Bárczi G, Karády J, Kolossváry M, Drobni ZD, Simon J, Boussoussou M, Vattay B, Szilveszter B, Jermendy G, Merkely B, Maurovich-Horvat P. Coronary plaque burden of the left anterior descending artery in patients with or without myocardial bridge: A case-control study based on coronary CT-angiography. Int J Cardiol 2020; 327:231-235. [PMID: 33276021 DOI: 10.1016/j.ijcard.2020.11.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The clinical significance of myocardial bridging (MB) on the left anterior descending artery (LAD) is debated. We aimed to assess the association between MB and LAD plaque volumes/compositions in a case-control set up. METHODS In our retrospective analysis we investigated 50 cases with incidentally recognized LAD MB and 50 matched controls without LAD MB on coronary computed tomography angiography. We quantified plaque volumes proximal to the MB and beneath it in patients with MB and in the corresponding coronary segments in patients without MB. RESULTS In total, we have included 100 patients (mean age 60.6 ± 10.8 years, males: 80%). Plaque volume was similar in the LAD segments proximal to the MB in cases vs. controls (150.0 mm3 [IQR: 90.7-194.5 mm3] vs. 132.8 mm3 [IQR: 94.2-184.3 mm3], respectively; p = 0.95) while the plaque volume was smaller beneath LAD MB vs. control segment (16.2 mm3 [IQR: 12.6-25.8 mm3] vs. 21.1 mm3 [IQR: 14.0-42.4 mm3], respectively; p = 0.002). No significant differences were found regarding different plaque components in segments proximal to the MB while fatty plaque and necrotic core volumes were smaller or negligible in coronary segment beneath MB than in controls (0.07 mm3 [IQR: 0.005-0.27 mm3] vs. 12.7 mm3 [IQR: 7.4-24.4 mm3] and 0.00 mm3 [IQR: 0.00-0.04 mm3] vs. 0.06 mm3 [IQR: 0.03-2.8 mm3], respectively (p < 0.001). CONCLUSION Comparing patients with MB vs. matched controls without it, MB was not associated with increased plaque volumes in LAD segment proximal to MB and plaque quantity was smaller in the MB segment. Our data are supportive of benign nature of incidentally recognized LAD MB.
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Affiliation(s)
- Sára Papp
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - György Bárczi
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Júlia Karády
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsófia D Drobni
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Melinda Boussoussou
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Borbála Vattay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - György Jermendy
- Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary; Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
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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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Nafakhi H, Al-Mosawi AA, Hassan MB, Hameed F, Alareedh M, Al-Shokry W. ECG changes and markers of increased risk of arrhythmia in patients with myocardial bridge. J Electrocardiol 2019; 56:90-93. [PMID: 31349132 DOI: 10.1016/j.jelectrocard.2019.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/20/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The clinical significance and prognosis of myocardial bridge (MB) is still a matter of debate. OBJECTIVES To assess the novel ECG markers of T peak-to-end (Tp-e) interval, transmural dispersion of repolarization (TDR), is assessed by Tp-e/QT ratio, and index of electrophysiogical index(iCEB),is defined by QT/QRS ratio and changes (ST-T changes) in MB patients. PATIENTS AND METHODS Forty one patients who were diagnosed as having MB (MB group) and other 41 patients without MB (non-MB group) at multi-detector CT (MDCT) exam matched by age, sex were enrolled in the study. RESULTS iCEB was significantly increased in MB group in comparison to non-MB group particularly in patients with no coronary atherosclerosis (5.3 Vs 4.5, p = 0.04). Tp-e and TDR values were decreased in MB in comparison to non-MB patients particularly in patients with coronary atherosclerosis (69 Vs 80, p = 0.003 and 0.18 Vs 0.2, p = 0.01 respectively). Isolated T inversion in V1 was observed more in MB compared to non-MB patients (58% Vs 5%, p ≤ 0.0001) particularly in patients without coronary atherosclerosis. CONCLUSION MB patients have shown decreased Tp-e and TDR markers particularly in MB patients with coronary atherosclerosis.
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Affiliation(s)
- Hussein Nafakhi
- Internal Medicine Department, Medicine College, University of Kufa, Najaf, Iraq.
| | | | | | - Fatima Hameed
- Radiology Department, Medicine College, Kufa University, Najaf, Iraq
| | - Mohammed Alareedh
- Internal medicine department, Medicine College, University of Kufa, Najaf, Iraq.
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Abstract
Coronary anomalies occur in about 1% of the general population and in severe cases can lead to sudden cardiac death. Coronary computed tomography angiography and magnetic resonance imaging have been deemed appropriate for the evaluation of coronary anomalies by accurately allowing the noninvasive depiction of coronary artery anomalies of origin, course, and termination. The aim of this article is to describe and illustrate a comprehensive array for the classification of coronary artery anomalies.
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Paraskevas G, Koutsouflianiotis K, Iliou K. Myocardial bridge over the left anterior descending coronary artery: A case report and review of the literature. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:113. [PMID: 29184571 PMCID: PMC5680658 DOI: 10.4103/jrms.jrms_775_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 05/27/2017] [Accepted: 09/18/2017] [Indexed: 11/11/2022]
Abstract
Myocardial bridging (MB) is considered as a topic of high interest since its occurrence in different studies is statistically significant, and the clinical manifestations of this phenomenon are complicated with cardiovascular diseases. Whether the MB participates in heart diseases and has a decisive effect to life-threatening situations is still under research, and many studies have been conducted to clarify the abovementioned question. A case report with a MB on the left anterior descending coronary artery is presented in the current study, and a review of the literature is provided as well. Cardiologists as well thoracic surgeons and radiologists should bear in their mind the potential presence of such variant during interpretation of angiographies and multidetector-computed tomography.
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Affiliation(s)
- George Paraskevas
- Department of Anatomy, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Kalliopi Iliou
- Department of Anatomy, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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14
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Forsdahl SH, Rogers IS, Schnittger I, Tanaka S, Kimura T, Pargaonkar VS, Chan FP, Fleischmann D, Tremmel JA, Becker HC. Myocardial Bridges on Coronary Computed Tomography Angiography - Correlation With Intravascular Ultrasound and Fractional Flow Reserve. Circ J 2017; 81:1894-1900. [PMID: 28690285 DOI: 10.1253/circj.cj-17-0284] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Myocardial bridges (MB) are commonly seen on coronary CT angiography (CCTA) in asymptomatic individuals, but in patients with recurrent typical angina symptoms, yet no obstructive coronary artery disease (CAD), evaluation of their potential hemodynamic significance is clinically relevant. The aim of this study was to compare CCTA to invasive coronary angiography (ICA), including intravascular ultrasound (IVUS), to confirm MB morphology and estimate their functional significance in symptomatic patients.Methods and Results:We retrospectively identified 59 patients from our clinical databases between 2009 and 2014 in whom the suspicion for MB was raised by symptoms of recurrent typical angina in the absence of significant obstructive CAD on ICA. All patients underwent CCTA, ICA and IVUS. MB length and depth by CCTA agreed well with length (0.6±23.7 mm) and depth (CT coverage) as seen on IVUS. The product of CT length and depth (CT coverage), (MB muscle index (MMI)), ≥31 predicted an abnormal diastolic fractional flow reserve (dFFR) ≤0.76 with a sensitivity and specificity of 74% and 62% respectively (area under the curve=0.722). CONCLUSIONS In patients with recurrent symptoms of typical angina yet no obstructive CAD, clinicians should consider dynamic ischemia from an MB in the differential diagnosis. The product of length and depth (i.e., MMI) by CCTA may provide some non-invasive insight into the hemodynamic significance of a myocardial bridge, as compared with invasive assessment with dFFR.
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Affiliation(s)
| | - Ian S Rogers
- Division of Cardiovascular Medicine, Stanford University School of Medicine
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University School of Medicine
| | - Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford University School of Medicine
| | - Takumi Kimura
- Division of Cardiovascular Medicine, Stanford University School of Medicine
| | | | - Frandics P Chan
- Department of Radiology, Stanford University School of Medicine
| | | | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University School of Medicine
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15
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Perl L, Daniels D, Schwartz J, Tanaka S, Yeung A, Tremmel JA, Schnittger I. Myocardial Bridge and Acute Plaque Rupture. J Investig Med High Impact Case Rep 2017; 4:2324709616680227. [PMID: 28251167 PMCID: PMC5317013 DOI: 10.1177/2324709616680227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022] Open
Abstract
A myocardial bridge (MB) is a common anatomic variant, most frequently located in the left anterior descending coronary artery, where a portion of the coronary artery is covered by myocardium. Importantly, MBs are known to result in a proximal atherosclerotic lesion. It has recently been postulated that these lesions predispose patients to acute coronary events, even in cases of otherwise low-risk patients. One such mechanism may involve acute plaque rupture. In this article, we report 2 cases of patients with MBs who presented with acute coronary syndromes despite having low cardiovascular risk. Their presentation was life-risking and both were treated urgently and studied with coronary angiographies and intravascular ultrasound. This latter modality confirmed a rupture of an atherosclerotic plaque proximal to the MB as a likely cause of the acute events. These cases, of unexplained acute coronary syndrome in low-risk patients, raise the question of alternative processes leading to the event and the role MB play as an underlying cause of ruptured plaques. In some cases, an active investigation for this entity may be warranted, due to the prognostic implications of the different therapeutic modalities, should an MB be discovered.
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Affiliation(s)
- Leor Perl
- Stanford University Medical Center, Stanford, CA, USA
| | | | | | - Shige Tanaka
- Stanford University Medical Center, Stanford, CA, USA
| | - Alan Yeung
- Stanford University Medical Center, Stanford, CA, USA
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Spontaneous coronary artery dissection in the presence of myocardial bridge causing myocardial infarction: an insight into mechanism. Int J Cardiol 2016; 206:77-8. [DOI: 10.1016/j.ijcard.2016.01.085] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/03/2016] [Indexed: 11/19/2022]
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17
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Coronary artery perforation in a patient with STEMI and a myocardial bridge: an increased risk for coronary artery perforation? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:246-8. [PMID: 25842348 DOI: 10.1016/j.carrev.2015.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/10/2015] [Accepted: 03/17/2015] [Indexed: 12/14/2022]
Abstract
We present the case of a patient with ST-elevation myocardial infarction (STEMI) due to subtotal occlusion of the left anterior descending coronary artery caused by an atherosclerotic lesion and a myocardial bridge (MB). Stenting of the MB caused coronary artery perforation resulting in a fistula to the right ventricle that was closed by implantation of a PTFE-covered stent. Follow-up coronary angiography showed persistent shunting, which was sealed by inflation of a high-pressure balloon over the site of extravasation guided by intravascular ultrasound. Additionally, we provide a short review of cases with coronary artery perforation after stenting of an MB.
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Domínguez Domínguez L, Costa Pérez-Herrero J. Bloqueo de rama dependiente de frecuencia y trayecto coronario intramiocárdico: otras causas de dolor torácico. Rev Clin Esp 2015; 215:135-6. [DOI: 10.1016/j.rce.2014.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/22/2014] [Accepted: 10/26/2014] [Indexed: 10/24/2022]
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Congenital coronary artery anomalies silent until geriatric age: non-invasive assessment, angiography tips, and treatment. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2015; 12:66-75. [PMID: 25678906 PMCID: PMC4308460 DOI: 10.11909/j.issn.1671-5411.2015.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/27/2014] [Accepted: 11/07/2014] [Indexed: 01/09/2023]
Abstract
Coronary artery anomalies (CAAs) may be discovered more often as incidental findings during the normal diagnostic process for other cardiac diseases or less frequently on the basis of manifestations of myocardial ischemia. The cardiovascular professional may be involved in their angiographic diagnosis, functional assessment and eventual endovascular treatment. A complete angiographic definition is mandatory in order to understand the functional effects and plan any intervention in CAAs: computed tomography and magnetic resonance imaging are useful non-invasive tools to detect three-dimensional morphology of the anomalies and its relationships with contiguous cardiac structures, whereas coronary arteriography remains the gold standard for a definitive anatomic picture. A practical idea of the possible functional significance is mandatory for deciding how to manage CAAs: non-invasive stress tests and in particular the invasive pharmacological stress tests with or without intravascular ultrasound monitoring can assess correctly the functional significance of the most CAAs. Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success. CAAs represent a complex issue, which rarely involve the cardiovascular professional at different levels. A timely practical knowledge of the main issues regarding CAAs is important in the management of such entities.
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