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Frontiers in Cardiovascular Medicine 2022
PubMed: 35669481
DOI: 10.3389/fcvm.2022.930230 -
Nature Reviews. Cardiology Apr 2020Atherosclerosis and plaque disruption have a central pathological role in the majority of patients who present with an acute coronary syndrome (ACS), but... (Review)
Review
Atherosclerosis and plaque disruption have a central pathological role in the majority of patients who present with an acute coronary syndrome (ACS), but non-atherosclerotic processes are also important contributors to a substantial number of ACS events and require different diagnostic and therapeutic strategies. In the absence of obstructive coronary artery disease, intravascular imaging techniques might be needed to delineate the underlying aetiology, together with a high index of suspicion for other important causes of ACS. In this Review, we discuss five non-atherosclerotic causes of ACS, including spontaneous coronary artery dissection, coronary artery embolism, vasospasm, myocardial bridging and stress-induced cardiomyopathy (Takotsubo syndrome). Important diagnostic findings, management strategies and prognostic data for these non-atherosclerotic mechanisms of ACS are reviewed.
Topics: Acute Coronary Syndrome; Humans
PubMed: 31582839
DOI: 10.1038/s41569-019-0273-3 -
Trends in Cardiovascular Medicine Jan 2024Myocardial bridging (MB) is a common congenital abnormality that remains asymptomatic in a large proportion of patients. The peak of clinical manifestation occurs during... (Review)
Review
Myocardial bridging (MB) is a common congenital abnormality that remains asymptomatic in a large proportion of patients. The peak of clinical manifestation occurs during the third and fourth decades of life. MB provokes myocardial ischemia through different mechanisms including supply-demand mismatch, endothelial dysfunction, coronary microvascular dysfunction and external mechanical compression. The association between MB and atherosclerotic disease is controversial. Recent studies established a significant association of MB with myocardial infarction and non-obstructive coronary artery disease. The first line medical treatment is based on beta-blockers and calcium channel blockers. Ivabradine is used in second line therapy. Invasive approaches involving percutaneous coronary intervention, coronary artery bypass graft and myotomy are performed in patients with symptoms refractory to maximally tolerated medical treatment. The choice of revascularization technique depends on anatomical characteristics, clinical condition and physician experience. Available data derived from anecdotal evidence view the lack of randomized clinical trials.
Topics: Humans; Myocardial Bridging; Coronary Artery Disease; Myocardial Ischemia; Coronary Artery Bypass; Myocardial Infarction; Coronary Angiography
PubMed: 35697237
DOI: 10.1016/j.tcm.2022.06.002 -
Cureus Aug 2023Myocardial bridging (MB) is a congenital coronary artery anomaly involving an overlying myocardium's partial or complete encasement of a coronary artery segment. The... (Review)
Review
Myocardial bridging (MB) is a congenital coronary artery anomaly involving an overlying myocardium's partial or complete encasement of a coronary artery segment. The obstruction can lead to significant cardiac symptoms, resulting in myocardial ischemia, arrhythmia, and sudden cardiac death. Several approaches, including invasive and non-invasive methods, have been proposed to diagnose and manage MB. Invasive modalities, such as intravascular ultrasound (IVUS) and coronary angiography, offer high specificity and sensitivity. In contrast, non-invasive methods like Doppler ultrasound, multislice computed tomography (MSCT), and magnetic resonance imaging (MRI) are advantageous due to their non-invasive nature, high sensitivity and specificity, and cost-effectiveness. Treatment options for MB mainly focus on relieving symptoms and preventing adverse outcomes. The use of pharmacological agents and surgical and percutaneous interventions has been documented in numerous studies. Studies conclude that MB is a treatable cardiac anomaly, and a combined approach of diagnosis, treatment, and follow-up is necessary to reduce the morbidity and mortality associated with this condition.
PubMed: 37692750
DOI: 10.7759/cureus.43132 -
International Journal of Cardiology Jul 2020
Topics: Coronary Artery Disease; Echocardiography, Stress; Humans; Myocardial Bridging; Prospective Studies; Retrospective Studies
PubMed: 32276771
DOI: 10.1016/j.ijcard.2020.03.076 -
Morphologie : Bulletin de L'Association... Dec 2023Myocardial bridging (MB) is a coronary anomaly in which a segment of the coronary artery is overlapped by a layer of myocardial tissue. Nowadays, there is no scientific... (Observational Study)
Observational Study
BACKGROUND
Myocardial bridging (MB) is a coronary anomaly in which a segment of the coronary artery is overlapped by a layer of myocardial tissue. Nowadays, there is no scientific agreement on if the MB are congenital or acquired or on the factors that determine their presence and/or absence.
OBJECTIVE
This study is performed to analyze the anatomical characteristics of adult and children's hearts regarding the shape of the left coronary artery branching, presence of pre-bridge arterial branch, coronary dominance and its correlations to MB formation.
METHODS
We analyzed 240 adults heart specimens and 63 children's specimens. The frequency of the myocardial bridges (MB) occurrence was performed through observational study of the anatomical specimens. The shape of the left coronary artery (LCA) branching, presence of pre-bridge arterial branch (PBB) and coronary dominance was determined superficial dissection of the epicardial adipose tissue and careful evaluation of the hearts.
RESULTS
A relation between the trifurcated pattern of the LCA and the presence of MB (P<0.0001, odds ratio=3.74) was found in adults heart and in children's hearts (P=0.003, odds ratio=16.0), as well as a relation between the presence of PBB and the presence of MB in adult hearts (P<0.0001) and children's hearts (P<0.0001).
CONCLUSION
Our findings suggest for the first time that the myocardial bridges are related to the presence of trifurcation of the left coronary artery and the pre-bridge arterial branch in adult and children's hearts.
Topics: Adult; Child; Humans; Myocardium; Myocardial Bridging; Dissection
PubMed: 37246099
DOI: 10.1016/j.morpho.2023.05.002 -
Comprehensive functional and anatomic assessment of myocardial bridging: Unlocking the Gordian Knot.Frontiers in Cardiovascular Medicine 2022Myocardial bridging (MB) is the most frequent congenital coronary anomaly in which a segment of an epicardial coronary artery takes a tunneled course under a bridge of... (Review)
Review
Myocardial bridging (MB) is the most frequent congenital coronary anomaly in which a segment of an epicardial coronary artery takes a tunneled course under a bridge of the myocardium. This segment is compressed during systole, resulting in the so-called "milking effect" at coronary angiography. As coronary blood flow occurs primarily during diastole, the clinical relevance of MB is heterogeneous, being usually considered an asymptomatic bystander. However, many studies have suggested its association with myocardial ischemia, anginal symptoms, and adverse cardiac events. The advent of contemporary non-invasive and invasive imaging modalities and the standardization of intracoronary functional assessment tools have remarkably improved our understanding of MB-related ischemia, suggesting the role of atherosclerotic lesions proximal to MB, vasomotor disorders and microvascular dysfunction as possible pathophysiological substrates. The aim of this review is to provide a contemporary overview of the pathophysiology and of the non-invasive and invasive assessment of MB, in the attempt to implement a case-by-case therapeutic approach according to the specific endotype of MB-related ischemia.
PubMed: 36426224
DOI: 10.3389/fcvm.2022.970422 -
The Annals of Thoracic Surgery Jun 2020
Topics: Humans; Myocardial Bridging
PubMed: 31981502
DOI: 10.1016/j.athoracsur.2019.11.057 -
European Cardiology Feb 2021Myocardial bridging occurs when coronary arteries run intramurally. Episodes of tachycardia can cause a dynamic obstruction that extends into diastole, compromising... (Review)
Review
Myocardial bridging occurs when coronary arteries run intramurally. Episodes of tachycardia can cause a dynamic obstruction that extends into diastole, compromising coronary filling time, and subsequently leading to ischaemia. Myocardial ischaemia, acute coronary syndrome, coronary spasm, myocardial stunning, arrhythmia, takotsubo cardiomyopathy, and sudden cardiac death have all been reported with bridging. Atherosclerotic plaques develop proximally in the bridge due to low shear stress and high oscillatory wall-flow. Factors affecting atherosclerotic build-up include disrupted flow patterns (particularly flow recirculation, which exacerbates LDL internalisation), cell adhesion and monocyte adhesion to the endothelium. Endothelial health depends on arterial flow patterns, given that the vessel reacts differently to various flow types, as confirmed in 3D simulations. Medication is the first-line therapy, while surgical de-roofing and coronary bypass are reserved for severe stenosis. Distinguishing physiological arterial compression from pathological stenosis is essential. Deeper bridges correlating with recurrent angina with an instantaneous wave-free ratio ≤0.89 or fractional flow reserve ≤0.80 are treated.
PubMed: 33737959
DOI: 10.15420/ecr.2020.33 -
European Heart Journal. Acute... Jun 2022Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a common disorder characterized by the presence of clinical criteria for acute myocardial... (Observational Study)
Observational Study
BACKGROUND
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a common disorder characterized by the presence of clinical criteria for acute myocardial infarction in the absence of obstructive coronary artery disease on angiography. We aim to investigate the relationship between myocardial bridging (MB) and MINOCA.
METHODS AND RESULTS
An observational retrospective study was conducted on 15 036 patients who had been referred for coronary angiography and who fulfilled the Fourth Universal Definition of Myocardial Infarction. The study population was divided into ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients, from which we defined two main groups: the MINOCA group and the coronary artery disease (CAD) group. Statistical analyses were carried out by using SPSS, version 20. The prevalence of angiographic MB among the groups was significantly greater in the MINOCA group (2.9% vs. 0.8%). MINOCA accounted for 14.5% of spontaneous myocardial infarction, and the clinical presentation was more frequently NSTEMI rather than STEMI (84.3% vs. 15.7%). After adjusting for confounders, multivariate analyses showed a positive association between MB and MINOCA [odds ratio = 3.28, 95% CI (2.34; 4.61) P < 0.001]. Cardiovascular risk factors were less common in the MINOCA population, which was younger and more often female.
CONCLUSION
MB is a risk factor for MINOCA. Because MB prevalence differed significantly between the controls (CAD group) and cases (MINOCA group), which were positively associated to MB, it seems likely that MB would be a potential cause of MINOCA. Investigations for MB in MINOCA cases and especially in NSTEMI patients seem necessary.
Topics: Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Female; Humans; MINOCA; Myocardial Bridging; Myocardial Infarction; Non-ST Elevated Myocardial Infarction; Retrospective Studies; Risk Factors; ST Elevation Myocardial Infarction
PubMed: 35511689
DOI: 10.1093/ehjacc/zuac047