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EuroIntervention : Journal of EuroPCR... Feb 2020Myocardial bridging (MB), characterised by the epicardial coronary vessel diving into the myocardium, is present in up to one third of adults and is associated with...
AIMS
Myocardial bridging (MB), characterised by the epicardial coronary vessel diving into the myocardium, is present in up to one third of adults and is associated with angina and acute coronary syndromes. MB is accompanied by altered blood flow mechanics and regional changes in wall sheer stress. The purpose of this study was to determine the association between myocardial bridging and coronary endothelial dysfunction.
METHODS AND RESULTS
Patients presenting with chest pain and found to have non-obstructive CAD (stenosis <40%) on angiography underwent an invasive assessment of epicardial and microvascular endothelial function. Epicardial endothelial function was assessed by measuring the percent change in coronary artery diameter in response to intracoronary infusions of acetylcholine (%ΔCADAch). Epicardial endothelial dysfunction was defined as a %ΔCADAch of <-20%. Microvascular endothelial function was assessed by the percent change in coronary blood flow in response to intracoronary infusions of acetylcholine (%ΔCBFAch), and microvascular endothelial dysfunction was defined as a %ΔCBFAch of <50%. MB was diagnosed angiographically by identifying the characteristic reduction in minimal luminal diameter during systole. Patients were divided into those with and those without MB, and the frequency of epicardial endothelial dysfunction and microvascular endothelial dysfunction was compared between patients with versus those without MB. Between 1993 and 2012, 1,469 patients (mean age 50.4 years, 35% male) underwent coronary angiography and invasive testing of endothelial function. Two hundred and eight (14.2%) patients were found to have MB in the LAD. Patients with any MB had a significantly higher frequency of endothelial dysfunction within the mid and/or distal vessel segment compared to patients without MB (60.1% vs 50.4%, p=0.012). In multivariate analyses, mid and/or distal vessel MB was a significant predictor of mid and/or distal vessel epicardial endothelial dysfunction (OR 1.44, 95% CI: 1.04-2.00, p=0.029) and of microvascular endothelial dysfunction (OR 1.34, 95% CI: 1.00-1.82, p=0.050).
CONCLUSIONS
MB co-localises with epicardial endothelial dysfunction and is significantly associated with microvascular endothelial dysfunction in symptomatic patients with non-obstructive CAD, supporting its potential role as a mechanism for angina in symptomatic patients with MB.
Topics: Chest Pain; Coronary Angiography; Coronary Artery Disease; Coronary Circulation; Coronary Vessels; Endothelium, Vascular; Female; Humans; Male; Middle Aged; Myocardial Bridging; Prevalence
PubMed: 30636680
DOI: 10.4244/EIJ-D-18-00920 -
Current Cardiology Reports Oct 2020The objective of this review is to present comparative echocardiography as a source of insights for human cardiovascular medicine. (Review)
Review
PURPOSE OF REVIEW
The objective of this review is to present comparative echocardiography as a source of insights for human cardiovascular medicine.
RECENT FINDINGS
We present echocardiographic examples of high impact human cardiovascular pathologies, including valvular, vascular, conduction, and myocardial disorders, in a wide range of species in varying environments. Unique features associated with comparative echocardiographic assessments are linked to human cardiology, including natural animal models of resistance and vulnerability. The cardiovascular vulnerabilities and strengths of other species can be a source of invaluable insights for human healthcare professionals. Echocardiography is playing a key role in bridging human and veterinary cardiology. Consequently, species-spanning echocardiography can deliver novel insights for human medicine.
Topics: Animals; Cardiology; Cardiomyopathies; Cardiovascular System; Echocardiography; Humans
PubMed: 33037937
DOI: 10.1007/s11886-020-01417-8 -
Acta Cardiologica Jul 2023To assess the effect of beta-blocker treatment on left ventricular global longitudinal strain (LV Gls) as measured by echocardiography in patients with MB (Myocardial...
OBJECTIVES
To assess the effect of beta-blocker treatment on left ventricular global longitudinal strain (LV Gls) as measured by echocardiography in patients with MB (Myocardial Bridge).
PATIENTS AND METHODS
Between January 2019 and February 2022, a prospective, single-center study was undertaken in which myocardial bridging was identified in individuals who had coronary angiography. One hundred patients with myocardial bridging were systematically recruited and strain echocardiography was performed. Patient data were analysed in two groups - those who weren't using beta-blockers in the last six months (Group I: = 50) vs. those who were (Group II: = 50).
RESULTS
One hundred patients participated in the study (38 females, 62 males; average age: 57.4 years). There was a statistically significant difference in the mean heart rate between groups I and II ( < 0.001). LV Gls was found to be statistically significantly improved in favour of group II when compared to group I [Group I: (-12.57)±3 vs. Group II: (-15.92)±2.9, < 0.001].
CONCLUSION
The negative chronotropic effect of beta-blocker medication in individuals with MB identified by coronary angiography has a beneficial effect on LV Gls as measured by echocardiography.
Topics: Male; Female; Humans; Middle Aged; Prospective Studies; Myocardial Bridging; Echocardiography; Heart Ventricles; Myocardium; Adrenergic beta-Antagonists; Ventricular Function, Left; Ventricular Dysfunction, Left
PubMed: 37171374
DOI: 10.1080/00015385.2023.2209421 -
Radiology Case Reports Jul 2022Myocardial bridging occurs when a segment of major epicardial coronary artery courses intramurally through myocardium, commonly involving the left anterior descending....
Myocardial bridging occurs when a segment of major epicardial coronary artery courses intramurally through myocardium, commonly involving the left anterior descending. However, myocardial bridging involving coronary arteries other than left anterior descending is less-common and rarely reported, especially in the elderly population. We report a rare case of multiple myocardial bridging involving the left anterior descending, first obtuse marginal, and ramus intermedius in a 68-year-old Asian female. We also briefly discuss the imaging evaluation and pathophysiology of myocardial ischemia in myocardial bridging. This is the second reported case of myocardial bridging involving such combination, and to our knowledge, the first for elderly patient.
PubMed: 35601387
DOI: 10.1016/j.radcr.2022.04.018 -
World Journal of Clinical Cases Oct 2022Myocardial bridging is a common anatomical malformation, and the milking effect is a characteristic phenomenon of myocardial bridging in coronary angiography. Generally,...
BACKGROUND
Myocardial bridging is a common anatomical malformation, and the milking effect is a characteristic phenomenon of myocardial bridging in coronary angiography. Generally, the phenomenon is invariable. However, this article reports an inconceivably rare myocardial bridging phenomenon that breaks through our conventional views. The milking effect changed obviously in two coronary angiography examinations, which subverted the traditional deep-rooted view of the myocardial bridging phenomenon and revealed the limitations of coronary angiography in diagnosing myocardial bridging and judging the prognosis of it.
CASE SUMMARY
A 63-year-old man was diagnosed with ST-segment elevation myocardial infarction and received primary percutaneous coronary intervention on December 26, 2019. His heart rate was 104 beats per minute, and blood pressure was 15.3/10.3 kPa. A severe milking effect was found in the left anterior descending coronary artery during his index coronary angiography on January 14, 2020. The patient was given intensive medical management, including a β1-adrenergic receptor blocker, during hospitalization and after discharge. Unexpectedly, coronary angiography showed that the previous impressive milking effect was dramatically alleviated (close to normal) at the follow-up on October 13, 2020. At that moment, the patient's heart rate was 83 beats per minute, and blood pressure was 12.7/8.0 kPa.
CONCLUSION
The myocardial bridging phenomenon is not invariable and, in certain circumstances, may vary. Furthermore, the autonomic nervous system may be involved in the myocardial bridging phenomenon.
PubMed: 36312505
DOI: 10.12998/wjcc.v10.i29.10721 -
American Journal of Physiology. Heart... Dec 2019Myocardial bridging (MB) is linked to angina and myocardial ischemia and may lead to sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, it...
Myocardial bridging (MB) is linked to angina and myocardial ischemia and may lead to sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, it remains unclear how MB affect the coronary blood flow in HCM patients. The aim of this study was to assess the effects of MB on coronary hemodynamics in HCM patients. Fifteen patients with MB (7 HCM and 8 non-HCM controls) in their left anterior descending (LAD) coronary artery were chosen. Transient computational fluid dynamics (CFD) simulations were conducted in anatomically realistic models of diseased (with MB) and virtually healthy (without MB) LAD from these patients, reconstructed from biplane angiograms. Our CFD simulation results demonstrated that dynamic compression of MB led to diastolic flow disturbances and could significantly reduce the coronary flow in HCM patients as compared with non-HCM group ( < 0.01). The pressure drop coefficient was remarkably higher ( < 0.05) in HCM patients. The flow rate change is strongly correlated with both upstream Reynolds number and MB compression ratio, while the MB length has less impact on coronary flow. The hemodynamic results and clinical outcomes revealed that HCM patients with an MB compression ratio higher than 65% required a surgical intervention. In conclusion, the transient MB compression can significantly alter the diastolic flow pattern and wall shear stress distribution in HCM patients. HCM patients with severe MB may need a surgical intervention. In this study, the hemodynamic significance of myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) was investigated to provide valuable information for surgical decision-making. Our results illustrated that the transient MB compression led to complex flow patterns, which can significantly alter the diastolic flow and wall shear stress distribution. The hemodynamic results and clinical outcomes demonstrated that patients with HCM and an MB compression ratio higher than 65% required a surgical intervention.
Topics: Adolescent; Adult; Aged; Cardiomyopathy, Hypertrophic; Coronary Circulation; Female; Hemodynamics; Humans; Male; Middle Aged; Models, Cardiovascular; Myocardial Bridging; Patient-Specific Modeling
PubMed: 31674812
DOI: 10.1152/ajpheart.00466.2019 -
Hellenic Journal of Cardiology : HJC =... 2023
Topics: Humans; Myocardial Bridging; Endocardium; Myocardial Infarction; Anterior Wall Myocardial Infarction
PubMed: 36184035
DOI: 10.1016/j.hjc.2022.09.010 -
The American Journal of Cardiology Nov 2023Our objective is to use computed tomography angiography (CTA) and computed tomography perfusion (CTP) to identify the ischemic significance of myocardial bridging (MB)....
Combined Computed Tomography Angiography-Computed Tomography Perfusion in the Identification and Prognostic Assessment of Myocardial Bridging from the CORE320 Study: 5-Year Follow-Up.
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.
Topics: Humans; Computed Tomography Angiography; Prospective Studies; Prognosis; Myocardial Bridging; Follow-Up Studies; Coronary Artery Disease; Coronary Angiography; Myocardial Infarction; Myocardial Perfusion Imaging; Perfusion; Predictive Value of Tests; Coronary Stenosis
PubMed: 37774472
DOI: 10.1016/j.amjcard.2023.08.040 -
Acta Cardiologica Oct 2023Myocardial bridging (MB) is a common congenital cardiovascular anomaly. There are reported associations of MB with different clinical presentations like effort angina,...
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 ( = .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.
Topics: Humans; Coronary Artery Disease; Percutaneous Coronary Intervention; Ultrasonography, Interventional; Plaque, Atherosclerotic; Coronary Vessels; Acute Coronary Syndrome; Atherosclerosis; Coronary Angiography
PubMed: 36939314
DOI: 10.1080/00015385.2023.2187117 -
The Journal of Emergency Medicine Mar 2022Left ventricular assist devices (LVADs) can be used as a bridging therapy for myocardial recovery or cardiac transplant, as well as a destination therapy for long-term... (Review)
Review
BACKGROUND
Left ventricular assist devices (LVADs) can be used as a bridging therapy for myocardial recovery or cardiac transplant, as well as a destination therapy for long-term support in patients with advanced heart failure. Patients with LVADs can present to the emergency department (ED) for acute deterioration and emergency physicians (EPs) must be equipped with the necessary knowledge and skill to treat this unique population.
OBJECTIVE
This review describes the role of point-of-care ultrasound (POCUS) in the evaluation of patients with LVADs and illustrates how EPs can incorporate POCUS into the evaluation of these patients in the ED.
DISCUSSION
The clinical applications for which POCUS may be useful in patients with LVADs include hypotension or shock, dyspnea, cardiac failure, dysrhythmia, syncope, and cardiac arrest. The normal features of POCUS in patients with LVADs and the features of POCUS associated with diseased states are presented.
CONCLUSIONS
Patients with LVADs have altered anatomy and physiology. Therefore, an understanding of key modifications to standard POCUS views is necessary so that EPs can use POCUS effectively in their evaluation of these patients.
Topics: Emergency Service, Hospital; Heart Failure; Heart-Assist Devices; Humans; Point-of-Care Systems; Ultrasonography
PubMed: 34991913
DOI: 10.1016/j.jemermed.2021.10.018