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Current Cardiology Reports Jan 2016In myocardial bridging (MB) a segment of the coronary artery is covered by the myocardium. MB can be seen as a systolic compression by invasive coronary angiography... (Review)
Review
In myocardial bridging (MB) a segment of the coronary artery is covered by the myocardium. MB can be seen as a systolic compression by invasive coronary angiography (ICA) or as an intramural course by computed tomography angiography (CTA). Intramural course is a common incidental finding in CTA studies. Only minority of the bridging segments are associated with systolic compression causing a possible impairment of myocardial perfusion. The relationship between myocardial blood flow and MB is complex and poorly evaluated by anatomic imaging. Furthermore, provocation tests are frequently needed to uncover systolic compression. Fractional flow reserve can be used to assess the hemodynamic significance of MB. Nuclear perfusion imaging can demonstrate flow abnormalities associated with MB. Stress echocardiography can demonstrate ischemic wall motion abnormalities. They can be complemented by hybrid imaging with CTA to distinguish epicardial coronary artery disease and MB. This article will review different imaging modalities for the evaluation of the physiologic significance of MB.
Topics: Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Echocardiography, Stress; Fractional Flow Reserve, Myocardial; Humans; Multimodal Imaging; Myocardial Bridging; Myocardial Perfusion Imaging; Regional Blood Flow; Severity of Illness Index
PubMed: 26694724
DOI: 10.1007/s11886-015-0685-6 -
Radiology Case Reports Dec 2022Myocardial bridgin in an adult with hypertrophic cardiomyopathy is a rare congenital coronary artery anomaly. It is often detected incidentally, and its true incidence...
Myocardial bridgin in an adult with hypertrophic cardiomyopathy is a rare congenital coronary artery anomaly. It is often detected incidentally, and its true incidence in the general population is not known. Myocardial bridging may cause compression of a coronary artery, and it has been suggested that myocardial ischemia may result. Symptoms of myocardial bridging in the adult with hypertrophic cardiomyopathy are syncope, palpitations, dyspnea, and chest pain. Also, arrhythmia and myocardial infarction can be seen; these can cause sudden death, especially in athletes and young people. We present a case of a 48-year-old male with hypertrophic cardiomyopathy and myocardial bridging detected by coronary computed tomography angiography who complained of chest pain.
PubMed: 36204398
DOI: 10.1016/j.radcr.2022.08.095 -
Journal of the American College of... Dec 2016A myocardial bridge (MB) is the term for the muscle overlying the intramyocardial segment of the epicardial coronary artery (referred to as a tunneled artery). Although... (Review)
Review
A myocardial bridge (MB) is the term for the muscle overlying the intramyocardial segment of the epicardial coronary artery (referred to as a tunneled artery). Although MBs can be found in any epicardial artery, most of them involve the left anterior descending artery. These congenital coronary anomalies have long been recognized anatomically, and are traditionally considered a benign condition; however, the association between myocardial ischemia and MBs has increased their clinical relevance. This review summarizes the prevalence, pathophysiology, and diagnostic findings, including morphological, functional assessment, and treatment of patients with MB involving the left anterior descending artery, suggesting a pragmatic clinical approach to this entity.
Topics: Coronary Angiography; Coronary Vessels; Fractional Flow Reserve, Myocardial; Humans; Myocardial Bridging; Percutaneous Coronary Intervention; Ultrasonography, Interventional
PubMed: 28007148
DOI: 10.1016/j.jacc.2016.09.973 -
The American Journal of Emergency... Feb 2022Myocardial bridging (MB) is a phenomenon that occurs when coronary arteries course through myocardial tissue rather than, as is normal, on the surface of the myocardium....
Myocardial bridging (MB) is a phenomenon that occurs when coronary arteries course through myocardial tissue rather than, as is normal, on the surface of the myocardium. Although often asymptomatic, contraction of the myocardium in the presence of a myocardial bridge can sometimes occlude the lumen of coronary arteries that penetrate the myocardium, resulting in symptoms, signs, and electrocardiographic changes indistinguishable from those associated with acute coronary syndromes (ACS) caused by intraluminal narrowing of coronary arteries or coronary artery plaque rupture. In this monograph, we present the case of a 45-year-old man who presented to the emergency department with typical chest pain accompanied by electrocardiographic changes consistent with acute occlusion of the left anterior descending artery. During percutaneous coronary intervention, fluoroscopically-obtained cine image loops revealed evidence of dynamic coronary artery narrowing due to myocardial bridging. There was no evidence of static coronary artery occlusion. Myocardial bridging is typically managed medically when symptomatic, although refractory cases may ultimately require invasive or surgical intervention. Given that emergency physicians are frequently the first providers to evaluate patients with acute coronary syndromes, myocardial bridging as an etiology for ACS is a clinical entity of which emergency physicians should be aware.
Topics: Acute Coronary Syndrome; Electrocardiography; Humans; Male; Middle Aged; Myocardial Bridging; Percutaneous Coronary Intervention
PubMed: 34629225
DOI: 10.1016/j.ajem.2021.08.080 -
Seminars in Ultrasound, CT, and MR Jun 2008The recent introduction of coronary computed tomographic angiography into clinical use as a noninvasive tool for coronary artery evaluation has evoked a new interest in... (Review)
Review
The recent introduction of coronary computed tomographic angiography into clinical use as a noninvasive tool for coronary artery evaluation has evoked a new interest in myocardial bridging. Recent studies using multidetector computed tomography for the evaluation of coronary anatomy have shown myocardial bridging to be more prevalent than previously reported in angiographic series. The purpose of this article was to provide an overview of the current knowledge on the prevalence and features of myocardial bridging as shown by multidetector computed tomography and to discuss the potential clinical implications of this entity.
Topics: Coronary Angiography; Humans; Myocardial Bridging; Prevalence; Tomography, X-Ray Computed
PubMed: 18564543
DOI: 10.1053/j.sult.2008.02.005 -
Journal of Biomechanics Mar 2019Myocardial bridging (MB) is associated with endothelial dysfunction in patients with angina and non-obstructive coronary artery disease. This study aims to determine if...
Myocardial bridging (MB) is associated with endothelial dysfunction in patients with angina and non-obstructive coronary artery disease. This study aims to determine if there is a link between abnormal blood flow patterns and endothelial dysfunction in patients with MB. Ten patients with MB in their left anterior descending (LAD) artery were selected, 5 of whom had endothelial dysfunction and 5 had no endothelial dysfunction based on their response to acetylcholine. Similarly, 10 patients without MB in their LAD, 5 of whom had endothelial dysfunction and 5 of whom had no endothelial dysfunction, were studied as a control group. Transient computational fluid dynamics simulations were performed to derive wall shear stress (WSS) over the entire vessel including proximal, middle and distal segments. Patients with MB and endothelial dysfunction had lower WSS in the proximal LAD and greater WSS in the mid-LAD than patients with MB but without endothelial dysfunction. When comparing patients with endothelial dysfunction, those with MB had significantly lower shear stress in the proximal LAD (0.32 ± 0.14 Pa (with MB) vs 0.71 ± 0.38 Pa (without MB), p = 0.01) and greater shear stress in the mid-LAD (2.81 ± 1.20 Pa (with MB) vs 1.66 ± 0.31 Pa (without MB), p = 0.014) than patients without MB. Our findings demonstrated that the presence of MB significantly contributes to low WSS and endothelial dysfunction relationship.
Topics: Aorta, Thoracic; Computational Chemistry; Coronary Artery Disease; Coronary Vessels; Endothelium; Female; Humans; Hydrodynamics; Male; Middle Aged; Myocardial Bridging; Stress, Mechanical
PubMed: 30685196
DOI: 10.1016/j.jbiomech.2019.01.021 -
BMC Medicine Feb 2024Myocardial 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...
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.
Topics: Humans; Middle Aged; Myocardium; Contrast Media; Retrospective Studies; Cohort Studies; Myocardial Bridging; Gadolinium; Cardiomyopathy, Hypertrophic; Fibrosis; Risk Factors
PubMed: 38413945
DOI: 10.1186/s12916-024-03301-6 -
Cureus Apr 2023We present a case of a 55-year-old male who presented to the emergency department with complaints of acute onset of chest pain. As part of the workup, an...
We present a case of a 55-year-old male who presented to the emergency department with complaints of acute onset of chest pain. As part of the workup, an electrocardiogram (ECG) revealed ST-segment elevation in leads V1-V5. Upon cardiac catheterization, myocardial bridging of the left anterior descending (LAD) artery was discovered without evidence of any obstructive coronary artery disease. The purpose of this report is to add to the existing literature that myocardial bridging, although traditionally thought to be a benign pathology, can also present risks for ischemia and infarction.
PubMed: 37168214
DOI: 10.7759/cureus.37200 -
Clinical Anatomy (New York, N.Y.) Sep 2011Much 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... (Review)
Review
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.
Topics: Animals; Atherosclerosis; Death, Sudden, Cardiac; Humans; Myocardial Bridging; Myocardial Ischemia; Myocardium
PubMed: 21751254
DOI: 10.1002/ca.21150 -
Clinical Anatomy (New York, N.Y.) Jul 2021Myocardial bridges are anatomical entities characterized by myocardium covering segments of coronary arteries. In some patients, the presence of a myocardial bridge is... (Meta-Analysis)
Meta-Analysis
Myocardial bridges are anatomical entities characterized by myocardium covering segments of coronary arteries. In some patients, the presence of a myocardial bridge is benign and is only incidentally found on autopsy. In other patients, however, myocardial bridges can lead to compression of the coronary artery during systolic contraction and delayed diastolic relaxation, resulting in myocardial ischemia. This ischemia in turn can lead to myocardial infarction, ventricular arrhythmias and sudden cardiac death. Myocardial bridges have also been linked to an increased incidence of atherosclerosis, which has been attributed to increased shear stress and the presence of vasoactive factors. Other studies however, demonstrated the protective roles of myocardial bridges. In this study, using systematic review and a meta-analytical approach we investigate the prevalence and morphology of myocardial bridges in both clinical imaging and cadaveric dissections. We also discuss the pathophysiology, clinical significance, and management of these anatomical entities.
Topics: Animals; Cadaver; Humans; Myocardial Bridging; Prevalence
PubMed: 33078444
DOI: 10.1002/ca.23697