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Scientific Reports Nov 2017Myocardial bridging, a congenital abnormality in which a coronary artery tunnels through the myocardial fibres was usually considered a benign condition. Many studies... (Meta-Analysis)
Meta-Analysis
Myocardial bridging, a congenital abnormality in which a coronary artery tunnels through the myocardial fibres was usually considered a benign condition. Many studies suggested a potential hemodynamic significance of myocardial bridging and some, usually case reports, implied a possible correlation between it and various cardiovascular pathologies like acute myocardial infarction, ventricular rupture, life-threatening arrhythmias, hypertrophic cardiomyopathy, apical ballooning syndrome or sudden death. The main objective of this article is to evaluate whether myocardial bridging may be associated with significant cardiac effects or if it is strictly a benign anatomical variation. To this purpose, we performed a meta-analysis (performed using the inverse variance heterogeneity model) and meta-regression, on scientific articles selected from three main databases (Scopus, Web of Science, Pubmed). The study included 21 articles. MB was associated with major adverse cardiac events - OR = 1.52 (1.01-2.30), and myocardial ischemia OR = 3.00 (1.02-8.82) but not with acute myocardial infarction, cardiovascular death, ischemia identified using imaging techniques, or positive exercise stress testing. Overall, myocardial bridging may have significant cardiovascular consequences (MACE, myocardial ischemia). More studies are needed to reveal/refute a clear association with MI, sudden death or other cardiovascular pathologies.
Topics: Cardiovascular Diseases; Humans; Myocardial Bridging; Regression Analysis
PubMed: 29116137
DOI: 10.1038/s41598-017-13958-0 -
The International Journal of... Feb 2019Myocardial Bridging (MB) refers to the band of myocardium that abnormally overlies a segment of a coronary artery. This paper quantitatively evaluates the influence of... (Comparative Study)
Comparative Study
Myocardial Bridging (MB) refers to the band of myocardium that abnormally overlies a segment of a coronary artery. This paper quantitatively evaluates the influence of MB of the left anterior descending artery (LAD) on myocardial perfusion of the entire left ventricle. We studied 131 consecutive patients who underwent hybrid rest/stress N-ammonia positron emission tomography (PET) and coronary computed tomography angiography (CCTA) due to suspected myocardial ischemia. Patients with previous myocardial infarction and/or significant coronary artery disease (≥ 50% stenosis) were excluded. Myocardial perfusion measurements were compared between patients with and without LAD-MB. Additionally, we evaluated the relationship between anatomical characteristics (length and depth) of LAD-MB and myocardial perfusion measurements. 17 (13%) patients presented a single LAD-MB. Global myocardial perfusion reserve (MPR) was lower in patients with LAD-MB than in patients without LAD-MB (1.9 ± 0.5 vs. 2.3 ± 0.6, p < 0.01). Global stress myocardial blood flow (MBF) was similar in patients with and without LAD-MB (2.2 ± 0.4 vs. 2.3 ± 0.7 ml/g/min, p = 0.40). Global rest MBF was higher in patients with LAD-MB than in patients without LAD-MB (1.2 ± 0.3 vs. 1.0 ± 0.2 ml/g/min, p < 0.01). Global rest MBF, stress MBF, and MPR quantifications were similar in patients with superficial and deep LAD-MB (all p = NS). We did not find any correlation between length and global rest MBF, stress MBF nor MPR (r = - 0.14, p = 0.59; r = 0.44, p = 0.07; and r = 0.45, p = 0.07 respectively). Quantitative myocardial perfusion suggests that LAD-MB may be related to impaired perfusion reserve, an indicator of microvascular dysfunction. Anatomical characteristics of LAD-MB were not related to changes in myocardial perfusion.
Topics: Aged; Ammonia; Computed Tomography Angiography; Coronary Angiography; Coronary Circulation; Coronary Vessels; Female; Humans; Male; Microcirculation; Middle Aged; Myocardial Bridging; Myocardial Perfusion Imaging; Nitrogen Radioisotopes; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Stroke Volume; Ventricular Function, Left
PubMed: 30267168
DOI: 10.1007/s10554-018-1460-8 -
Journal of Insurance Medicine (New... 2009Myocardial bridging is a congenital anomaly of the left anterior descending coronary artery resulting in systolic compression by overlying myocardial tissue.
Myocardial bridging is a congenital anomaly of the left anterior descending coronary artery resulting in systolic compression by overlying myocardial tissue.
Topics: Adult; Coronary Angiography; Coronary Vessels; Diastole; Humans; Male; Myocardial Bridging; Myocardium; Prognosis; Systole
PubMed: 19845219
DOI: No ID Found -
Circulation Aug 2009
Topics: Coronary Artery Disease; Humans; Myocardial Bridging; Myocardial Infarction; Risk Factors
PubMed: 19620498
DOI: 10.1161/CIRCULATIONAHA.109.881367 -
Northern Clinics of Istanbul 2020Sustained monomorphic ventricular tachycardia is rarely a concomitant condition with myocardial bridging for which no evidence-based medical management has yet been...
Sustained monomorphic ventricular tachycardia is rarely a concomitant condition with myocardial bridging for which no evidence-based medical management has yet been certainly described. Here, in this case study, we present a case of malignant ventricular arrhythmia that may be associated with the myocardial bridge on the coronary artery. The clinical management and medical treatment of the patient are discussed.
PubMed: 33381704
DOI: 10.14744/nci.2019.13549 -
Heart and Vessels Apr 2020The relationship between myocardial bridging (MB) and coronary spasms during spasm provocation testing (SPT) remains unclear. We aimed to investigate whether MB was... (Observational Study)
Observational Study
The relationship between myocardial bridging (MB) and coronary spasms during spasm provocation testing (SPT) remains unclear. We aimed to investigate whether MB was correlated with the SPT by ergonovine (ER) injections in a retrospective observational study. Of the 3340 patients who underwent a first coronary angiography, 166 underwent SPT using ER injections and were divided into 2 groups: MB(+) (n = 23), and MB(-) (n = 143). MB was defined as an angiographic reduction in the diameter of the coronary artery during systole. The patients who had severe organic stenosis in the left anterior descending coronary artery were excluded. The MB(+) group more frequently had diabetes mellitus and chronic kidney disease, and a thicker interventricular septum thickness. The rate of SPT-positivity was higher in the MB(+) group than MB(-) group (56.5% vs. 22.4%, P = 0.001). A multivariate regression analysis showed that the presence of MB was independently associated with SPT-positivity (odds ratio 5.587, 95% confidence interval 2.061-15.149, P = 0.001). In conclusion, coronary spasms during provocation tests with ER independently correlated with the MB. MB may predict coronary spasms.
Topics: Aged; Coronary Angiography; Coronary Vasospasm; Coronary Vessels; Ergonovine; Female; Humans; Injections, Intra-Arterial; Logistic Models; Male; Middle Aged; Myocardial Bridging; Predictive Value of Tests; Retrospective Studies; Vasodilator Agents
PubMed: 31562555
DOI: 10.1007/s00380-019-01518-7 -
The National Medical Journal of India 2023
Topics: Humans; Myocardial Bridging; Coronary Angiography; Male; Coronary Vessel Anomalies; Middle Aged; Coronary Vessels
PubMed: 38759993
DOI: 10.25259/NMJI_1112_2022 -
Journal of the American Heart... Jul 2021Background Myocardial bridging (MB) may represent a cause of myocardial ischemia in patients with non-obstructive coronary artery disease (NOCAD). Herein, we assessed...
Interplay Between Myocardial Bridging and Coronary Spasm in Patients With Myocardial Ischemia and Non-Obstructive Coronary Arteries: Pathogenic and Prognostic Implications.
Background Myocardial bridging (MB) may represent a cause of myocardial ischemia in patients with non-obstructive coronary artery disease (NOCAD). Herein, we assessed the interplay between MB and coronary vasomotor disorders, also evaluating their prognostic relevance in patients with myocardial infarction and non-obstructive coronary arteries (MINOCA) or stable NOCAD. Methods and Results We prospectively enrolled patients with NOCAD undergoing intracoronary acetylcholine provocative test. The incidence of major adverse cardiac events, defined as the composite of cardiac death, non-fatal myocardial infarction, and rehospitalization for unstable angina, was assessed at follow-up. We also assessed angina status using Seattle Angina Questionnaires summary score. We enrolled 310 patients (mean age, 60.6±11.9; 136 [43.9%] men; 169 [54.5%] stable NOCAD and 141 [45.5%] MINOCA). MB was found in 53 (17.1%) patients. MB and a positive acetylcholine test coexisted more frequently in patients with MINOCA versus stable NOCAD. MB was an independent predictor of positive acetylcholine test and MINOCA. At follow-up (median, 22 months; interquartile range, 13-32), patients with MB had a higher rate of major adverse cardiac events, mainly driven by a higher rate of hospitalization attributable to angina, and a lower Seattle Angina Questionnaires summary score (all <0.001) compared with patients without MB. In particular, the group of patients with MB and a positive acetylcholine test had the worst prognosis. Conclusions Among patients with NOCAD, coronary spasm associated with MB may predict a worse clinical presentation with MINOCA and a higher rate of hospitalization attributable to angina at long-term follow-up with a low rate of hard events.
Topics: Acetylcholine; Coronary Angiography; Coronary Artery Disease; Coronary Vasospasm; Coronary Vessels; Diagnosis, Differential; Electrocardiography; Female; Follow-Up Studies; Humans; Incidence; Injections, Intra-Arterial; Male; Middle Aged; Myocardial Bridging; Myocardial Ischemia; Prognosis; Prospective Studies; Risk Factors; Rome; Vasodilation; Vasodilator Agents
PubMed: 34259010
DOI: 10.1161/JAHA.120.020535 -
Journal of the American Heart... Jul 2021Background Functional assessment of myocardial bridging (MB) remains clinically challenging because of the dynamic nature of the extravascular coronary compression with... (Comparative Study)
Comparative Study
Background Functional assessment of myocardial bridging (MB) remains clinically challenging because of the dynamic nature of the extravascular coronary compression with a certain degree of intraluminal coronary reduction. The aim of our study was to assess performance and diagnostic value of diastolic-fractional flow reserve (d-FFR) during dobutamine provocation versus conventional-FFR during adenosine provocation with exercise-induced myocardial ischemia as reference. Methods and Results This prospective study includes 60 symptomatic patients (45 men, mean age 57±9 years) with MB on the left anterior descending artery and systolic compression ≥50% diameter stenosis. Patients were evaluated by exercise stress-echocardiography test, and both conventional-FFR and d-FFR in the distal segment of left anterior descending artery during intravenous infusion of adenosine (140 μg/kg per minute) and dobutamine (10-50 μg/kg per minute), separately. Exercise-stress-echocardiography test was positive for myocardial ischemia in 19/60 patients (32%). Conventional-FFR during adenosine and peak dobutamine had similar values (0.84±0.04 versus 0.84±0.06, =0.852), but d-FFR during peak dobutamine was significantly lower than d-FFR during adenosine (0.76±0.08 versus 0.79±0.08, =0.018). Diastolic-FFR during peak dobutamine was significantly lower in the exercise-stress-echocardiography test -positive group compared with the exercise- stress-echocardiography test -negative group (0.70±0.07 versus 0.79±0.06, <0.001), but not during adenosine (0.79±0.07 versus 0.78±0.09, =0.613). Among physiological indices, d-FFR during peak dobutamine was the only independent predictor of functionally significant MB (odds ratio, 0.870; 95% CI, 0.767-0.986, =0.03). Receiver-operating characteristics curve analysis identifies the optimal d-FFR during peak dobutamine cut-off ≤0.76 (area under curve, 0.927; 95% CI, 0.833-1.000; <0.001) with a sensitivity, specificity, and positive and negative predictive value of 95%, 95%, 90%, and 98%, respectively, for identifying MB associated with stress-induced ischemia. Conclusions Diastolic-FFR, but not conventional-FFR, during inotropic stimulation with high-dose dobutamine, in comparison to vasodilatation with adenosine, provides more reliable functional significance of MB in relation to stress-induced myocardial ischemia.
Topics: Adenosine; Adult; Aged; Cardiotonic Agents; Diastole; Dobutamine; Echocardiography, Stress; Exercise Test; Feasibility Studies; Female; Fractional Flow Reserve, Myocardial; Humans; Male; Middle Aged; Myocardial Bridging; Myocardial Ischemia; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; Vasodilator Agents
PubMed: 34151580
DOI: 10.1161/JAHA.120.020597 -
International Journal of Cardiology Nov 2010Significant and serious cardiovascular end-points can be seen in patients with myocardial bridging although it has been thought as a benign condition. Unfortunately,...
Significant and serious cardiovascular end-points can be seen in patients with myocardial bridging although it has been thought as a benign condition. Unfortunately, there is no consensus on 'which diagnostic tool has prognostic significance?'. Conventional transthoracic echocardiography can be used for this purpose as in the presented case.
Topics: Echocardiography; Humans; Myocardial Bridging; Tomography, X-Ray Computed
PubMed: 19477029
DOI: 10.1016/j.ijcard.2009.05.017