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Journal of Clinical Medicine Sep 2023Many variables obtained during cardiopulmonary exercise test (CPET), including O uptake (VO) versus heart rate (HR, O-pulse) and work rate (VO/Watt), provide...
Many variables obtained during cardiopulmonary exercise test (CPET), including O uptake (VO) versus heart rate (HR, O-pulse) and work rate (VO/Watt), provide quantitative patterns of responses to exercise when left ventricular dysfunction is an effect of myocardial ischemia (MI). Therefore, CPET offers a unique approach to evaluate exercise-induced MI in the presence of fixed or dynamic coronary arteries stenosis. In this paper, we examined the case of a 74-year-old patient presenting with an ischemic CPET and a normal stress cardiac magnetic resonance (CMR) with dipyridamole. A coronary angiography demonstrated the presence of myocardial bridging (MB), a well-known congenital coronary anomaly that is able to generate MI during exercise (but not in provocative testing using coronary artery vasodilators, such as dipyridamole). Despite the good diagnostic accuracy of the imaging methods (i.e., stress CMR) in MI detection, this case shows that exercise should be the method of choice in elicit ischemia in specific cases, like MB.
PubMed: 37685831
DOI: 10.3390/jcm12175764 -
Arquivos Brasileiros de Cardiologia Sep 2023
Topics: Humans; Myocardial Bridging
PubMed: 37672467
DOI: 10.36660/abc.20230426 -
Cureus Jul 2023Myocardial bridging (MB) is a condition where the coronary artery is intramural instead of its natural course through the epicardium. Here, we present a case of a...
Myocardial bridging (MB) is a condition where the coronary artery is intramural instead of its natural course through the epicardium. Here, we present a case of a 25-year-old male without any medical history who presented with intermittent substernal chest discomfort on exertion. EKG was suggestive of ST changes in leads V1-V4 with right axis deviation. A left heart catheterization revealed myocardial bridging of the midportion of the left anterior descending artery. Myocardial bridging is commonly not associated with severe complications. However, it is imperative to diagnose it appropriately, especially in cases of chest pain, and provide immediate treatment to prevent mortality and morbidity.
PubMed: 37546119
DOI: 10.7759/cureus.41452 -
Academic Radiology Oct 2023This study was designed to investigate the association between the perivascular fat attenuation index (FAI) and atherosclerotic plaque formation proximal to myocardial...
Diagnostic Ability of Perivascular Fat Attenuation Index in Predicting Atherosclerotic Plaque Formation Proximal to Myocardial Bridging of the Left Anterior Descending Artery within 3 Years.
RATIONALE AND OBJECTIVES
This study was designed to investigate the association between the perivascular fat attenuation index (FAI) and atherosclerotic plaque formation proximal to myocardial bridging (MB) of the left anterior descending artery (LAD) within 3 years.
MATERIALS AND METHODS
LAD-MB patients who underwent coronary computed tomography angiography at least twice between January 2016 and December 2022 were retrospectively included in this study. In total, 99 LAD-MB patients were included in the study. Based on the formation of atherosclerotic plaques proximal to LAD-MB during follow-up, the patients were classified into two groups: LAD-MB with plaque formation and LAD-MB without plaque formation within 3 years. The anatomical features, clinical factors, and proximal perivascular FAI of LAD-MB were measured and recorded. The association of the previously mentioned factors with the presence of atherosclerotic plaque proximal to LAD-MB was determined.
RESULTS
The results showed that MB length, MB stenosis, and the perivascular FAI were significant predictors of the formation of atherosclerotic plaques proximal to LAD-MB. The area under the curve of the combined predictive model incorporating MB length, MB stenosis, and the perivascular FAI was 0.901(95% confidence interval: 0.824-0.952), with higher diagnostic performance than any other single parameter (all P < 0.05). Moreover, dynamic changes in the perivascular FAI of the vascular segments proximal to LAD-MB were higher in high-risk plaques than in non-high-risk plaques (P = 0.003).
CONCLUSION
The combined use of the perivascular FAI, MB length, and MB stenosis may enable prediction of the probability of atherosclerotic plaque formation proximal to LAD-MB within 3 years. Dynamic changes in perivascular FAI were associated with the vulnerability of plaques proximal to LAD-MB.
Topics: Humans; Plaque, Atherosclerotic; Coronary Artery Disease; Myocardial Bridging; Coronary Angiography; Constriction, Pathologic; Retrospective Studies; Coronary Vessels; Adipose Tissue
PubMed: 37474348
DOI: 10.1016/j.acra.2023.06.019 -
Catheterization and Cardiovascular... Sep 2023There are limited national-level data on the contemporary practices of mechanical circulatory support (MCS) use in acute myocardial infarction-cardiogenic shock (AMI-CS).
BACKGROUND
There are limited national-level data on the contemporary practices of mechanical circulatory support (MCS) use in acute myocardial infarction-cardiogenic shock (AMI-CS).
METHODS
We utilized the Healthcare Cost and Utilization Project-National/Nationwide Inpatient Sample data (2005-2017) to identify adult admissions (>18 years) with AMI-CS. MCS devices were classified as intra-aortic balloon pump (IABP), percutaneous left ventricular assist devices (pLVAD), or extracorporeal membrane oxygenation (ECMO). We evaluated trends in the initial device used (IABP alone, pLVAD alone or ≥2 MCS devices), device escalation, bridging to durable LVAD/heart transplantation, and predictors of in-hospital mortality and device escalation.
RESULTS
Among 327,283 AMI-CS admissions, 131,435 (40.2%) had an MCS device placed with available information on timing of placement. IABP, pLVAD, and ≥2 MCS devices were used as initial device in 120,928 (92.0%), 8202 (6.2%), and 2305 (1.7%) admissions, respectively. Most admissions were maintained on the initial MCS device with 1%-1.5% being escalated (IABP to pLVAD/ECMO, pLVAD to ECMO). Urban, medium, and large-sized hospitals and acute multiorgan failure were significant independent predictors of MCS escalation. In admissions receiving MCS, escalation of MCS device was associated with higher in-hospital mortality (adjusted odds ratio: 1.56, 95% confidence interval: 1.38-1.75; p < 0.001). Admissions receiving durable LVAD/heart transplantation increased over time in those initiated on pLVAD and ≥2 MCS devices, resulting in lower in-hospital mortality.
CONCLUSIONS
In this 13-year study, escalation of MCS in AMI-CS was associated with higher in-hospital mortality suggestive of higher acuity of illness. The increase in number of durable LVAD/heart transplantations alludes to the role of MCS as successful bridge strategies.
Topics: Adult; Humans; Shock, Cardiogenic; Treatment Outcome; Myocardial Infarction; Heart-Assist Devices; Intra-Aortic Balloon Pumping
PubMed: 37473420
DOI: 10.1002/ccd.30786 -
European Heart Journal. Case Reports Jul 2023In patients with cardiogenic shock the clinical treatment often involves temporary mechanical circulatory support for initial haemodynamic stabilization to enable...
Unloading, ablation, bridging and transplant: different indications and treatments using the Impella 5.5 as longer-term circulatory support in one patient-an interdisciplinary case report.
BACKGROUND
In patients with cardiogenic shock the clinical treatment often involves temporary mechanical circulatory support for initial haemodynamic stabilization to enable further assessment of therapeutic strategies. The surgically implanted Impella 5.5 can be used for several indications like ventricular unloading, haemodynamic support during high-risk interventions, and as a bridge-to-transplant strategy.We present an interdisciplinary managed case of using Impella 5.5 for multiple indications and treatment strategies in one patient.
CASE SUMMARY
A 66-year-old patient with known dilated cardiomyopathy was admitted with non-ST-elevation myocardial infarction and underwent urgent coronary bypass grafting. His native heart function did not recover and he experienced recurrent episodes of sustained ventricular tachycardia (VT) and electrical storm. He was evaluated for heart transplantation (OHT) and received a VT-ablation. However, he suffered an in-hospital cardiac arrest (IHCA) with subsequent implantation of an extracorporeal life support system (ECLS). After surgical placement of an Impella 5.5 due to left ventricular distension and pulmonary congestion, the ECLS was successfully weaned. He showed good neurological outcomes and underwent another high-risk VT-ablation. The patient was further stabilized under Impella 5.5 support in a bridge-to-transplant strategy. After 34 days he underwent a successful OHT.
DISCUSSION
In this interdisciplinary case report the surgically implanted Impella 5.5 as temporary mechanical circulatory support was used for multiple different indications and treatment strategies like ventricular unloading, haemodynamic support during high-risk interventions, and as bridge-to-transplant strategy in one patient.
PubMed: 37457054
DOI: 10.1093/ehjcr/ytad293 -
Cardiology in Review Jul 2023Ischemic heart disease is the leading cause of mortality and morbidity in the Western world. Thus, coronary artery bypass graft is the most common cardiac procedure...
Ischemic heart disease is the leading cause of mortality and morbidity in the Western world. Thus, coronary artery bypass graft is the most common cardiac procedure performed as it remains the gold standard for multiple vessel disease and left main disease. Long saphenous vein is the conduit of choice for coronary artery bypass graft as it is accessible and easy to harvest. Over the previous 4 decades, several techniques have emerged to optimize harvesting and reducing adverse clinical outcomes. The most cited techniques are open vein harvesting, no-touch technique, endoscopic vein harvesting, and standard bridging technique. In this literature review, we aim to summarize current literature for each of the 4 techniques in terms of: (A) graft patency and attrition, (B) myocardial infarction and revascularization, (C) wound infections, (D) postoperative pain, and (E) patient satisfaction.
PubMed: 37395590
DOI: 10.1097/CRD.0000000000000580 -
Journal of the American Society of... Oct 2023Myocardial bridging (MB) correlation with ischemia remains a diagnostic challenge. There is a lack of studies that have assessed MB using contrast stress echo and...
BACKGROUND
Myocardial bridging (MB) correlation with ischemia remains a diagnostic challenge. There is a lack of studies that have assessed MB using contrast stress echo and compared the findings with those in patients demonstrating a normal coronary course, with or without obstructive coronary artery disease (CAD).
METHODS
We evaluated all consecutive patients who underwent contrast stress echocardiography and coronary computed tomography angiography (CCTA) due to suspected symptoms of CAD within 3 months in Parma Hospital. Coronary computed tomography angiography served as the reference standard for detecting MB and obstructive CAD. The patients were divided into 3 groups: (1) MB and no evidence of obstructive CAD (MB group, N = 64), (2) no evidence of obstructive CAD or MB (NoCAD group, N = 135), (3) obstructive CAD without MB (CAD group, N = 68).
RESULTS
The coronary flow velocity reserve in the LAD (CFVR-LAD) was reduced in the MB and CAD groups, measuring 1.91 ± 0.21 and 1.82 ± 0.28, respectively, whereas it was 2.27 ± 0.34 in the NoCAD group (P < .001). The MB and CAD groups exhibited a higher prevalence of reversible myocardial perfusion defects (rMPDs) compared to the NoCAD group (57.8% vs 64.7% vs 3.7%, P < .001). Reversible wall motion abnormalities were frequently observed in the CAD group and rarely found in the MB and NoCAD groups (47.1% vs 18.8% vs 4.4%, P < .001). In multivariable analyses, the presence of MB was independently associated with reduced CFVR-LAD (odds ratio = 14.55; 95% CI, 6.84-30.93; P < .001) and the presence of rMPD (odds ratio = 37.96; 95% CI, 13.49-106.84; P < .001). Patients with deep MB (>2 mm depth) and very deep MB (≥5 mm depth) exhibited significantly greater CFVR-LAD reduction and rMPD than those with superficial MB.
CONCLUSIONS
Myocardial bridging is capable of inducing rMPD and reducing CFVR-LAD similar to obstructive CAD. The depth of the MB correlates with the abnormalities found in the stress echo evaluation. Contrast stress echo may serve as a valuable noninvasive tool for evaluating patients with MB.
Topics: Humans; Coronary Artery Disease; Echocardiography, Stress; Myocardial Bridging; Prospective Studies; Echocardiography; Coronary Angiography
PubMed: 37356674
DOI: 10.1016/j.echo.2023.06.008 -
Heart (British Cardiac Society) Dec 2023Myocardial bridging is a common anatomical variant in which a major epicardial coronary artery takes an intramyocardial course, leading to dynamic systolic compression.... (Review)
Review
Myocardial bridging is a common anatomical variant in which a major epicardial coronary artery takes an intramyocardial course, leading to dynamic systolic compression. Because coronary perfusion occurs primarily during diastole, most patients with this anatomical variant have no associated perfusion abnormalities or symptoms. Despite this, there is a subset of patients with myocardial bridging who experience ischaemic symptoms. Determining which anatomical variants are benign and which are clinically relevant remains a challenge. Further complicating the picture, functional factors such as diastolic dysfunction and coronary vasospasm may exacerbate myocardial bridging-related ischaemia. In patients with ischaemic symptoms in the absence of alternative explanations, a detailed assessment of myocardial bridging with invasive physiology should be performed to define the significance of the lesion and guide tailored medical therapy. Patients with refractory symptoms despite maximally tolerated medical therapy should be considered for surgical coronary unroofing.
Topics: Humans; Myocardial Bridging; Heart; Coronary Angiography
PubMed: 37344169
DOI: 10.1136/heartjnl-2022-321586 -
Journal of Nuclear Cardiology :... Oct 2023
Utility of myocardial blood flow assessment with dynamic CZT single photon emission computed tomography in patients with myocardial bridging: Is this 'wishful thinking' in this dynamic situation?
Topics: Humans; Myocardial Bridging; Tomography, Emission-Computed, Single-Photon; Coronary Artery Disease; Myocardial Perfusion Imaging; Cadmium; Tellurium
PubMed: 37340234
DOI: 10.1007/s12350-023-03319-y