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The Impact of Myocardial Bridging on the Coronary Functional Test in Patients with Ischaemia with Non-Obstructive Coronary Artery Disease. Life (Basel) 2022; 12:life12101560. [PMID: 36294995 PMCID: PMC9604606 DOI: 10.3390/life12101560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 01/03/2023] Open
Abstract
Background: The possibility of myocardial bridging (MB) causing chest pain has been widely reported; however, the effect of MB on coronary microvessels has not been thoroughly investigated. Therefore, this study evaluated the effects of MB on epicardial coronary artery and coronary microvascular function during coronary angiography (CAG) and coronary function test (CFT) in patients with ischaemia with non-obstructive coronary artery disease (INOCA). Methods: This study included 62 patients with INOCA who underwent CAG and CFT for the left anterior descending coronary artery (LAD) to evaluate chest pain. In the CFT, acetylcholine was first administered intracoronarily in a stepwise manner, followed by chest symptoms, electrocardiographic ST-T changes and CAG. Positive coronary spasm was defined as coronary vasoconstriction of >90% on CAG accompanied by chest symptoms or electrocardiographic ST-T changes. After nitroglycerin administration, CAG was performed to assess MB, which was defined as systolic narrowing of the coronary artery diameter by >20% compared with that in diastole. Coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were subsequently obtained via transvenous adenosine triphosphate infusion using a pressure wire. Coronary microvascular vasodilatory dysfunction (CMD) was defined as a CFR of <2.0 or an IMR of ≥25 units. Results: Of the 62 patients, 15 (24%) had MB. The patients’ characteristics did not differ between the two groups. Regarding the CAG and CFT results, the presence of coronary spasm in the LAD was higher in the MB (+) group (87%) than in the MB (−) group (53%, p = 0.02), whereas the values of CFR (MB (+): 2.7 ± 1.4, MB (−): 2.8 ± 1.1) and IMR (MB (+): 26.9 ± 1.0, MB (−): 30.0 ± 17.3) and the presence of CMD (MB (+): 53%, MB (−): 60%) were similar in the two groups. Conclusions: The findings suggest that MB predisposes patients with INOCA to coronary spasms. Conversely, MBs may have a limited effect on microvessels, particularly in such patients.
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Darabont RO, Vișoiu IS, Magda ȘL, Stoicescu C, Vintilă VD, Udroiu C, Vinereanu D. Implications of Myocardial Bridge on Coronary Atherosclerosis and Survival. Diagnostics (Basel) 2022; 12:diagnostics12040948. [PMID: 35453995 PMCID: PMC9026775 DOI: 10.3390/diagnostics12040948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 12/04/2022] Open
Abstract
Background: In this study, we aimed to describe the impact of MBs on atherosclerosis and survival, in patients with coronary artery disease (CAD). Methods: We retrospectively studied 1920 consecutive patients who underwent conventional coronary angiography for suspected CAD. Atherosclerotic load (AL), defined as the sum of degrees of stenosis, and general atherosclerotic load (GAL), representing the sum of AL, were compared between patients with MB and a control group without MB; patients in these groups were similar in age and sex. We assessed survival at 10 years after the last enrolled patient. Results: Prevalence of MB was 3.96%, predominantly in the mid-segment of left anterior descendent artery (LAD). In the presence of MB, GAL was lower (158.1 ± 93.7 vs. 205.3 ± 117.9, p = 0.004) with a lesser AL in the proximal (30.3 ± 39.9 vs. 42.9 ± 41.1, p = 0.038) and mid-segments (8.1 ± 20.0 vs. 25.3 ± 35.9, p < 0.001) of LAD. Based on a Multinominal Logistic Regression, we found that the presence of MB on LAD (regardless of its location on this artery) is a protective factor against atherosclerotic lesions, decreasing the probability of significant stenosis, especially of those ≥70%, on the entire artery (B −1.539, OR 4660; 95% CI = 1.873−11.595, p = 0.001) and on each of its segments as well: proximal LAD (B −1.275, OR 0.280; 95% CI = 0.015−5.073; p = 0.038), mid-LAD (B −1.879, OR 6.545; 95% CI = 1.492−28.712; p = 0.013) and distal LAD (B −0.900, OR 2.459, 95% CI = 2.459−2.459, p = 0.032). However, 10-year survival was similar between groups (76.70% vs. 74.30%, p = 0.740). Conclusion: The presence of MB on LAD proved to be a protective factor against atherosclerosis for the entire artery and for each of its segments, but it does not influence long-term survival in patients with CAD.
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Affiliation(s)
- Roxana Oana Darabont
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu, 030167 Bucharest, Romania; (Ș.L.M.); (C.S.); (V.D.V.); (D.V.)
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independenței, 050098 Bucharest, Romania; (I.S.V.); (C.U.)
- Correspondence: ; Tel.: +40-723-441-315
| | - Ionela Simona Vișoiu
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independenței, 050098 Bucharest, Romania; (I.S.V.); (C.U.)
| | - Ștefania Lucia Magda
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu, 030167 Bucharest, Romania; (Ș.L.M.); (C.S.); (V.D.V.); (D.V.)
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independenței, 050098 Bucharest, Romania; (I.S.V.); (C.U.)
| | - Claudiu Stoicescu
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu, 030167 Bucharest, Romania; (Ș.L.M.); (C.S.); (V.D.V.); (D.V.)
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independenței, 050098 Bucharest, Romania; (I.S.V.); (C.U.)
| | - Vlad Damian Vintilă
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu, 030167 Bucharest, Romania; (Ș.L.M.); (C.S.); (V.D.V.); (D.V.)
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independenței, 050098 Bucharest, Romania; (I.S.V.); (C.U.)
| | - Cristian Udroiu
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independenței, 050098 Bucharest, Romania; (I.S.V.); (C.U.)
| | - Dragoș Vinereanu
- Department of Cardiology and Cardiovascular Surgery, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu, 030167 Bucharest, Romania; (Ș.L.M.); (C.S.); (V.D.V.); (D.V.)
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independenței, 050098 Bucharest, Romania; (I.S.V.); (C.U.)
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Bianco F, Bucciarelli V, Surace FC, Iezzi FV, Berton E, Baldinelli A, Piva T, Maolo A, Schicchi N, Colaneri M, Pozzi M, Gallina S. Echocardiographic changes and quality of life after surgical unroofing of myocardial bridges. J Int Med Res 2021; 49:3000605211014847. [PMID: 34013761 PMCID: PMC8150422 DOI: 10.1177/03000605211014847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the echocardiographic changes and quality of life (QoL) after surgical unroofing of myocardial bridges (MBs) involving the left anterior descending (LAD) coronary artery compared with optimal medical therapy (OMT). METHODS Twenty-two patients (median age, 24 years; interquartile range, 16-40 years) with MBs of the LAD artery and exertional angina from 2018 to 2019 were retrospectively analyzed. Twelve patients underwent OMT and 10 underwent surgery. Both groups underwent clinical and echocardiographic examinations during hospitalization and follow-up (mean, 1.0 ± 0.8 years). QoL was assessed with the Seattle Angina Questionnaire, short version (SAQ-7). RESULTS Surgery resulted in significantly better QoL than OMT, with a significant improvement in left ventricular global longitudinal strain (GLS) [mean (standard error): 19% (0.19) to 22% (0.34) and 19% (0.15) to 20% (0.24), respectively; delta-change (delta-GLS) of 0.15 vs. 0.067]. In the univariate and multivariable analyses, delta-GLS was positively correlated with the SAQ-7 score and MB length (rho = 0.64 and 0.71, respectively), with a significant interaction between MB length and surgical treatment (beta coefficient, 1.95; 95% confidence interval, 0.14-3.77). CONCLUSIONS MB unroofing surgery provided benefits in terms of QoL and left ventricular GLS improvement compared with 1 year of OMT.
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Affiliation(s)
- Francesco Bianco
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio," University of Chieti, Italy
| | - Valentina Bucciarelli
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio," University of Chieti, Italy.,Department of Pharmacy, "G. d'Annunzio," University of Chieti, Italy
| | - Francesca Chiara Surace
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Federica Valentina Iezzi
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Emanuela Berton
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Alessandra Baldinelli
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Tommaso Piva
- Interventional Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Alessandro Maolo
- Interventional Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Nicolo' Schicchi
- Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Massimo Colaneri
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Marco Pozzi
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio," University of Chieti, Italy
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Zhang M, Yang J, Ma C, Liu M. Longitudinal strain measured by two-dimensional speckle tracking echocardiography to evaluate left ventricular function in patients with myocardial bridging of the left anterior descending coronary artery. Echocardiography 2019; 36:1066-1073. [PMID: 31087389 DOI: 10.1111/echo.14357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/30/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Myocardial bridging (MB) can cause myocardial ischemia, myocardial infarction, or even sudden cardiac death. We aimed to evaluate the left ventricular function in patients with MB of the left anterior descending coronary artery (LAD) using longitudinal strain (LS) measured by two-dimensional speckle tracking echocardiography. METHODS We enrolled 46 subjects with MB in the LAD diagnosed by coronary angiography. Patients were categorized into two groups according to the severity of tunneled artery stenosis: <50% as group I (23 patients) and ≥50% as group II (23 patients). Twenty-five gender- and age-matched subjects without MB confirmed by coronary angiography or with normal results on treadmill exercise test were included as controls. Two-dimensional strain software was applied to measure the territories systolic average peak LS of the LAD coronary artery (LAD-TPLS), right coronary artery (RCA-TPLS), and left circumflex coronary artery (LCX-TPLS) and to measure the global systolic peak LS of left ventricle (LV-GPLS). RESULTS The ratio of mitral peak early (E) and late (A) filling velocity (E/A) and the average mitral annular velocity (e') were lower, and the mitral E/e' ratio was higher in group II than in group I and controls (P < 0.05). LV-GPLS and LAD-TPLS were significantly less negative in group II than in group I and controls (LV-GPLS: -19.77 ± 1.60% vs -21.10 ± 1.91% and -21.76 ± 1.23%; LAD-TPLS: -19.24 ± 2.22% vs -22.00 ± 2.22% and -22.74 ± 1.82%, P < 0.001). The systolic compression severity of the tunneled artery was significantly correlated with LAD-TPLS (r = -0.56, P < 0.001), but less strongly correlated with LV-GPLS (r = -0.40, P < 0.05). The area under the curves of LAD-TPLS was larger than that of LV-GPLS; a cutoff value for LAD-TPLS of -21.68% had 91.3% sensitivity and 73.9% specificity for detection of ≥50% of the tunneled artery stenosis. CONCLUSIONS In patients with ≥50% systolic narrowing of the tunneled artery, left ventricular systolic function and diastolic function were impaired, and the LAD-TPLS is an excellent predictor of ≥50% systolic narrowing of the tunneled artery in patients with MB of the LAD.
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Affiliation(s)
- Minping Zhang
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shen Yang, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shen Yang, China
| | - Minghui Liu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
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Teragawa H, Oshita C, Ueda T. The Myocardial Bridge: Potential Influences on the Coronary Artery Vasculature. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819846493. [PMID: 31068756 PMCID: PMC6495429 DOI: 10.1177/1179546819846493] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 04/03/2019] [Indexed: 12/18/2022]
Abstract
A myocardial bridge (MB) is an anatomical abnormality of the coronary artery and is characterized by the systolic narrowing of the epicardial coronary artery caused by myocardial compression during systole. An MB is frequently observed on cardiac computed tomography or coronary angiography and generally appears to be harmless in the majority of patients. However, the presence of MB is reportedly associated with abnormalities of the cardiovascular system, including coronary artery diseases, arrhythmia, certain types of cardiomyopathy, and cardiac death, indicating that MB serves a pivotal role in the occurrence and/or development of such cardiovascular events. Recently, there has been an increasing interest in the coexistence of MB and coronary spasm in research due to opposing aspects regarding their treatments. For example, monotherapy using β-blockers, which are effective in patients with MB, may worsen symptoms in patients with coronary spasm. By contrast, nitroglycerin, which is an effective treatment option for coronary spasm, may worsen symptoms in patients with MB. This review focuses on the pathophysiology and diagnosis of MB and MB-related cardiovascular diseases, including coronary spasm, and on the treatment strategies for MB.
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Affiliation(s)
- Hiroki Teragawa
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan
| | - Chikage Oshita
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan
| | - Tomohiro Ueda
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan
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