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Yang TL, Hao WR, Chen CC, Fang YA, Leu HB, Liu JC, Lin SJ, Horng JL, Shih CM. Myocardial Bridging Increases the Risk of Adverse Cardiovascular Events in Patients without Coronary Atherosclerosis. Life (Basel) 2024; 14:811. [PMID: 39063566 PMCID: PMC11278439 DOI: 10.3390/life14070811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/18/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Myocardial bridging (MB) is a congenital coronary anomaly and an important cause of chest pain. The long-term effects of MB on cardiovascular events remain elusive. Methods: We used the National Health Insurance Research Database of Taiwan to conduct an analysis. All patients who had undergone coronary angiography were considered for inclusion. The primary endpoint was a composite of nonfatal myocardial infarction, nonfatal ischemic stroke, and cardiovascular death. Results: We identified 10,749 patients from 2008 to 2018 and matched them with an equal number of controls by propensity-score matching. The mean follow-up period was 5.78 years. In patients without coronary artery disease, MB increased the risk of the composite endpoint (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.44-1.72, p < 0.001), which was driven by increased risks of nonfatal myocardial infarction and cardiovascular death. In patients with significant coronary artery disease, MB did not increase the risk of major adverse cardiovascular events. MB was identical to insignificant coronary artery disease from the viewpoint of clinical outcomes. Conclusions: The presence of MB significantly increases cardiovascular risks in patients with normal coronary vessels. Atherosclerotic coronary artery disease mitigates the effect of MB on cardiovascular outcomes. MB can be considered an insignificant coronary artery disease equivalent.
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Affiliation(s)
- Tsung-Lin Yang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; (W.-R.H.); (C.-C.C.); (J.-C.L.)
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan;
- Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
| | - Wen-Rui Hao
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; (W.-R.H.); (C.-C.C.); (J.-C.L.)
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
| | - Chun-Chao Chen
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; (W.-R.H.); (C.-C.C.); (J.-C.L.)
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
| | - Yu-Ann Fang
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
| | - Hsin-Bang Leu
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Section 2, Linong Street, Taipei 112, Taiwan;
- Division of Healthcare and Management, Healthcare Center, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Ju-Chi Liu
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; (W.-R.H.); (C.-C.C.); (J.-C.L.)
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
| | - Shing-Jong Lin
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan;
- Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
| | - Jiun-Lin Horng
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
| | - Chun-Ming Shih
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; (W.-R.H.); (C.-C.C.); (J.-C.L.)
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan;
- Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
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Mohamed S, Abdelaziz S. Wellens Syndrome: prevalence, risk factors and coronary angiographic variation. A cross-sectional study. BMC Cardiovasc Disord 2024; 24:84. [PMID: 38302954 PMCID: PMC10832078 DOI: 10.1186/s12872-024-03752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/29/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Wellens syndrome complicates acute coronary syndrome and, if unmanaged, can lead to immanent myocardial infarction. This study aimed towards determining the prevalence of Wellens syndrome among acute coronary syndrome patients while focusing on both types and identifying the associated risk factors, then exploring the variation in affected coronary arteries within patients fulfilling Wellens syndrome criteria. METHODS Implementing a descriptive cross sectional hospital based observational study design, at Ahmed Gasim Teaching Hospital for Cardiac Surgery and Renal Transplantation in Khartoum North, Sudan, the study was conducted following using a non probability convenience sampling of patients fitting the inclusion criteria. Data was collected using closed ended structured questionnaires. Ethical clearance was obtained from relevant authorities. Statistical analysis was done using descriptive and comparative data analysis with the aid of the SPSS software, and STROBE guidelines were followed. RESULTS A total of 120 patients were included, 70 males and 50 females, majority in their fifth decade. 14 patients had no documented risk factors. 42.5% had STEMI, 34.2% had NSTEMI and 23.3% had unstable angina. Patients fulfilling Wellens syndrome criteria were 18 (15%), 55.6% of them were type A and 44.4% were type B. Most frequently encountered risk factor among Wellens syndrome patients was Diabetes (50%). Out of 16 Wellens syndrome patients who underwent coronary angiography, 50% had mid LAD involvement, most were type A; 25% had proximal LAD involvement and 25% had normal coronary angiography. There was some association between Wellens syndrome and NSTEMI, but no significant association with any specific risk factor. CONCLUSION Wellens syndrome complicates 15% of acute coronary syndrome patients with a 55.6% possibility of becoming type A, it can present even without a specific predisposing risk factor and coronary angiographic variation other than the proximal part of the LAD artery may occur, including multiple vessels involvement. This is a descriptive cross sectional study conducted at Ahmed Gasim Teaching Hospital in Sudan, to determine the prevalence and risk factors of Wellens syndrome. Data was collected using questionnaires and analyzed with the SPSS software. Out of 120 patients, 14 patients had no documented risk factors. 34.2% had NSTEMI and 23.3% had unstable angina. Patients fulfilling Wellens syndrome criteria were 18 (15%). The commonest risk factor among Wellens syndrome patients was Diabetes (50%). 50% of Wellens syndrome patients had mid LAD involvement. The study concluded that Wellens syndrome is not rare, it can present without specific risk factor and coronary angiographic variation other than the proximal LAD artery can occur.
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Affiliation(s)
- Sami Mohamed
- Department of Internal Medicine, Faculty of Medicine, Nile University, Khartoum, Sudan.
| | - Samoal Abdelaziz
- Department of cardiology, Ahmed Gasim Teaching Hospital, Khartoum North, Sudan
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Obi MF, Sharma M, Namireddy V, Gargiulo P, Noel C, Hyun C, Gale BD. Variant of Wellen's syndrome in type 1 diabetic patient: A case report. World J Cardiol 2023; 15:462-468. [PMID: 37900265 PMCID: PMC10600782 DOI: 10.4330/wjc.v15.i9.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/29/2023] [Accepted: 08/17/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Wellen's syndrome is a form of acute coronary syndrome associated with proximal left anterior descending artery (LAD) stenosis and characteristic electrocardiograph (ECG) patterns in pain free state. The abnormal ECG pattern is classified into type A (biphasic T waves) and type B (deeply inverted T waves), based on the T wave pattern seen in the pericodial chest leads. CASE SUMMARY We present the case of a 37-year-old male with history of type 1 diabetes mellitus (T1DM), gastroparesis, mild peripheral artery disease and right toe cellulitis on IV antibiotics who presented to the emergency department with nausea, vomiting and abdominal pain for 3 d and as a result couldn't take his insulin. Noted to have fasting blood sugar 392 mg/dL. Admitted for diabetic gastroparesis. During the hospital course, the patient was asymptomatic and denied any chest pain. On admission, No ECG and troponin draws were performed. On day 2, the patient became hypoxic with oxygen saturation 80% on room air, intermittent mild right-sided chest pain which he attributed to vomiting from his gastroparesis. Initial ECG done was significant for Biphasic T wave changes in leads V2 and V3 and elevated high sensitivity troponin. Patient was transitioned to cardiac intensive care unit and cardiac catheterization performed with result significant for extensive coronary artery disease. CONCLUSION This case highlights an exceptional manifestation of Wellen's syndrome, wherein the right coronary artery and circumflex artery display a remarkable 100% constriction, alongside a proximal LAD stenosis of 90%-95%. Notably, this occurrence transpired in a patient grappling with extensive complications arising from T1DM. Moreover, it underscores the utmost significance of promptly recognizing the presence of Wellen's syndrome and swiftly initiating appropriate medical intervention.
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Affiliation(s)
- Mukosolu Florence Obi
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, United States.
| | - Manjari Sharma
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, United States
| | - Vikhyath Namireddy
- Clinical Rotations, St Georges University, School of Medicine, True Blue 96038, Grenada
| | - Paul Gargiulo
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, United States
| | - Chelsea Noel
- Clinical Rotations, St Georges University, School of Medicine, True Blue 96038, Grenada
| | - Cho Hyun
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, United States
| | - Blossom De Gale
- Clinical Rotations, St Georges University, School of Medicine, True Blue 96038, Grenada
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Garcia Rivero G, Nadeau C, Cardy C, Crenshaw N, Gonzalez JM. Arm Pain After Walking Up a Flight of Stairs. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Tascanov MB, Tanriverdi Z, Gungoren F, Tapar GG, Bicer A. The relationship between myocardial bridge and frontal
QRS‐T
angle. J Arrhythm 2022; 38:772-777. [PMID: 36237851 PMCID: PMC9535755 DOI: 10.1002/joa3.12774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/09/2022] [Accepted: 08/22/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Zulkif Tanriverdi
- Faculty of Medicine, Sanliurfa Department of Cardiology Harran University Turkey
| | - Fatih Gungoren
- Faculty of Medicine, Sanliurfa Department of Cardiology Harran University Turkey
| | | | - Asuman Bicer
- Faculty of Medicine, Sanliurfa Department of Cardiology Harran University Turkey
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Tang N, Li YH, Kang L, Li R, Chu QM. Entire process of electrocardiogram recording of Wellens syndrome: A case report. World J Clin Cases 2022; 10:6672-6678. [PMID: 35979282 PMCID: PMC9294889 DOI: 10.12998/wjcc.v10.i19.6672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/19/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Wellens syndrome is an electrocardiogram (ECG) pattern seen in high-risk patients with unstable angina pectoris. It is characterized by inverted or biphasic T-waves that change into positive or pseudo-normalized waves at precordial leads when the patient experiences an angina attack; however, the mechanism for this condition remains unclear.
CASE SUMMARY A 47-year-old male patient experienced repeated, unprovoked episodes of chest pain for > 20 d, with worsening during the previous day. On the day of admission, he experienced episodes of paroxysmal chest pain lasting more than 30 min, in addition to radiating pain to the left arm and exertional dyspnea. The patient presented to the emergency department with no chest pain or other discomfort at that time. ECG at presentation showed sinus tachycardia and T-wave changes, which were identified as Wellens syndrome when combined with previous ECG findings. ECGs and myocardial enzymology examinations were normal when angina was present, but the ECG showed inverted or biphasic T-waves when angina was absent. After percutaneous coronary intervention, the ECGs demonstrated inverted or biphasic T-waves in the anterior precordial leads on days 0, 1, and 2, but normal T-waves on day 3. The ECGs showed no subsequent ischemic ST-T-wave changes.
CONCLUSION The Wellens syndrome pseudo-normalized T-waves likely reflect development of unstable angina pectoris into the hyperacute phase of ST-segment elevation myocardial infarction.
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Affiliation(s)
- Na Tang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Yi-Hua Li
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Liang Kang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Rong Li
- Department of Cardiovascular Disease, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Qing-Min Chu
- Department of Cardiovascular Disease, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
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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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Milne D, Ramadhin D, Seecheran R, Seecheran V, Henry R, Seecheran NA. The Curious Case of Pseudo-Wellens' Syndrome and Myocardial Bridging. J Investig Med High Impact Case Rep 2022; 10:23247096211073255. [PMID: 35038933 PMCID: PMC8961209 DOI: 10.1177/23247096211073255] [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] [Indexed: 11/17/2022] Open
Abstract
Wellens’ syndrome is an electrocardiographic harbinger of a critical left anterior
descending (LAD) coronary artery stenosis in acute coronary syndromes (ACS), whereas
pseudo-Wellens’ syndrome typically has angiographically normal coronary arteries.
Myocardial bridging (MB) occurs when an epicardial coronary artery segment takes a
tunneled intramuscular course. We describe a rare case of MB-induced pseudo-Wellens’
syndrome in a young patient presenting with unstable angina (USA).
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Affiliation(s)
- David Milne
- North West Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Divya Ramadhin
- Advanced Cardiovascular Institute, Port of Spain, Trinidad and Tobago
| | | | - Valmiki Seecheran
- North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Ronald Henry
- Advanced Cardiovascular Institute, Port of Spain, Trinidad and Tobago
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Sternheim D, Power DA, Samtani R, Kini A, Fuster V, Sharma S. Myocardial Bridging: Diagnosis, Functional Assessment, and Management: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:2196-2212. [PMID: 34823663 DOI: 10.1016/j.jacc.2021.09.859] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 02/08/2023]
Abstract
Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of the epicardial coronary artery traverses through the myocardium for a portion of its length. The muscle overlying the artery is termed a myocardial bridge, and the intramyocardial segment is referred to as a tunneled artery. MB can occur in any coronary artery, although is most commonly seen in the left anterior descending artery. Although traditionally considered benign in nature, increasing attention is being given to specific subsets of MB associated with ischemic symptomatology. The advent of contemporary functional and anatomic imaging modalities, both invasive and noninvasive, have dramatically improved our understanding of dynamic pathophysiology associated with MBs. This review provides a contemporary overview of epidemiology, pathobiology, diagnosis, functional assessment, and management of MBs.
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Affiliation(s)
- David Sternheim
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David A Power
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. https://twitter.com/rowpower
| | - Rajeev Samtani
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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