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Chandrasekhar S, Woods E, Bennett J, Newman N, McLean P, Alam M, Jneid H, Sharma S, Khawaja M, Krittanawong C. Coronary Artery Anomalies: Diagnosis & Management. Cardiol Rev 2024:00045415-990000000-00334. [PMID: 39315746 DOI: 10.1097/crd.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Coronary artery anomalies encompass a spectrum of congenital abnormalities affecting the origin, course, or termination of the major epicardial coronary arteries. Despite their rarity, coronary artery anomalies represent a significant burden on cardiovascular health due to their potential to disrupt myocardial blood flow and precipitate adverse cardiac events. While historically diagnosed postmortem, the widespread availability of imaging modalities has led to an increased recognition of coronary artery anomalies, particularly in adults. This review synthesizes current knowledge on the classification, mechanisms, and clinical implications of coronary anomalies, focusing on prevalent variants with significant clinical impact. We discuss strategies for medical and surgical management, as well as contemporary screening recommendations, acknowledging the evolving understanding of these anomalies. Given the breadth of possible variants and the limited data on some presentations, this review provides a framework to aid clinicians in the recognition and management of coronary anomalies, with a particular emphasis on their stratification by anatomical location. By consolidating existing knowledge and highlighting areas of uncertainty, this review aims to enhance clinical decision-making and improve outcomes for individuals with coronary anomalies.
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Affiliation(s)
- Sanjay Chandrasekhar
- From the Division of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Edward Woods
- From the Division of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Josiah Bennett
- From the Division of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Noah Newman
- From the Division of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Patrick McLean
- From the Division of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Mahboob Alam
- Cardiology Division, The Texas Heart Institute, Baylor College of Medicine, Houston, TX
| | - Hani Jneid
- John Sealy Distinguished Centennial Chair in Cardiology, Chief, Division of Cardiology, University of Texas Medical Branch, Houston, TX
| | - Samin Sharma
- Department of Cardiology, Mount Sinai Hospital, New York, NY
| | - Muzamil Khawaja
- Cardiology Division, Emory University School of Medicine, Atlanta, GA
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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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Rojas-Granados A, Pérez-Campos E, Sanchez-Sanchez M, Chávez MAM, Pérez-Campos-Mayoral L, Ángeles-Castellanos M. Prevalence of myocardial bridges in the Mexican population: A morphometric and histological analysis. Morphologie 2024; 108:100760. [PMID: 38157748 DOI: 10.1016/j.morpho.2023.100760] [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: 11/21/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Myocardial bridge (MB) is described as an abnormal band of myocardium covering a variable portion of any coronary artery. METHODS The current study explores the presence of MB throughout the coronary arterial system and provides a morphometric description through instrumented dissection of a sample of 100 human hearts. The study shows a higher prevalence of MB in the Mexican population than in previous reports. RESULTS In the total sample (n=100), MB was identified in 96% of it. A total of 421 MBs were observed, with a mean of 4.38mm (±0.28) per dissected heart. The most frequently affected vessel is the anterior interventricular artery where a total of 52 MBs were found, of the total sample studied. DISCUSSION The high prevalence of MB among Mexican patients could be the result of a genetic association for this population or the neoformation of MB after birth due to lifestyle-associated factors. Further studies are required to better understand the high prevalence of MB among Mexican subjects.
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Affiliation(s)
- A Rojas-Granados
- Departamento de Anatomia, Facultad de Medicina. Universidad Nacional Autónoma de México, México, Mexico
| | - E Pérez-Campos
- Tecnológico Nacional de México/IT, Oaxaca, Oaxaca City, Mexico
| | - M Sanchez-Sanchez
- Posgrado Facultad de Odontologia, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca, Mexico
| | - M A M Chávez
- Facultad de Medicina y Cirugia, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca, Mexico
| | - L Pérez-Campos-Mayoral
- Facultad de Medicina y Cirugia, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca, Mexico
| | - M Ángeles-Castellanos
- Departamento de Anatomia, Facultad de Medicina. Universidad Nacional Autónoma de México, México, Mexico; Departamento de Innovacion en Material Biologico Humano, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, México, Mexico.
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Yoshida K, Tanabe Y, Hosokawa T, Morikawa T, Fukuyama N, Kobayashi Y, Kouchi T, Kawaguchi N, Matsuda M, Kido T, Kido T. Coronary computed tomography angiography for clinical practice. Jpn J Radiol 2024; 42:555-580. [PMID: 38453814 PMCID: PMC11139719 DOI: 10.1007/s11604-024-01543-1] [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: 07/14/2023] [Accepted: 01/28/2024] [Indexed: 03/09/2024]
Abstract
Coronary artery disease (CAD) is a common condition caused by the accumulation of atherosclerotic plaques. It can be classified into stable CAD or acute coronary syndrome. Coronary computed tomography angiography (CCTA) has a high negative predictive value and is used as the first examination for diagnosing stable CAD, particularly in patients at intermediate-to-high risk. CCTA is also adopted for diagnosing acute coronary syndrome, particularly in patients at low-to-intermediate risk. Myocardial ischemia does not always co-exist with coronary artery stenosis, and the positive predictive value of CCTA for myocardial ischemia is limited. However, CCTA has overcome this limitation with recent technological advancements such as CT perfusion and CT-fractional flow reserve. In addition, CCTA can be used to assess coronary artery plaques. Thus, the indications for CCTA have expanded, leading to an increased demand for radiologists. The CAD reporting and data system (CAD-RADS) 2.0 was recently proposed for standardizing CCTA reporting. This RADS evaluates and categorizes patients based on coronary artery stenosis and the overall amount of coronary artery plaque and links this to patient management. In this review, we aimed to review the major trials and guidelines for CCTA to understand its clinical role. Furthermore, we aimed to introduce the CAD-RADS 2.0 including the assessment of coronary artery stenosis, plaque, and other key findings, and highlight the steps for CCTA reporting. Finally, we aimed to present recent research trends including the perivascular fat attenuation index, artificial intelligence, and the advancements in CT technology.
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Affiliation(s)
- Kazuki Yoshida
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Takaaki Hosokawa
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Tomoro Morikawa
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naoki Fukuyama
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yusuke Kobayashi
- Department of Radiology, Matsuyama Red Cross Hospital, Bunkyocho, Matsuyama, Ehime, Japan
| | - Takanori Kouchi
- Department of Radiology, Juzen General Hospital, Kitashinmachi, Niihama, Ehime, Japan
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Megumi Matsuda
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Koesbandono, Lukito AA, Muljadi R, Yuniarti M, Sindunata NA, Sarikie A, Pratama TA, Thio RS, Christanti J, Octavius GS. High Prevalence of Myocardial Bridging Detected in an Indonesian Population Using Multi-Detector Computed Tomography. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:794. [PMID: 38792977 PMCID: PMC11123036 DOI: 10.3390/medicina60050794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Myocardial bridging (MB) is still not yet considered a significant finding in Indonesia both radiographically and clinically. Hence, this article aims to assess the prevalence of MB using multi-detector computed tomography (MDCT) and look at factors contributing to stenosis amongst patients with MB. Materials and Methods: This study is cross-sectional in a single centre, with consecutive sampling, looking at all patients who underwent a multi-detector computed tomography (MDCT) scan from February 2021 until February 2023. GraphPad Prism version 9.0.0 for Windows (GraphPad Software, Boston, MA, USA) was used to analyse the results. Results: There are 1029 patients with an MB, yielding a prevalence of 44.3% (95%CI 42.3-46.4). The left anterior descending vessel is the most commonly implicated, with 99.6%. Among those with stenosis, the middle portion of the bridging vessel is the most common site of stenosis (n = 269), followed by the proximal portion (n = 237). The severity of stenosis is more often moderate, with 30-50% (n = 238). Females (odds ratio [OR] of 1.8, 95%CI 1.4-2.3; p-value < 0.0001), older age (t-value 5.6, p-value < 0.0001), symptomatic patients (OR 1.4, 95% CI 1.1-1.9; p-value = 0.013), and higher mean coronary artery calcium score (t-value 11.3, p-value < 0.0001) are more likely to have stenosis. The degree of stenosis is significantly higher in the proximal stenosis group than in the middle stenosis group (t-value 27, p-value < 0.0001). Conclusions: Our research demonstrates that MB may prevent atheromatosis of the coronary segment distal to the MB and predispose the development of atherosclerosis in the section proximal to the bridge.
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Affiliation(s)
- Koesbandono
- Interventional Radiology Division, Department of Radiology, Faculty of Universitas Pelita Harapan, Tangerang 15811, Indonesia
- Department of Radiology, Siloam Hospital Lippo Village, Tangerang 15811, Indonesia
| | - Antonia Anna Lukito
- Department of Cardiology and Vascular Medicine, Siloam Hospital Lippo Village, Tangerang 15810, Indonesia
| | - Rusli Muljadi
- Department of Radiology, Siloam Hospital Lippo Village, Tangerang 15811, Indonesia
- Thoracic and Cardiovascular Imaging Division, Department of Radiology, Faculty of Universitas Pelita Harapan, Tangerang 15811, Indonesia
| | - Mira Yuniarti
- Department of Radiology, Siloam Hospital Lippo Village, Tangerang 15811, Indonesia
- Thoracic and Cardiovascular Imaging Division, Department of Radiology, Faculty of Universitas Pelita Harapan, Tangerang 15811, Indonesia
| | | | - Andreyano Sarikie
- Department of Radiology, Faculty of Universitas Pelita Harapan, Tangerang 15811, Indonesia
| | | | - Reynaldy Santosa Thio
- Department of Radiology, Faculty of Universitas Pelita Harapan, Tangerang 15811, Indonesia
| | - Jessica Christanti
- Department of Radiology, Faculty of Universitas Pelita Harapan, Tangerang 15811, Indonesia
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Abouzid MR, Kamel I, Esteghamati S, Mohamed K, Hamed A. Intramyocardial Bridging: An Overlooked Cause of Atypical Chest Pain. Cureus 2024; 16:e60874. [PMID: 38910665 PMCID: PMC11193663 DOI: 10.7759/cureus.60874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2024] [Indexed: 06/25/2024] Open
Abstract
Intramyocardial bridging (IMB) is a congenital anomaly characterized by the tunneling of a coronary artery segment through the myocardium, potentially leading to serious cardiac complications, such as myocardial ischemia, infarction, and sudden death, challenging the traditional view of it being benign. A case involving a 42-year-old man with a seven-day history of atypical chest pain highlights the significance of considering IMB in the differential diagnosis. Despite normal troponin levels, creatine kinase (CK), CK-MB, D-dimer, a negative drug screen, a normal ECG, and chest X-ray and no apparent issues on echocardiogram, left heart catheterization revealed IMB in the left anterior descending artery. This case underscores the necessity of including IMB in the differential diagnosis for chest pain, particularly in young males with familial cardiovascular disease history. While noninvasive imaging methods are useful for diagnosis, coronary angiography is the definitive diagnostic tool. Treatment primarily involves beta-blockers and calcium-channel blockers, with revascularization as a secondary option for those unresponsive to medication.
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Affiliation(s)
- Mohamed R Abouzid
- Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, USA
| | - Ibrahim Kamel
- Internal Medicine, Tufts Medical Center, Boston, USA
- Internal Medicine, Steward Carney Hospital, Boston, USA
| | | | - Kareem Mohamed
- Internal Medicine, University of Missouri-Kansas City, Kansas City, USA
| | - Amr Hamed
- Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, USA
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Zhang Z, Liu Z, Hong N, Chen L. Effect of a second-generation motion correction algorithm on image quality and measurement reproducibility of coronary CT angiography in patients with a myocardial bridge and mural coronary artery. Clin Radiol 2024; 79:e462-e467. [PMID: 38135576 DOI: 10.1016/j.crad.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
AIM To determine the effect of second-generation motion correction (MC2) on image quality and measurement reproducibility of cardiac CT images in patients with a myocardial bridge and mural coronary artery (MB-MCA) compared to standard (STD) images without motion correction and with first-generation motion correction (MC1). MATERIALS AND METHODS A total of 66 patients with MB-MCA in the left anterior descending branch who underwent 256-detector CT with single-heartbeat acquisition were included. Images were reconstructed at 45% and 75% R-R intervals using STD, MC1, and MC2 algorithms. Image quality for MB-MCA was assessed by two observers on a four-point scale (1 = poor and 4 = excellent) and compared among STD, MC1, and MC2. Depth and length of MB, lumen area, and minimal diameter of MCA were measured and compared. RESULTS At 45% R-R interval, image quality scores were 1.59 ± 0.78, 2.21 ± 0.97, and 3.21 ± 0.62 for MCA, and 2.48 ± 0.79, 2.76 ± 0.75, and 3.58 ± 0.58 for MB with STD, MC1 and MC2, respectively. At 75% R-R interval, these values were 2.26 ± 0.60, 3.03 ± 0.89, and 3.59 ± 0.55 for MCA and 3.00 ± 0.93, 3.17 ± 0.83, and 3.80 ± 0.44 for MB. Although MC1 was superior to STD in displaying MCA, there was no statistical difference between the two algorithms for MB (p>0.05). Compared with STD and MC1, MC2 statistically improved image quality and interpretability for both MCA and MB and had narrower limits in interobserver agreement for measurements at both 45% and 75% R-R intervals. CONCLUSION MC2 improves CT image quality and measurement reproducibility in patients with MB-MCA compared to STD and MC1.
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Affiliation(s)
- Z Zhang
- Department of Radiology, Peking University People's Hospital, Beijing, 100044, China
| | - Z Liu
- Department of Radiology, Peking University People's Hospital, Beijing, 100044, China
| | - N Hong
- Department of Radiology, Peking University People's Hospital, Beijing, 100044, China
| | - L Chen
- Department of Radiology, Peking University People's Hospital, Beijing, 100044, China.
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Azzalini L, Boukhris M. Percutaneous Coronary Intervention of Left Anterior Descending Chronic Total Occlusion: Watch Out for Myocardial Bridging! JACC Cardiovasc Interv 2024; 17:502-504. [PMID: 38340100 DOI: 10.1016/j.jcin.2023.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/31/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA.
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Matta A, Roncalli J, Carrié D. Update review on myocardial bridging: New insights. Trends Cardiovasc Med 2024; 34:10-15. [PMID: 35697237 DOI: 10.1016/j.tcm.2022.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022]
Abstract
Myocardial bridging (MB) is a common congenital abnormality that remains asymptomatic in a large proportion of patients. The peak of clinical manifestation occurs during the third and fourth decades of life. MB provokes myocardial ischemia through different mechanisms including supply-demand mismatch, endothelial dysfunction, coronary microvascular dysfunction and external mechanical compression. The association between MB and atherosclerotic disease is controversial. Recent studies established a significant association of MB with myocardial infarction and non-obstructive coronary artery disease. The first line medical treatment is based on beta-blockers and calcium channel blockers. Ivabradine is used in second line therapy. Invasive approaches involving percutaneous coronary intervention, coronary artery bypass graft and myotomy are performed in patients with symptoms refractory to maximally tolerated medical treatment. The choice of revascularization technique depends on anatomical characteristics, clinical condition and physician experience. Available data derived from anecdotal evidence view the lack of randomized clinical trials.
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Affiliation(s)
- Anthony Matta
- Department of cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse, France; Department of cardiology, Intercommunal Hospital Centre Castres-Mazamet, Castres, France; Faculty of medicine, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Jerome Roncalli
- Department of cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse, France
| | - Didier Carrié
- Department of cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse, France.
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10
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Danek BA, Kearney K, Steinberg ZL. Clinically significant myocardial bridging. Heart 2023; 110:81-86. [PMID: 37344169 DOI: 10.1136/heartjnl-2022-321586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
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.
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Affiliation(s)
- Barbara A Danek
- Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Kathleen Kearney
- Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Zachary L Steinberg
- Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
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Yang TL, Ting J, Lin MR, Chang WC, Shih CM. Identification of Genetic Variants Associated with Severe Myocardial Bridging through Whole-Exome Sequencing. J Pers Med 2023; 13:1509. [PMID: 37888120 PMCID: PMC10608235 DOI: 10.3390/jpm13101509] [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: 09/06/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
Myocardial bridging (MB) is a congenital coronary artery anomaly and an important cause of angina. The genetic basis of MB is currently unknown. This study used a whole-exome sequencing technique and analyzed genotypic differences. Eight coronary angiography-confirmed cases of severe MB and eight age- and sex-matched control patients were investigated. In total, 139 rare variants that are potentially pathogenic for severe MB were identified in 132 genes. Genes with multiple rare variants or co-predicted by ClinVar and CADD/REVEL for severe MB were collected, from which heart-specific genes were selected under the guidance of tissue expression levels. Functional annotation indicated significant genetic associations with abnormal skeletal muscle mass, cardiomyopathies, and transmembrane ion channels. Candidate genes were reviewed regarding the functions and locations of each individual gene product. Among the gene candidates for severe MB, rare variants in DMD, SGCA, and TTN were determined to be the most crucial. The results suggest that altered anchoring proteins on the cell membrane and intracellular sarcomere unit of cardiomyocytes play a role in the development of the missed trajectory of coronary vessels. Additional studies are required to support the diagnostic application of cardiac sarcoglycan and dystroglycan complexes in patients with severe MB.
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Affiliation(s)
- Tsung-Lin Yang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Jafit Ting
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan; (J.T.); (M.-R.L.)
| | - Min-Rou Lin
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan; (J.T.); (M.-R.L.)
| | - Wei-Chiao Chang
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan; (J.T.); (M.-R.L.)
- Master’ Program in Clinical Genomics and Proteomics, School of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Chun-Ming Shih
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 11031, Taiwan
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12
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Maynard C. Understanding the Natural History of Myocardial Bridges. Am J Cardiol 2023; 205:499. [PMID: 37633794 DOI: 10.1016/j.amjcard.2023.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Charles Maynard
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington.
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13
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Medina F, Estrada A, Fernandez C, Balkhy H, Kim G, Shah A, Nathan S, Paul J, Kalathiya R, Blair J. Use of Intravascular Ultrasound and Coronary Angiography to Measure the Prevalence of Myocardial Bridge in Heart Transplant Patients. Am J Cardiol 2023; 205:176-181. [PMID: 37604064 DOI: 10.1016/j.amjcard.2023.07.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Abstract
Myocardial bridge (MB) detection rates vary across methods and most studies that have assessed MB include symptomatic patients. Intravascular ultrasound (IVUS) is a sensitive tool for MB detection and donor hearts may serve as a surrogate measure of asymptomatic patients. We used IVUS and coronary angiography to measure MB prevalence in heart transplant patients during routine follow-up invasive coronary assessments. This was a retrospective, single-center study of heart transplant patients who received follow-up coronary assessments at the University of Chicago Heart and Vascular Center between December 2014 and December 2021. A single experienced interventional cardiologist assessed incidental findings of MB in IVUS and coronary angiography. Detection rates were compared with meta-analysis-reported prevalence. Of 129 patients, IVUS-detected MB in 87 patients (67.4%), whereas coronary angiography detected 41 (31.8%). All MB found by coronary angiography were detected by IVUS. Some level of cardiac allograft vasculopathy was found in 92 patients (71.3%). Our IVUS-detected MB prevalence was greater than meta-analysis-reported pooled prevalence across all methods: autopsy, computed tomography angiography, and coronary angiography (67.4% [95% confidence interval [CI] 59.4 to 75.5] vs 42% [95% CI 30 to 55]; 22% [95% CI 18 to 25]; 6% [95% CI 5 to 8], p ≤0.005). The difference between our observed IVUS-detected MB prevalence and meta-analysis autopsy reported MB prevalence was 1.25 (95% CI 1.11 to 1.40). In conclusion, the high prevalence of MB recorded in donor hearts emphasizes the need to further investigate the causes of chest pain in patients who are found to have MB.
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Affiliation(s)
- Frank Medina
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Andy Estrada
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Christopher Fernandez
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Husam Balkhy
- Section of Cardiology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Gene Kim
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Atman Shah
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Sandeep Nathan
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Jonathan Paul
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Rohan Kalathiya
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - John Blair
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
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14
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Giordano G, Mastrantoni L, Colloca GF. Myocardial bridge in a patient with castration-resistant metastatic prostate cancer treated with enzalutamide. J Oncol Pharm Pract 2023; 29:1754-1756. [PMID: 37282514 DOI: 10.1177/10781552231180599] [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] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Myocardial bridge is a morphological anomaly of the heart characterised by the presence of a myocardial segment above a coronary artery, which results in a higher risk of cardiovascular events. In patients with prostate cancer treated with androgen receptor-targeted agents, a higher risk of cardiotoxicity was observed. CASE REPORT An 88 years old man with metastatic castration-resistant prostate cancer in treatment with enzalutamide, denosumab, and triptorelin presented to our attention complaining dyspnoea and angina pectoris. MANAGEMENT AND OUTCOME Blood examinations revealed normal Troponin I levels. Transthoracic echocardiography revealed no signs of acute myocardial ischaemia. The treadmill stress test revealed S-T tract under levelling in V4-V6 with a very slow resolution. Coronary angiography identified a myocardial bridge in the medium tract of the interventricular anterior artery. Due to these findings, ranolazine and simvastatin were started and, after multidisciplinary assessment, we decided to continue the treatment with enzalutamide. At the first follow-up visit echocardiography found out the cardiological reports stability and no therapy changes were performed. During follow-up visit cardiological revaluation showed reports stability and no therapy changes were performed. DISCUSSION Due to the high prevalence of prostate cancer in elderly patients at high cardiovascular risk and the increasing use of androgen receptor-targeted agent, a multidisciplinary approach is highly recommended to weigh survival benefits on toxicities. This case report may support the use of androgen receptor-targeted agent in elderly patients with controlled cardiovascular diseases, a population that is often excluded from randomised trials.
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Affiliation(s)
- Giulia Giordano
- Department of Geriatrics and orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Mastrantoni
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Ferdinando Colloca
- Department of Imaging Diagnostic, Oncologic radiotherapy and Haematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Guerra E, Bergamaschi L, Tuttolomondo D, Pizzi C, Sartorio D, Gaibazzi N. Contrast Stress Echocardiography Findings in Myocardial Bridging Compared to Normal Coronary Course, With and Without Coronary Artery Disease. J Am Soc Echocardiogr 2023; 36:1092-1099. [PMID: 37356674 DOI: 10.1016/j.echo.2023.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 06/27/2023]
Abstract
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.
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Affiliation(s)
- Emiliano Guerra
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Domenico Tuttolomondo
- Cardiology Division, Parma University Hospital, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Daniele Sartorio
- Cardiology Division, Parma University Hospital, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Nicola Gaibazzi
- Cardiology Division, Parma University Hospital, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; PacC Heart Centre, Parma, Italy.
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16
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Narayanan S, Joseph S, Varghese AC, Nair RG, Mohan H, Edger D, Sudhakar A. Plaque morphology and distribution in patients with and without myocardial bridge - an intravascular ultrasound study. Acta Cardiol 2023; 78:894-900. [PMID: 36939314 DOI: 10.1080/00015385.2023.2187117] [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: 09/30/2022] [Accepted: 02/22/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Myocardial bridging (MB) is a common congenital cardiovascular anomaly. There are reported associations of MB with different clinical presentations like effort angina, acute coronary syndromes (ACS) and sudden cardiac death. Acceleration of atherosclerosis in proximal vessel is reported in patients with MB, while bridged segments are reported to be free of atherosclerosis. METHODS We assessed patients who underwent intravascular ultrasound (IVUS) guided percutaneous intervention (PCI) of left anterior descending (LAD) artery. Plaque characteristics derived from IVUS analysis were compared between those who displayed myocardial bridge versus those who did not harbour the anomaly. RESULTS One hundred and forty-seven (147) patients underwent IVUS guided PCI. Incidence of MB was 44/147 (29.9%). Mean age of patients who had MB {+} was higher (62.1 ± 10.3 vs. 57.8 ± 11.2 (p = .03). 142/147 (96.6%) patients presented with ACS. ST elevation myocardial infarction (STEMI) was the most common presenting diagnosis (110/147 to 74.8%). There were no differences in qualitative plaque characteristics - attenuated plaque, calcification or calcium score between two groups. Plaque burden and length of the lesion in the proximal vessel were not different. Among patients with MB {+}, atheromatous extension to segments underlying the bridge was seen in 31/44 (70.5%) cases. CONCLUSIONS In a series of patients who presented with advanced clinical atherosclerosis, plaque characteristics were not different in patients who harboured myocardial bridge vs. those who did not have the anomaly. Atheromatous involvement was seen extending into bridged segment contrary to previous reports.
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Affiliation(s)
- Sajan Narayanan
- Little Flower Hospital & Research Institute, Angamaly, India
| | - Stigi Joseph
- Little Flower Hospital & Research Institute, Angamaly, India
| | | | | | - Hareesh Mohan
- Little Flower Hospital & Research Institute, Angamaly, India
| | - Denim Edger
- Little Flower Hospital & Research Institute, Angamaly, India
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17
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Cheng S, Ni J, Deng W, Wang P. 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. Acad Radiol 2023; 30:2234-2242. [PMID: 37474348 DOI: 10.1016/j.acra.2023.06.019] [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: 05/13/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023]
Abstract
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.
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Affiliation(s)
- Shuihua Cheng
- Department of Radiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (S.C., J.N., P.W.)
| | - Jiong Ni
- Department of Radiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (S.C., J.N., P.W.)
| | - Weiwei Deng
- CT Clinical Science, Philips Healthcare, Shanghai, China (W.D.)
| | - Peijun Wang
- Department of Radiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (S.C., J.N., P.W.).
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18
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Rovera C, Moretti C, Bisanti F, De Zan G, Guglielmo M. Myocardial Bridging: Review on the Role of Coronary Computed Tomography Angiography. J Clin Med 2023; 12:5949. [PMID: 37762890 PMCID: PMC10532361 DOI: 10.3390/jcm12185949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/20/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of a coronary artery, most frequently the left anterior descending artery, deviates from its epicardial route by passing through the myocardium. The advent of cardiac computed tomography angiography (CCTA), equipped with its multiplane and three-dimensional functionalities, has notably enhanced the ability to identify MBs. Furthermore, novel post-processing methods have recently emerged to extract functional insights from anatomical evaluations. MB is generally considered a benign entity with very good survival rates; however, there is an increasing volume of evidence that certain MB characteristics may be associated with cardiovascular morbidity. This review is intended to depict the diagnostic and prognostic role of CCTA in the MB context.
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Affiliation(s)
- Chiara Rovera
- Department of Cardiology, Civic Hospital of Chivasso, 10034 Chivasso, Italy; (C.R.); (C.M.)
| | - Claudio Moretti
- Department of Cardiology, Civic Hospital of Chivasso, 10034 Chivasso, Italy; (C.R.); (C.M.)
| | - Francesca Bisanti
- Department of Radiology, Civic Hospital of Chivasso, 10034 Chivasso, Italy;
| | - Giulia De Zan
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, 3584 CX Utrecht, The Netherlands;
- Department of Translational Medicine, University of Easter Piedmont, Maggiore della Carita’ Hospital, 28100 Novara, Italy
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, 3584 CX Utrecht, The Netherlands;
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19
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Leković A, Nikolić S. Atheroprotective effect of myocardial bridge sustains in aging: Autopsy study on subjects with dual left anterior descending coronary artery type 3. Cardiovasc Pathol 2023; 66:107553. [PMID: 37321465 DOI: 10.1016/j.carpath.2023.107553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/18/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The atheroprotective role of the myocardial bridge (MB) on a tunneled segment is already demonstrated in subjects with dual left anterior descending coronary artery (dual LAD) type 3 anomaly, but the dynamics of changes and whether this protective effect sustains during aging is unknown. METHODS The retrospective autopsy study included cases of dual LAD type 3 anomaly identified over 18 years. The severity grade of atherosclerosis in branches of dual LAD was estimated by microscopy. The Spearman's correlation test and Receiver operator characteristics (ROC) curve analyses were performed to determine the relation of subjects' age with a degree of the protective role of the myocardial bridge. RESULTS A total of 32 dual LAD type 3 cases were identified. The systematic heart examination revealed an anomaly prevalence of 2.1%. The age significantly positively correlated with the severity of atherosclerosis in the subepicardial dual LAD branch but not with the severity of atherosclerosis in the intramyocardial dual LAD branch. Subjects aged ≥38 years were likely to have a more severe degree of atherosclerosis in subepicardial than in intramyocardial LAD arteries (AUC 0.81 95% CI 0.59-1; sensitivity 100%, specificity 66.7%). In subjects aged ≥58 years, this difference was likely to be more pronounced (≥2 degree difference; AUC 0.75 95% CI 0.58-0.93; sensitivity 92.9%, specificity 66.7%). CONCLUSION The atheroprotective effect of the myocardial bridge on tunneled segments usually becomes evident throughout the second half of the fourth decade of life and is most pronounced after about 60 years and ceases only in some.
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Affiliation(s)
- Aleksa Leković
- Institute of Forensic Medicine, University of Belgrade Faculty of Medicine, Belgrade, Serbia.
| | - Slobodan Nikolić
- Institute of Forensic Medicine, University of Belgrade Faculty of Medicine, Belgrade, Serbia.
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20
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Luo L, Zhao C, Chen N, Dong Y, Li Z, Bai Y, Wu P, Gao C, Guo X. Characterization of global research trends and prospects on sudden coronary death: A literature visualization analysis. Heliyon 2023; 9:e18586. [PMID: 37576229 PMCID: PMC10413084 DOI: 10.1016/j.heliyon.2023.e18586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023] Open
Abstract
Background Sudden coronary death is a major global public health issue that has a significant impact on both individuals and society. Nowadays, scholars are active in sudden coronary death all over the world. However, no relevant bibliometric studies have been published. Here, we aim to gain a better understanding the current state of research and to explore potential new research directions through bibliometric analysis. Methods Articles and reviews on sudden coronary death from 2012 to 2023 were retrieved from the Web of Science Core Collection (WoSCC). The topic search was conducted using the following keywords: ((("sudden cardiac death" OR "sudden death") AND (coronary OR "myocardial infarction")) OR "sudden coronary death"). Knowledge maps of authors, countries, institutions, journals, keywords, and citations were conducted by CiteSpace. Publication dynamics, hotspots, and frontiers were analyzed independently by authors. Results A total of 2914 articles were identified from January 1, 2012 to June 20, 2023. The USA (n = 972) contributed the greatest absolute productivity and UK (centrality = 0.13) built a robust global collaboration. Harvard University was the institution with the highest number of publications (n = 143). Huikuri HV and Junttila MJ were the most published authors who devoted to searching for biomarkers of sudden coronary death. American Journal of Cardiology was the journal with the most publications, and Circulation was the most cited journal. Left ventricular ejection fraction, society, inflammation, and fractional flow reserve became novel burst words that lasted until 2023. Research on etiology and pathology, role of early risk factors in risk stratification, potential predictive biomarkers and novel measurement methods for the prevention and management of sudden coronary death were identified as the research hotspots and frontiers. Conclusion Our knowledge and understanding of sudden coronary death have significantly improved. Ongoing efforts should focus on the various etiologies and pathologies of sudden coronary death. Furthermore, a novel sudden coronary death risk model, large-scale population studies, and the rational use of multiple indicators to individualize the assessment of sudden coronary death and other risk factors are other emerging research trends.
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Affiliation(s)
- Li Luo
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Chunmei Zhao
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Niannian Chen
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Yiming Dong
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Zhanpeng Li
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Yaqin Bai
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Peng Wu
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Cairong Gao
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Xiangjie Guo
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
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21
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Lucena JDD, Brito HMD, Sanders JVS, Cavalcante JB, Collyer MC, Leite CDL, Silveira HFD, Ferreira Filho JCC. Incidence and Morphological Study of Myocardial Bridge in the State of Ceará: A Cadaveric Study. Arq Bras Cardiol 2023; 120:e20220460. [PMID: 37466617 PMCID: PMC10365010 DOI: 10.36660/abc.20220460] [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: 07/12/2022] [Revised: 01/26/2023] [Accepted: 04/05/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Myocardial bridges (MB) are anatomical anomalies with possible clinical repercussions; hence, their understanding deserves attention. OBJECTIVE To determinate the prevalence and characterize MB in human hearts from the state of Ceará. Methods: Fifty hearts of adult human cadavers from the Medicine School of Federal University of Ceará, Brazil. The hearts were dissected to identify MBs that pass over part of the coronary artery. The segment of the artery (proximal, middle, and distal) with a bridge was identified. The external diameter of the artery at the proximal and distal points of the MB was measured. The length and thickness of the MB were also measured with an electronic caliper. The muscle index (MMI) of the MB was calculated as the product of length and thickness expressed in millimeters. The significance level adopted in the statistical analysis was 5%. RESULTS MB was confirmed in 40% of sample. Approximately one third of the sample had only 1 MB. MB was most frequently found over the anterior interventricular branch of the left coronary artery (59.25%, p=0.02), and its prevalence in other branches was much lower (22.23%). The most affected segments of arteries were the superior (44.44%) and medium (40.74%). The mean diameter of arteries proximal to the MB was 2.38±0.97mm (range=0.78-5.15mm), and the diameter distal to the MB was 1.71±0.75mm (range=0.42-3.58mm). The length was measured as mean=8.55±5.27mm, while the mean thickness was 0.89±0.33mm. CONCLUSION A high prevalence of MB is more likely to affect the left coronary artery system with larger MMI than other affected branches.
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Guevara-Bermudez LP, Toleva O. Worsening of Angina Following Nitroglycerin Administration: A Case Report of the Interplay With Undiagnosed Myocardial Bridge. Cureus 2023; 15:e40091. [PMID: 37425580 PMCID: PMC10328144 DOI: 10.7759/cureus.40091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Myocardial bridge (MB) is a congenital abnormality where part of a coronary epicardial artery runs under the myocardium fibers and is compressed in systole; this becomes more pronounced when nitroglycerin (NTG) is administered. In this report, we describe the case of a 40-year-old African American man who presented with chest pain that did not respond to NTG or isosorbide mononitrate and was only partially relieved by narcotics. His past medical history was significant for coronary artery disease (CAD) with a stent into the left anterior descending artery (LAD) several months prior, hypertension, hyperlipidemia, paroxysmal atrial fibrillation, sick sinus syndrome, permanent pacemaker, pulmonary embolism, and cerebral vascular accident. No explanation for his angina was found either in the previous outpatient left heart catheterization (LHC) procedures demonstrating LAD stent patency or initial chest pain workup upon admission. Functional LHC procedure with adenosine infusion and acetylcholine provocation demonstrated endothelial dysfunction with notable epicardial spasm and MB of the LAD that worsened with NTG. Cardiology advised dual antiplatelet therapy and a statin as part of treatment for CAD and a calcium channel blocker with a bradycardic effect (e.g., diltiazem, verapamil) for the MB and coronary vasospasm, and avoidance of NTG and long-acting nitrates (e.g., isosorbide mononitrate), which can cause reflex tachycardia and worsen angina from MB. A selective serotonin reuptake inhibitor was added for increased cardiac nociception. The patient's pain resolved, and he was discharged. MB is an important alternate etiology to consider when chest pain does not respond to NTG administration for adjustment of treatment modalities. The initial treatment for this patient's pain with NTG likely exacerbated symptoms by reducing intrinsic coronary wall tension and subsequently increasing reflex sympathetic stimulation of contractility of the left ventricular myocardium, which can, in turn, increase anginal symptoms and ischemia.
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Affiliation(s)
- Liliana P Guevara-Bermudez
- Department of Hospital Medicine, Emory Saint Joseph's Hospital, Atlanta, USA
- Department of Medicine, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, USA
| | - Olga Toleva
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, USA
- Emory Women's Heart Center, Emory Saint Joseph's Hospital, Atlanta, USA
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Rinaldi R, Princi G, La Vecchia G, Bonanni A, Chiariello GA, Candreva A, Gragnano F, Calabrò P, Crea F, Montone RA. MINOCA Associated with a Myocardial Bridge: Pathogenesis, Diagnosis and Treatment. J Clin Med 2023; 12:3799. [PMID: 37297993 PMCID: PMC10253711 DOI: 10.3390/jcm12113799] [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: 05/01/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Myocardial bridging (MB) is the most frequent congenital coronary anomaly characterized by a segment of an epicardial coronary artery that passes through the myocardium. MB is an important cause of myocardial ischemia and is also emerging as a possible cause of myocardial infarction with non-obstructed coronary arteries (MINOCA). There are multiple mechanisms underlying MINOCA in patients with MB (i.e., MB-mediated increased risk of epicardial or microvascular coronary spasm, atherosclerotic plaque disruption and spontaneous coronary artery dissection). The identification of the exact pathogenetic mechanism is crucial in order to establish a patient-tailored therapy. This review provides the most up-to-date evidence regarding the pathophysiology of MINOCA in patients with MB. Moreover, it focuses on the available diagnostic tools that could be implemented at the time of coronary angiography to achieve a pathophysiologic diagnosis. Finally, it focuses on the therapeutic implications associated with the different pathogenetic mechanisms of MINOCA in patients with MB.
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Affiliation(s)
- Riccardo Rinaldi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giulia La Vecchia
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Alice Bonanni
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Alfonso Chiariello
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alessandro Candreva
- Department of Cardiology, Zurich University Hospital, 8091 Zurich, Switzerland
| | - Felice Gragnano
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80133 Naples, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80133 Naples, Italy
- Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, 81100 Caserta, Italy
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Rocco A. Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Hashikata T, Kameda R, Ako J. Clinical Implication and Optimal Management of Myocardial Bridging: Role of Cardiovascular Imaging. Interv Cardiol Clin 2023; 12:281-288. [PMID: 36922068 DOI: 10.1016/j.iccl.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Myocardial bridging (MB) was historically considered a benign structure as most people with MB are clinically asymptomatic. Recently, however, mounting evidence indicates that MB can cause adverse cardiac events owing to arterial systolic compression/diastolic restriction, atherosclerotic plaque progression upstream from MB, and/or vasospastic angina. In MB patients with refractory angina, the optimal treatment strategy should be determined individually based on versatile anatomic and hemodynamical assessments that often require multidisciplinary diagnostic approaches. The present review summarizes the clinical implication and management of MB, highlighting the role of imaging modalities currently available in this arena.
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Affiliation(s)
- Takehiro Hashikata
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan.
| | - Ryo Kameda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
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Shah SM, Quesada O, Henry TD. The Challenge of Myocardial Bridging. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100545. [PMID: 39129805 PMCID: PMC11308591 DOI: 10.1016/j.jscai.2022.100545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 08/13/2024]
Affiliation(s)
- Samit M. Shah
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Department of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Odayme Quesada
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
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Dilling-Boer D, Nof E, Beinaert R, Wakili R, Heidbuchel H, Koopman P, Schurmans J, Phlips T, Didenko M, Vijgen J. Damage to the left descending coronary artery due to radiofrequency ablation in the right ventricular outflow tract: Clinical case series and anatomical considerations. J Cardiovasc Electrophysiol 2023; 34:468-477. [PMID: 36651349 DOI: 10.1111/jce.15816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023]
Abstract
The purpose of this paper was to highlight the importance of the anatomy of the right ventricular outflow tract (RVOT) and the proximity of the mid segment of the left anterior descending coronary artery (LAD) to the RVOT in the setting of ablation of ventricular arrhythmias in the RVOT. During the period from 2014 till 2017, five patients with injury to the LAD during ablation within RVOT were identified in three centers, in Belgium, Germany and Israel. The clinical characteristics, procedural data and follow up data, where available, are reported. The literature review over coronary artery damage during radiofrequency ablation procedures is provided and the anatomy of the RVOT and the neighboring vascular structures is discussed. We present five patients who underwent radiofrequency ablation of ventricular arrhythmias mapped to the inferior and anterior part of the RVOT, at the insertion of the right ventricular wall to the septum, whereby ablation resulted in occlusion in four and severe stenosis in one, of the mid segment of the LAD coronary artery. All patients underwent percutaneous coronary intervention and stenting, four of them immediately during the same procedure and one 3 days later because of lack of signs and symptoms of acute coronary occlusion. In conclusion, the mid segment of the LAD at the level of the second septal perforator/second diagonal branch runs in very close proximity to the endocardial aspect of the lower part of the RVOT and care should be taken during ablation of ventricular arrhythmias in this region. Additional imaging such as intracardiac echocardiography and coronary angiography may be helpful in avoiding complications.
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Affiliation(s)
| | - Eyal Nof
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sacler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Beinaert
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sacler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reza Wakili
- Arrhythmia Service and Electrophysiology Section West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp University, Antwerp, Belgium.,Faculty of Medicine, Hasselt University, Hasselt, Belgium
| | - Pieter Koopman
- Department of Cardiology, Hartcentrum Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Joris Schurmans
- Department of Cardiology, Hartcentrum Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Thomas Phlips
- Department of Cardiology, Hartcentrum Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Maxim Didenko
- Kupriyanov Cardiovascular Surgery Clinic, Military Medical Academy, St. Petersburg, Russia
| | - Johan Vijgen
- Department of Cardiology, Hartcentrum Hasselt, Jessa Hospital, Hasselt, Belgium
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Charaf Z, Tanaka K, Wellens F, Nijs J, Van Loo I, Argacha JF, La Meir M. A chart review on surgical myocardial debridging in symptomatic patients: a safe procedure with good long-term clinical outcome and coronary computed tomographic angiography results. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:6976706. [PMID: 36802254 PMCID: PMC9931072 DOI: 10.1093/icvts/ivac286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/31/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Myocardial bridging is mostly diagnosed as an incidental imaging finding but can result in severe vessel compression and significant clinical adverse complications. Since there is still an ongoing debate when to propose surgical unroofing, we studied a group of patients where this was performed as an isolated procedure. METHODS In 16 patients (38.9 ± 15.7 years, 75% men) who had surgical unroofing for symptomatic isolated myocardial bridges of the left anterior descending artery, we retrospectively analysed symptomatology, medication, imaging modalities used, operative techniques, complications and long-term outcome. Computed tomographic fractional flow reserve was calculated to understand its potential value for decision-making. RESULTS Most procedures were performed on-pump (75%, mean cardiopulmonary bypass 56.5 ± 27.9 min, mean aortic cross-clamping 36.4 ± 19.7 min). Three patients needed a left internal mammary artery bypass since the artery dived inside the ventricle. There were no major complications or deaths. The mean follow-up was 5.5 years. Although there was a dramatic improvement in symptoms, still 31% experienced atypical chest pain at various moments during follow-up. Postoperative radiological control was performed in 88%, showing no residual compression or recurrent myocardial bridge and patent bypass if performed. All postoperative computed tomographic flow calculations (7) showed a normalization of coronary flow. CONCLUSIONS Surgical unroofing for symptomatic isolated myocardial bridging is a safe procedure. Patient selection remains difficult but introducing standard coronary computed tomographic angiography with flow calculations could be helpful in preoperative decision-making and during follow-up.
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Affiliation(s)
- Zohra Charaf
- Department of Cardiac Surgery, UZ Brussel, Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, UZ Brussel, Brussels, Belgium
| | - Francis Wellens
- Department of Cardiac Surgery, UZ Brussel, Brussels, Belgium
| | - Jan Nijs
- Department of Cardiac Surgery, UZ Brussel, Brussels, Belgium
| | - Ines Van Loo
- Department of Cardiac Surgery, UZ Brussel, Brussels, Belgium
| | | | - Mark La Meir
- Corresponding author. Department of Cardiac Surgery, UZ Brussel, Laarbeeklaan 101, 1090 Brussel, Belgium. Tel: +32-24776009; e-mail: (M. La Meir)
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Chen L, Yu WY, Liu R, Gao MX, Wang BL, Ding XH, Yu Y. A bibliometric analysis on the progress of myocardial bridge from 1980 to 2022. Front Cardiovasc Med 2023; 9:1051383. [PMID: 36684604 PMCID: PMC9853984 DOI: 10.3389/fcvm.2022.1051383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Although the vast majority of patients with a myocardial bridge (MB) are asymptomatic, the anomaly was found to be associated with stable or unstable angina, vasospastic angina, acute coronary syndrome, and even malignant arrhythmias and sudden cardiac death in some cases. Methods By retrieving the relevant literature on MB from 1 January 1980 to 31 July 2022 from the Web of Science Core Collection (WoSCC) database, we used the bibliometric tools, including CiteSpace, VOS viewer, and alluvial generator, to visualize the scientific achievements on MB. Results A total of 630 articles were included. The number of published articles was in a fluctuating growth trend. These publications came from 37 contries, led by the USA and China. The leading country on MB was the United States, the leading position among institutions was Stanford University, and the most productive researcher on MB was Jennifer A. Tremmel. After analysis, the most common keywords were myocardial bridge, mortality, coronary angiography, descending coronary artery, and sudden death. Conclusion Our findings can aid researchers in understanding the current state of MB research and in choosing fresh lines of inquiry for forthcoming investigations. Prevalence and prognosis, mechanism atherosclerosis, hemodynamic significance, and molecular autops will likely become the focus of future research. In addition, more studies and cooperations are still needed worldwide.
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Khan MI, Qureshi H, Akhtar S, Bae SJ, Hassan F. Prevalence of neuropsychiatric disorders in patients with systemic lupus erythematosus in Pakistan: A systematic review and meta-analysis. Front Psychiatry 2023; 14:1098734. [PMID: 36816415 PMCID: PMC9931908 DOI: 10.3389/fpsyt.2023.1098734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION By conducting a systematic review and meta-analysis, we investigated the prevalence of neuropsychiatric (NP) symptoms among systemic lupus erythematosus (SLE) patients in Pakistan. METHODS In this review work, three electronic databases (Web of Science, MEDLINE, and Google Scholar) and local databases were screened for 20 years from 1 January 2002 to 30 September 2022, to identify the articles evaluating the prevalence of NP symptoms in SLE patients in Pakistan. We performed a random-effects meta-analysis to estimate the prevalence of NPSLE. Statistical heterogeneity was measured by the I2 index, and subgroup meta-analyses were used to access the statistical heterogeneity. Furthermore, meta-regression models were used to examine the associations between prevalence estimates and study characteristics of interest. Three independent authors reviewed existing studies, extracted data, and rated the qualities of selected studies. This review was registered on PROSPERO (Registration no. CRD42022361798). RESULTS Thirteen studies met the inclusion criteria out of the 322 studies with a total of 2,003 SLE patients for this systematic review and meta-analysis. The prevalence of NP disorders in SLE patients was estimated to be 30.42% (95% CI:18.26-44.11%), with cognitive dysfunction being the most common (31.51%; 95% CI:1.28-76.27%), followed by headache (10.22%; 95% CI: 0.00-33.43%), seizures (5.96%; 95% CI: 3.80-8.53%), psychosis (3.64%; 95% CI: 2.38-5.13%), and neuropathy is the least common (0.86%; 95% CI: 0.00-2.74%). The heterogeneity between studies was significant (p < 0.01). The pooled prevalence of NP disorders among SLE patients was found highest in Punjab (41.21%) and lowest in Sindh (17.60%). CONCLUSION Findings from this study revealed that SLE patients have a high prevalence of NP disorders. The most common symptoms were cognitive dysfunctions, headaches, seizures, psychosis, and neuropathy. Clinicians can manage these potentially deadly and disabling diseases more effectively if they understand the incidence of each NP symptom in SLE patients. NP symptoms among SLE patients are at their peak in Pakistan; policymakers should devise preventive strategies to curb the disease. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record. php?RecordID=361798, identifier CRD42022361798.
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Affiliation(s)
- Muhammad Imran Khan
- Department of Industrial Engineering, Hanyang University, Seoul, Republic of Korea
| | - Humera Qureshi
- Department of Industrial Engineering, Hanyang University, Seoul, Republic of Korea
| | - Sohail Akhtar
- Department of Mathematics and Statistics, The University of Haripur, Haripur, Pakistan
| | - Suk Joo Bae
- Department of Industrial Engineering, Hanyang University, Seoul, Republic of Korea
| | - Fazal Hassan
- Department of Mathematics and Statistics, The University of Haripur, Haripur, Pakistan
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Santucci A, Jacoangeli F, Cavallini S, d’Ammando M, de Angelis F, Cavallini C. The myocardial bridge: incidence, diagnosis, and prognosis of a pathology of uncertain clinical significance. Eur Heart J Suppl 2022; 24:I61-I67. [PMID: 36380808 PMCID: PMC9653150 DOI: 10.1093/eurheartjsupp/suac075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The myocardial bridge (MB) is a common anomaly of the coronary tree, very often clinically silent. The artery typically involved is the left anterior descending in its proximal and/or middle portion. MB can cause ischaemia with various mechanisms, directly proportional to the degree of compression of the intra-myocardial tract, which impairs the coronary flow. It is a dynamic phenomenon that is affected by the adrenergic tone and is therefore often brought by physical exercise. MB, when symptomatic, often begins with angina from exertion; some patients have more severe conditions such as unstable angina or myocardial infarction. Coronary vasospasm related to MB-induced endothelial dysfunction can explain a number of cases that come to observation even with catastrophic pictures such as ventricular fibrillation caused by ischaemia. The diagnostic workup includes the non-invasive study using computed tomography angiography and the invasive study of the haemodynamic impact using pressure and Doppler guides. In symptomatic cases, drug therapy with a beta-blocker is enough to manage angina. When it fails, there is the option of coronary angioplasty or surgical treatment techniques.
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Use of Novel Blunt Dissection Technique for Surgical Unroofing in Myocardial Bridging Patients. Cardiol Res Pract 2022; 2022:2370802. [PMID: 36407284 PMCID: PMC9668448 DOI: 10.1155/2022/2370802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/02/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
Background Myocardial bridging (MB) is a congenital anomaly involving the myocardial tissue encasement of a segment of the coronary artery. The purpose of the present study was to assess safety and efficacy of two surgical methods used for treating MB patients at our institute. Methods Off-pump MB unroofing was performed in 45 adult patients between January 2016 and December 2021 by traditional surgical unroofing techniques (conventional group, n = 26) and blunt dissection techniques (blunt dissection group, n = 19). We retrospectively reviewed our patients by examining the baseline clinical characteristics, risk factors, medications, and diagnostic data for coronary artery disease. The Seattle Angina Questionnaire (SAQ) was used to assess angina symptoms both preoperatively and 6 months postsurgery. Results No significant difference in preoperative clinical characteristics was observed between the two groups. The blunt dissection group had shorter unroofed period (14.69 vs. 18.91 mins, P=0.001), less ventilator time (16.26 vs. 24.62 hours, P < 0.001), and a shorter hospital stay (8.74 vs. 12.89 days, P < 0.001). Although both traditional and blunt dissection techniques significantly improved postoperative SAQ scores including physical limitation due to angina, anginal stability, anginal frequency, treatment satisfaction, and quality of life (P < 0.001), no significant difference was observed between the traditional and blunt dissection techniques for SAQ. No cases of left anterior descending (LAD) injury in the blunt dissection group were observed although seven patients in the conventional group had LAD injuries. Conclusions In our single-center experience of MB unroofing, the blunt dissection technique is a safe, effective technique that significantly reduces surgical and ventilator time and hospital stay. MB patients with severe angina who underwent the blunt dissection for surgical unroofing experienced significant improvements in anginal symptoms and quality of life six months after the surgery.
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Ciliberti G, Laborante R, Di Francesco M, Restivo A, Rizzo G, Galli M, Canonico F, Zito A, Princi G, Vergallo R, Leone AM, Burzotta F, Trani C, Palmieri V, Zeppilli P, Crea F, D’Amario D. Comprehensive functional and anatomic assessment of myocardial bridging: Unlocking the Gordian Knot. Front Cardiovasc Med 2022; 9:970422. [PMID: 36426224 PMCID: PMC9678929 DOI: 10.3389/fcvm.2022.970422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/21/2022] [Indexed: 08/01/2023] Open
Abstract
Myocardial bridging (MB) is the most frequent congenital coronary anomaly in which a segment of an epicardial coronary artery takes a tunneled course under a bridge of the myocardium. This segment is compressed during systole, resulting in the so-called "milking effect" at coronary angiography. As coronary blood flow occurs primarily during diastole, the clinical relevance of MB is heterogeneous, being usually considered an asymptomatic bystander. However, many studies have suggested its association with myocardial ischemia, anginal symptoms, and adverse cardiac events. The advent of contemporary non-invasive and invasive imaging modalities and the standardization of intracoronary functional assessment tools have remarkably improved our understanding of MB-related ischemia, suggesting the role of atherosclerotic lesions proximal to MB, vasomotor disorders and microvascular dysfunction as possible pathophysiological substrates. The aim of this review is to provide a contemporary overview of the pathophysiology and of the non-invasive and invasive assessment of MB, in the attempt to implement a case-by-case therapeutic approach according to the specific endotype of MB-related ischemia.
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Affiliation(s)
- Giuseppe Ciliberti
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Renzo Laborante
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Di Francesco
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano Rizzo
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Maria Cecilia Hospital, Gruppo Villa Maria (GVM) Care and Research, Cotignola, Italy
| | - Francesco Canonico
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Zito
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Antonio Maria Leone
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Vincenzo Palmieri
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Paolo Zeppilli
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Domenico D’Amario
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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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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Çetin N, Özlek B, Özdemir İH, Yıldız BS, Yavuz V, Tıkız H. Comparison of Framingham risk score and atherogenic indices as a predictor of atherosclerosis in patients with myocardial bridge in left anterior descending artery. Acta Cardiol 2022; 77:342-349. [PMID: 34210253 DOI: 10.1080/00015385.2021.1945763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Myocardial bridge (MB) is generally considered as a benign condition, but it may trigger atherosclerosis, especially in the adjacent proximal coronary artery segment. In this study, we aimed to investigate whether the Framingham risk score (FRS) or atherogenic indices are risk factors for coronary atherosclerosis in patients with MB in the left anterior descending coronary artery (LAD). METHODS We performed a retrospective study evaluating 155 patients who have MB in LAD. The patients were evaluated in two groups according to the presence of atherosclerosis (74 patients in atherosclerotic group vs. 81 patients in non-atherosclerotic group). Baseline characteristics, FRS and atherogenic indices were reviewed between groups. Significant independent risk factors for coronary atherosclerosis were investigated by logistic regression analysis. RESULTS Patients in atherosclerotic group were significantly older (58.15 ± 10.04 vs. 50.22 ± 9.27 years, p < .001) and 74.3% of the patients were male. While the mean FRS in the atherosclerotic group was 21.20 ± 8.81, it was 12.79 ± 8.61 in the non-atherosclerotic group (p < .001). Among the atherogenic indices, only LDL-c/HDL-c ratio was significantly higher in the atherosclerotic group (3.49 ± 1.2 vs. 3.11 ± 0.98, p:.033). Multivariable analysis showed that age (OR: 1.08, 95% CI 1.03-1.13, p < .001) and FRS (OR: 1.06, 95% CI 1.01-1.11, p:.012) were independently associated with the presence of atherosclerotic lesion. CONCLUSIONS FRS is an easily applicable predictor in clinical practice that indicates the presence of coronary atherosclerosis in patients with MB in LAD.
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Affiliation(s)
- Nurullah Çetin
- Department of Cardiology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Bülent Özlek
- Department of Cardiology, Training and Research Hospital, Mugla Sitki Kocman University, Mugla, Turkey
| | | | - Bekir Serhat Yıldız
- Department of Cardiology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Veysel Yavuz
- Department of Cardiology, Akhisar Mustafa Kirazoglu State Hospital, Manisa, Turkey
| | - Hakan Tıkız
- Department of Cardiology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
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Sun LJ, Yan DG, Huang SW. Evaluation of intracoronary function after reduction of ventricular rate by esmolol in severe stenotic myocardial bridge: A case report. World J Clin Cases 2022; 10:3828-3833. [PMID: 35647165 PMCID: PMC9100712 DOI: 10.12998/wjcc.v10.i12.3828] [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: 07/17/2021] [Revised: 12/18/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe stenotic myocardial bridges (MBs) have been reported to lead to intracoronary ischaemia, but the physiological evaluation of MBs using intracoronary function evaluation indicators after intraoperative drug treatment has not been fully established.
CASE SUMMARY We performed through snuff fossa for coronary angiography in a patient with chest tightness after repeated exercise, and the results showed that the middle part of the anterior descending branch was a MB with 100% systolic compression. The intracoronary function evaluation (defined as the ratio of distal coronary pressure to aortic pressure with zero microcirculation resistance) was instantaneous wave-free ratio (IFR) without drug and fractional flow reserve (FFR) with adenosine. The IFR was 0.73, and the FFR was 0.66. Then esmolol 0.02 µg/kg/min was intravenously injected. The IFR and FFR were measured again when the heart rate dropped to 60 beats/min. The IFR was 0.83, and the FFR 0.65.
CONCLUSION This case report is a case of isolated MB with severe stenosis. After intraoperative drug treatment decreased the ventricular rate, an increase in the coronary function evaluation index was immediately observed to confirm the effective improvement of coronary blood flow.
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Affiliation(s)
- Long-Jun Sun
- Department of Cardiovascular Medicine, Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Ding-Guang Yan
- Department of Cardiovascular Medicine, Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Shu-Wei Huang
- Department of Cardiovascular Medicine, Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
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36
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Lee HJ, Kim JY. Coronary Artery Anomaly, What Radiologist Should Know? JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:84-101. [PMID: 36237368 PMCID: PMC9238192 DOI: 10.3348/jksr.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 11/15/2022]
Abstract
심장 전산화단층촬영(이하 CT)은 현재 관상동맥기형을 진단하고, 평가하는 가장 정확한 진단 도구로 자리매김하였으며, 심장 CT 촬영 건수가 증가함에 따라 관상동맥기형을 종종 관찰할 수 있다. 본 종설은 관상동맥기형에서 영상의학과 의사들이 꼭 알아야 할 대표적인 기형의 CT 소견들에 대해 다루었다. 관상동맥기형의 종류를 3부분 즉, 기시부, 동맥 내, 그리고 연결 부위로 나누어 설명하였으며, 임상에서 볼 수 있는 대표적인 기형들 중심으로 다루었다. 특히 혈역학적 이상을 유발하거나, 급사의 위험이 있는 기형들의 CT상 위험한 해부학적 소견에 대해서는 자세히 기술하였다.
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Affiliation(s)
- Hyun Jin Lee
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Jin Young Kim
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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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: 84] [Impact Index Per Article: 28.0] [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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38
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Aziz MU, Singh SP. Coronary artery anomalies evaluation with cardiac computed tomography: A review. J Med Imaging Radiat Sci 2021; 52:S40-S50. [PMID: 34479833 DOI: 10.1016/j.jmir.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Coronary artery anomalies involve either their origin, course, or termination of the vessel. Coronary artery anomalies are congenital and relatively few develop symptoms, which can include potentially serious effects like arrhythmia, chest pain, syncope, myocardial infarction, or sudden death. Conventional coronary angiography has been used extensively in the past few decades for evaluation of coronary anomalies. With recent advancements in the software and hardware, noninvasive nature, and excellent temporal and spatial resolution; coronary computed tomographic angiography (CTA) is now the mainstay in the diagnosis of coronary arterial anomalies. Many studies have shown better performance of cardiac CTA compared to invasive angiography in detection of anomalous coronary arteries.
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Affiliation(s)
- Muhammad Usman Aziz
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, Birmingham, AL, USA.
| | - Satinder P Singh
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, Birmingham, AL, USA
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39
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Myocardial bridging presenting as myocardial ischaemia induced cardiac arrest: a case report. BMC Cardiovasc Disord 2021; 21:178. [PMID: 33853525 PMCID: PMC8045353 DOI: 10.1186/s12872-021-01975-x] [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] [Received: 09/19/2020] [Accepted: 04/02/2021] [Indexed: 02/08/2023] Open
Abstract
Background Myocardial bridging is a congenital anomaly defined as a segment of epicardial coronary arteries running through the myocardium. Various complications related to myocardial bridging have been reported, but at present, cardiac arrest has rarely been reported. Case presentation We report one case of a patient who was successfully resuscitated from ventricular fibrillation cardiac arrest and was diagnosed with myocardial bridging accompanied by myocardial ischaemia. A 50-year-old woman who had been resuscitated from cardiac arrest transferred to our institution for evaluation and management of out-of-hospital cardiac arrest. We confirmed the diagnosis of significant myocardial bridging with evident myocardial ischaemia by coronary angiography, resting echocardiography and heart MRI. Vasospasm was thought to be a trigger factor judging from the transient ST elevation on electrocardiography. In addition, the finding of septal buckling was detected for the first time throughout the whole cardiac cycle by resting echocardiography in MB. Conclusion We report a rare case of survival after out-of-hospital cardiac arrest that might be caused by significant myocardial bridging-induced myocardial ischaemia, which was objectively confirmed by echocardiography and heart MRI. Although myocardial bridging is often overlooked as an aetiology for sudden cardiac death, this case highlights the importance of expanding the differential diagnosis to myocardial bridging in the work-up for the cause of sudden cardiac death.
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40
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Roberts W, Charles SM, Ang C, Holda MK, Walocha J, Lachman N, Tubbs RS, Loukas M. Myocardial bridges: A meta-analysis. Clin Anat 2021; 34:685-709. [PMID: 33078444 DOI: 10.1002/ca.23697] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Wallisa Roberts
- Department of Medicine, Princess Royal Hospital, Apley Castle, Telford Shropshire, UK
| | - Stacey M Charles
- Department of Anatomical Sciences, St. George's University, School of Medicine, Grenada, West Indies
| | - Cassandra Ang
- Department of Medicine, Princess Royal Hospital, Apley Castle, Telford Shropshire, UK
| | - Mateusz K Holda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, England, UK
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University, Medical College, Krakow, Poland
| | - Nirusha Lachman
- Department of Clinical Anatomy and Department of Plastic Surgery, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, School of Medicine, Grenada, West Indies.,Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, School of Medicine, Grenada, West Indies.,Department of Anatomy, University of Warmia and Mazury, Olsztyn, Poland
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Papp S, Bárczi G, Karády J, Kolossváry M, Drobni ZD, Simon J, Boussoussou M, Vattay B, Szilveszter B, Jermendy G, Merkely B, Maurovich-Horvat P. Coronary plaque burden of the left anterior descending artery in patients with or without myocardial bridge: A case-control study based on coronary CT-angiography. Int J Cardiol 2020; 327:231-235. [PMID: 33276021 DOI: 10.1016/j.ijcard.2020.11.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The clinical significance of myocardial bridging (MB) on the left anterior descending artery (LAD) is debated. We aimed to assess the association between MB and LAD plaque volumes/compositions in a case-control set up. METHODS In our retrospective analysis we investigated 50 cases with incidentally recognized LAD MB and 50 matched controls without LAD MB on coronary computed tomography angiography. We quantified plaque volumes proximal to the MB and beneath it in patients with MB and in the corresponding coronary segments in patients without MB. RESULTS In total, we have included 100 patients (mean age 60.6 ± 10.8 years, males: 80%). Plaque volume was similar in the LAD segments proximal to the MB in cases vs. controls (150.0 mm3 [IQR: 90.7-194.5 mm3] vs. 132.8 mm3 [IQR: 94.2-184.3 mm3], respectively; p = 0.95) while the plaque volume was smaller beneath LAD MB vs. control segment (16.2 mm3 [IQR: 12.6-25.8 mm3] vs. 21.1 mm3 [IQR: 14.0-42.4 mm3], respectively; p = 0.002). No significant differences were found regarding different plaque components in segments proximal to the MB while fatty plaque and necrotic core volumes were smaller or negligible in coronary segment beneath MB than in controls (0.07 mm3 [IQR: 0.005-0.27 mm3] vs. 12.7 mm3 [IQR: 7.4-24.4 mm3] and 0.00 mm3 [IQR: 0.00-0.04 mm3] vs. 0.06 mm3 [IQR: 0.03-2.8 mm3], respectively (p < 0.001). CONCLUSION Comparing patients with MB vs. matched controls without it, MB was not associated with increased plaque volumes in LAD segment proximal to MB and plaque quantity was smaller in the MB segment. Our data are supportive of benign nature of incidentally recognized LAD MB.
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Affiliation(s)
- Sára Papp
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - György Bárczi
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Júlia Karády
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsófia D Drobni
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Melinda Boussoussou
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Borbála Vattay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - György Jermendy
- Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary; Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
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Avram A, Chioncel V, Guberna S, Cuciureanu I, Brezeanu RC, Andrei CL, Sinescu C. Myocardial bridging-an unusual cause of Wellens syndrome: A case report. Medicine (Baltimore) 2020; 99:e22491. [PMID: 33031283 PMCID: PMC7544376 DOI: 10.1097/md.0000000000022491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 07/06/2020] [Accepted: 09/01/2020] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Coronary chest pain is usually ischemic in etiology and has various electrocardiographic presentations. Lately, it has been recognized that myocardial bridging (MB) with severe externally mechanical compression of an epicardial coronary artery during systole may result in myocardial ischemia. Such a phenomenon can be associated with chronic angina pectoris, acute coronary syndromes (ACS), coronary spasm, ventricular septal rupture, arrhythmias, exercise-induced atrioventricular conduction blocks, transient ventricular dysfunction, and sudden death. PATIENT CONCERNS We report the case of a 58-year-old woman presenting with recurrent episodes of constrictive chest pain during exercise within the last 2 weeks. Except for obesity, general and cardiovascular clinical examination on admission were normal. DIAGNOSES The resting 12 lead electrocardiogram (ECG) revealed changes typically for Wellens syndrome. High-sensitive cardiac troponin I was normal. We established the diagnosis of low-risk non-ST-segment elevation acute coronary syndrome with a Global Registry of Acute Coronary Events risk score of 92 points. INTERVENTIONS The patient underwent coronary angiography, who showed subocclusive dynamic obstruction of the left anterior descending artery due to MB. OUTCOMES The patient was managed conservatively. Her hospital course was uneventful and she was discharged on pharmacological therapy (clopidogrel, bisoprolol, amlodipine, atorvastatin, and metformin) with well-controlled symptoms on followup. LESSONS MB is an unusual cause of myocardial ischemia. Wellens syndrome is an unusual presentation of ACS. We present herein a rare case of Wellens syndrome caused by MB. This case highlights the importance of subtle and frequently overseen ECG findings when assessing patients with chest pain and second, the importance of considering nonatherosclerotic causes for ACS.
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Affiliation(s)
- Anamaria Avram
- Carol Davila University of Medicine and Pharmacy
- Bagdasar-Arseni Emergency Clinical Hospital, Bucharest, Romania
| | - Valentin Chioncel
- Carol Davila University of Medicine and Pharmacy
- Bagdasar-Arseni Emergency Clinical Hospital, Bucharest, Romania
| | - Suzana Guberna
- Carol Davila University of Medicine and Pharmacy
- Bagdasar-Arseni Emergency Clinical Hospital, Bucharest, Romania
| | - Irina Cuciureanu
- Carol Davila University of Medicine and Pharmacy
- Bagdasar-Arseni Emergency Clinical Hospital, Bucharest, Romania
| | - Radu Constantin Brezeanu
- Carol Davila University of Medicine and Pharmacy
- Bagdasar-Arseni Emergency Clinical Hospital, Bucharest, Romania
| | - Catalina Liliana Andrei
- Carol Davila University of Medicine and Pharmacy
- Bagdasar-Arseni Emergency Clinical Hospital, Bucharest, Romania
| | - Crina Sinescu
- Carol Davila University of Medicine and Pharmacy
- Bagdasar-Arseni Emergency Clinical Hospital, Bucharest, Romania
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Murtaza G, Mukherjee D, Gharacholou SM, Nanjundappa A, Lavie CJ, Khan AA, Shanmugasundaram M, Paul TK. An Updated Review on Myocardial Bridging. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1169-1179. [PMID: 32173330 DOI: 10.1016/j.carrev.2020.02.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/03/2020] [Accepted: 02/17/2020] [Indexed: 02/08/2023]
Abstract
Myocardial bridging is a congenital coronary anomaly with normal epicardial coronary artery taking an intra-myocardial course also described as tunneled artery. The majority of patients with this coronary anomaly are asymptomatic and generally it is a benign condition. However, it is an important cause of myocardial ischemia, which may lead to anginal symptoms, acute coronary syndrome, cardiac arrhythmias and rarely sudden cardiac death. There are numerous studies published in the recent past on understanding the pathophysiology, diagnostic and management strategies of myocardial bridging. This review highlights some of the recent updates in the diagnosis and management of patients with myocardial bridging. We discuss the role of various non-invasive and invasive diagnostic methods to evaluate functional significance of bridging. In addition, role of medical therapy such as beta-blockers, percutaneous coronary intervention with stents/bioresorbable scaffolds and surgical unroofing in patients unresponsive to medical therapy is highlighted as well.
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Affiliation(s)
- Ghulam Murtaza
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University, Johnson City, TN, USA
| | - Debabrata Mukherjee
- Division of Cardiology, Department of Internal Medicine, Texas Tech University, TX, USA
| | | | | | - Carl J Lavie
- Department of Cardiology, Ochsner Clinic, New Orleans, LA, USA
| | - Abdul Ahad Khan
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University, Johnson City, TN, USA
| | | | - Timir K Paul
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University, Johnson City, TN, USA.
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Hostiuc S, Rusu MC, Negoi I, Dorobanțu B, Grigoriu M. Anatomical variants of renal veins: A meta-analysis of prevalence. Sci Rep 2019; 9:10802. [PMID: 31346244 PMCID: PMC6658480 DOI: 10.1038/s41598-019-47280-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/15/2019] [Indexed: 11/22/2022] Open
Abstract
The main aim of this article is to establish the actual prevalence of renal vein variations (circumaortic renal vein, retroaortic renal vein, double renal vein), and to increase awareness about them. To this purpose, we have performed a meta-analysis of prevalence, using the MetaXL package, We included 105 articles in the final analysis of prevalence, of which 88 contained data about retroaortic renal vein, 84 - about circumaortic renal vein, and 51 - about multiple renal veins. The overall prevalence for retroaortic renal vein was 3% (CI:2.4-3.6%), for circumaortic renal vein - 3.5% (CI:2.8-4.4%), and for multiple renal veins - 16.7% (14.3-19.2%), much higher on the right 16.6 (14.2-19.1%) than on the left side 2.1 (1.3-3.2%). The results were relatively homogenous between studies, with only a minor publication bias overall.
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Affiliation(s)
- Sorin Hostiuc
- Carol Davila University of Medicine and Pharmacy, Faculty of Dental Medicine, Department of Legal Medicine and Bioethics, Bucharest, Romania.
| | - Mugurel Constantin Rusu
- Carol Davila University of Medicine and Pharmacy, Faculty of Dental Medicine, Department of Anatomy, Bucharest, Romania
| | - Ionut Negoi
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Department of Surgery, Bucharest, Romania
- Clinical Emergency Hospital, Bucharest, Romania
| | - Bogdan Dorobanțu
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Department of Surgery, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Mihai Grigoriu
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Department of Surgery, Bucharest, Romania
- University Emergency Hospital Bucharest, First Surgery Clinic, Bucharest, Romania
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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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Javadzadegan A, Moshfegh A, Qian Y, Kritharides L, Yong AS. Myocardial bridging and endothelial dysfunction – Computational fluid dynamics study. J Biomech 2019; 85:92-100. [DOI: 10.1016/j.jbiomech.2019.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/14/2018] [Accepted: 01/08/2019] [Indexed: 12/26/2022]
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Kroneman JGH, Faber JW, Schouten JCM, Wolschrijn CF, Christoffels VM, Jensen B. Comparative analysis of avian hearts provides little evidence for variation among species with acquired endothermy. J Morphol 2019; 280:395-410. [PMID: 30667083 PMCID: PMC6590421 DOI: 10.1002/jmor.20952] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/19/2018] [Accepted: 01/01/2019] [Indexed: 12/12/2022]
Abstract
Mammals and birds acquired high performance hearts and endothermy during their independent evolution from amniotes with many sauropsid features. A literature review shows that the variation in atrial morphology is greater in mammals than in ectothermic sauropsids. We therefore hypothesized that the transition from ectothermy to endothermy was associated with greater variation in cardiac structure. We tested the hypothesis in 14 orders of birds by assessing the variation in 15 cardiac structures by macroscopic inspection and histology, with an emphasis on the atria as they have multiple features that lend themselves to quantification. We found bird hearts to have multiple features in common with ectothermic sauropsids (synapomorphies), such as the presence of three sinus horns. Convergent features were shared with crocodylians and mammals, such as the cranial offset of the left atrioventricular junction. Other convergent features, like the compact organization of the atrial walls, were shared with mammals only. Pacemaker myocardium, identified by Isl1 expression, was anatomically node‐like (Mallard), thickened (Chicken), or indistinct (Lesser redpoll, Jackdaw). Some features were distinctly avian, (autapomorphies) including the presence of a left atrial antechamber and the ventral merger of the left and right atrial auricles, which was found in some species of parrots and passerines. Most features, however, exhibited little variation. For instance, there were always three systemic veins and two pulmonary veins, whereas among mammals there are 2–3 and 1–7, respectively. Our findings suggest that the transition to high cardiac performance does not necessarily lead to a greater variation in cardiac structure.
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Affiliation(s)
- Jelle G H Kroneman
- Department of Pathobiology, Anatomy and Physiology division, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.,Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
| | - Jaeike W Faber
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
| | - Jacobine C M Schouten
- Department of Pathobiology, Anatomy and Physiology division, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Claudia F Wolschrijn
- Department of Pathobiology, Anatomy and Physiology division, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Vincent M Christoffels
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
| | - Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
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Hostiuc S, Negoi I, Dogaroiu C, Drima E, Iancu CB. Cardiac telocytes. From basic science to cardiac diseases. I. Atrial fibrillation. Ann Anat 2018; 218:83-87. [PMID: 29655845 DOI: 10.1016/j.aanat.2017.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/27/2017] [Accepted: 12/31/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is nowadays considered to be one of the most important causes of heart failure, stroke, cognitive decline, vascular dementia, sudden death and overall cardiovascular morbidity. Recently were published a few articles suggesting a possible involvement of telocytes in the development of atrial fibrillation. The purpose of this article is to analyze the results obtained in the field systematically, and to see if there is enough data to support a possible involvement of telocytes in arrhythmogenesis. MATERIALS AND METHODS To this end, we performed a systematic review of the relevant scientific literature, indexed in PubMed, Web of Science, and Scopus. RESULTS AND DISCUSSIONS Our systematic review of the published data identified five articles containing original data, based on which the association between telocytes and atrial fibrillation was inferred in later studies. We analyzed the usefulness of the information contained in the original articles to support this association, showing a lack of definite proofs correlating telocytes with atrial fibrillation. CONCLUSIONS Even if a few articles implied a potential association between AF and telocytes, the current data is not enough to support it. Moreover, even an association between the morphology, characteristics, or density of the telocytes in the atrium/pulmonary veins and AF is potentially speculative, and more studies should be performed before implying it with a reasonable degree of certainty.
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Affiliation(s)
- Sorin Hostiuc
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Ionuț Negoi
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Catalin Dogaroiu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Eduard Drima
- University of Medicine and Pharmacy, Galaţi, Romania
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Hostiuc S, Marinescu M, Costescu M, Aluaș M, Negoi I. Cardiac telocytes. From basic science to cardiac diseases. II. Acute myocardial infarction. Ann Anat 2018; 218:18-27. [PMID: 29604385 DOI: 10.1016/j.aanat.2018.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/28/2018] [Accepted: 02/04/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the scientific evidence regarding a potential role of telocytes in myocardial infarction. MATERIALS AND METHODS To this purpose, we performed a systematic review of relevant scientific literature, indexed in PubMed, Web of Science, and Scopus. RESULTS AND DISCUSSIONS We found six articles containing relevant studies aimed at liking myocardial infarction and telocytes. The studies that were analysed in this review failed to show, beyond a reasonable doubt, that telocytes do actually have significant roles in myocardial regeneration after myocardial infarction. The main issues to be addressed in future studies are a correct characterization of telocytes, and a differentiation from other cell types that either have similar morphologies (using electron microscopy) or similar immunophenotypes, with emphasis on endothelial progenitors, which were previously shown to have similar morphology, and functions in cardiac regeneration after myocardial infarction.
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Affiliation(s)
- Sorin Hostiuc
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Mihai Marinescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihnea Costescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Maria Aluaș
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ionut Negoi
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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