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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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2
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Zhang H, Cao Y. A bibliometric analysis of myocardial bridge combined with myocardial infarction. Medicine (Baltimore) 2024; 103:e38420. [PMID: 38847718 PMCID: PMC11155543 DOI: 10.1097/md.0000000000038420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/09/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND The aim of this study is to analyze the process and frontiers of research in myocardial bridges (MB) to identify future research directions in the last 3 decades. METHODS Relevant literature on MB combined with myocardial infarction (MI) was searched from 1991 to 2023 in the Web of Science database, and was analyzed by bibliometric analysis using VOSviewer, CiteSpace, and the R package "bibliometrix." RESULTS A total of 1233 English articles were included in this study. The number of published articles showed an increasing trend yearly. From 2017 to 2022, the annual publication volume rose rapidly, and in 2021 the publication volume even reached 95 articles, which was the highest in all years. These publications were from 68 countries and 1854 institutions, with the leading country being the U.S. and the leading institution being Columbia University. Myoho Clinical International has a close collaborative relationship with Columbia University, while in recent years, the Harvard Medical School has explored the study of MB combined with MI. Annals of Thoracic Surgery was the journal with the highest number of publications, and Takayama Hiroo and Naka Yoshifumi were the authors with the highest number of publications. The most common keywords were MI, cardiogenic shock, and MB. CONCLUSIONS Our findings can help researchers explore the current status of MB combined with MI research and choose new survey routes for upcoming studies. Prevalence and prognosis, mechanism of MB combined with MI and molecular mechanism may become the focus of future research. In addition, more research and cooperation are needed worldwide.
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Affiliation(s)
- Haiyuan Zhang
- School of Graduate, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuejuan Cao
- Department of Cardiology, Tianjin Union Medical Center, Tianjin, China
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Hanci K, Acar B, Cakir O, Baris O, Omay O, Ural E. Stent fracture due to myocardial bridging causes cockboat deformity with large ischaemic myocardium. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2024; 20:227-231. [PMID: 39022722 PMCID: PMC11249878 DOI: 10.5114/aic.2024.139970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/12/2024] [Indexed: 07/20/2024] Open
Affiliation(s)
- Kaan Hanci
- Department of Cardiology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Burak Acar
- Department of Cardiology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Ozgur Cakir
- Department of Radiology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Ozgur Baris
- Department of Cardiovascular Surgery, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Oguz Omay
- Department of Cardiovascular Surgery, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Ertan Ural
- Department of Cardiology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
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4
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Zhang D, Tian X, Li MY, Zhang HW, Yu Y, Pan T, Li CY. Quantitative analysis of the relationship between the myocardial bridge and the FAI of pericoronal fat on computed tomography. Sci Rep 2024; 14:5976. [PMID: 38472256 DOI: 10.1038/s41598-024-55005-9] [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: 03/19/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
We performed this cohort study to investigate whether the myocardial bridge (MB) affects the fat attenuation index (FAI) and to determine the optimal cardiac phase to measure the volume and the FAI of pericoronary adipose tissue (PCAT). The data of 300 patients who were diagnosed with MB of the left anterior descending (LAD) coronary artery were retrospectively analyzed. All of patients were divided into the MB group and the MB with atherosclerosis group. In addition, 104 patients with negative CCTA results were enrolled as the control group. There was no significant difference between FAI values measured in systole and diastole (P > 0.05). There was no significant difference in FAI among the MB group, the MB with atherosclerosis group, and the control group (P > 0.05). In MB with atherosclerosis group, LAD stenosis degree (< 50%) (OR = 0.186, 95% CI 0.036-0.960; P = 0.045) and MB located in the distal part of LAD opening (OR = 0.880, 95% CI 0.789-0.980; P = 0.020) were protective factors of FAI value. A distance (from the LAD opening to the proximal point of the MB) of 29.85 mm had the highest predictive value for abnormal FAI [area under the curve (AUC), 0.798], with a sensitivity of 81.1% and a specificity of 74.6%.
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Affiliation(s)
- Dan Zhang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei, China
- Department of Radiology, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050000, Hebei, China
| | - Xin Tian
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei, China
| | - Meng-Ya Li
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei, China
| | - Hao-Wen Zhang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei, China
| | - Yang Yu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei, China
| | - Tong Pan
- Department of Medical Imaging, Hebei General Hospital, Shijiazhuang, 050000, Hebei, China
| | - Cai-Ying Li
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050011, Hebei, China.
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5
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Vales L. Editorial commentary: Crossing the bridge: Have we gotten to it? Trends Cardiovasc Med 2024; 34:16-17. [PMID: 35779776 DOI: 10.1016/j.tcm.2022.06.008] [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: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Lori Vales
- NYU Langone Medical Center: NYU Langone Health, New York, NY, United States.
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6
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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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7
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Evbayekha EO, Nwogwugwu E, Olawoye A, Bolaji K, Adeosun AA, Ajibowo AO, Nsofor GC, Chukwuma VN, Shittu HO, Onuegbu CA, Adedoyin AM, Okobi OE. A Comprehensive Review of Myocardial Bridging: Exploring Diagnostic and Treatment Modalities. Cureus 2023; 15:e43132. [PMID: 37692750 PMCID: PMC10484041 DOI: 10.7759/cureus.43132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Myocardial bridging (MB) is a congenital coronary artery anomaly involving an overlying myocardium's partial or complete encasement of a coronary artery segment. The obstruction can lead to significant cardiac symptoms, resulting in myocardial ischemia, arrhythmia, and sudden cardiac death. Several approaches, including invasive and non-invasive methods, have been proposed to diagnose and manage MB. Invasive modalities, such as intravascular ultrasound (IVUS) and coronary angiography, offer high specificity and sensitivity. In contrast, non-invasive methods like Doppler ultrasound, multislice computed tomography (MSCT), and magnetic resonance imaging (MRI) are advantageous due to their non-invasive nature, high sensitivity and specificity, and cost-effectiveness. Treatment options for MB mainly focus on relieving symptoms and preventing adverse outcomes. The use of pharmacological agents and surgical and percutaneous interventions has been documented in numerous studies. Studies conclude that MB is a treatable cardiac anomaly, and a combined approach of diagnosis, treatment, and follow-up is necessary to reduce the morbidity and mortality associated with this condition.
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Affiliation(s)
| | - Enyioma Nwogwugwu
- Internal Medicine, Lincoln Medical and Mental Health Center, New York, USA
| | | | | | - Adeyemi A Adeosun
- Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, USA
| | | | - G Chinenye Nsofor
- Internal Medicine, Buckinghamshire Healthcare NHS Trust, Buckinghamshire, GBR
| | - Vivian N Chukwuma
- Internal Medicine, University of Illinois at Chicago/Advocate Christ Medical Center, Chicago, USA
| | | | | | | | - Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
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8
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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:jcm12113799. [PMID: 37297993 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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9
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Tanaka S, Okada K, Kitahara H, Luikart H, Yock PG, Yeung AC, Schnittger I, Tremmel JA, Fitzgerald PJ, Khush KK, Fearon WF, Honda Y. Impact of myocardial bridging on coronary artery plaque formation and long-term mortality after heart transplantation. Int J Cardiol 2023; 379:24-32. [PMID: 36893856 PMCID: PMC10085846 DOI: 10.1016/j.ijcard.2023.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/25/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES This study aimed to explore the impact of myocardial bridging (MB) on early development of cardiac allograft vasculopathy and long-term graft survival after heart transplantation. BACKGROUND MB has been reported to be associated with acceleration of proximal plaque development and endothelial dysfunction in native coronary atherosclerosis. However, its clinical significance in heart transplantation remains unclear. METHODS In 103 heart-transplant recipients, serial (baseline and 1-year post-transplant) volumetric intravascular ultrasound (IVUS) analyses were performed in the first 50 mm of the left anterior descending (LAD) artery. Standard IVUS indices were evaluated in 3 equally divided LAD segments (proximal, middle, and distal segments). MB was defined by IVUS as an echolucent muscular band lying on top of the artery. The primary endpoint was death or re-transplantation, assessed for up to 12.2 years (median follow-up: 4.7 years). RESULTS IVUS identified MB in 62% of the study population. At baseline, MB patients had smaller intimal volume in the distal LAD than non-MB patients (p = 0.002). During the first year, vessel volume decreased diffusely irrespective of the presence of MB. Intimal growth diffusely distributed in non-MB patients, whereas MB patients demonstrated significantly augmented intimal formation in the proximal LAD. Kaplan-Meier analysis revealed significantly lower event-free survival in patients with versus without MB (log-rank p = 0.02). In multivariate analysis, the presence of MB was independently associated with late adverse events [hazard ratio 5.1 (1.6-22.2)]. CONCLUSION MB appears to relate to accelerated proximal intimal growth and reduced long-term survival in heart-transplant recipients.
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Affiliation(s)
- Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Kozo Okada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Hideki Kitahara
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Helen Luikart
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
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10
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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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11
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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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12
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Saito K, Saito Y, Kitahara H, Kobayashi Y. Impact of myocardial bridge on non-culprit vessel lumen changes in patients with acute coronary syndrome. Heart Vessels 2023; 38:32-39. [PMID: 35802184 DOI: 10.1007/s00380-022-02130-y] [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: 12/22/2021] [Accepted: 06/23/2022] [Indexed: 01/06/2023]
Abstract
This study aims to clarify the impact of myocardial bridge (MB) on the presence and progression of atherosclerosis in left descending coronary artery (LAD) in patients with acute coronary syndrome (ACS). Ninety-eight patients who underwent percutaneous coronary intervention with the diagnosis of ACS and follow-up coronary angiography but had no significant stenosis in the LAD were included. MB was defined based on coronary angiography. Quantitative coronary angiography was performed to determine the segments where MB was present and proximal to the MB (proximal segment) in patients with MB. In patients without MB, a corresponding region was quantitatively analyzed. The primary endpoint was changes in minimum lumen diameter (MLD) and percentage of diameter stenosis (%DS) in the proximal segment from baseline to follow-up angiography, namely ΔMLD and Δ%DS. MB was identified in 29 (29.6%) patients. Patients with MB had larger MLD and smaller %DS in the proximal segment than their counterpart. During the mean follow-up period of 12.9 ± 5.7 months, MLD and %DS in the proximal segment did not change significantly from baseline to follow-up in patients with and without MB. No significant between-group differences were observed in ΔMLD and Δ%DS. Baseline MLD was identified as the only factor associated with ΔMLD in the proximal segment. ACS patients who had MB but no significant stenosis in the LAD had larger MLD and smaller %DS at the segment proximal to MB compared to those without. In this selected population, serial lumen changes assessed by ΔMLD were not associated with the presence of MB in the LAD.
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Affiliation(s)
- Kan Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
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Sylvia MT, Soundharia R, Bhat RV, Marak F. Myocardial Bridging in Cases of Sudden Death and its Association with Clinicopathologic Characteristics. Heart Views 2023; 24:6-10. [PMID: 37124430 PMCID: PMC10144417 DOI: 10.4103/heartviews.heartviews_79_22] [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: 08/29/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
Background Myocardial bridging (MB) is the course of the epicardial segment of a coronary artery within the myocardium. The systolic compression of this segment called the tunneled segment may lead to alterations in blood flow to the heart. We have studied the gross and microscopic features of MB in cases of sudden cardiac death and analyzed its characteristics and whether there is any association with other clinicopathological characteristics which may help us to understand the pathogenesis and risk stratification. Materials and Methods This is a retrospective descriptive study of 132 postmortem heart specimens of sudden cardiac death. The coronary arteries were dissected, and MB and its characteristics were studied. Statistical analysis was performed using the Chi-square and Fisher's exact tests (P < 0.05 significant). Results MB was present in 28 cases (21.2%), with a mean age of 49.5 years and male:female ratio of 27:1. MB was seen in the left anterior descending artery in 86.2% of cases, the right coronary artery in 10%, and left circumflex artery in 3.5% of cases. Atherosclerosis was seen in the segment proximal to the tunneling in 89.2% of cases leading to infarction in four cases. Left ventricular hypertrophy (LVH) was significantly associated with MB cases (19/68%) (P < 0.05). Conclusion MB causes turbulence of blood in the proximal segment leading to coronary atherosclerosis, thereby predisposing the heart to ischemic changes and LVH and may lead to infarction in a few cases.
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Affiliation(s)
- Mary Theresa Sylvia
- Department of Pathology, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - R Soundharia
- Department of Pathology, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - Ramachandra V. Bhat
- Department of Pathology, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - Fremingston Marak
- Department of Pathology, Indira Gandhi Medical College and Research Institute, Puducherry, India
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14
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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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15
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D’Amario D, Ciliberti G, Restivo A, Laborante R, Migliaro S, Canonico F, Sangiorgi GM, Tebaldi M, Porto I, Andreini D, Vergallo R, Leone AM, Gervasi S, Cammarano M, Palmieri V, Burzotta F, Trani C, Zeppilli P, Crea F. Myocardial bridge evaluation towards personalized medicine: study design and preliminary results of the RIALTO registry. Eur Heart J Suppl 2022; 24:H48-H56. [PMID: 36382004 PMCID: PMC9650458 DOI: 10.1093/eurheartjsupp/suac059] [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] [Indexed: 09/29/2023]
Abstract
Myocardial bridge (MB) is the most frequent inborn coronary artery variant in which a portion of the myocardium overlies an epicardial coronary artery segment. Although MB has long been considered a benign entity, a growing body of evidence has suggested its association with angina and adverse cardiac events. However, to date, no data on long-term prognosis are available, nor on therapies improving cardiovascular outcomes. We are currently conducting an ambispective, observational, multicentre, study in which we enrol patients with a clinical indication to undergo coronary angiography (CA) and evidence of MB, aiming to describe the incidence of symptoms and cardiovascular events at baseline and at long-term follow-up (FUP). The role of invasive full-physiology assessment in modifying the discharge therapy and eventually the perceived quality of life and the incidence of major cardiovascular events will be analysed. Basal clinical-instrumental data of eligible and consenting patients have been acquired after CA; FUP was performed 6, 12, and 24 months after the angiographic diagnosis of MB. The primary endpoint of the study is the incidence of major adverse cardiovascular events (MACE), defined as the composite of cardiac death, myocardial infarction, cardiac hospitalization, and target vessel revascularization; the secondary endpoints are the rate of patients with Seattle Angina Questionnaire (SAQ) summary score <70 and the incidence of MACE in patients undergoing invasive intracoronary assessment. Among patients undergone FUP visits, we recorded 31 MACE at 6 months (11.6%), 16 MACE at 12 months (6.5%), and 26 MACE at 24 months (13.5%). The rate of patients with SAQ <70 is 18.8% at 6 months, 20.6% at 12 months, and 21.8% at 24 months. To evaluate the prognostic role of invasive intracoronary assessment, we compared MB patients who underwent only angiographic evaluation (Angio group) to those who underwent acetylcholine (ACH) provocative test with indication to calcium-channel blockers (CCBs) at discharge (Angio + ACH + CCBs group) and those who underwent functional assessment with fractional flow reserve (FFR) with indication to beta-blockers (BBs) at discharge (Angio + FFR + BBs group). After 2 years of FUP, the rate of MACE was significantly reduced in both Angio + ACH + CCBs group (6 vs. 25%, P = 0.029) and Angio + FFR + BBs group (3 vs. 25%, P = 0.005) compared with Angio group. The preliminary results of our study showed that MB may be a cause of angina and adverse cardiac events in patients referred to CA for suspected coronary artery disease (CAD). Full-physiology assessment unmasking MB-related ischaemia mechanisms, allowed to guide the treatment, personalizing the clinical management, improving the quality of life, and cardiovascular outcomes in patients with MB.
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Affiliation(s)
- Domenico D’Amario
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Giuseppe Ciliberti
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Renzo Laborante
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Catholic University of the Sacred Heart, Rome 00168, Italy
| | | | - Francesco Canonico
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Massimo Sangiorgi
- Department of Biomedicine and Prevention, Institute of Cardiology, University of Rome Tor Vergata, Rome 00133, Italy
| | - Matteo Tebaldi
- Cardiologic Center, S. Anna University Hospital, Ferrara 44124, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genova, Genova 16132, Italy
| | | | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Antonio Maria Leone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Salvatore Gervasi
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Michela Cammarano
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Vincenzo Palmieri
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Paolo Zeppilli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Catholic University of the Sacred Heart, Rome 00168, Italy
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16
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Khan MO, Nishi T, Imura S, Seo J, Wang H, Honda Y, Nieman K, Rogers IS, Tremmel JA, Boyd J, Schnittger I, Marsden A. Colocalization of Coronary Plaque with Wall Shear Stress in Myocardial Bridge Patients. Cardiovasc Eng Technol 2022; 13:797-807. [PMID: 35296987 DOI: 10.1007/s13239-022-00616-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/25/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Patients with myocardial bridges (MBs) have a higher prevalence of atherosclerosis. Wall shear stress (WSS) has previously been correlated with plaque in coronary artery disease patients, but such correlations have not been investigated in symptomatic MB patients. The aim of this paper was to use a multi-scale computational fluid dynamics (CFD) framework to simulate hemodynamics in MB patient, and investigate the co-localization of WSS and plaque. METHODS We identified N = 10 patients from a previously reported cohort of 50 symptomatic MB patients, all of whom had plaque in the proximal vessel. Dynamic 3D models were reconstructed from coronary computed tomography angiography (CCTA), intravascular ultrasound (IVUS) and catheter angiograms. CFD simulations were performed to compute WSS proximal to, within and distal to the MB. Plaque was quantified from IVUS images in 2 mm segments and registered to CFD model. Plaque area was compared to absolute and patient-normalized WSS. RESULTS WSS was lower in the proximal segment compared to the bridge segment (6.1 ± 2.9 vs. 16.0 ± 7.1 dynes/cm2, p value < 0.01). Plaque area and plaque burden measured from IVUS peaked at 1-3 cm proximal to the MB entrance, coinciding with the first diagonal branch. Normalized WSS showed a statistically significant moderate correlation with plaque area (r = 0.41, p < 0.01). CONCLUSION WSS may be obtained non-invasively in MB patients and provides a surrogate marker of plaque area. Using CFD, it may be possible to non-invasively assess the extent of plaque area, and identify patients who could benefit from frequent monitoring or medical management.
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Affiliation(s)
- Muhammad Owais Khan
- Department of Pediatrics, Stanford University School of Medicine, 318 Campus Drive, Clark Center E100b, Stanford, CA, 94305-5428, USA.,Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Takeshi Nishi
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Shinji Imura
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Jongmin Seo
- Department of Pediatrics, Stanford University School of Medicine, 318 Campus Drive, Clark Center E100b, Stanford, CA, 94305-5428, USA.,Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Koen Nieman
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA.,Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ian S Rogers
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Jack Boyd
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Alison Marsden
- Department of Pediatrics, Stanford University School of Medicine, 318 Campus Drive, Clark Center E100b, Stanford, CA, 94305-5428, USA. .,Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA. .,Department of Bioengineering, Stanford University, Stanford, CA, USA.
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17
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Premyodhin N, Kern MJ, Seto AH. When Intracoronary Anatomy is Superior to Physiology. Rev Cardiovasc Med 2022; 23:251. [PMID: 39076897 PMCID: PMC11266758 DOI: 10.31083/j.rcm2307251] [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] [Received: 02/23/2022] [Revised: 04/11/2022] [Accepted: 06/24/2022] [Indexed: 07/31/2024] Open
Abstract
Physiologic assessment has become an essential tool to guide revascularization decisions due to the multiple limitations of angiographic and anatomic measures of physiologic significance. However, in certain cases the apparent physiologic measurement may not accurately reflect the severity of coronary disease compared with anatomical measurements. This article will review how anatomy trumps physiology in cases of acute coronary syndromes, left main disease, saphenous vein graft lesions, and myocardial bridging, and how to overcome the limitations of physiologic measurement in these clinical situations.
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Affiliation(s)
- Ned Premyodhin
- Department of Medicine, Veterans Administration Long Beach Health Care System, Long Beach, CA 90822 USA
- Department of Medicine, University of California, Irvine, Orange, CA 92868, USA
| | - Morton J. Kern
- Department of Medicine, Veterans Administration Long Beach Health Care System, Long Beach, CA 90822 USA
- Department of Medicine, University of California, Irvine, Orange, CA 92868, USA
| | - Arnold H. Seto
- Department of Medicine, Veterans Administration Long Beach Health Care System, Long Beach, CA 90822 USA
- Department of Medicine, University of California, Irvine, Orange, CA 92868, USA
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18
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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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Okamura A, Okura H, Iwai S, Kyodo A, Kamon D, Hashimoto Y, Ueda T, Soeda T, Watanabe M, Saito Y. Detection of myocardial bridge by optical coherence tomography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1169-1176. [PMID: 35015165 DOI: 10.1007/s10554-021-02497-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022]
Abstract
Myocardial bridge (MB) is less commonly documented by angiography than autopsy. Optical coherence tomography (OCT) may be useful to detect angiographically undetectable MB. To investigate OCT characteristics of MB, 86 LAD vessels were imaged by OCT. MB was defined as presence of intermediate optical intensity, "fine" layer surrounding coronary artery by OCT. Frequency and characteristics of the angio-detectable and angio-undetectable but OCT-detectable MB were investigated. In a subset of patients with angio-detectable MB, cyclic changes in coronary arterial dimensions were analyzed. OCT detected MB in 44 of 86 (51%). Arc of the MB was significantly larger (334.8 ± 58.5° vs. 268.4 ± 92.1°, P = 0.008) and length was significantly longer (22.6 ± 11.7 mm vs. 14.5 ± 8.1 mm, P = 0.014) in angio-detectable MB than OCT-detectable but angio-undetectable MB. Both vessel (6.8 ± 1.5 to 5.3 ± 1.0 mm2, P = 0.035) and lumen area (4.4 ± 1.5 to 3.1 ± 0.7 mm2, P = 0.040) decreased significantly from diastole to systole. Adventitial (0.08 ± 0.03 to 0.08 ± 0.02 mm, P = 0.828) and intima + plaque thickness (0.12 ± 0.05 to 0.10 ± 0.03 mm, P = 0.398) did not change significantly during cardiac cycle. On the other hand, medial thickness increased significantly from diastole to systole (0.08 ± 0.03 to 0.12 ± 0.03 mm, P = 0.022). In conclusion, MB is frequently detected as intermediate intensity, fine layer by OCT. During systole, vessel and lumen size decrease with increased medial thickness. Therefore, we should be careful for OCT interpretation of the coronary arteries with MB.
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Affiliation(s)
- Akihiko Okamura
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Hiroyuki Okura
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan.
- Department of Cardiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Saki Iwai
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Atsushi Kyodo
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Daisuke Kamon
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
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20
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Influence of myocardial bridge on atherosclerotic plaque distribution and characteristics evaluated by near-infrared spectroscopy intravascular ultrasound. Heart Vessels 2022; 37:1701-1709. [PMID: 35488911 DOI: 10.1007/s00380-022-02083-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/15/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aims to clarify whether myocardial bridge (MB) could influence atherosclerotic plaque characteristics assessed using near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) imaging. METHODS One hundred and sixteen patients who underwent percutaneous coronary intervention (PCI) using NIRS-IVUS imaging were included. MB was defined as an echo-lucent band surrounding left anterior descending artery (LAD). In MB patients, LAD was divided into three segments: proximal, MB, and distal segments. In non-MB patients, corresponding three segments were defined based on the average length of the above segments. Segmental maximum plaque burden and lipid content derived from NIRS-IVUS imaging in the section of maximum plaque burden were evaluated in each segment. Lipid content of atherosclerotic plaque was evaluated as lipid core burden index (LCBI) and maxLCBI4mm. LCBI is the fraction of pixels indicating lipid within a region multiplied by 1000, and the maximum LCBI in any 4-mm region was defined as maxLCBI4mm. RESULTS MB was identified in 42 patients. MB was not associated with maximum plaque burden in proximal segment. LCBI and maxLCBI4mm were significantly lower in patients with MB than those without in proximal segment. Multivariable analysis demonstrated both MB and maximum plaque burden in proximal segment to be independent predictors of LCBI in proximal segment. CONCLUSIONS Lipid content of atherosclerotic plaque assessed by NIRS-IVUS imaging was significantly smaller in patients with MB than those without. MB could be considered as a predictor of lipid content of atherosclerotic plaque when assessed by NIRS-IVUS imaging.
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21
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Xu T, You W, Wu Z, Meng P, Ye F, Wu X, Chen S. Retrospective analysis of OCT on MB characteristics and 1-year follow-up of the ISR incidence after the DES implantation in patients with MB. Sci Rep 2022; 12:534. [PMID: 35017626 PMCID: PMC8752833 DOI: 10.1038/s41598-021-04579-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
We used optical coherence tomography (OCT) to analyze the "half-moon" like phenomenon and its characteristics and observe 1-year follow-up of the in-stent restenosis (ISR) incidence after the drug eluted stent (DES) implantation in patients with the myocardial bridge (MB). Patients were retrospectively analyzed from January 2013 to December 2019. We used OCT to check 45 patients with MB and found a visible muscle layer (VML) around the vessel adventitia with the same or high density compared to the vessel media layer. There was not any significant difference in maximal thickness, maximal arch, and total length between the half-moon layer and the visible muscle layer groups (p > 0.05). Maximal thickness, arch, and total length of the half-moon layer were significantly positively related to VML, respectively (r = 0.962, 0.985, 0.742, p < 0.01). Of these 626 patients with MB seen by OCT, only 300 could be checked out by coronary angiography (CAG). Besides, the larger the thickness and arch of the VML around the vessel adventitia, the more severe the MB in these patients (p < 0.05). After the OCT use, there was no coronary perforation in these patients with MB covered with DES. After 1-year follow-up, ISR in MB covered with DES showed a notable difference among no MB, mild MB, moderate MB, and severe MB groups (p < 0.05), and ISR in DES aggravated with the MB severity. However, ISR in MB with and without covered with DES had no significant difference among the 4 groups (p > 0.05). OCT could evaluate MB characteristics accurately compared to IVUS and had a higher rate of detecting MB than CAG. Moreover, it is safe and effective to guide DES covering the mild MB segment in patients with severe coronary lesions detected by the OCT.
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Affiliation(s)
- Tian Xu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China
| | - Wei You
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China
| | - Zhiming Wu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China
| | - Peina Meng
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China
| | - Fei Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China.
| | - Xiangqi Wu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China.
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China.
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22
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McLaughlin T, Schnittger I, Nagy A, Zanley E, Xu Y, Song Y, Nieman K, Tremmel JA, Dey D, Boyd J, Sacks H. Relationship Between Coronary Atheroma, Epicardial Adipose Tissue Inflammation, and Adipocyte Differentiation Across the Human Myocardial Bridge. J Am Heart Assoc 2021; 10:e021003. [PMID: 34726081 PMCID: PMC8751937 DOI: 10.1161/jaha.121.021003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Inflammation in epicardial adipose tissue (EAT) may contribute to coronary atherosclerosis. Myocardial bridge is a congenital anomaly in which the left anterior descending coronary artery takes a "tunneled" course under a bridge of myocardium: while atherosclerosis develops in the proximal left anterior descending coronary artery, the bridged portion is spared, highlighting the possibility that geographic separation from inflamed EAT is protective. We tested the hypothesis that inflammation in EAT was related to atherosclerosis by comparing EAT from proximal and bridge depots in individuals with myocardial bridge and varying degrees of atherosclerotic plaque. Methods and Results Maximal plaque burden was quantified by intravascular ultrasound, and inflammation was quantified by pericoronary EAT signal attenuation (pericoronary adipose tissue attenuation) from cardiac computed tomography scans. EAT overlying the proximal left anterior descending coronary artery and myocardial bridge was harvested for measurement of mRNA and microRNA (miRNA) using custom chips by Nanostring; inflammatory cytokines were measured in tissue culture supernatants. Pericoronary adipose tissue attenuation was increased, indicating inflammation, in proximal versus bridge EAT, in proportion to atherosclerotic plaque. Individuals with moderate-high versus low plaque burden exhibited greater expression of inflammation and hypoxia genes, and lower expression of adipogenesis genes. Comparison of gene expression in proximal versus bridge depots revealed differences only in participants with moderate-high plaque: inflammation was higher in proximal and adipogenesis lower in bridge EAT. Secreted inflammatory cytokines tended to be higher in proximal EAT. Hypoxia-inducible factor 1a was highly associated with inflammatory gene expression. Seven miRNAs were differentially expressed by depot: 3192-5P, 518D-3P, and 532-5P were upregulated in proximal EAT, whereas miR 630, 575, 16-5P, and 320E were upregulated in bridge EAT. miR 630 correlated directly with plaque burden and inversely with adipogenesis genes. miR 3192-5P, 518D-3P, and 532-5P correlated inversely with hypoxia/oxidative stress, peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PCG1a), adipogenesis, and angiogenesis genes. Conclusions Inflammation is specifically elevated in EAT overlying atherosclerotic plaque, suggesting that EAT inflammation is caused by atherogenic molecular signals, including hypoxia-inducible factor 1a and/or miRNAs in an "inside-to-out" relationship. Adipogenesis was suppressed in the bridge EAT, but only in the presence of atherosclerotic plaque, supporting cross talk between the vasculature and EAT. miR 630 in EAT, expressed differentially according to burden of atherosclerotic plaque, and 3 other miRNAs appear to inhibit key genes related to adipogenesis, angiogenesis, hypoxia/oxidative stress, and thermogenesis in EAT, highlighting a role for miRNA in mediating cross talk between the coronary vasculature and EAT.
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Affiliation(s)
- Tracey McLaughlin
- Division of Endocrinology Stanford University School of Medicine Stanford CA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA
| | - Anna Nagy
- Division of Endocrinology Stanford University School of Medicine Stanford CA
| | - Elizabeth Zanley
- Division of Endocrinology Stanford University School of Medicine Stanford CA
| | - Yue Xu
- Division of Endocrinology Stanford University School of Medicine Stanford CA
| | - Yanqiu Song
- Cardiovascular Institute Tianjin Chest Hospital Tianjin China
| | - Koen Nieman
- Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA
| | - Damini Dey
- Department of Biomedical Sciences and Medicine Cedars-Sinai Medical Center Biomedical Imaging Research Institute Los Angeles CA
| | - Jack Boyd
- Department of Cardiothoracic Surgery Stanford University School of Medicine Stanford CA
| | - Harold Sacks
- Division of Endocrinology Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA
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23
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Hashikata T, Honda Y, Wang H, Pargaonkar VS, Nishi T, Hollak MB, Rogers IS, Nieman K, Yock PG, Fitzgerald PJ, Schnittger I, Boyd JH, Tremmel JA. Impact of Diastolic Vessel Restriction on Quality of Life in Symptomatic Myocardial Bridging Patients Treated With Surgical Unroofing: Preoperative Assessments With Intravascular Ultrasound and Coronary Computed Tomography Angiography. Circ Cardiovasc Interv 2021; 14:e011062. [PMID: 34665656 DOI: 10.1161/circinterventions.121.011062] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Takehiro Hashikata
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Hanjay Wang
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Vedant S Pargaonkar
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Takeshi Nishi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.).,Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan (T.N.)
| | - M Brooke Hollak
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Ian S Rogers
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Koen Nieman
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.).,Department of Radiology, Stanford University School of Medicine, CA (K.N.)
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Jack H Boyd
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
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24
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Yong ASC, Pargaonkar VS, Wong CCY, Javadzdegan A, Yamada R, Tanaka S, Kimura T, Rogers IS, Sen I, Kritharides L, Schnittger I, Tremmel JA. Abnormal shear stress and residence time are associated with proximal coronary atheroma in the presence of myocardial bridging. Int J Cardiol 2021; 340:7-13. [PMID: 34375705 DOI: 10.1016/j.ijcard.2021.08.011] [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: 05/19/2021] [Revised: 07/12/2021] [Accepted: 08/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atheromatous plaques tend to form in the coronary segments proximal to a myocardial bridge (MB), but the mechanism of this occurrence remains unclear. This study evaluates the relationship between blood flow perturbations and plaque formation in patients with an MB. METHODS AND RESULTS A total of 92 patients with an MB in the mid left anterior descending artery (LAD) and 20 patients without an MB were included. Coronary angiography, intravascular ultrasound, and coronary physiology measurements were performed. A moving-boundary computational fluid dynamics algorithm was used to derive wall shear stress (WSS) and peak residence time (PRT). Patients with an MB had lower WSS (0.46 ± 0.21 vs. 0.96 ± 0.33 Pa, p < 0.001) and higher maximal plaque burden (33.6 ± 15.0 vs. 14.2 ± 5.8%, p < 0.001) within the proximal LAD compared to those without. Plaque burden in the proximal LAD correlated significantly with proximal WSS (r = -0.51, p < 0.001) and PRT (r = 0.60, p < 0.001). In patients with an MB, the site of maximal plaque burden occurred 23.4 ± 13.3 mm proximal to the entrance of the MB, corresponding to the site of PRT. CONCLUSIONS Regions of low WSS and high PRT occur in arterial segments proximal to an MB, and this is associated with the degree and location of coronary atheroma formation.
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Affiliation(s)
- Andy S C Yong
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia
| | | | - Christopher C Y Wong
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ashkan Javadzdegan
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Ryotaro Yamada
- Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Shigemitsu Tanaka
- Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Takumi Kimura
- Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Ian S Rogers
- Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Itsu Sen
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ingela Schnittger
- Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
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25
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Guía ESC 2020 sobre cardiología del deporte y el ejercicio en pacientes con enfermedad cardiovascular. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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26
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Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021; 42:17-96. [PMID: 32860412 DOI: 10.1093/eurheartj/ehaa605] [Citation(s) in RCA: 751] [Impact Index Per Article: 250.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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27
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Erol N. Challenges in Evaluation and Management of Children with Myocardial Bridging. Cardiology 2021; 146:273-280. [PMID: 33631747 DOI: 10.1159/000513900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 12/10/2020] [Indexed: 11/19/2022]
Abstract
Myocardial bridging (MB) is a congenital anomaly where a coronary artery branch or group of branches extends inside a tunnel consisting of myocardium. Although it is mostly considered "benign," it is reported that MB may lead to significant cardiac problems and sudden cardiac deaths. While it is a congenital anomaly, its symptoms usually arise at further ages rather than childhood. The literature on MB in children is in the form of case reports or small case series. This is why pediatric cases are assessed in the light of information obtained from adults. This review compiled the literature on MB in adults and children and compared it, as well as discussing questions arising regarding the clinic, diagnosis, and treatment of MB.
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Affiliation(s)
- Nurdan Erol
- Pediatric Clinics, Zeynep Kamil Gynecology and Pediatrics Training and Research Hospital, Health Sciences University, Uskudar/Istanbul, Turkey,
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28
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Semerdzhieva NE, Denchev S. Coronary Flow in Patients With Myocardial Bridges, Coronary Fistulae in the Setting of Unstable Non-Obstructive Coronary Disease. Cureus 2021; 13:e13130. [PMID: 33728147 PMCID: PMC7936646 DOI: 10.7759/cureus.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Оbjective Our aim was to describe the difference in epicardial coronary flow at baseline on background anti-ischaemic therapy and following intracoronary glyceryl trinitrate in patients with acute coronary syndrome and non-obstructive coronary disease with and without myocardial bridges and coronary artery fistulae. Materials and methods Coronary flow was characterized in a group of 88 patients with coronary stenoses <50% diagnosed with acute coronary syndrome using the corrected Thrombolysis in Myocardial Infarction frame count (cTFC) method at coronary angiography at baseline and after the application of 200 µg glyceryl trinitrate. Results Тhe patients with myocardial bridges and coronary artery fistulae accounted for 4.4% (n=4) and 2.2% (n=2), respectively, of the patients with acute coronary syndrome. Sixty-two (70%) of all patients demonstrated slow progression of the contrast media (cTFC>25 frames) in at least one coronary artery. Coronary flow was similarly impaired in the patients with myocardial bridges, coronary artery fistulae, and those without coronary anomalies and variants. After the intracoronary infusion of glyceryl trinitrate, the epicardial flow improved in the patients with myocardial bridges and to a lesser degree in the cases with coronary fistulae. Most of the patients who responded to glyceryl trinitrate were on background therapy with calcium channel blockers. Conclusion The epicardial coronary flow of patients with non-obstructive coronary disease with myocardial bridges and acute coronary syndrome showed less impairment compared to baseline in response to intracoronary glyceryl trinitrate applied at background anti-ischaemic therapy that included calcium channel blockers.
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29
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Pargaonkar V, Kimura T, Kameda R, Tanaka S, Yamada R, Schwartz J, Perl L, Rogers I, Honda Y, Fitzgerald P, Schnittger I, Tremmel J. Invasive assessment of myocardial bridging in patients with angina and no obstructive coronary artery disease. EUROINTERVENTION 2021; 16:1070-1078. [PMID: 33074153 PMCID: PMC9725037 DOI: 10.4244/eij-d-20-00779] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Angina and no obstructive coronary artery disease (ANOCA) is common. A potential cause of angina in this patient population is a myocardial bridge (MB). We aimed to study the anatomical and haemodynamic characteristics of an MB in patients with ANOCA. METHODS AND RESULTS Using intravascular ultrasound (IVUS), we identified 184 MBs in 154 patients. We evaluated MB length, arterial compression, and halo thickness. MB muscle index (MMI) was defined as MB length×halo thickness. Haemodynamic testing of the MB was performed using an intracoronary pressure/Doppler flow wire at rest and during dobutamine stress. We defined an abnormal diastolic fractional flow reserve (dFFR) as ≤0.76 during stress. The median MB length was 22.9 mm, arterial compression 30.9%, and halo thickness 0.5 mm. The median MMI was 12.1. Endothelial and microvascular dysfunction were present in 85.4% and 22.1%, respectively. At peak dobutamine stress, 94.2% of patients had a dFFR ≤0.76 within and/or distal to the MB. MMI was associated with an abnormal dFFR. CONCLUSIONS In select patients with ANOCA who have an MB by IVUS, the majority have evidence of a haemodynamically significant dFFR during dobutamine stress, suggesting the MB as being a cause of their angina. A comprehensive invasive assessment of such patients during coronary angiography provides important diagnostic information that can guide management.
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Affiliation(s)
- Vedant Pargaonkar
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Takumi Kimura
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Ryo Kameda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Ryotaro Yamada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathan Schwartz
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Leor Perl
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Ian Rogers
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer Tremmel
- 300 Pasteur Drive, Room H2103, Stanford, CA 94305-5218, USA. E-mail:
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30
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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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31
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Okada K, Hibi K, Ogino Y, Maejima N, Kikuchi S, Kirigaya H, Kirigaya J, Sato R, Nakahashi H, Minamimoto Y, Kimura Y, Akiyama E, Matsuzawa Y, Iwahashi N, Kosuge M, Ebina T, Tamura K, Kimura K. Impact of Myocardial Bridge on Life‐Threatening Ventricular Arrhythmia in Patients With Implantable Cardioverter Defibrillator. J Am Heart Assoc 2020; 9:e017455. [PMID: 33094668 PMCID: PMC7763400 DOI: 10.1161/jaha.120.017455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Myocardial bridge (MB), common anatomic variant, is generally considered benign, while previous studies have shown associations between MB and various cardiovascular pathologies. This study aimed to investigate for the first time possible impact of MB on long‐term outcomes in patients with implantable cardioverter defibrillator, focusing on life‐threatening ventricular arrhythmia (LTVA).
Methods and Results
This retrospective analysis included 140 patients with implantable cardioverter defibrillator implantation for primary (n=23) or secondary (n=117) prevention of sudden cardiac death. Angiographically apparent MB was identified on coronary angiography as systolic milking appearance with significant arterial compression. The primary end point was the first episode(s) of LTVA defined as appropriate implantable cardioverter defibrillator treatments (antitachyarrhythmia pacing and/or shock) or sudden cardiac death, assessed for a median of 4.5 (2.2–7.1) years. During the follow‐up period, LTVA occurred in 37.9% of patients. Angiographically apparent MB was present in 22.1% of patients; this group showed younger age, lower rates of coronary risk factors and ischemic cardiomyopathy, higher prevalence of vasospastic angina and greater left ventricular ejection fraction compared with those without. Despite its lower risk profiles above, Kaplan–Meier analysis revealed significantly lower event‐free rates in patients with versus without angiographically apparent MB. In multivariate analysis, presence of angiographically apparent MB was independently associated with LTVA (hazard ratio, 4.24; 95% CI, 2.39–7.55;
P
<0.0001).
Conclusions
Angiographically apparent MB was the independent determinant of LTVA in patients with implantable cardioverter defibrillator. Although further studies will need to confirm our findings, assessment of MB appears to enhance identification of high‐risk patients who may benefit from closer follow‐up and targeted therapies.
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Affiliation(s)
- Kozo Okada
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Kiyoshi Hibi
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Yutaka Ogino
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Nobuhiko Maejima
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Shinnosuke Kikuchi
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Hidekuni Kirigaya
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Jin Kirigaya
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Ryosuke Sato
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Hidefumi Nakahashi
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Yugo Minamimoto
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Yuichiro Kimura
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Eiichi Akiyama
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Yasushi Matsuzawa
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Noriaki Iwahashi
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Masami Kosuge
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Toshiaki Ebina
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
| | - Kouichi Tamura
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
- Department of Medical Science and Cardiorenal Medicine Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Kazuo Kimura
- Division of Cardiology Yokohama City University Medical Center Yokohama Japan
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Gao W, Zhang J, Duan F, Guo S, Chen C, Du L, Zhao J, Zhou Z. Clinical characteristics and factors associated with coronary stenosis proximal to a myocardial bridge: a retrospective study. BMC Cardiovasc Disord 2020; 20:371. [PMID: 32795253 PMCID: PMC7427715 DOI: 10.1186/s12872-020-01655-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/04/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The association of myocardial bridge (MB) with cardiovascular risk and the possible cardiovascular risk factors remain unclear. This study aimed to explore the clinical characteristics and related factors of coronary stenosis proximal to an MB. METHODS This was a retrospective study of patients with symptoms of coronary atherosclerotic heart disease admitted between 10/2011 and 12/2014 to the Emergency and Cardiology Department of Bayannur Hospital, who underwent selective coronary angiography (SCAG). The patients were assigned to the non-stenosis and stenosis groups according to whether coronary stenosis was proximal to the MB. RESULTS Among 244 patients with MB and cardiovascular symptoms, 91 (37.3%) had stenosis proximal to the MB. Compared with the non-stenosis group, there were more males (80.2% vs. 55.6%, P < 0.001) and smokers (including those who had quit smoking) (P < 0.001) in the stenosis group. There were no significant differences in blood lipid-related indexes (TG, TC, HDL-C, LDL-C, and VLDL-C) between the two groups. Multivariable analysis suggested that MB location in the middle distal or distal segment of the left anterior descending artery (LAD) increased the odds of coronary stenosis proximal to the MB (OR = 0.439, 95% CI: 1.57-7.532, P = 0.002), which was then considered an independent factor associated with coronary stenosis proximal to the MB. CONCLUSIONS In patients diagnosed with an MB by SCAG, only MB located in the middle distal or distal segment of the LAD is independently associated with coronary stenosis proximal to the MB.
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Affiliation(s)
- Wen Gao
- First Department of Cardiology, Bayannaoer City Hospital, No. 98 Wulan Buhe Road, Linhe District, Bayannaoer City, 015000 Inner Mongolia Autonomous Region China
| | - Jiaxi Zhang
- Department of Cardiac Rehabilitation, Bayannaoer City Hospital, Bayannaoer City, Inner Mongolia Autonomous Region China
| | - Fei Duan
- Department of Vascular Abdominal Wall Hernia Surgery, Bayannaoer City Hospital, Bayannaoer City, Inner Mongolia Autonomous Region China
| | - Shujun Guo
- First Department of Cardiology, Bayannaoer City Hospital, No. 98 Wulan Buhe Road, Linhe District, Bayannaoer City, 015000 Inner Mongolia Autonomous Region China
| | - Chun Chen
- Department of Cardiac Rehabilitation, Bayannaoer City Hospital, Bayannaoer City, Inner Mongolia Autonomous Region China
| | - Liping Du
- First Department of Cardiology, Bayannaoer City Hospital, No. 98 Wulan Buhe Road, Linhe District, Bayannaoer City, 015000 Inner Mongolia Autonomous Region China
| | - Jianquan Zhao
- First Department of Cardiology, Bayannaoer City Hospital, No. 98 Wulan Buhe Road, Linhe District, Bayannaoer City, 015000 Inner Mongolia Autonomous Region China
| | - Zhihong Zhou
- First Department of Cardiology, Bayannaoer City Hospital, No. 98 Wulan Buhe Road, Linhe District, Bayannaoer City, 015000 Inner Mongolia Autonomous Region China
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Rajmohan D, Sung YK, Kudelko K, Perez VDJ, Haddad F, Tremmel JA, Schnittger I, Zamanian RT, Spiekerkoetter E. EXPRESS: Myocardial Bridge - An Unrecognized Cause of Chest Pain in Pulmonary Arterial Hypertension. Pulm Circ 2019; 10:2045894019860738. [PMID: 31187693 PMCID: PMC7029537 DOI: 10.1177/2045894019860738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/05/2019] [Indexed: 11/22/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterized by an increased pulmonary vascular resistance resulting in progressive right ventricular hypertrophy and failure. While dyspnea on exertion is the leading symptom at diagnosis, the occurrence of chest pain, although less frequently observed, is an alarming symptom that requires immediate diagnostic work-up. Here we report the case of a 44-year-old woman with severe end-stage group 1 PAH who had repetitive occurrences of chest pain that led to frequent emergency room visits with documented signs of myocardial ischemia on EKG and troponin leaks. A computed tomography (CT) angiogram of the coronary arteries revealed the presence of a myocardial bridge (MB). An invasive coronary angiogram confirmed a MB over the left anterior descending (LAD) artery compressing the lumen of the LAD. As the patient was deteriorating on maximal medical PAH therapy, she was listed for, and subsequently received, a bilateral lung transplantation. Recognizing that the MB would pose a significant risk for ischemia during surgery as well as continuing source for chest pain after lung transplantation, the MB was surgically “unroofed” during the transplant surgery. The patient did well after surgery and did not complain of any residual chest pain. In conclusion, a MB compressing a segment of the coronary artery could be an under-diagnosed, but potentially not so rare cause of recurrent chest pain in PAH patients, which requires specialized diagnostic evaluation and treatment
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Affiliation(s)
- Divya Rajmohan
- Division Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Wall Center for Pulmonary Vascular Disease, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Yon K. Sung
- Division Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Kristina Kudelko
- Division Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Vinicio de Jesus Perez
- Division Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Francois Haddad
- Wall Center for Pulmonary Vascular Disease, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer A. Tremmel
- Wall Center for Pulmonary Vascular Disease, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ingela Schnittger
- Wall Center for Pulmonary Vascular Disease, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Roham T. Zamanian
- Division Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Edda Spiekerkoetter
- Division Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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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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35
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Mok S, Majdalany D, Pettersson GB. Extensive unroofing of myocardial bridge: A case report and literature review. SAGE Open Med Case Rep 2019; 7:2050313X18823380. [PMID: 30719302 PMCID: PMC6349980 DOI: 10.1177/2050313x18823380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 12/13/2018] [Indexed: 01/29/2023] Open
Abstract
Background: Myocardial bridge is defined as a segment of a coronary artery that takes an
intramyocardial course. The presence of myocardial bridge has been observed
in as many as 40%–80% of cases on autopsy, angiographically from 0.5% to
16.0%, and often asymptomatic. However, it has been associated with angina,
coronary spasm, myocardial infarction, arrhythmias, syncope, sudden cardiac
arrest, and death. Conflicting opinions exist on the timing of surgical
intervention for myocardial bridge. Methods: We present an unusual case of a young female, with prior aortic surgery, who
had refractory chest pain despite optimal medical therapy. Stress testing
revealed anterior ischemia. Cardiac catherization showed myocardial bridge
of the left anterior descending artery with significant compromise of blood
flow (fractional flow reserve = 0.75 with adenosine). We proceeded with
surgery. Intraoperatively, we found an unusually long (10-cm)
intramyocardial segment of the left anterior descending artery which was
managed by surgically unroofing. Our patient felt better post procedure.
Repeat cardiac catheterization showed no further narrowing of the left
anterior descending artery with a fractional flow reserve of 0.87 in its
distal segment. Results/discussion: Myocardial bridge is present mostly in female patients (74.5%), with median
age at 56.2 years and mostly involving the left anterior descending artery
(77.2%). The average length of myocardial bridge is 21.85 ± 16.10 mm (range:
5–70 mm). Our case is unique as the involved myocardial bridge was 10 cm in
length, the longest ever reported. Multiple imaging modality revealed
significant coronary insufficiency, with a subsequent clinical and
angiographic improvement upon unroofing of the culprit coronary vessel. Conclusion: Management decision on myocardial bridge remains controversial. This is a
case of the longest symptomatic myocardial bridge, with a subsequent
improvement post unroofing.
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Affiliation(s)
- Salvior Mok
- Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - David Majdalany
- Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Borjesson M, Dellborg M, Niebauer J, LaGerche A, Schmied C, Solberg EE, Halle M, Adami E, Biffi A, Carré F, Caselli S, Papadakis M, Pressler A, Rasmusen H, Serratosa L, Sharma S, van Buuren F, Pelliccia A. Recommendations for participation in leisure time or competitive sports in athletes-patients with coronary artery disease: a position statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC). Eur Heart J 2018; 40:13-18. [DOI: 10.1093/eurheartj/ehy408] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 06/26/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
- Mats Borjesson
- Department of Food, Nutrition and Sports Science, Gothenburg University, Skånegatan 14b, Göteborg, Sweden
- Department of Neuroscience and Physiology, Gothenburg University and Sahlgrenska University Hospital/Östra, Diagnosvägen 11, Göteborg, Sweden
| | - Mikael Dellborg
- Department of Medicine, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, Göteborg, Sweden
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Strubergasse 21, Salzburg, Austria
| | - Andre LaGerche
- Baker Heart and Diabetes Institute, 99 Commercial Road, Melbourne VIC, Australia
| | - Christian Schmied
- Kardiologisches Ambulatorium, Sportmedizin/Sportkardiologie, Universitäres Herzzentrum Zürich, Rämistrasse 100, Zurich, Switzerland
| | - Erik E Solberg
- Department of Medicine, Diakonhjemmet Hospital, Diakonveien 12, Oslo, Norway
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Medical Faculty, University Hospital, Technical University Munich, Georg-Brauchle-Ring 56, Munchen, Germany
| | - Emilio Adami
- Istituto di Medicina e Scienza dello Sport CONI, Largo Piero Gabrielli, 1, Roma, Italy
| | - Alessandro Biffi
- Italian Olympic Committe, Institute for Sports Medicine and Science, Largo Piero Gabrielli, 1, Roma, Italy
| | - Francois Carré
- Sport Medicine Department, Rennes University Hospital, LTSI INSERM UMR 1099, 2 Rue Henri le Guilloux, Rennes, France
| | - Stefano Caselli
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, Roma, Italy
- Ospedale San Pietro Fatebenefratelli, Via Cassia, 600, Roma, Italy
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St George's, University of London, Blackshaw Rd, London, UK
| | - Axel Pressler
- Department of Prevention, Rehabilitation and Sports Medicine, Center for General, Sports and Preventive Cardiology, Technical University of Munich, Georg-Brauchle-Ring 56, Munchen, Germany
| | - Hanne Rasmusen
- Department of Cardiology, Bisbebjerg University Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark
| | - Luis Serratosa
- Hospital Universitario Quironsalud Madrid, Ripoll y De Prado Sport Clinic, FIFA Medical Centre of Excellence, Calle Diego de Velazquez 1, Pozuelo de Alarcon, Madrid, Spain
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St George's, University of London, Blackshaw Rd, London, UK
| | - Frank van Buuren
- Catholic Hospital Southwestfalia, St. Martinus-Hospital Olpe, Hospitalweg 6, Olpe, Germany
| | - Antonio Pelliccia
- Institute for Sports Medicine and Science, Largo Piero Gabrielli, 1, Roma, Italy
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37
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Xie Y, Wang X, Xie W, Chen F, Gao S, Xu Y. Contrast opacification difference of mural artery and the transluminal attenuation gradient on coronary computed tomography angiography for detection of systolic compression of myocardial bridge. Surg Radiol Anat 2018; 40:757-767. [DOI: 10.1007/s00276-018-2014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/03/2018] [Indexed: 11/29/2022]
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38
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Maeda K, Schnittger I, Murphy DJ, Tremmel JA, Boyd JH, Peng L, Okada K, Pargaonkar VS, Hanley FL, Mitchell RS, Rogers IS. Surgical unroofing of hemodynamically significant myocardial bridges in a pediatric population. J Thorac Cardiovasc Surg 2018; 156:1618-1626. [PMID: 30005887 DOI: 10.1016/j.jtcvs.2018.01.081] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 12/22/2017] [Accepted: 01/09/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although myocardial bridges (MBs) are traditionally regarded as incidental findings, it has been reported that adult patients with symptomatic MBs refractory to medical therapy benefit from unroofing. However, there is limited literature in the pediatric population. The aim of our study was to evaluate the indications and outcomes for unroofing in pediatric patients. METHODS We retrospectively reviewed all pediatric patients with MB in our institution who underwent surgical relief. Clinical characteristics, relevant diagnostic data, intraoperative findings, and postoperative outcomes were evaluated. RESULTS Between 2012 and 2016, 14 pediatric patients underwent surgical unroofing of left anterior descending artery MBs. Thirteen patients had anginal symptoms refractory to medical therapy, and 1 patient was asymptomatic until experiencing aborted sudden cardiac arrest during exercise. Thirteen patients underwent exercise stress echocardiography, all of which showed mid-septal dys-synergy. Coronary computed tomography imaging confirmed the presence of MBs in all patients. Intravascular ultrasound imaging confirmed the length of MBs: 28.2 ± 16.3 mm, halo thickness: 0.59 ± 0.24 mm, and compression of left anterior descending artery at resting heart rate: 33.0 ± 11.6%. Invasive hemodynamic assessment with dobutamine confirmed the physiologic significance of the MBs with diastolic fractional flow reserve: 0.59 ± 0.13. Unroofing was performed with the patient under cardiopulmonary bypass (CPB) in the initial 9 cases and without CPB in the subsequent 5 cases. All patients were discharged without complications. The 13 symptomatic patients reported resolution of symptoms on follow-up, and improvement in symptoms and quality of life was documented using the Seattle Angina Questionnaire version 7. CONCLUSIONS Unroofing of MBs can be safely performed in pediatric patients, with or without use of CPB. In symptomatic patients, unroofing can provide relief of symptoms refractory to medical therapy.
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Affiliation(s)
- Katsuhide Maeda
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
| | - Ingela Schnittger
- Department of Cardiovascular Medicine, Stanford University, Stanford, Calif
| | - Daniel J Murphy
- Department of Cardiovascular Medicine, Stanford University, Stanford, Calif
| | - Jennifer A Tremmel
- Department of Cardiovascular Medicine, Stanford University, Stanford, Calif
| | - Jack H Boyd
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Lynn Peng
- Department of Pediatric Cardiology, Stanford University, Stanford, Calif
| | - Kozo Okada
- Department of Cardiovascular Medicine, Stanford University, Stanford, Calif
| | | | - Frank L Hanley
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | | | - Ian S Rogers
- Department of Cardiovascular Medicine, Stanford University, Stanford, Calif
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39
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Akishima-Fukasawa Y, Ishikawa Y, Mikami T, Akasaka Y, Ishii T. Settlement of Stenotic Site and Enhancement of Risk Factor Load for Atherosclerosis in Left Anterior Descending Coronary Artery by Myocardial Bridge. Arterioscler Thromb Vasc Biol 2018; 38:1407-1414. [DOI: 10.1161/atvbaha.118.310933] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/07/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Yuri Akishima-Fukasawa
- From the Department of Pathology, Toho University School of Medicine, Tokyo, Japan (Y.A-F., Y.I., T.M., Y.A.)
| | - Yukio Ishikawa
- From the Department of Pathology, Toho University School of Medicine, Tokyo, Japan (Y.A-F., Y.I., T.M., Y.A.)
| | - Tetuo Mikami
- From the Department of Pathology, Toho University School of Medicine, Tokyo, Japan (Y.A-F., Y.I., T.M., Y.A.)
| | - Yoshikiyo Akasaka
- From the Department of Pathology, Toho University School of Medicine, Tokyo, Japan (Y.A-F., Y.I., T.M., Y.A.)
| | - Toshiharu Ishii
- Department of Pathology, Saiseikai Yokohamashi Tobu Hospital, Japan (T.I.)
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40
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Javadzadegan A, Moshfegh A, Fulker D, Barber T, Qian Y, Kritharides L, Yong ASC. Development of a Computational Fluid Dynamics Model for Myocardial Bridging. J Biomech Eng 2018; 140:2681003. [DOI: 10.1115/1.4040127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Indexed: 01/08/2023]
Abstract
Computational fluid dynamics (CFD) modeling of myocardial bridging (MB) remains challenging due to its dynamic and phasic nature. This study aims to develop a patient-specific CFD model of MB. There were two parts to this study. The first part consisted of developing an in silico model of the left anterior descending (LAD) coronary artery of a patient with MB. In this regard, a moving-boundary CFD algorithm was developed to simulate the patient-specific muscle compression caused by MB. A second simulation was also performed with the bridge artificially removed to determine the hemodynamics in the same vessel in the absence of MB. The second part of the study consisted of hemodynamic analysis of three patients with mild and moderate and severe MB in their LAD by means of the developed in silico model in the first part. The average shear stress in the proximal and bridge segments for model with MB were significantly different from those for model without MB (proximal segment: 0.32 ± 0.14 Pa (with MB) versus 0.97 ± 0.39 Pa (without MB), P < 0.0001 — bridge segment: 2.60 ± 0.94 Pa (with MB) versus 1.50 ± 0.64 Pa (without MB), P < 0.0001). When all three patients were evaluated, increasing the degree of vessel compression shear stress in the proximal segment decreased, whereas the shear stress in the bridge segment increased. The presence of MB resulted in hemodynamic abnormalities in the proximal segment, whereas segments within the bridge exhibited hemodynamic patterns which tend to discourage atheroma development.
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Affiliation(s)
- Ashkan Javadzadegan
- Faculty of Medicine and Health Sciences, Macquarie University, Level 1, 75 Talavera Road, Sydney 2109, NSW, Australia
- ANZAC Research Institute, The University of Sydney, Sydney 2139, NSW, Australia e-mail:
| | - Abouzar Moshfegh
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney 2109, NSW, Australia
- ANZAC Research Institute, The University of Sydney, Sydney 2139, NSW, Australia
| | - David Fulker
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney 2052, Australia
| | - Tracie Barber
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney 2052, Australia
| | - Yi Qian
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney 2109, NSW, Australia
| | - Leonard Kritharides
- ANZAC Research Institute, The University of Sydney, Sydney 2139, NSW, Australia
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney 2139, NSW, Australia
| | - Andy S. C. Yong
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney 2109, NSW, Australia
- ANZAC Research Institute, The University of Sydney, Sydney 2139, NSW, Australia
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney 2139, NSW, Australia
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41
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Nishikii-Tachibana M, Pargaonkar VS, Schnittger I, Haddad F, Rogers IS, Tremmel JA, Wang PJ. Myocardial bridging is associated with exercise-induced ventricular arrhythmia and increases in QT dispersion. Ann Noninvasive Electrocardiol 2017; 23:e12492. [PMID: 28921787 PMCID: PMC6931813 DOI: 10.1111/anec.12492] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/27/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A myocardial bridge (MB) has been associated with ventricular arrhythmia and sudden death during exercise. QT dispersion (QTd) is a measure of abnormal repolarization and may predict ventricular arrhythmia. We investigated the frequency of ventricular arrhythmias during exercise and the QTd at rest and after exercise, in patients with an MB compared to a normal cohort. METHODS We studied the rest and stress ECG tracings of patients with an MB suspected by focal septal buckling on exercise echocardiography (EE) (Echo-MB group, N = 510), those with an MB confirmed by another examination (MB group, N = 110), and healthy controls (Control group, N = 198). RESULTS The frequency of exercise-induced premature ventricular contractions (PVCs) was significantly higher in the Echo-MB and MB groups compared with the Control group (both p < .001). In all, 25 patients (4.9%) in the Echo-MB group, seven patients (6.4%) in the MB group and no patients in the Control group had exercise-induced non-sustained ventricular tachycardia (NSVT). There was no difference in the baseline QTd between the groups. In the Echo-MB and MB groups, QTd postexercise increased significantly when compared with baseline (both p < .001). Patients with NSVT had a higher frequency of male gender and an even greater increase in QTd with exercise compared with the non-NSVT group. DISCUSSION There is an increased frequency of exercise-induced PVCs and NSVT in patients with MBs. Exercise significantly increases QTd in MB patients, with an even greater increase in QTd in MB patients with NSVT. Exercise in MB patients results in ventricular arrhythmias and abnormalities in repolarization.
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Affiliation(s)
- Makiko Nishikii-Tachibana
- The Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Vedant S Pargaonkar
- The Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ingela Schnittger
- The Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Francois Haddad
- The Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ian S Rogers
- The Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer A Tremmel
- The Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul J Wang
- The Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
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42
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Forsdahl SH, Rogers IS, Schnittger I, Tanaka S, Kimura T, Pargaonkar VS, Chan FP, Fleischmann D, Tremmel JA, Becker HC. Myocardial Bridges on Coronary Computed Tomography Angiography - Correlation With Intravascular Ultrasound and Fractional Flow Reserve. Circ J 2017; 81:1894-1900. [PMID: 28690285 DOI: 10.1253/circj.cj-17-0284] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Myocardial bridges (MB) are commonly seen on coronary CT angiography (CCTA) in asymptomatic individuals, but in patients with recurrent typical angina symptoms, yet no obstructive coronary artery disease (CAD), evaluation of their potential hemodynamic significance is clinically relevant. The aim of this study was to compare CCTA to invasive coronary angiography (ICA), including intravascular ultrasound (IVUS), to confirm MB morphology and estimate their functional significance in symptomatic patients.Methods and Results:We retrospectively identified 59 patients from our clinical databases between 2009 and 2014 in whom the suspicion for MB was raised by symptoms of recurrent typical angina in the absence of significant obstructive CAD on ICA. All patients underwent CCTA, ICA and IVUS. MB length and depth by CCTA agreed well with length (0.6±23.7 mm) and depth (CT coverage) as seen on IVUS. The product of CT length and depth (CT coverage), (MB muscle index (MMI)), ≥31 predicted an abnormal diastolic fractional flow reserve (dFFR) ≤0.76 with a sensitivity and specificity of 74% and 62% respectively (area under the curve=0.722). CONCLUSIONS In patients with recurrent symptoms of typical angina yet no obstructive CAD, clinicians should consider dynamic ischemia from an MB in the differential diagnosis. The product of length and depth (i.e., MMI) by CCTA may provide some non-invasive insight into the hemodynamic significance of a myocardial bridge, as compared with invasive assessment with dFFR.
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Affiliation(s)
| | - Ian S Rogers
- Division of Cardiovascular Medicine, Stanford University School of Medicine
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University School of Medicine
| | - Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford University School of Medicine
| | - Takumi Kimura
- Division of Cardiovascular Medicine, Stanford University School of Medicine
| | | | - Frandics P Chan
- Department of Radiology, Stanford University School of Medicine
| | | | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University School of Medicine
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43
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Perl L, Daniels D, Schwartz J, Tanaka S, Yeung A, Tremmel JA, Schnittger I. Myocardial Bridge and Acute Plaque Rupture. J Investig Med High Impact Case Rep 2017; 4:2324709616680227. [PMID: 28251167 PMCID: PMC5317013 DOI: 10.1177/2324709616680227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022] Open
Abstract
A myocardial bridge (MB) is a common anatomic variant, most frequently located in the left anterior descending coronary artery, where a portion of the coronary artery is covered by myocardium. Importantly, MBs are known to result in a proximal atherosclerotic lesion. It has recently been postulated that these lesions predispose patients to acute coronary events, even in cases of otherwise low-risk patients. One such mechanism may involve acute plaque rupture. In this article, we report 2 cases of patients with MBs who presented with acute coronary syndromes despite having low cardiovascular risk. Their presentation was life-risking and both were treated urgently and studied with coronary angiographies and intravascular ultrasound. This latter modality confirmed a rupture of an atherosclerotic plaque proximal to the MB as a likely cause of the acute events. These cases, of unexplained acute coronary syndrome in low-risk patients, raise the question of alternative processes leading to the event and the role MB play as an underlying cause of ruptured plaques. In some cases, an active investigation for this entity may be warranted, due to the prognostic implications of the different therapeutic modalities, should an MB be discovered.
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Affiliation(s)
- Leor Perl
- Stanford University Medical Center, Stanford, CA, USA
| | | | | | - Shige Tanaka
- Stanford University Medical Center, Stanford, CA, USA
| | - Alan Yeung
- Stanford University Medical Center, Stanford, CA, USA
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44
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Yamada R, Tremmel JA, Tanaka S, Lin S, Kobayashi Y, Hollak MB, Yock PG, Fitzgerald PJ, Schnittger I, Honda Y. Functional Versus Anatomic Assessment of Myocardial Bridging by Intravascular Ultrasound: Impact of Arterial Compression on Proximal Atherosclerotic Plaque. J Am Heart Assoc 2016; 5:e001735. [PMID: 27098967 PMCID: PMC4843493 DOI: 10.1161/jaha.114.001735] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The presence of a myocardial bridge (MB) has been shown to promote atherosclerotic plaque formation proximal to the MB, presumably because of hemodynamic disturbances provoked by retrograde blood flow toward this segment in cardiac systole. We aimed to determine the anatomic and functional properties of an MB related to the extent of atherosclerosis assessed by intravascular ultrasound. Methods and Results We enrolled 100 patients with angina but no significant obstructive coronary artery disease who had an intravascular ultrasound–detected MB in the left anterior descending artery (median age 54 years, 36% male). The MB was identified with intravascular ultrasound by the presence of an echolucent band (halo). Anatomically, the MB length was 22±13 mm, and halo thickness was 0.7±0.6 mm. Functionally, systolic arterial compression was 23±12%. The maximum plaque burden up to 20 mm proximal to the MB entrance was significantly greater than the maximum plaque burden within the MB segment. Among the intravascular ultrasound–defined MB properties, arterial compression was the sole MB parameter that demonstrated a significant positive correlation with maximum plaque burden up to 20 mm proximal to the MB entrance (r=0.254, P=0.011 overall; r=0.545, P<0.001 low coronary risk). In multivariate analysis, adjusting for clinical characteristics and coronary risk factors, arterial compression was independently associated with maximum plaque burden up to 20 mm proximal to the MB entrance. Conclusions In patients with an MB in the left anterior descending artery, the percentage of arterial compression is related directly to the burden of atherosclerotic plaque located proximally to the MB, particularly in patients who otherwise have low coronary risk. This may prove helpful in identifying high‐risk MB patients.
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Affiliation(s)
- Ryotaro Yamada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Shin Lin
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - M Brooke Hollak
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
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