Abstract

BackgroundThe 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. MethodsIn 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. ResultsIn 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). ConclusionComparing 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.

Highlights

  • Intramural course of an epicardial coronary artery segment referred to as a myocardial bridge (MB) is a frequently observed congenital abnormality, mainly present in the left anterior descending artery (LAD)

  • To establish the control group, we identified patients with excellent image quality of coronary computed tomography angiography (CTA) but without LAD MB

  • We found no significant difference between cases and controls regarding total plaque volume of the coronary segments proximal to MB vs. control segments (150.0 mm3 [IQR: 90.7–194.5 mm3] vs. 132.8 mm3 [IQR: 94.2–184.3 mm3], respectively; p = 0.95)

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Summary

Introduction

Intramural course of an epicardial coronary artery segment referred to as a myocardial bridge (MB) is a frequently observed congenital abnormality, mainly present in the left anterior descending artery (LAD). 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. 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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