Multidetector Computed Tomography Findings of Myocardial Bridge and Its Relationship With Coronary Calcification

Multislice computed tomography (MSCT) can be used to detect myocardial bridging (MB) of coronary arteries. However, most published studies included small cohorts and did not collect data about predictors. We investigated prevalence and predictors of MB in an Indonesian population. All patients who had MSCT at Cinere Hospital, Jakarta, Indonesia between 2006 and 2009 were included in a prospective registry. MB was defined when at least half of the coronary artery was imbedded within the myocardium with a normal epicardial course of the proximal and distal portion. Of the 934 patients (mean age 53years, 37.8% female), MB could be observed in 152 patients (16.3%). Patients with MB were younger compared with those without MB. Coronary risk factors were not different between the two groups. Coronary calcifications and moderate to severe coronary stenoses were less prevalent in patients with MB, also after adjusting for differences in age. At the time of diagnosis, only a few patients with MB were treated with beta-blockers (35%) or calcium channel blockers (13%). Prevalence of myocardial bridging as detected by MSCT is relatively high. Patients with MB were younger and had a lower prevalence of coronary sclerosis. MB could be the cause of their unexplained symptoms. Follow-up studies are necessary to assess the symptoms of these patients, their response to treatment and the incidence of (coronary) events. MSCT can be used to identify patients for potential new treatment strategies.

Myocardial Bridge (MB) on the coronary artery and myocardial coat (MC) on the cardiac veins are usually detected in angiography and cadaveric dissection. Left anterior descending branch (LAD) of the left coronary artery is the most frequent site of MB. Rarely MB is also seen over the right coronary arterial branches. MB has proven association with ischemic heart disease and other critical cardiac consequences like myocardial infarction (MI) (Alegria et al., 2000; Soran et al., 2000). MC, on the other hand has not gained enough attention in previous studies. Large MB can be readily identified in angiograms, but minutes MB can be picked up by newer imaging studies like multidetector computed tomography (MDCT) and optical coherence tomography (OCT) scan (Tiryakioglu and Aliyu, 2020). Cadaveric dissection, however, holds its unique place in direct visualization and studying the macro and micro-anatomical characteristics. To study the prevalence and anatomical attributes of MB and MC in Indian population, ten adult cadaveric hearts (6 male and 4 female) were dissected as part of a routine undergraduate teaching at the Anatomy Department, All India Institute of Medical Sciences, New Delhi, India. MB over the coronary artery and MC over the cardiac vein were identified. Data pertaining to the MB and MC dimensions were measured with a digital vernier calliper. Histology of the MC was carried out to confirm its presence and observe the cytoarchitecture pattern. Relevant gross macroscopic and microscopic images were photographed and photomicrographed. 20% of the dissected cadavers revealed MB involving LAD in first heart while LAD and RCA both in second heart with lengths 5 mm, 18 mm and 2 mm respectively. MC was noted over coronary sinus and proximal few millimeters of great and middle cardiac veins. Histological examination revealed cardiac striated muscle in MC with typical cyto- architecture. The mean myocardial muscle index (MMI) of MBs ranged from 1.6 to 21.6. The present study highlights 20% prevalence of MBs in Indian population involving both right and left coronary artery. 10% of the subjects had histologically confirmed MC over cardiac veins. MC over the coronary sinus and other cardiac veins need more elaborate explorative studies to quantify the anatomic properties and to examine the possible association with cardiovascular disease. Nevertheless, anatomic attributes should be kept in mind to better appreciate MI in evolution and MI at evaluation in a case with MB.

PurposeRecent evidence suggests that early repolarization (ER) is related with myocardial ischemia. Compression of coronary artery by a myocardial bridging (MB) can be associated with clinical manifestations of myocardial ischemia. This study aimed to evaluate the associations of MB in patients with ER.Materials and MethodsIn consecutive patients (n=1303, age, 61±12 years) who had undergone coronary angiography, we assessed the prevalence and prognostic implication of MB in those with ER (n=142) and those without ER (n=1161).ResultsMB was observed in 54 (38%) and 196 (17%) patients in ER and no-ER groups (p<0.001). In multivariate analysis, MB was independently associated with ER (odd ratio: 2.9, 95% confidence interval: 1.98–4.24, p<0.001). Notched type ER was more frequently observed in MB involving the mid portion of left anterior descending coronary artery (LAD) (69.8% vs. 30.2%, p=0.03). Cardiac event was observed in nine (6.3%) and 22 (1.9%) subjects with and without ER, respectively. MB was more frequently observed in sudden death patients with ER (2 out of 9, 22%) than in those without ER (0 out of 22).ConclusionMB was independently associated with ER in patients without out structural heart disease who underwent coronary angiography. Notched type ER was closely related with MB involving the mid portion of the LAD. Among patients who had experienced cardiac events, a higher prevalence of MB was observed in patients with ER than those without ER. Further prospective studies on the prognosis of MB in ER patients are required.

Muscle fibers overlying the intramyocardial segment of an epicardial coronary artery are termed myocardial bridging (MB). Variable prevalence of MB has been described at autopsy and angiographic series with small and large sample size studies. In addition, no similar study was reported in Chinese population. The aim of this study was to investigate the angiographic prevalence of MB in consecutive 37,106 Chinese patients with chest pain from our center. We conducted an observational study to evaluate the consecutive cases with MB among patients undergone selective coronary angiography, and analyzed the angiograhic prevalence and clinical features of MB in this study of very large sample size. Among 37 105 patients with chest pain we found 1002 cases with 1011 MBs in a retrospective manner, and the overall prevalence was 2.70%. Although more than 99% (991/1002) of patients had single bridge, 8 cases were found to have more than two MBs (seven with two, and one with three). Altogether 54.39% of cases (545/1002) had MB without atherosclerotic lesions, and 96.24% (973/1011) of bridging located in the left anterior descending coronary artery (LAD), mainly in the middle of LAD (792/1011, 78.33%). According to Nobel classification, of the single bridge (n=991), <50% of obstruction was predominant (471/991, 47.52%). Totally 50%-69% accounted for 34.81% (345/991), >70% of obstruction was 17.65% (175/991). These data showed that the prevalence of angiographically detectable MB in Chinese patients with chest pain was similar to those of the previous studies, with 2.7% prevalence in this very large sample size.

This scientific statement reviews the scientific data for cardiac computed tomography (CT) related to imaging of coronary artery disease (CAD) and atherosclerosis. Cardiac CT is a CT imaging technique that accounts for cardiac motion, typically through the use of ECG gating. The utility and limitations of generations of cardiac CT systems are reviewed in this statement with emphasis on CT measurement of CAD and coronary artery calcified plaque (CACP) and noncalcified plaque. Successive generations of CT technology have been applied to cardiac imaging beginning in the early 1980s with conventional CT, electron beam CT (EBCT) in 1987, and multidetector CT (MDCT) in 1999. Compared with other imaging modalities, cardiac CT has undergone an accelerated …

Background: Myocardial bridging (MB) is an anatomical variant in which segments of epicardial coronary arteries course partially within the myocardium. The prevalence of MB is reportedly as high as 15–85% in autopsy studies, whereas coronary angiography studies show a prevalence ranging from 0.5–3%. The aim of this study was to investigate the prevalence and demographic characteristics of MB in patients undergoing coronary angiography in Northern Cyprus. Methods: This retrospective review analyzed coronary angiography data for 6980 consecutive adult patients undergoing coronary angiography between December 2020 and January 2023. Results: MB was detected in 89 of 6980 patients who underwent coronary angiography, giving an angiographic prevalence of 1.27%. The mean age of patients was 59.4 ± 13.5 years (range: 26–90 years), with 28 (31.5%) females and 61 (68.5%) males. MB was most commonly observed in the left anterior descending (LAD) artery. MB was found in the middle LAD segment in 65 patients (73.0% of all cases), in the distal LAD segment in 22 patients (24.7%), and in the right coronary artery (RCA) in two patients (2.2%). Conclusion: This study provides new data on the prevalence of MB in Northern Cyprus and on regional differences in this condition. Further epidemiological research is needed to better characterize MB distribution and its potential clinical significance.

Background Myocardial bridging (MB) are congenital defects of the coronary arteries in which a segment of an epicardial artery lies in the myocardium for part of its course. The current gold standard for diagnosing MB is coronary angiography; however other invasive techniques are also useful. Myocardial bridging can also be visualized with the use of novel non-invasive imaging techniques such as multidetector-row computed tomography coronary angiography (MDCT-CA). ObjectivesTo assess the prevalence and characteristics of myocardial bridging in patients undergoing multidetector-row computed tomography coronary angiography (MDCT-CA). Material and MethodsA total of 452 consecutive patients were evaluated with 16-row and 64-row MDCT-CA due to the presence of abnormal findings in myocardial perfusion image tests, symptoms suggestive of coronary artery disease, and in asymptomatic patients with a family history of coronary artery disease. The presence of MB, their location and characteristics were analyzed. Myocardial bridges were classified as complete and incomplete with respect to continuity of the myocardium over the tunneled segment of the artery involved. Quantitative measurements of vessel diameter during systole and diastole were evaluated. ResultsThe prevalence of MB was 35.18%; 88 were complete and 71 incomplete. Among complete MB, 6 affected both systole and diastole, 27 presented only systolic compression and 55 showed no compression. Incomplete MB showed absence of arterial compression. Conclusions Multidetector-row computed tomography coronary angiography detected a higher prevalence of MB in the study population and allowed to classify them and to assess their functional aspects throughout the cardiac cycle.

Background: Band of Myocardial tissue overlying a segment of an epicardial coronary artery is termed myocardial bridge (MB). The aim of this study was to identify the prevalence, risk factors and angiographic profile of patients with myocardial bridge in a tertiary care hospital, Dhaka, Bangladesh. Materials and Methods: This retrospective observational study included a total of 1480 patients with suspected coronary artery disease admitted to Enam Medical College and Hospital, Savar, Dhaka, Bangladesh for coronary angiography between April 2016 to June 20019 of them 43 cases were found to have myocardial bridge. Coronary compression was defined as a maximum systolic luminal compression ≥50%. In this population, 43 patients had systolic luminal compression ≥50%, and all 43 patients were selected for the study to determine the prevalence and risk factors of MB and recorded coronary angiogram was reviewed to see the angiographic location of MB, length of MB and number of vessels involved. Results: In this study incidence of MB was 2.9%. The risk factors associated with MB hypertension were 33 (76.74%), diabetes mellitus 28 (65.11%), hyperlipidaemia 18 (41.86%), family history of CAD 15 (34.88%), smoking history 22 (51.16%). Located of MB in LAD were 34 (79.06%), LCX 07 (16.27%) and RCA 02 (4.65%). The MB were in single vessel 38 (88.37%) and double vessels 05 (11.62%). MBs with atherosclerotic stenosis in LAD were 18 (41.86%), LCX 02 (4.65%), RCA 01 (2.32%) and severity of MB stenosis were in LAD 50 -70% were 27 (62.79%), >70% were 07 (16.27%), LCX 50-70% were 06 (13.95%) and >70% was 01 (2.32%) and RCA 50-70% was 02 (4.65%). The length of MBs segment <10 mm were 06 (13.95%), 10-20 mm were 25 (58.19%) and >20 mm were 12 (27.90%). Conclusion: In this study the prevalence of MB was 2.91%, commonly presented with chronic stable angina. The most risk factors of myocardial bridges were hypertension, diabetes mellitus, hyperlipidaemia, family history and smoking history. In coronary angiography most of the patient of MB was present in association of acute coronary syndrome with documented coronary artery disease and was mainly located in LAD mid segment and the length of MB was mostly 10-20 mm. Further large numbers of case are needed to validate the result of the study.

Introduction:Myocardial bridges (MB) are congenital anomalies of hearts observed as muscle fibers covering epicardial branches of the coronary artery. The left anterior descending artery (LAD) was found to be commonly showing myocardial bridges (MBs). Clinically, MBs were claimed to cause varied symptomatology. The data on the morphology and prevalence of MBs in fetuses was limited, despite the commonly accepted congenital origin. Material and methods:Fetal hearts obtained from 37 fetuses from the donation program were used. The hearts were dissected out from the thorax by standard dissection procedure. The pericardium and epicardium were dissected. The coronary arteries were delineated, and MBs were observed and noted. The coronary artery segment having MBs, its distance from the ostium as well as the direction and length of the MBs were studied. Results:The MBs were observed in 20 out of 37 fetal hearts studied over the left anterior descending, right coronary, posterior interventricular and circumflex arteries. The mid or distal part of the coronary arteries frequently exhibited MBs. The mean length of the MB was 4.2 mm, with MBs being situated about 1.5 cm away from the coronary ostium. The oblique pattern of MB was more frequently noted. Conclusion:The morphology and prevalence of fetal MBs showed common occurrence in the LAD artery, with a predominant oblique morphological pattern.

BACKGROUND A myocardial bridge (MB) is defined as a congenital anomaly, in which a segment of an epicardial coronary artery takes an intramuscular course. AIMS The aim of the study was to evaluate the prevalence of MB in coronary arteries among patients who were diagnosed using coronary angiography. METHODS Data were obtained from the National Polish Percutaneous Interventions Registry for patients hospitalized between January 1, 2014, and December 31, 2016, in invasive cardiology departments in Poland and divided into groups with and without MB. RESULTS The study included 298 558 patients. The non‑MB group comprised 296 133 patients (99.19%; women, 38.01%), while the MB group included 2425 patients (0.81%; women, 39.98%). The most frequent location of MB was the left anterior descending artery (n = 2355; 97.11% of patients). The MB group less often had diabetes (14.68% vs 21.63%), previous stroke (1.61% vs 2.96%), previous myocardial infarction (10.97% vs 21.97%), kidney disease (2.8% vs 5.04%), previous coronary artery bypass graft (1.03% vs 5.64%), previous percutaneous coronary intervention (13.20% vs 25.86%) than the non‑MB group (P <0.0001). The incidence of acute coronary syndromes was lower in the MB group (P <0.0001), while smoking was more common (18.76% vs 16.87%, P <0.01). CONCLUSIONS Patients with MB were younger and had fewer comorbidities and risk factors for atherosclerosis than patients without MB. The condition was more common among patients with stable coronary artery disease. Smoking and female sex appeared to be associated with a more clinically symptomatic presentation of MB.

Non-traditional risk factors predict coronary calcification in chronic kidney disease in a population-based cohort

This study aimed to assess the prevalence and characteristics of myocardial bridging in patients who underwent multislice computed tomography coronary angiography (MSCT-CA) and to evaluate the correlation between bridged coronary segments and atherosclerosis. A total of 277 patients (mean age 60+/-11 years) we consecutively examined with 64-slice MSCT-CA for suspected or known coronary atherosclerosis were retrospectively reviewed for myocardial bridging. Segments proximal and distal to the bridging were evaluated for atherosclerotic plaque, as were the remaining coronary segments. Myocardial bridging was present in 82 patients (30%, mean age 59+/-12). Bridges were of variable length (<1 cm 58%; 1-2 cm 32%; >2 cm 10%) and depth (superficial 69%, intramyocardial 31%) and frequently localised in the mid-distal segment of the left anterior descending artery (95%). Myocardial bridging cannot be considered a significant risk factor for coronary atherosclerosis (odds ratio 0.49) compared with traditional cardiovascular risk factors. Coronary segments proximal to the bridge showed no atherosclerotic disease (33%), positive remodelling (27%), <50% stenosis (20%) or >50% stenosis (20%). We identified 12 noncalcified, 32 mixed and 17 calcified plaques. The distal segments were significantly less affected (p<0.0001). MSCT-CA is a reliable, noninvasive method that is able to depict myocardial bridging and associated atherosclerotic plaque in the proximal segments.

HomeCirculationVol. 144, No. 12Letter by Matta et al Regarding Article, “Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of Myocardial Infarction With Nonobstructive Coronary Arteries in Women” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessLetterPDF/EPUBLetter by Matta et al Regarding Article, “Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of Myocardial Infarction With Nonobstructive Coronary Arteries in Women” Anthony Matta, MD Meyer Elbaz, MD Jerome RoncalliMD, PhD Anthony MattaAnthony Matta Department of Cardiology, CARDIOMET Institute, University Hospital of Toulouse, France (A.M., M.E., J.R.). Faculty of Medicine, Holy Spirit University of Kaslik, Lebanon (A.M.). Search for more papers by this author , Meyer ElbazMeyer Elbaz Department of Cardiology, CARDIOMET Institute, University Hospital of Toulouse, France (A.M., M.E., J.R.). Search for more papers by this author and Jerome RoncalliJerome Roncalli https://orcid.org/0000-0002-4093-0435 Department of Cardiology, CARDIOMET Institute, University Hospital of Toulouse, France (A.M., M.E., J.R.). Search for more papers by this author Originally published20 Sep 2021https://doi.org/10.1161/CIRCULATIONAHA.120.053041Circulation. 2021;144:e204To the Editor:We read with great interest the original research article by Reynolds et al that assessed the causes and mechanisms of myocardial infarction and nonobstructive coronary artery disease (MINOCA) in women. The authors reported the detection of culprit lesions by coronary optical coherence tomography in 46.2% and abnormalities by cardiac magnetic resonance imaging in 74.1% of patients.1 Moreover, they presented the combined optical coherence tomography and cardiac magnetic resonance imaging results in revealing an underlying cause of MINOCA in 84.5% of cases.However, the authors did not report on the prevalence of myocardial bridge (MB), which could be detected by invasive coronary angiography or optical coherence tomography among the studied population. A recently published study from the ORPKI national registry showed that MB is significantly more frequent in the MINOCA population (2.2% versus 0.4%).2 In addition, a comparison of the detection rate of MB among those diagnosed with Tako–Tsubo cardiomyopathy (4 patients) and coronary artery spasm (46 patients) to other study participants (95 patients) is lacking. This comparison may reveal the pathophysiological mechanism of MB in patients with MINOCA. A previous study by Migliore et al showed a prevalence of angiographic MB 4 times higher in patients with Tako–Tsubo cardiomyopathy than in control groups.3 MB is associated with a high incidence of coronary artery spasm, which significantly increases the risk of MINOCA.4,5Because of the significant difference in the distribution of MB in patients with MINOCA (especially those with Tako–Tsubo cardiomyopathy and coronary artery spasm) and those in control groups, MB would likely be a cause of MINOCA. Last, we agree with the authors that additional research is required to investigate the causes, mechanisms, and diagnostic algorithms in patients with MINOCA.AcknowledgmentsWe thank Editage (www.editage.com) for English-language editing.Disclosures None.Footnoteshttps://www.ahajournals.org/journal/circ

Myocardial Bridging Assessed by Multidetector Computed Tomography: Likely Cause of Chest Pain in Younger Patients With Low Prevalence of Dyslipidemia

Introduction Myocardial bridge is a rare, benign, normal anatomical variant of the coronary artery that puts the patient at risk for significant cardiac symptoms, resulting in myocardial ischemia, arrhythmia, and sudden cardiac death. The aim of the study was to assess the prevalence and characteristics of myocardial bridging (MB) in patients with chest pain undergoing coronary angiography. Methodology A total of 1301 patients presenting with chest pain suggestive of acute coronary syndrome with associated non-invasive supportive cardiac evaluation were subjected to coronary angiography by Philips Allura Xper FD10 Cath Lab (Philips Healthcare, Andover, MA)and evaluated. Results Out of 1301 patients, the mean age was 54.70 ± 11.41 years with a male-to-female ratio of 1.9:1. Tobacco use and diabetes mellitus were the most common associated risk factors (49% and 44%, respectively). MBwas seen in 51 patients, making the prevalence 3.9%, with male predominance over females in the ratio of 3.9:1. The most common clinical presentation was unstable angina (UA) (n = 22, 43.1%), followed by stable angina (SA) (n = 11, 21.6%), non-ST-elevation myocardial infarction (NSTEMI) (n = 10, 19.6%), and ST-elevation myocardial infarction (STEMI) (n = 8, 15.7%). Myocardial bridgeswere more common among patients with stable coronary artery disease. The left anterior descending artery (n = 51, 3.9%) was involved in all the cases and the middle segment was affected in all patients with MB.Among patients with myocardial bridge, 26 patients (51%) had atherosclerosis and 25 patients had a normal artery. Among patients with myocardial bridge with atherosclerosis, 17 patients (65%) had atherosclerosis in the same artery in which the myocardial bridge was present. Among patients with myocardial bridge with atherosclerosis, nine patients (52%) had atherosclerosis proximal to the bridge, three patients (17%) had atherosclerosis distal to the bridge, and five patients (31%) had atherosclerosis both proximal and distal to the bridge. Conclusion The prevalence of MB in the Indian population is significantly lower than in the Western populations, and it is significantly higher in the male population with patients diagnosed as normal coronaries on coronary angiography.