Myocardial bridge analysis by multidetector computed tomography and its association with coronary atherosclerosis

Abstract

Background: myocardial bridge is still a major public health problem despite the impressive stride in diagnosis and management. Furthermore, the early and accurate diagnosis with the proper management is an important challenge. The determination of the prevalence of myocardial bridges and their location and morphology is extremely important for the prediction of potential complications which are likely to cause greater myocardial damage. Aim of the work: this study aimed to assess noninvasively by using MDCT the presence of atherosclerotic plaques in relation to myocardial bridge coronary segments and to determine the prevalence of myocardial bridges and their morphology (length, depthand diameter) and location. Methods: this was a prospective observation study that was done from June 2017 to April 2018 and included 52 patients presented to the Coronary Care Unit at Al-Azhar University Hospital with stable angina. All patients were subjected to: thorough history taking, full clinical examination, surface ECG, treadmill stresses ECG and do MDCT scan to detect of the presence of myocardial bridge: as regard site, length, depth and degree of systolic obstruction, coronary plaque assessment. Results: among the 52 patients we found that 23 patients had MB and coronary plaque included in group A, 29 patients had MB without coronary plaque included in groupB, In group A, MB was in Mid LAD in 18(78.3%) patients, Distal LAD in 5(21.7%) patients, the mean depth of MB was 3.89 ± 1.75 mm, the mean length of MB was 22.16 ± 9.44 mm, the mean degree of systolic obstruction of MB was 61.65 ± 19.47 %. While, in group B mid LAD in 20 (69.0%) patients, distal LAD in 7 (24.1%) patients and proximal LAD in 1 (3.4%) patients, distal RCA in 1(3.4%) patient, the mean depth was 2.83 ± 1.54 mm (p = 0.017), the mean length was22.22 ± 13.55 mm, the mean degree of systolic obstruction was is 41.72 ± 24.94 % (P < 0.004). Conclusion: some anatomic characteristics of myocardial bridge, such as degree of systolic obstruction and depth, may help the development of coronary plaque.