Myocardial Bridge Group Research Articles

Assessment of the Ischaemic Effects of Myocardial Bridge by Echocardiographic Exercise Stress Test.

Detection of myocardial bridge (MB) at angiography suggests it has a role in ischaemic-related symptoms in patients with angina without obstructive coronary artery disease. However, evidence that MB may cause myocardial ischaemia is limited. We studied 41 patients with MB of the left anterior descending coronary artery and otherwise normal coronary arteries. Fourteen patients with normal coronary arteries and without MB served as controls. All subjects underwent a maximal treadmill exercise stress test (EST) under ECG monitoring. Standard and speckle-tracking echocardiography were performed at baseline and immediately after peak EST. EST duration and peak heart rate and systolic pressure were similar in the two groups. A positive EST (ST-segment depression .1 mm) was found in 18 patients in the MB group (43.9%) and none in the control group (p=0.001). No abnormalities in both left ventricle systolic and diastolic function were found between the two groups in the standard echocardiographic evaluation. Global and segmental (anterior, inferior) longitudinal strain (LS) did not differ at baseline between the groups. There was a small increase in global LS during EST in MB patients but not in the control group (p=0.01). Similar trends were found for regional LSs, with differences being significant for the medium (p=0.028) and apical (p=0.032) anterior segments. No differences in echocardiographic parameters and both global and segmental LSs were observed between MB patients with ischaemic ECG changes during EST versus those without. Our findings do not support the notion that MB results in significant degrees of myocardial ischaemia during maximal myocardial work.

CONTRAST STRESS ECHOCARDIOGRAPHY FINDINGS IN MYOCARDIAL BRIDGING COMPARED TO NORMAL CORONARY COURSE, WITH AND WITHOUT CORONARY ARTERY DISEASE

Abstract Background Myocardial bridging (MB) correlation with ischemia remains a diagnostic challenge. There is a lack of studies that have assessed MB using contrast stress echo and compared the findings with those in patients demonstrating a normal coronary course, with or without obstructive coronary artery disease (CAD). Methods We evaluated all consecutive patients who underwent contrast stress echocardiography and coronary computed tomography angiography (CCTA) due to suspected symptoms of CAD within 3 months in Parma Hospital. Coronary computed tomography angiography served as the reference standard for detecting MB and obstructive CAD. The patients were divided into 3 groups: (1) MB and no evidence of obstructive CAD (MB group, N = 64), (2) no evidence of obstructive CAD or MB (NoCAD group, N = 135), (3) obstructive CAD without MB (CAD group, N = 68). Results The coronary flow velocity reserve in the LAD (CFVR–LAD) was reduced in the MB and CAD groups, measuring 1.91 ± 0.21 and 1.82 ± 0.28, respectively, whereas it was 2.27 ± 0.34 in the NoCAD group (P < .001). The MB and CAD groups exhibited a higher prevalence of reversible myocardial perfusion defects (rMPDs) compared to the NoCAD group (57.8% vs 64.7% vs 3.7%, P < .001). Reversible wall motion abnormalities were frequently observed in the CAD group and rarely found in the MB and NoCAD groups (47.1% vs 18.8% vs 4.4%, P < .001). In multivariable analyses, the presence of MB was independently associated with reduced CFVR–LAD (odds ratio = 14.55; 95% CI, 6.84–30.93; P < .001) and the presence of rMPD (odds ratio = 37.96; 95% CI, 13.49–106.84; P < .001). Patients with deep MB (>2 mm depth) and very deep MB (≥5 mm depth) exhibited significantly greater CFVR–LAD reduction and rMPD than those with superficial MB. Conclusions Myocardial bridging is capable of inducing rMPD and reducing CFVR–LAD similar to obstructive CAD. The depth of the MB correlates with the abnormalities found in the stress echo evaluation. Contrast stress echo may serve as a valuable noninvasive tool for evaluating patients with MB.

Quantitative analysis of the relationship between the myocardial bridge and the FAI of pericoronal fat on computed tomography

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%.

Contrast Stress Echocardiography Findings in Myocardial Bridging Compared to Normal Coronary Course, With and Without Coronary Artery Disease

Myocardial bridging (MB) correlation with ischemia remains a diagnostic challenge. There is a lack of studies that have assessed MB using contrast stress echo and compared the findings with those in patients demonstrating a normal coronary course, with or without obstructive coronary artery disease (CAD). We evaluated all consecutive patients who underwent contrast stress echocardiography and coronary computed tomography angiography (CCTA) due to suspected symptoms of CAD within 3months in Parma Hospital. Coronary computed tomography angiography served as the reference standard for detecting MB and obstructive CAD. The patients were divided into 3 groups: (1) MB and no evidence of obstructive CAD (MB group, N=64), (2) no evidence of obstructive CAD or MB (NoCAD group, N=135), (3) obstructive CAD without MB (CAD group, N=68). The coronary flow velocity reserve in the LAD (CFVR-LAD) was reduced in the MB and CAD groups, measuring 1.91±0.21 and 1.82±0.28, respectively, whereas it was 2.27±0.34 in the NoCAD group (P<.001). The MB and CAD groups exhibited a higher prevalence of reversible myocardial perfusion defects (rMPDs) compared to the NoCAD group (57.8% vs 64.7% vs 3.7%, P<.001). Reversible wall motion abnormalities were frequently observed in the CAD group and rarely found in the MB and NoCAD groups (47.1% vs 18.8% vs 4.4%, P<.001). In multivariable analyses, the presence of MB was independently associated with reduced CFVR-LAD (odds ratio= 14.55; 95% CI, 6.84-30.93; P<.001) and the presence of rMPD (odds ratio= 37.96; 95% CI, 13.49-106.84; P<.001). Patients with deep MB (>2 mm depth) and very deep MB (≥5 mm depth) exhibited significantly greater CFVR-LAD reduction and rMPD than those with superficial MB. Myocardial bridging is capable of inducing rMPD and reducing CFVR-LAD similar to obstructive CAD. The depth of the MB correlates with the abnormalities found in the stress echo evaluation. Contrast stress echo may serve as a valuable noninvasive tool for evaluating patients with MB.

The Impact of Myocardial Bridging on the Coronary Functional Test in Patients with Ischaemia with Non-Obstructive Coronary Artery Disease.

Background: The possibility of myocardial bridging (MB) causing chest pain has been widely reported; however, the effect of MB on coronary microvessels has not been thoroughly investigated. Therefore, this study evaluated the effects of MB on epicardial coronary artery and coronary microvascular function during coronary angiography (CAG) and coronary function test (CFT) in patients with ischaemia with non-obstructive coronary artery disease (INOCA). Methods: This study included 62 patients with INOCA who underwent CAG and CFT for the left anterior descending coronary artery (LAD) to evaluate chest pain. In the CFT, acetylcholine was first administered intracoronarily in a stepwise manner, followed by chest symptoms, electrocardiographic ST-T changes and CAG. Positive coronary spasm was defined as coronary vasoconstriction of >90% on CAG accompanied by chest symptoms or electrocardiographic ST-T changes. After nitroglycerin administration, CAG was performed to assess MB, which was defined as systolic narrowing of the coronary artery diameter by >20% compared with that in diastole. Coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were subsequently obtained via transvenous adenosine triphosphate infusion using a pressure wire. Coronary microvascular vasodilatory dysfunction (CMD) was defined as a CFR of <2.0 or an IMR of ≥25 units. Results: Of the 62 patients, 15 (24%) had MB. The patients’ characteristics did not differ between the two groups. Regarding the CAG and CFT results, the presence of coronary spasm in the LAD was higher in the MB (+) group (87%) than in the MB (−) group (53%, p = 0.02), whereas the values of CFR (MB (+): 2.7 ± 1.4, MB (−): 2.8 ± 1.1) and IMR (MB (+): 26.9 ± 1.0, MB (−): 30.0 ± 17.3) and the presence of CMD (MB (+): 53%, MB (−): 60%) were similar in the two groups. Conclusions: The findings suggest that MB predisposes patients with INOCA to coronary spasms. Conversely, MBs may have a limited effect on microvessels, particularly in such patients.

The relationship between myocardial bridge and frontal QRS-T angle.

AimAlthough Myocardial bridge (MB) is known as a benign condition, it has been demonstrated to be associated with cardiac arrhythmias and poor outcomes. Frontal QRS‐T angle (fQRSTa) is a novel indicator of repolarization and depolarization heterogeneity. Last studies indicated that associated with fQRSTa and adverse cardiac events. No study evaluated the relationship between fQRSTa and MB. In the present study, we aimed to investigate the relationship between MB and fQRSTa.MethodsThis study included 91 patients with normal coronary arteries and 89 patients with MB. Coronary angiography was performed in all patients due to ischemia findings on treadmill exercise test or myocardial scintigraphy.2‐lead surface electrocardiograms (ECGs) of all patients were evaluated. QT interval, fQRSTa, QTc interval were measured from surface ECGs.ResultsBaseline clinical, echocardiographic and laboratory parameters were similar between MB and control group. However, when compared to control group, patients with MB had importantly raised fQRSTa [27 (20–41) vs. 23 (12–37) p = 0.007]. In correlation analysis, fQRSTa was positively correlated with MB length (r = 0.411, p < 0.001). Linear regression analysis showed that MB length was the just considerable predictor of fQRSTa (β = 0.247, p = 0.041).ConclusionsThe fQRSTa is a novel electrocardiographic marker that can be easily obtained from surface ECG. We have shown for the first time that MB length is a significant predictor of fQRSTa.

Abstract 12297: Myocardial Bridging Increases the Risk of Preoperative Atrial Fibrillation in Adult Patients with Obstructive Hypertrophic Cardiomyopathy

Background: Myocardial bridging (MB) was associated with various arrhythmia forms like supraventricular tachycardia, ventricular tachycardia, atrioventricular conduction block, and sudden cardiac death. However, the relationship between MB and preoperative atrial fibrillation (AF) remains unknown. Hypothesis: The presence of MB increases the risk of preoperation AF in adult patients with obstructive hypertrophic cardiomyopathy (OHCM). Method: We recruited 968 consecutive patients with OHCM who underwent surgical myectomy at Fuwai Hospital in Beijing, China, from January 2015 to December 2019. Patients were divided into two groups based on invasive coronary angiography: patients with MB group (N=144) and patients without MB group (N=824). Result: Patients with MB were much younger (43.6 vs. 48.8 years, p &lt; 0.001), more likely to have palpitation (37.4% vs. 25.5%, p = 0.003), had a lower body mass index (24.8 vs. 25.7 kg/m2, p = 0.009), a lower incidence of hypertension (14.6% vs. 27.9% p = 0.001), a higher prevalence of AF (26.4% vs. 11.5%, p &lt;0.001). After adjusting for age, sex, left atrial diameter, and LVOT gradient, multivariate logistic regression analysis revealed that the presence of MB was independently associated with AF (Odds ratio [OR] 3.73; 95% Confidential interval [CI] 2.32-5.98, p &lt; 0.001). Furthermore, we conducted a LASSO logistic regression to select variables associated with AF from patients with MB subgroup, and five non-zero variables were included in the multivariate logistic regression model. The results indicated that compared to patients with MB on the middle left anterior descending coronary (LAD), those with MB on the proximal LAD had a higher likelihood to develop AF (OR 4.22; 95% CI 1.40-12.68, p = 0.01). Moreover, MB compression (OR 1.04; 95% CI 1.04-1.08, p = 0.013) and MB length (OR 1.06; 95% CI 1.004-1.11, p = 0.034) were independently associated with a higher prevalence of AF after adjusting for age and left atrial diameter. Conclusion: The presence of MB and its location, length, and compression degree were independently associated with an increased risk of preoperative AF in adult HOCM patients, which suggested that whether MB needed surgical treatment during septal myectomy should be considered.

Investigation and analysis of somatic symptom disorder and anxiety and depression in patients with myocardial bridge

Objective To investigate and analyze the somatic symptom disorder, anxiety and depression in patients with myocardial bridge. Methods A total of 276 patients with myocardial bridge diagnosed by coronary angiography (CAG) were enrolled in the department of cardiology of Renji hospital in Shanghai from June to December in 2016. There were 151 cases of simple myocardial bridge (no coronary stenosis or coronary artery stenosis 30%). A total of 1067 patients with myocardial bridge without coronary angiography were collected at the same time. Self-rating somatic symptom scale (SSS), generalized anxiety disorder (GAD-7) and patient health questionnaire (PHQ -9) were given to these patients during hospitalization. At the same time, somatic symptoms disorder and anxiety and depression in the myocardial bridge group and non-myocardial bridge group were compared. Results The prevalence of somatic symptom disorder in patients with myocardial bridge was higher than that in non-myocardial bridge patients (35.86% vs 28.30%, P<0.05). There was significant correlation between somatic symptom disorder and depression and anxiety, with correlation coefficients of 0.629 and 0.565, respectively. The prevalence of depression and anxiety in myocardial bridge patients was higher than that in non-myocardial bridge patients (depression: 23.91% vs 22.11%. P=0.467; anxiety: 17.02% vs 14.15%, P=0.22), but there was no statistical difference. For male patients or female patients, the prevalence of somatic symptom disorder, depression and anxiety in the simple myocardial bridge patients were higher than those in the complex myocardial bridge patients, but there was no statistical difference. The most common non-specific somatic symptoms disorder in patients with myocardial bridge were fatigue (64.5%), followed by sleep disorders (63.8%) and decreased attention (63.0%). Conclusion The somatic symptom disorder in patients with myocardial bridge is significantly higher than that in non-myocardial bridge group. Especially for patients with myocardial bridge with non-specific somatic symptoms, early identification of somatic symptoms disorder of myocardial bridge patients will be beneficial to proper clinical invitation. Key words: Myocardial bridge; Somatic symptom disorder; Anxiety; Depression

Myocardial bridging is an independent predictor of positive spasm provocation testing by intracoronary ergonovine injections: a retrospective observational study

The relationship between myocardial bridging (MB) and coronary spasms during spasm provocation testing (SPT) remains unclear. We aimed to investigate whether MB was correlated with the SPT by ergonovine (ER) injections in a retrospective observational study. Of the 3340 patients who underwent a first coronary angiography, 166 underwent SPT using ER injections and were divided into 2 groups: MB(+) (n = 23), and MB(−) (n = 143). MB was defined as an angiographic reduction in the diameter of the coronary artery during systole. The patients who had severe organic stenosis in the left anterior descending coronary artery were excluded. The MB(+) group more frequently had diabetes mellitus and chronic kidney disease, and a thicker interventricular septum thickness. The rate of SPT-positivity was higher in the MB(+) group than MB(−) group (56.5% vs. 22.4%, P = 0.001). A multivariate regression analysis showed that the presence of MB was independently associated with SPT-positivity (odds ratio 5.587, 95% confidence interval 2.061–15.149, P = 0.001). In conclusion, coronary spasms during provocation tests with ER independently correlated with the MB. MB may predict coronary spasms.

ECG changes and markers of increased risk of arrhythmia in patients with myocardial bridge

BackgroundThe clinical significance and prognosis of myocardial bridge (MB) is still a matter of debate. ObjectivesTo assess the novel ECG markers of T peak-to-end (Tp-e) interval, transmural dispersion of repolarization (TDR), is assessed by Tp-e/QT ratio, and index of electrophysiogical index(iCEB),is defined by QT/QRS ratio and changes (ST-T changes) in MB patients. Patients and methodsForty one patients who were diagnosed as having MB (MB group) and other 41 patients without MB (non-MB group) at multi-detector CT (MDCT) exam matched by age, sex were enrolled in the study. ResultsiCEB was significantly increased in MB group in comparison to non-MB group particularly in patients with no coronary atherosclerosis (5.3 Vs 4.5, p = 0.04). Tp-e and TDR values were decreased in MB in comparison to non-MB patients particularly in patients with coronary atherosclerosis (69 Vs 80, p = 0.003 and 0.18 Vs 0.2, p = 0.01 respectively). Isolated T inversion in V1 was observed more in MB compared to non-MB patients (58% Vs 5%, p ≤ 0.0001) particularly in patients without coronary atherosclerosis. ConclusionMB patients have shown decreased Tp-e and TDR markers particularly in MB patients with coronary atherosclerosis.

Evaluating the relationship between myocardial bridge of the left anterior descending branch and atherosclerosis of coronary artery using transluminal attenuation gradient on CT

Objective To evaluate the relationship between concurrent myocardial bridge at anterior descending branch and the formation of coronary atherosclerosis plaques by using transluminal attenuation gradient (TAG). Methods A total of 198 patients underwent coronary CTA in Renji Hospital of Shanghai Jiaotong University School of Medcine from June 2017 to March 2018 and the results showed the anterior descending myocardial bridge. The data were retrospectively analyzed. All patients completed the coronary CTA with 320-row detector CT. According to the manifestations of myocardial bridge on CTA,the patients were divided into deep and superficial myocardial bridge groups. According to whether the patients were complicated with coronary atherosclerotic plaques,they were divided into isolated myocardial bridge group and myocardial bridge with coronary atherosclerotic plaque group. The thickness and length of myocardial bridge,the volume of coronary atherosclerotic plaques at the site of myocardial bridge,the pre-bridge and post-bridge TAG values,and the K ratio were recorded. Independent sample t test (normal distribution) or Mann-Whitney U test (skewed distribution) was used to compare the difference of measurement data among different groups. χ2 test was used to compare the difference of enumeration data among different groups. Pearson correlation test was used to analyze the correlation among pre-bridge and post-bridge TAG values,K ratio,thickness and length of myocardial bridge and plaque volume. The influence of above indexes on plaque occurrence was analyzed by binary logistic regression analysis. The relationship between main influence indexes and plaque formation was analyzed by receiver operating characteristic curve (ROC). Results Ninety nine patients had isolated myocardial bridge,99 with myocardial bridge and coronary atherosclerotic plaques,27 with superficial myocardial bridge and 171 with deep myocardial bridge. All atherosclerotic plaques occurred in pre-bridge and the mean volume of plaques was (91.6±83.0)mm3. The differences in sex,age,height,body weight and body mass index werenot statistically significant between isolated myocardial bridge group and myocardial bridge with coronary atherosclerotic plaque group (all P>0.05). The difference in pre-bridge TAG value was statistically significant between the isolated myocardial bridge group and myocardial bridge with coronary atherosclerotic plaque group (all P 0.05). The difference in pre-bridge and post-bridge TAG values and K value was not statistically significant between the superficial group and the deep group (all P>0.05). There was a weak negative correlation (r=-0.205,-0.316,-0.339,respectively,P 0.05). The area under curveof plaque formation promoted by pre-bridge TAG value was 0.582. When the diagnostic critical value was-37.26 HU/mm,the sensitivity and specificity of pre-bridge TAG value in plaque formation were 31.31% and 81.82%,respectively. Conclusion The TAG value of anterior descending bridge is an independent risk factor for plaque occurrence. The abnormal TAG value of anterior descending myocardial bridge can be detected early by CTA. Key words: Coronary vessels; Tomography, X-ray computed; Transluminal attenuation gradient; Myocardial bridge

The role of non-invasive fractional flow reserve derived from coronary CT angiography in assessing the hemodynamic relevance of myocardial bridging

Objective To evaluate the role of non-invasive fractional flow reserve (FFR) derived from coronary CT angiography (CCTA) in assessing the hemodynamic relevance of myocardial bridging (MB). Methods A total of 60 patients without obstructive coronary artery disease but with CCTA-confirmed MB of the left anterior descending coronary artery and 30 patients with negative CCTA findings as control group were retrospectively included in this study. The 60 patients with MB were divided into 2 groups (superficial and deep MB group) according to the depth of MB. Age and sex were matched among three groups. The location, length, depth, and degree of systolic compression of the MB were measured. The FFRCT values(including systolic and diastolic phases) were measured at three points (segments 1 to 2 cm proximal to a MB, mid-tunneled segment and segments 1 to 2 cm distal to the MB) by cFFR software. Patients with FFRCT<0.75 were deemed to have hemodynamic relevance (abnormal group). χ2 test, ANOVA test, Mann-Whitney U test, Kruskal-Wallis H test and logistic regression model were used for statistical analysis. Results The FFRCT values decreased from diastolic phase to systolic phase in deep MB group [0.90 (0.81-0.94) vs. 0.93 (0.91-0.97), Z=-2.172, P=0.03]. Compared to control group, the FFRCT values decreased in both diastolic phase and systolic phase in superficial MB group as well as deep MB group [systole 0.92 (0.90-0.94) control vs. 0.84 (0.77-0.88) superficial vs. 0.67 (0.50-0.88) deep, H=37.193, P<0.001; diastole 0.93 (0.89-0.94) control vs. 0.85 (0.73-0.92) superficial vs. 0.81 (0.65-0.87) deep, H=26.508, P<0.001]. Abnormal FFRCT values (<0.75) were found in 28 (47.7%) MB patients (9 superficial vs. 19 deep). The length (OR=1.067, 95% CI:1.016-1.122, P=0.010) and depth (OR=2.028, 95%CI:1.129-3.644, P=0.018) of MB were associated with the abnormal FFRCT values. Conclusions The FFRCT values of coronary artery distal to MB were lower than that without MB. Abnormal FFRCT values are more prevalent in deep MB. MB length and depth demonstrate moderate predictive value for an abnormal FFRCT value. Key words: Myocardial bridging; Tomography, X-ray computed; Fractional flow reserve

Prevalence and clinical presentation of myocardial bridge on the basis of the National Polish Percutaneous Interventions Registry and the Classification of Rare Cardiovascular Diseases.

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.

The Outcome of Percutaneous Coronary Intervention for Significant Atherosclerotic Lesions in Segment Proximal to Myocardial Bridge at Left Anterior Descending Coronary Artery

This study aimed to evaluate the efficacy of percutaneous coronary intervention (PCI) for significant atherosclerosis lesions proximal to myocardial bridge (MB) at left anterior descending coronary artery (LAD).A total of 330 consecutive patients with LAD significant stenosis, diagnosed as acute coronary syndrome (ACS), were included. Based on whether combined with MB, the patients were divided into the MB group (MB, n = 48) and non-MB group (NMB, n = 282). Drug eluting stents (DES) were successfully implanted in the stenostic segments prior to MB. All patients were followed up during the hospital stay, 30 days and 12 months after PCI, to evaluate the major adverse cardiac events (MACEs).There was no difference in the incidence of MACEs between the two groups (6.2% versus 2.1%, P = 0.254) when in the hospital. During the follow-up of 30 days and 12 months after PCI, the rate of MACEs was significantly higher in the MB group than in the NMB group (18.2% versus 6.4% and 43.8% versus 17.0%, respectively, P < 0.001). Stent restenosis occurred in four patients in the MB group; whereas, in five patients in the NMB group, the rate of stent restenosis was higher in the MB group than in the NMB group (8.3% versus 1.8%, P = 0.036). Cox proportional hazards regression analysis revealed that the presence of MB was an independent predictor of MACEs (hazard ratio (HR) = 1.781, 95% confidence intervals (95% CI) = 1.108-2.863, P = 0.017).DES implantation for significant atherosclerosis stenosis in the segments proximal to MB have higher incidence of MACEs. MB appears to be associated with a higher incidence of stent restenosis after PCI and is a significant factor in the occurrence of MACEs.

Assessment of the Relationship between Monocyte to High-Density Lipoprotein Ratio and Myocardial Bridge.

BackgroundAssessing the monocyte to high-density lipoprotein ratio (MHR) is a new tool for predicting inflamation, which plays a major role in atherosclerosis. Myocardial bridge (MB) is thought to be a benign condition with development of atherosclerosis, particularly at the proximal segment of the brigde.ObjectiveTo evaluate the relationhip between MHR and the presence of MB.MethodsWe consecutively scanned patients referred for coronary angiography between January 2013- December 2016, and a total of 160 patients who had a MB and normal coronary artery were enrolled in the study. The patients’ angiographic, demographic and clinic characteristics of the patients were reviewed from medical records. Monocytes and HDL-cholesterols were measured via complete blood count. MHR was calculated as the ratio of the absolute monocyte count to the HDL-cholesterol value. MHR values were divided into three tertiles as follows: lower (8.25 ± 1.61), moderate (13.11 ± 1.46), and higher (21.21 ± 4.30) tertile. A p-value of < 0.05 was considered significant.ResultsMHR was significantly higher in the MB group compared to the control group with normal coronary arteries. We found the frequency of MB (p = 0.002) to increase as the MHR tertiles rose. The Monocyte-HDL ratio with a cut-point of 13.35 had 59% sensitivity and 65.0% specificity (ROC area under curve: 0.687, 95% CI: 0.606-0.769, p < 0.001) in accurately predicting a MB diagnosis. In the multivariate analysis, MHR (p = 0.013) was found to be a significant independent predictor of the presence of MB, after adjusting for other risk factors.ConclusionThe present study revealed a significant correlation between MHR and MB.

Assessment of indirect inflammatory markers in patients with myocardial bridging.

SummaryIntroduction:Myocardial bridging (MB) is a congenital variant of the coronary artery in which a portion of the epicardial coronary artery takes an intramuscular course. Although it is considered a benign anomaly, it may lead to such complications as myocardial ischaemia, acute coronary syndrome, coronary spasm, exercise-induced dysrhythmias or even sudden death. MB may be related to increased inflammatory and atherosclerotic processes. This study was conducted with the aim of evaluating the relationship between neutrophil/ lymphocyte ratio (NLR) and MB.Methods:Taking into consideration the inclusion criteria, 86 patients with MB and 88 with normal coronary angiographies (control group) were included in the study. The association between MB and laboratory and other clinical parameters was evaluated.Results:The platelet distribution width (PDW) (17.3 ± 0.40 vs 16.1 ± 0 .5; p < 0.05), NLR (3.2 ± 1.3 vs 2.2 ± 0.9; p < 0.05) and red cell distribution width (RDW) (14.3 ± 1.3 vs 13.1 ± 1.1; p < 0.05) were significantly higher in the MB group than in the control group.Conclusions:This study demonstrated that compared to normal coronary arteries, PDW, NLR and RDW were significantly higher in MB patients. Further studies are needed to clarify the increased inflammatory parameters in patients with MB.

Impact of Myocardial Bridging on the Long-term Clinical Outcomes of Patients with Left Anterior Descending Coronary Artery Disease Treated with a Drug-Eluting Stent

Myocardial bridging (MB) is mostly confined to the left anterior descending coronary artery (LAD) and has been reported to be correlated with increased atherosclerotic plaques in the segment proximal to the bridging. This study aimed to assess the impact of MB on the clinical outcomes of patients with DES implantation in the LAD. A total of 551 consecutive patients with DES implantation on LAD from January 2008 to December 2009 were included. Patients were divided into an MB group (n=94, 17.1%) and a non-MB group (n=457, 82.9%) based on angiographic findings. They were followed up for three years to evaluate major adverse cardiac events (MACE), which were defined as all-cause death, myocardial infarction (MI), target lesion revascularisation (TLR) or ischaemic driven target vessel revascularisation (Id-TVR). During three years of follow-up, the rate of MACE was significantly higher in the MB group than in the non-MB group (18.1% vs. 9.8%, p=0.024), especially rates of TLR (8.5% vs. 2.4%; p=0.003) and Id-TVR (13.8% vs. 4.2%; p<0.001). However, no difference was observed for MI (3.2 vs. 2.6%; p=0.692) and all-cause death rates (3.2 vs. 4.6%; p=0.575). Multivariate regression analysis showed that the presence of MB was an independent predictor for MACE (Hazard ratio 2.897, 95% CI 1.536 - 5.464, p=0.001). MB appears to be associated with adverse effects in patients with DES implantation in the LAD.

Relation of myocardial bridge to myocardial infarction: a meta-analysis

Background Small case series have suggested an association of coronary myocardial bridge (MB) with myocardial infarction (MI). However, the relationship between MB and major adverse cardiac events (MACE) remains largely unknown. The aim of this study was to assess the relationship between MB and MACE involving MI. Methods We performed a systematic search of MEDLINE, PreMEDLINE, and all EMB Reviews as well as a reference list of relevant articles according to the SPICO (Study design, Patient, Intervention, Control-intervention, and Outcome) criteria using the following keywords: myocardial bridging, myocardial bridge, intramural coronary artery, mural coronary artery, tunneled coronary artery, coronary artery overbridging, etc. Bibliographies of the retrieved publications were additionally hand searched. Studies were included for the meta-analysis if they satisfied the following criteria: (1) they evaluate the association of MB with cardiovascular endpoint event; (2) they included individuals with MB and those without MB; 3) they excluded individuals with obstructive coronary artery disease (CAD). Studies were reviewed by a predetermined protocol including quality assessment. Dates were pooled using a random effect model. Results Seven observational studies that followed 5 486 patients eligible for the enrolled criteria were included from 7 136 initially identified articles. The prevalence of MB was 24.8% (1 363/5 486). During 0.5-7.0 years of follow-up of this cohort of population, crude outcome rates were 8.0% in the MB group and 7.7% in the non-MB group. The odds ratio of overall MACE and MI were 1.34 (95% confidence interval (CI): 0.57-3.17, P=0.51, n=7 studies) and 2.75 (95% CI: 1.08-7.02, P &lt;0.03, n=5 studies) respectively for subjects of MB compared to non-MB. Conclusion Relationship between MB and MI appears to be a real one, although the study did not reveal a connection of MB to MACE, suggesting whether the necessity of antiplatelet therapy needs to be further studied in a larger cohort of patients with MB prospectively.

Does isolated myocardial bridge really interfere with coronary blood flow?

Myocardial bridge (MB) is defined as a segment of a major epicardial coronary artery the “tunneled artery” that goes intramurally through the myocardium beneath the muscle bridge. Multiple methods have been proposed to assess coronary flow rate among which thrombolysis in acute myocardial infarction frame count was a relatively new semiquantitative method. Our goal was to determine incidence of MB in the patients undergoing coronary angiography in Mansoura Specialized Hospital, Cardiac Catheterization Laboratory, also to investigate the hypothesis that slow coronary flow rate may be linked to angina or angina like symptoms in patients with MB without stenotic lesions in epicardial coronary arteries using TFC. Fifteen patients with MB (group I) were retrospectively collected from Mansoura Specialized Hospital, Cardiac Catheterization Laboratory, we review 3000 cases referred to diagnostic coronary angiography to exclude significant coronary artery disease. Fifteen patients with normal coronary angiography served as control (group II). We review the clinical presentations, risk factors, echocardiographic data for both test and control groups. TFC was calculated using a simple continuous index. The incidence of MB in our study was 0.5%. CTFC in LAD was significantly higher in the patients with MB compared with control. No significant correlation between TFC and echocardiographic parameters. Myocardial bridging must be considered especially in patients at low risk for coronary atherosclerosis but with angina like chest pain or established myocardial ischemia. We suggest that coronary blood flow is decreased in the patients with MB compared with the patients having normal coronary.

Evaluation of left ventricular twist in patients with myocardial bridge

ObjectiveTo probe into the speckle tracking imaging assessment of the influence on the left ventricular twist by myocardial bridge of the left anterior descending (LAD)coronary artery.Methods21 patients with symptoms with...