Angiographic Evidence of Myocardial Squeezing Accompanying Tachyarrhythmia as a Possible Cause of Myocardial Infarction

Endo, Masahiro; Lee, Young Woo; Hayashi, Hisae; Wada, J

doi:10.1378/chest.73.3.431

Cited by 58 publications

(22 citation statements)

References 8 publications

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“…[4][5][6][7][8] The clinical management of patients with symptomatic MB is not well established. On the basis of previous pathophysiological and clinFrom the…”

Section: Discussionmentioning

confidence: 99%

Angiographic Restenosis After Myocardial Bridge Stenting: A Comparative Study With Direct Stenting of De-Novo Atherosclerotic Lesions

et al. 2004

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SUMMARYData on restenosis after stent implantation in myocardial bridges (MB) are very limited. Six-month angiographic results for 12 symptomatic patients who underwent stent implantation for myocardial bridges were compared retrospectively with those of 39 patients who underwent direct stent implantation for de novo atherosclerotic lesions in the left anterior descending artery. Diameter stenosis decreased from 69 ± 8% to 4 ± 5% in the MB group and from 79 ± 8% to 7 ± 6% in the control group after stent deployment. Systolic narrowing was abolished in all patients with MB. In follow-up, quantitative angiography revealed late loss of 1.8 ± 1.3 mm in the MB group and 0.9 ± 0.9 mm in the control group (P = 0.025). The in-stent restenosis rate was also higher in the MB group compared to the control group (67% versus 28%; P = 0.037). Despite favorable immediate results, stent implantation in MBs may not be promising because of the higher in-stent restenosis rate compared to stenting in de novo atherosclerotic lesions. ( A myocardial bridge (MB) is an anatomical variation in which a part of a coronary artery (mostly left anterior descending artery (LAD)) courses under a segment of myocardium that compresses the lumen during systole despite a normal appearance during diastole. The reported incidence of MB varies over a wide range according to the method of diagnosis, changing from 0.5 to 2.5% in angiographic studies to 15 to 85% in autopsy series.1-3) Although known as a benign and asymptomatic condition in a majority of the patients, MBs may cause angina, myocardial ischemia, infarction, life-threatening cardiac arrhythmias, and even sudden cardiac death. [4][5][6][7][8] The clinical management of patients with symptomatic MB is not well established. On the basis of previous pathophysiological and clinFrom the

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“…[4][5][6][7][8] The clinical management of patients with symptomatic MB is not well established. On the basis of previous pathophysiological and clinFrom the…”

Section: Discussionmentioning

confidence: 99%

Angiographic Restenosis After Myocardial Bridge Stenting: A Comparative Study With Direct Stenting of De-Novo Atherosclerotic Lesions

et al. 2004

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“…Some case reports have indicated that a relationship exists between MB and major cardiac events, such as myocardial infarction [12][13][14][15][16][17] and cardiac sudden death. [18][19][20][21] Several factors may account for MB-related myocardial ischemia.…”

Section: Cardiac Events Associated With Myocardial Bridgingmentioning

confidence: 99%

“…[1][2][3] The frequency of MB has been reported to range from 5.4 to 85% in autopsy series [4][5][6] and from 0.5 to 29.4% on coronary angiography. 1,[6][7][8][9][10][11] Although it remains to be determined how MB affects the cardiovascular system, MB has been associated with myocardial infarction [12][13][14][15][16][17] and sudden cardiac death, [18][19][20][21] and coronary spasm is thought to be one factor connecting cardiac events and MB. 13,22,23 However, it has yet to be verified that coronary spasm is more frequent in patients with MB.…”

Section: Introductionmentioning

confidence: 99%

Myocardial bridging increases the risk of coronary spasm

Teragawa

Fukuda

Matsuda

et al. 2003

Clinical Cardiology

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SummaryBackground: Myocardial bridging (MB) has been associated with cardiac events. Whether coronary spasm is one factor contributing to those events is unknown.Hypothesis: This study investigated whether the likelihood of coronary spasm is increased in patients with MB.Methods: A spasm-provocation test was performed by infusing acetylcholine into the left coronary artery in 114 Japanese patients with chest pain. The test result was defined as positive when the diameter of the coronary artery was reduced by ≥ 50% and ST-segment changes were documented. Myocardial bridging was defined as a > 15% reduction in coronary arterial diameter during systole after intracoronary injection of nitroglycerin.Results: Myocardial bridging was identified in 41 patients (36%) and was located in the mid-segment of the left anterior descending coronary artery (LAD) in all patients. Patients with MB experienced coronary spasm more frequently than patients without MB (MB+: 73%; MBϪ: 40%, p = 0.0006). Furthermore, among patients with a positive spasm-provocation test, coronary spasm occurred more frequently in the midsegment of the LAD in patients with MB than in those without MB (MB+: 73%; MBϪ: 45%, p = 0.0259). Multivariate regression analysis demonstrated that MB was a predictor of coronary spasm (odds ratio: 3.478, p = 0.0088).

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“…Accumulating evidence throughout the world has indicated that myocardial bridge may cause angina pectoris (7,8), coronary spasms (9, 10), myocardial infarction (10)(11)(12)(13)(14), ventricular septal perforation (15), life threatening cardiac arrhythmias (6,16) and sudden cardiac death (2). Many case reports from Japan contributed much to the understanding of the pathophysiological role of myocardial bridge (4-6, 9, 17) including a case report by Kurisu et al (18) in this issue of the Journal.…”

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confidence: 99%