Importance of diastolic fractional flow reserve and dobutamine challenge in physiologic assessment of myocardial bridging

Escaned, Javier; Cortés, Jorge E.; Flores, Álex; Goicolea, Javier; Alfonso, Fernándo; Hernández, Rosana; Fernández‐Ortíz, Antonio; Sabaté, Manel; Bañuelos, Camino; Macaya, Carlos

doi:10.1016/s0735-1097(03)00588-6

Cited by 159 publications

(154 citation statements)

References 32 publications

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“…This suggests that cardiologists should consider the possibility of coronary spasm in patients with chest pain and MB on coronary angiograms. Several methods have been used to assess MB-related myocardial ischemia due to mechanical compression of the coronary artery by MB, such as pharmacological stress echocardiography [26] , stress myocardial perfusion imaging [27] , intracoronary blood flow velocity measurements [21,26] , and intracoronary pressure measurements [1,21,26,28] . In the current case, we assessed intracoronary pressure using a pressure wire because this technique has a reliable cutoff value [29] and can be used conveniently in the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

“…the MB segment is present even at baseline [21] , only during pharmacological stress [1,26,28] , only within the MB segment [26] , or both within and beneath MB [1,21,28] . These different results may have been due to differences in the severity and degree of the MB itself as well as differences in the methods used to measure intracoronary pressure.…”

Section: Discussionmentioning

confidence: 99%

“…However, it has been reported that dobutamine is more useful as the stress agent during the assessment of MB [1,26,28] because it causes a more severe and longer compression within the MB [28] . Assessing the FFR of the vessel containing the MB can be challenging [30] because atherosclerotic changes often occur proximal to the MB [1] , which may reduce FFR.…”

Section: Discussionmentioning

confidence: 99%

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Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging

Teragawa

Fujii

Ueda

et al. 2015

WJC

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We present a case of a 71-year-old male who had chest symptoms at rest and during effort. He had felt chest oppression during effort for 1 year, and his chest symptoms had recently worsened. One month before admission he felt chest squeezing at rest in the early morning. He presented at our institution to evaluate his chest symptoms. Electrocardiography and echocardiography failed to show any specific changes. Because of the possibility that his chest symptoms were due to myocardial ischemia, he was admitted to our institution for coronary angiography (CAG). An initial CAG showed mild atherosclerotic changes in the proximal segment of the left anterior descending coronary artery (LAD) and mid-segment of the left circumflex coronary artery. Subsequent spasm provocation testing using acetylcholine revealed a bilateral coronary vasospasm, which was relieved after the intracoronary infusion of nitroglycerin. Finally, a CAG showed myocardial bridging (MB) of the mid-distal segments of the LAD. Fractional flow reserve using the intravenous administration of adenosine triphosphate was positive at 0.77, which jumped up to 0.90 through the myocardial bridging segments when the pressure wire was pulled back. Thus, coronary vasospasm and MB might have contributed to his chest symptoms at rest and during effort. Interventional cardiologists should consider the presence of MB as a potential cause of myocardial ischemia. Core tip: Myocardial bridging (MB), an anomaly in which the myocardium overlies the intramural course of segments of the epicardial coronary arteries, is associated with cardiac events. This may be explained by myocardial ischemia, coronary spasms, and/or mechanical compression of the coronary artery by the MB itself. We encountered a patient with angina pectoris both at rest and during exercise, which was caused by both coronary spasm and MB-induced direct myocardial ischemia. The latter finding was revealed using a pressure wire. MB sometimes causes two vascular characteristics, coronary spasms and direct myocardial ischemia, whose management is quite different.Teragawa H, Fujii Y, Ueda T, Murata D, Nomura S. Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging

Teragawa

Fujii

Ueda

et al. 2015

WJC

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“…The two techniques are complementary, as the first shows "milking" of a segment of the artery (Videos 2,3) while the latter shows the thickness of the bridge or tunnel. The relevance of such a finding can be defined further by measuring diastolic FFR (18), which can help in deciding whether such a segment needs de-tunnelling at the time of myectomy (Figure 9).…”

Section: Myocardial Bridges and Tunnelsmentioning

confidence: 99%

Current state of the art and future of myectomy

Yacoub¹,

Afifi²,

Saad³

et al. 2017

ASVIDE

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Surgical relief of left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) requires more than septal myectomy. The procedure is currently the gold standard for all symptomatic HCM patients except those with comorbidities. The operation requires an individualized approach to restore the sophisticated functions of the left ventricular outflow tract (LVOT) without injury to the surrounding vital structures. The procedure should be tailored to deal with all the varied components of the obstruction including fibrous trigones, accessory tissues, and papillary muscle fusion. Preoperative multimodality imaging and numerical modeling combined with intraoperative transesophageal echocardiography (TEE) are essential to define existing anomalies as well as assess the adequacy of the repair. The mitral valve can be conserved in virtually all patients. The operation can be conducted with very low mortality and morbidity with predictable good outcomes both in the short and long term. Nevertheless, surgical relief of LVOTO is still grossly underused.

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“…Escaned et al 15 demonstrated that the use of diastolic pressure ratios rather than mean pressure ratios may be more accurate in unmasking the physiologic significance of myocardial bridges. In their study, both the mean and diastolic pressure ratios were recorded in 12 symptomatic myocardial bridging patients (9/12 had abnormal non-invasive testing) with and without dobutamine challenge.…”

mentioning

confidence: 99%

SPECT perfusion imaging and myocardial bridges: Bridging the gap of diagnostic uncertainty

Galbraith

Eshtehardi

Samady

2011

Journal of Nuclear Cardiology

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Importance of diastolic fractional flow reserve and dobutamine challenge in physiologic assessment of myocardial bridging

Cited by 159 publications

References 32 publications

Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging

Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging

Current state of the art and future of myectomy

SPECT perfusion imaging and myocardial bridges: Bridging the gap of diagnostic uncertainty

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