Intramural Coronary Arterial Course Is Associated With Coronary Arterial Stenosis and Prognosis of Major Cardiac Events

Wang, Yibo; Lv, Bin; Chen, Jin-xing; Zhang, Yu; Fang, Luo; Lu, Na; Sun, Kai; Hou, Zhiyong; Cao, Huili; Zeb, Irfan; Budoff, Matthew J.; Hui, Rutai

doi:10.1161/atvbaha.112.300717

Cited by 13 publications

(8 citation statements)

References 29 publications

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“…The most likely explanation for their fi nding was that deep MB has hemodynamic signifi cance causing a disturbed fl ow in the other coronary arteries leading to atherosclerotic changes. 14 In our study, there was no signifi cant association between PFV with MB length, depth and proximal stenosis presence and higher PFV was observed in patients with LADA MB.…”

Section: Discussioncontrasting

confidence: 61%

Myocardial bridge characteristics and coronary atherosclerotic markers

Nafakhi¹,

Alam²,

Al‐Mosawi³

et al. 2019

Cor Vasa

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Klinický význam svalového můstku (myocardial bridge, MB) pro celý systém věnčitých tepen a koronární aterosklerózu je stále předmětem diskuse. Cílem této studie bylo zjistit možnou spojitost mezi charakteristikami MB (délka, hloubka, přítomnost a místo proximální stenózy) a markery koronární aterosklerózy (kalcifi kace koronárních tepen [coronary artery calcifi cation, CAC], pláty, stenózy a objem perikardiálního tuku [pericardial fat volume, PFV]). Pacienti a metody: Z celkového počtu 225 po sobě následujících pacientů s podezřením na ischemickou chorobu srdeční, u nichž byla provedena multidetektorová (64-slice) CT koronarografi e (multi-detector CT, MDCT), bylo do studie zařazeno 41 pacientů s MB. Výsledky: Přítomnost MB byla nejčastěji zaznamenána v ramus interventricular anterior (RIA) (92,5 %). Délka MB nebyla statisticky významně spojena s hodnotami CAC, PFV, koronárními pláty ani závažností stenózy. Hloubka MB vykazovala významnou spojitost s hodnotami CAC (r = 0,4; p < 0,00), přítomností koronárních plátů (p < 0,00) a s výjimkou proximální stenózy i se stenózou koronárních tepen (p = 0,03). Nebyla nalezena významná spojitost mezi hloubkou MB a PFV (r = 0,1; p = 0,4). Přítomnost proximální stenózy v MB vykazovala významnou souvislost s celkovou hodnotou CAC (p < 0,00), přítomností koronárního plátu (p < 0,00) a stenózou koronárních tepen na jiných místech (p < 0,00) bez významné spojitosti s hodnotou PFV (p = 0,4). Spojitost mezi hloubkou MB a koronární stenózou i plátem a přítomností proximální stenózy v MB a hodnotou CAC i plátem přetrvávala i po adjustaci na klasické faktory kardiovaskulárního rizika. Závěr: Hloubka MB a přítomnost proximální stenózy byly významně spojeny s přítomností koronárních plátů a stenóz. Stanovení přesného vlivu MB na celý systém koronárních tepen si vyžádá další studie s kontrolními skupinami.

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Section: Discussioncontrasting

confidence: 61%

Myocardial bridge characteristics and coronary atherosclerotic markers

Nafakhi¹,

Alam²,

Al‐Mosawi³

et al. 2019

Cor Vasa

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“…The association of MB with cardiovascular risk and the possible cardiovascular risk factors remain unclear [2,3,[12][13][14][15][16][17][18]. Therefore, this study aimed to examine the clinical characteristics and related factors of coronary stenosis proximal to an MB.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study suggested that the MB is not associated with the risk of cardiovascular (CV) death or myocardial infarction (MI) [10], but this finding remains controversial [11]. Studies suggested that the MB shifts the local hemodynamics toward an increased CV risk [2,12,13], while other reports indicated that individuals with or without an MB have similar CV risk [3,[14][15][16][17][18]. Nevertheless, irrespective of the CV risk, it is well recognized that the LAD under an MB or distal to the MB remains free of atherosclerosis, while the proximal part of the MB is vulnerable to the development of atherosclerotic plaques and stenosis [2, 4, 12-14, 19, 20].…”

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics and factors associated with coronary stenosis proximal to a myocardial bridge: a retrospective study

Gao¹,

Jia-xi²,

Duan³

et al. 2020

BMC Cardiovasc Disord

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Background: The association of myocardial bridge (MB) with cardiovascular risk and the possible cardiovascular risk factors remain unclear. This study aimed to explore the clinical characteristics and related factors of coronary stenosis proximal to an MB. Methods: This was a retrospective study of patients with symptoms of coronary atherosclerotic heart disease admitted between 10/2011 and 12/2014 to the Emergency and Cardiology Department of Bayannur Hospital, who underwent selective coronary angiography (SCAG). The patients were assigned to the non-stenosis and stenosis groups according to whether coronary stenosis was proximal to the MB. Results: Among 244 patients with MB and cardiovascular symptoms, 91 (37.3%) had stenosis proximal to the MB. Compared with the non-stenosis group, there were more males (80.2% vs. 55.6%, P < 0.001) and smokers (including those who had quit smoking) (P < 0.001) in the stenosis group. There were no significant differences in blood lipidrelated indexes (TG, TC, HDL-C, LDL-C, and VLDL-C) between the two groups. Multivariable analysis suggested that MB location in the middle distal or distal segment of the left anterior descending artery (LAD) increased the odds of coronary stenosis proximal to the MB (OR = 0.439, 95% CI: 1.57-7.532, P = 0.002), which was then considered an independent factor associated with coronary stenosis proximal to the MB. Conclusions: In patients diagnosed with an MB by SCAG, only MB located in the middle distal or distal segment of the LAD is independently associated with coronary stenosis proximal to the MB.

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“…showed that MB (both superficial and deep) is associated with non-significant stenosis proximal to the bridged area and that MB in middle LAD is positively associated with stenosis in non-bridged arteries. The most likely explanation for the latter is the fact that deep MB has hemodynamic significance, causing a disturbed flow in the other coronaries, and therefore increases the frequency of atherosclerotic deposits 57 . By compressing the tunnelled artery during systole, MB increases lymph drainage of the vessel wall, protecting against lipid accumulation within the bridged coronary wall 57 , 58 .…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular consequences of myocardial bridging: A meta-analysis and meta-regression

Hostiuc

Rusu

Hostiuc

et al. 2017

Sci Rep

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Myocardial bridging, a congenital abnormality in which a coronary artery tunnels through the myocardial fibres was usually considered a benign condition. Many studies suggested a potential hemodynamic significance of myocardial bridging and some, usually case reports, implied a possible correlation between it and various cardiovascular pathologies like acute myocardial infarction, ventricular rupture, life-threatening arrhythmias, hypertrophic cardiomyopathy, apical ballooning syndrome or sudden death. The main objective of this article is to evaluate whether myocardial bridging may be associated with significant cardiac effects or if it is strictly a benign anatomical variation. To this purpose, we performed a meta-analysis (performed using the inverse variance heterogeneity model) and meta-regression, on scientific articles selected from three main databases (Scopus, Web of Science, Pubmed). The study included 21 articles. MB was associated with major adverse cardiac events - OR = 1.52 (1.01–2.30), and myocardial ischemia OR = 3.00 (1.02–8.82) but not with acute myocardial infarction, cardiovascular death, ischemia identified using imaging techniques, or positive exercise stress testing. Overall, myocardial bridging may have significant cardiovascular consequences (MACE, myocardial ischemia). More studies are needed to reveal/refute a clear association with MI, sudden death or other cardiovascular pathologies.

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Intramural Coronary Arterial Course Is Associated With Coronary Arterial Stenosis and Prognosis of Major Cardiac Events

Cited by 13 publications

References 29 publications

Myocardial bridge characteristics and coronary atherosclerotic markers

Myocardial bridge characteristics and coronary atherosclerotic markers

Clinical characteristics and factors associated with coronary stenosis proximal to a myocardial bridge: a retrospective study

Cardiovascular consequences of myocardial bridging: A meta-analysis and meta-regression

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