Isolated myocardial bridges with angiographic milking of the left anterior descending coronary artery: A long-term follow-up study

Juillière, Yves; Berder, V.; Suty-Selton, C; Buffet, Philippe; Danchin, Nicolás; Cherrie, Francois

doi:10.1016/0002-8703(95)90312-7

Cited by 137 publications

(94 citation statements)

References 18 publications

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“…Kramer et al found that patients with isolated myocardial bridging during a 5-year follow-up period had the same survival as angiographically similar patients without bridging while none of the survivors sustained an acute myocardial infarction [23]. Juillière et al found in an 11-year follow-up study of patients with isolated myocardial bridging that there were no cardiac deaths or acute myocardial infarctions [37]. More recently similar results were reported by Çiçek et al who observed no major cardiac events or need for revascularisation in a 4-year follow-up of 118 patients with isolated myocardial bridging [38].…”

Section: Prognosismentioning

confidence: 99%

Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights?

et al. 2012

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The clinical significance of myocardial bridging has been a subject of discussion and controversy since the introduction of coronary arteriography (CAG) in the early 1960s. More recently computed tomography coronary angiography (CTCA) has made it possible to visualise the overlying muscular bands and appears to have a higher sensitivity for detecting myocardial bridging than CAG. Combining CTCA with invasive techniques such as CAG should make it possible to improve our understanding of the pathophysiology of myocardial bridging and to provide answers to hitherto unresolved questions. This paper critically reviews the outcomes of previous studies and defines remaining questions that should be answered to optimise the management of the presumably fast growing number of patients in whom a diagnosis of myocardial bridging has been made. Keywords Myocardial bridging . Computed tomography angiography . Coronary arteriographyAccording to the original definitions the term 'myocardial bridging' is used for an anatomic variation in which a band of cardiac muscle overlies a segment of an epicardial coronary artery while the artery involved is referred to as being 'tunnelled'. Initially the diagnosis could only be made at autopsy but soon after coronary arteriography (CAG) had become an established clinical diagnostic tool systolic compression of a coronary artery, usually the left anterior descending artery (LAD), was occasionally observed and correctly interpreted as evidence of myocardial bridging [1,2]. Since then the clinical significance of myocardial bridging has been a subject of discussion and controversy. In the last decade it was shown that myocardial bridging can be very well depicted by computed tomography coronary angiography (CTCA) [3,4] which has rekindled the interest in this anomaly. We expect that in the near future increasing numbers of patients with myocardial bridging will be detected by CTCA which may significantly enhance our understanding of the pathology and clinical consequences. At the same time, to ensure that these patients receive optimal treatment it is imperative that we stay aware of what previous studies have taught us. It is the purpose of this paper to critically review the outcomes of previous studies and to define remaining questions of clinical relevance that hopefully can be resolved with newer diagnostic modalities. DiagnosisAlthough myocardial bridging has been held responsible for a variety of symptoms in individual cases, ranging from atypical chest pain to sudden death, thus far clinical studies have been unable to identify specific diagnostic features that allow a diagnosis of myocardial bridging without visualisation of the coronary arteries [5][6][7][8][9][10][11]. The diagnosis is usually established by chance in patients who are examined by CAG or CTCA for various reasons but not because they are suspected of having myocardial bridging. It should be noted that there are essential differences between the diagnostic information provided by each of the two visualisati...

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Section: Prognosismentioning

confidence: 99%

Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights?

et al. 2012

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“…In a larger study, assessing 7467 consecutive coronary angiograms, only 61 (<1%!) of the patients had a myocardial bridge of the LAD [13].…”

Section: Previous Studiesmentioning

confidence: 99%

Prevalence and predictors of bridging of coronary arteries in a large Indonesian population, as detected by 64-slice computed tomography scan

et al. 2012

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Background Multislice computed tomography (MSCT) can be used to detect myocardial bridging (MB) of coronary arteries. However, most published studies included small cohorts and did not collect data about predictors. We investigated prevalence and predictors of MB in an Indonesian population. Methods All patients who had MSCT at Cinere Hospital, Jakarta, Indonesia between 2006 and 2009 were included in a prospective registry. MB was defined when at least half of the coronary artery was imbedded within the myocardium with a normal epicardial course of the proximal and distal portion. Results Of the 934 patients (mean age 53 years, 37.8 % female), MB could be observed in 152 patients (16.3 %). Patients with MB were younger compared with those without MB. Coronary risk factors were not different between the two groups. Coronary calcifications and moderate to severe coronary stenoses were less prevalent in patients with MB, also after adjusting for differences in age. At the time of diagnosis, only a few patients with MB were treated with beta-blockers (35 %) or calcium channel blockers (13 %). Conclusions Prevalence of myocardial bridging as detected by MSCT is relatively high. Patients with MB were younger and had a lower prevalence of coronary sclerosis. MB could be the cause of their unexplained symptoms. Follow-up studies are necessary to assess the symptoms of these patients, their response to treatment and the incidence of (coronary) events. MSCT can be used to identify patients for potential new treatment strategies.

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“…In another study, no myocardial infarction was observed. [10] It is possible to say with some certainty that MB carries relatively good prognosis. Nevertheless, connections with unstable angina, acute myocardial infarction, arrhythmia, and sudden death have been reported.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and three-year follow-up of patients with isolated myocardial bridge in the mid-Black Sea region: a retrospective single-center study

Aksakal

Urumdaş

Yaman

et al. 2016

Arch Turk Soc Cardiol

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Objective: Myocardial bridge (MB), also known as muscular bridge, is a rare congenital disease with relatively good prognosis. However, it has been associated with unstable angina, myocardial infarction, and sudden cardiac death. Incidence and prognosis of patients diagnosed with isolated MB after having undergone coronary angiography are evaluated in the present retrospective study. Methods: Coronary angiograms of 18,250 patients, obtained between 2008 and 2011, were reexamined for presence of MB at the cardiology clinic. Of these patients, 241 (0.95%) had MB, and 181 (0.99%) had it as an isolated finding. Patients with isolated MB were divided into 2 groups according to severity of the lesion in the cardiac systole. Group 1 was comprised of patients with non-critical (<70%) stenosis; group 2 was comprised of patients with critical (≥70%) stenosis. Demographic characteristics, symptoms at initial diagnosis, and coronary angiographic findings regarding localization and severity of stenosis were noted. Follow-up was performed by phone, with outpatient clinic visits, and by reviewing hospital records.Results: Twenty-five patients (13%) had critical stenosis (group 2), and 146 (87%) had non-critical stenosis (group 1). Mean follow-up duration was 38±7 months. Recurrent angina and repeated coronary angiography were reported in 15 group 1 patients (10.2%) and in 2 group 2 patients (8.0%) (p=non-significant). No instance of myocardial infarction was reported. Conclusion:Isolated MB seems to be a relatively benign disease, a conclusion made in accordance with those of previous studies. Symptoms and prognosis are not determined by degree of stenosis generated by the muscular bridge.

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Isolated myocardial bridges with angiographic milking of the left anterior descending coronary artery: A long-term follow-up study

Cited by 137 publications

References 18 publications

Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights?

Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights?

Prevalence and predictors of bridging of coronary arteries in a large Indonesian population, as detected by 64-slice computed tomography scan

Prevalence and three-year follow-up of patients with isolated myocardial bridge in the mid-Black Sea region: a retrospective single-center study

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