Long-Term Clinical Course of Patients With Isolated Myocardial Bridge

Kim, Sung Soo; Jeong, Myung Ho; Kim, Hyun Kuk; Kim, Min Chul; Cho, Kyung Hun; Lee, Min Goo; Ko, Jum Suk; Park, Keun Ho; Sim, Doo Sun; Yoon, Nam Sik; Yoon, Hyun Ju; Park, Hyung Wook; Kim, Ju Han; Hong, Young Joon; Ahn, Young Keun; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

doi:10.1253/circj.cj-09-0648

Cited by 32 publications

(42 citation statements)

References 20 publications

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“…14 Another study reported that a long MB is an independent predictor of long-term cardiac events. 39 Based on these results, the mechanism described in the Discussion does not contradict the findings of the present study. The culprit lesions were observed using CAG and intravascular ultrasound as much as possible in the culprit group, but it is possible that the actual plaque property before the onset of MI or the positional relationship between the culprit lesion and MB was not observed as accurately as those in the autopsy study because MDCT was acquired after stenting in all cases.…”

Section: Study Limitationssupporting

confidence: 74%

Anatomical Characteristics of Myocardial Bridge in Patients With Myocardial Infarction by Multi-Detector Computed Tomography

Takamura

Fujimoto

Nanjo

et al. 2011

Circ J

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Background: Recent development of multi-detector computed tomography (MDCT) has made the detection of myocardial bridge (MB) easier on the left anterior descending coronary artery (LAD). The LAD segment proximal to the MB is well known to be susceptible to atherosclerosis. Anatomical characteristics of MB on LAD in patients with myocardial infarction (MI) were examined by MDCT. Methods and Results:Subjects were 43 MI patients who had MB in the LAD and comprised 2 groups: 14 with culprit lesions in the LAD proximal to MB (culprit group) and 29 without culprit lesions in the LAD (non-culprit group). MB length, MB thickness, and the distance from the orifice of left main trunk (LMT) to MB entrance were compared. Age and coronary risk factors showed no significant difference between the 2 groups. MB length (P=0.011), MB thickness (P=0.035), and index of the length multiplied by thickness of MB (P=0.031) were significantly greater in the culprit group. The distance from the orifice of the LMT to MB entrance was significantly shorter in the culprit group (P=0.006).Conclusions: Anatomical properties of MB, such as length and thickness of MB as well as MB location, are associated with the formation of culprit lesions of LAD proximal to MB in MI. (Circ J 2011; 75: 642 - 648)

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Section: Study Limitationssupporting

confidence: 74%

Anatomical Characteristics of Myocardial Bridge in Patients With Myocardial Infarction by Multi-Detector Computed Tomography

Takamura

Fujimoto

Nanjo

et al. 2011

Circ J

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“…The anatomical properties of the MB also influence the method of treatment and the patient's outcome. 65 …”

Section: Treatment For Chd Caused By the Mbmentioning

confidence: 99%

Significance of the Anatomical Properties of a Myocardial Bridge in Coronary Heart Disease

Ishikawa

Kawawa

Kohda

et al. 2011

Circ J

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he myocardial bridge (MB) is an anatomical variant that often covers part of the left anterior descending coronary artery (LAD). 1 It occurs almost exclusively in the mid-portion of the LAD (Figure 1). 2,3 Muscular contraction of the MB itself alters blood flow within the LAD, as demonstrated by coronary angiography, and influences the distribution of hemodynamic stress. [3][4][5] It is widely accepted that an MB sometimes causes coronary heart disease (CHD), 2,5,6 either from direct compression of the MB at cardiac systole or by enhancement of the natural progression of coronary atherosclerosis in the LAD segment proximal to the MB. 2,5,7 Both mechanisms are closely associated with changes in hemodynamic stress driven by the force of the MB contraction through a combination of anatomical properties, such as the location, length, and thickness of the MB. 3,7,8 This review focuses on the relationship between the presence of an MB in the LAD and the occurrence of CHD, specifically addressing the importance of the anatomical properties of the MB as the common root for the 2 distinct mechanisms. In addition, therapeutic approaches to CHD caused by an MB are summarized, along with their outcomes. A myocardial bridge (MB), partially covering the coronary artery, is a congenital anatomical variant usually present in the left anterior descending coronary artery (LAD). MB causes coronary heart disease (CHD) by 2 distinct mechanisms influenced by the anatomical properties of the MB, such as its length, thickness, and location. One is direct MB compression of the LAD at cardiac systole, resulting in delayed arterial relaxation at diastole, reduced blood flow reserve, and decreased blood perfusion. The other is enhancement of coronary atherosclerosis causing stenosis of the LAD proximal to the MB, occurring because of endothelial injury arising from the abnormal hemodynamics provoked by retrograde blood flow up toward the left coronary ostium at cardiac systole. The magnitude of the effect of the 2 distinct mechanisms of the MB on LAD blood flow is prescribed by a common root of the MB-muscle mass volume generated by those properties. Furthermore, the anatomical properties of the MB are closely associated with the choice of treatment and therapeutic outcome in CHD patients having an MB. Thus, the anatomical properties of an MB should be considered in the diagnosis and management of CHD patients with this anomaly. (Circ J 2011; 75: 1559 - 1566

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“…MB causes recurrent angina resistant to therapy and may be complicated with myocardial infarction or malignant arrhythmia. [17] Therefore, the signs and symptoms of patients with MB may be different from stable angina pectoris and not predictable or reproducible. Sometimes it may be diagnosed as variant angina due to recurrent coronary vasospasm in daily clinical practice [18].…”

Section: Discussionmentioning

confidence: 99%

Increased TIMI frame count of coronary arteries in patients with myocardial bridging

Aksu

Güneş

2019

The European Research Journal

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Objectives. Myocardial bridging (MB) is associated with recurrent chest pain and cardiovascular events. Recently it has been proposed that MB has the features of vasospastic coronary artery characterized with reduced coronary flow reserve and endothelial dysfunction. In this study, an evaluation was made of the angiographic Thrombolysis in Myocardial Infarction (TIMI) frame counts (TFCs) of patients with normal angiogram and those with MB. Methods. The study was conducted as a retrospective analysis of the demographic, laboratory, and angiographic features of consecutive patients who underwent coronary angiography between January 2014 and December 2017 in Necip Fazıl City Hospital and Sütçü Imam University, Kahramanmaraş, Turkey. Results. The except for age (51.1 ± 11.6 years vs 56.8 ± 11.4 years) (p = 0.011), no difference was determined between the groups in respect of laboratory parameters and demographic features. TFCs of LAD (42.9 ± 6.1 vs 54.5 ± 11.5. p < 0.001), Cx (19.4 ± 4.5 vs 24.4 ± 7.1, p < 0.001), and RCA (26.8 ± 6.2 vs 32.5 ± 8.9, p < 0.001), and corrected TFC of LAD artery (25.2 ± 3.6 vs 32.0 ± 6.8, p < 0.001) were observed to be significantly increased in patients with MB compared to patients with normal coronary flow. Multiple regression analysis revealed that MB was the only determinant of increased corrected TFC of LAD artery (r=0.537, Adjusted r=0.281, p < 0.001). Conclusions. Patients with MB had abnormally slow coronary flow demonstrated by increased TFC. This finding may explain the recurrent angina and cardiovascular events of patients with MB. It may also explain the reversible myocardial perfusion defects which are associated with recurrent cardiovascular events in patients with MB.Eur Res J 2018

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Long-Term Clinical Course of Patients With Isolated Myocardial Bridge

Cited by 32 publications

References 20 publications

Anatomical Characteristics of Myocardial Bridge in Patients With Myocardial Infarction by Multi-Detector Computed Tomography

Anatomical Characteristics of Myocardial Bridge in Patients With Myocardial Infarction by Multi-Detector Computed Tomography

Significance of the Anatomical Properties of a Myocardial Bridge in Coronary Heart Disease

Increased TIMI frame count of coronary arteries in patients with myocardial bridging

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