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

Abstract

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.

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

“…Although 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.…”

“…An overview of the prevalence in CTCA studies was recently published by Wirianta et al in this Journal [11] showing that in most studies the prevalence lies between 15 % and 50 %. Overall the prevalence in CTCA studies is in the same order as in autopsy studies [18,19].…”

Management of ventricular perforation during revascularization of an intramyocardial left anterior descending artery

“…In contrast, myocardial bridging seen at angiography is 5‐12% . Multidetector coronary angiography studies report the incidence of intramyocardial left anterior descending artery at 16.3% . In our surgical experience, we see the LAD in an intramyocardial position in approximately 8% of patients undergoing coronary artery bypass grafting.…”

Crown years for non-invasive cardiovascular imaging (Part IV): 30 years of cardiac computed tomography

“…Apart from the detection of CAD per se, cardiac CT has shown its value in other patient groups: patients with myocardial bridging, patients with coronary artery stents to assess restenosis, patients with congenital heart disease to evaluate right ventricular volumes and function, patients scheduled for radiofrequency ablation for atrial fibrillation to assess cardiac venous anatomy, and patients with valvular lesions to calculate dimensions of the aortic root or the mitral valve annulus [42–54]. …”