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Myocardial bridging of the coronary arteries
K S Channer1, E Bukis, G Hartnell
1Department of Cardiology, Bristol Royal Infirmary.
Insights
Myocardial bridging, a condition where coronary arteries narrow during systole, was found in 1.4% of patients. This condition occurred more often than expected in normal angiograms and was linked to left ventricular hypertrophy and coronary artery disease.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Pathology
Background:
- Myocardial bridging is a congenital anomaly where a segment of a coronary artery tunneled through the heart muscle.
- Its prevalence and clinical significance, especially in relation to other cardiovascular conditions, require further elucidation.
Purpose of the Study:
- To determine the prevalence of myocardial bridging in patients undergoing coronary angiography.
- To investigate the association of myocardial bridging with left ventricular hypertrophy and coronary artery disease.
Main Methods:
- Retrospective analysis of 1102 consecutive coronary angiograms.
- Identification and characterization of myocardial bridging based on systolic narrowing.
- Correlation of bridging with patient demographics, comorbidities, and angiographic findings.
Main Results:
- Myocardial bridging was identified in 1.4% (16 out of 1102) of cases, predominantly affecting the left anterior descending artery.
- Bridging was observed more frequently than anticipated in angiograms without significant coronary artery disease.
- In patients with left ventricular hypertrophy, bridging involved longer segments and caused more severe compression.
- No association with atheroma was found at the site of bridging in patients with coronary artery disease.
Conclusions:
- Myocardial bridging is an underrecognized finding on coronary angiography.
- The association with left ventricular hypertrophy suggests a potential role in cardiac dysfunction.
- Further research is warranted to establish the pathogenic role of myocardial bridging in ischemic heart disease.
Abstract:
Of 1102 consecutive coronary angiograms 16 (1.4%) were found to have systolic narrowing typical of myocardial bridging on the left anterior coronary artery or its branches. Four cases of bridging had otherwise normal coronary arteriograms, four were associated with left ventricular hypertrophy (three in cases of aortic valve disease and one case of hypertrophic cardiomyopathy) and eight were found in association with fixed coronary artery stenoses. Bridging was seen more commonly than expected on normal angiograms. When bridging was associated with left ventricular hypertrophy it affected a longer segment and caused more severe compression. When bridging was found in patients with coronary artery disease, it was not associated with atheroma at its site. Evidence for a pathogenic role of myocardial bridging in ischaemic heart disease is discussed.