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Myocardial bridging and endothelial dysfunction - Computational fluid dynamics study

Ashkan Javadzadegan1, Abouzar Moshfegh1, Yi Qian2

  • 1Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia; ANZAC Research Institute, The University of Sydney, Sydney, NSW 2139, Australia.

Journal of Biomechanics
|January 28, 2019
PubMed

Insights

Myocardial bridging (MB) is linked to abnormal blood flow and endothelial dysfunction. Reduced wall shear stress (WSS) in the proximal LAD artery of MB patients correlates with this dysfunction.

Area of Science:

  • Cardiovascular Medicine
  • Biomedical Engineering
  • Physiology

Background:

  • Myocardial bridging (MB) is a congenital anomaly where a segment of a coronary artery travels through heart muscle.
  • MB is associated with endothelial dysfunction, particularly in patients with angina and non-obstructive coronary artery disease.
  • Abnormal coronary blood flow patterns may underlie the endothelial dysfunction observed in MB patients.

Purpose of the Study:

  • To investigate the relationship between altered blood flow dynamics and endothelial dysfunction in patients with myocardial bridging.
  • To determine if specific wall shear stress (WSS) patterns are associated with endothelial dysfunction in the left anterior descending (LAD) artery.

Main Methods:

  • Transient computational fluid dynamics (CFD) simulations were employed to analyze blood flow patterns.
  • Wall shear stress (WSS) was calculated across proximal, middle, and distal segments of the LAD artery in patients with and without MB.
  • Patients were categorized based on the presence of MB and acetylcholine-induced endothelial dysfunction.

Main Results:

  • Patients with MB and endothelial dysfunction exhibited lower WSS in the proximal LAD and higher WSS in the mid-LAD compared to MB patients without dysfunction.
  • In patients with endothelial dysfunction, those with MB showed significantly lower proximal LAD WSS (0.32 ± 0.14 Pa) versus controls (0.71 ± 0.38 Pa).
  • Conversely, MB patients with endothelial dysfunction had significantly higher mid-LAD WSS (2.81 ± 1.20 Pa) compared to controls (1.66 ± 0.31 Pa).

Conclusions:

  • The study demonstrates a significant association between myocardial bridging, altered WSS patterns, and endothelial dysfunction.
  • Reduced WSS in the proximal LAD segment appears to be a key factor contributing to endothelial dysfunction in MB patients.
  • These findings highlight the role of hemodynamic alterations in the pathophysiology of MB-related cardiovascular complications.

Keywords:
Computational fluid dynamicsEndothelial dysfunctionMyocardial bridgingWall shear stress

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