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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.

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PubMed
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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.

Keywords:
Computational fluid dynamicsEndothelial dysfunctionMyocardial bridgingWall shear stress

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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.