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Hemodynamic effects of myocardial bridging in patients with hypertrophic cardiomyopathy

Mohammadali Sharzehee1, Yuan Chang2, Jiang-Ping Song2

  • 1Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, Texas.

American Journal of Physiology. Heart and Circulatory Physiology
|November 2, 2019
PubMed

Insights

Myocardial bridging (MB) significantly reduces coronary blood flow in hypertrophic cardiomyopathy (HCM) patients, causing diastolic disturbances. Severe MB compression (over 65%) indicates a need for surgical intervention in HCM patients.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Fluid Dynamics

Background:

  • Myocardial bridging (MB) is associated with angina, ischemia, and sudden cardiac death in hypertrophic cardiomyopathy (HCM) patients.
  • The impact of MB on coronary blood flow dynamics in HCM remains incompletely understood.

Purpose of the Study:

  • To assess the effects of MB on coronary hemodynamics in HCM patients.
  • To correlate hemodynamic findings with clinical outcomes for surgical decision-making.

Main Methods:

  • Transient computational fluid dynamics (CFD) simulations were performed on anatomically realistic models of the left anterior descending (LAD) coronary artery with and without MB.
  • Models were reconstructed from biplane angiograms of 15 patients (7 with HCM and MB, 8 non-HCM controls with MB).

Main Results:

  • Dynamic MB compression significantly reduced diastolic coronary flow and increased the pressure drop coefficient in HCM patients compared to controls (P < 0.01 and P < 0.05, respectively).
  • Flow rate changes correlated strongly with upstream Reynolds number and MB compression ratio; MB length had minimal impact.
  • HCM patients with an MB compression ratio >65% required surgical intervention.

Conclusions:

  • Transient MB compression alters diastolic flow patterns and wall shear stress distribution in HCM patients.
  • Severe MB, indicated by a compression ratio >65%, may necessitate surgical intervention in HCM patients.

Keywords:
computational fluid dynamicscoronary angiographyhypertrophic cardiomyopathymyocardial bridgingmyocardial ischemia

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