Plaque morphology and distribution in patients with and without myocardial bridge - an intravascular ultrasound study
Sajan Narayanan1, Stigi Joseph1, Anwar Chennakkadan Varghese1
1Little Flower Hospital & Research Institute, Angamaly, India.
Insights
Myocardial bridging (MB) is a congenital heart anomaly. Atherosclerosis extended into bridged segments in 70.5% of patients, contrary to prior research.
Area of Science:
- Cardiology
- Vascular Biology
- Congenital Heart Disease
Background:
- Myocardial bridging (MB) is a common congenital cardiovascular anomaly.
- MB is associated with angina, acute coronary syndromes (ACS), and sudden cardiac death.
- Previous studies suggested accelerated atherosclerosis in proximal vessels with MB, while bridged segments remained unaffected.
Purpose of the Study:
- To compare plaque characteristics in patients with and without myocardial bridging undergoing percutaneous intervention.
- To investigate the extent of atherosclerosis within bridged segments of the left anterior descending artery.
Main Methods:
- Intravascular ultrasound (IVUS) guided percutaneous intervention (PCI) was performed on 147 patients.
- Plaque characteristics were analyzed using IVUS and compared between patients with and without MB.
- Patients predominantly presented with ACS, most commonly STEMI.
Main Results:
- The incidence of MB was 29.9% (44/147 patients).
- Patients with MB were older (62.1 vs. 57.8 years).
- No significant differences in qualitative plaque characteristics, burden, or lesion length were observed between groups. Atheromatous extension into bridged segments occurred in 70.5% of MB patients.
Conclusions:
- Plaque characteristics were similar in patients with and without MB presenting with advanced atherosclerosis.
- Atheromatous involvement was observed extending into bridged segments, contradicting previous findings.
Background:
Myocardial bridging (MB) is a common congenital cardiovascular anomaly. There are reported associations of MB with different clinical presentations like effort angina, acute coronary syndromes (ACS) and sudden cardiac death. Acceleration of atherosclerosis in proximal vessel is reported in patients with MB, while bridged segments are reported to be free of atherosclerosis.
Methods:
We assessed patients who underwent intravascular ultrasound (IVUS) guided percutaneous intervention (PCI) of left anterior descending (LAD) artery. Plaque characteristics derived from IVUS analysis were compared between those who displayed myocardial bridge versus those who did not harbour the anomaly.
Results:
One hundred and forty-seven (147) patients underwent IVUS guided PCI. Incidence of MB was 44/147 (29.9%). Mean age of patients who had MB {+} was higher (62.1 ± 10.3 vs. 57.8 ± 11.2 (p = .03). 142/147 (96.6%) patients presented with ACS. ST elevation myocardial infarction (STEMI) was the most common presenting diagnosis (110/147 to 74.8%). There were no differences in qualitative plaque characteristics - attenuated plaque, calcification or calcium score between two groups. Plaque burden and length of the lesion in the proximal vessel were not different. Among patients with MB {+}, atheromatous extension to segments underlying the bridge was seen in 31/44 (70.5%) cases.
Conclusions:
In a series of patients who presented with advanced clinical atherosclerosis, plaque characteristics were not different in patients who harboured myocardial bridge vs. those who did not have the anomaly. Atheromatous involvement was seen extending into bridged segment contrary to previous reports.
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