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Combined Computed Tomography Angiography-Computed Tomography Perfusion in the Identification and Prognostic

Michael P Gannon1, Rodrigo J Cerci2, Carolina Valdiviezo3

  • 1Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania; National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, Maryland.

The American Journal of Cardiology
|September 29, 2023
PubMed

Insights

Computed tomography angiography and perfusion accurately assess myocardial bridging (MB) ischemia. The presence of MB did not impact 5-year cardiovascular events in patients with obstructive or non-obstructive coronary artery disease.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Myocardial bridging (MB) is a congenital anomaly where a segment of the coronary artery travels through the heart muscle.
  • Assessing the ischemic significance and long-term prognosis of MB remains challenging.

Purpose of the Study:

  • To evaluate the utility of computed tomography angiography (CTA) and computed tomography perfusion (CTP) in identifying the ischemic significance of MB.
  • To determine the long-term prognostication of MB in patients with and without obstructive coronary artery disease (CAD).

Main Methods:

  • A prospective, multicenter study (CORE320) involving 381 patients with suspected CAD.
  • Combined CTA-CTP and single-photon emission computed tomography were performed before invasive coronary angiography.
  • MB was identified and categorized as partially or fully encased.

Main Results:

  • MB was identified in 35.4% of patients, predominantly in the left anterior descending artery.
  • No significant difference in ischemia was detected between partially and fully encased MB using CTA-CTP or SPECT.
  • The 5-year incidence of myocardial infarction or death was similar in patients with or without MB, irrespective of CAD severity.

Conclusions:

  • Cardiac CT perfusion imaging effectively assesses the anatomic and functional significance of MB with accuracy comparable to standard methods.
  • The presence of MB does not appear to influence long-term cardiovascular outcomes in patients with obstructive or non-obstructive CAD.

Keywords:
cardiac CT perfusioncoronary artery diseasecoronary computed tomography angiographymyocardial bridgingmyocardial ischemia

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