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Myocardial bridging in obstructive hypertrophic cardiomyopathy: a risk factor for myocardial fibrosis
Changpeng Song1, Shengwei Wang2, Xinli Guo1
1Department of Special Medical Treatment Center in Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China.
Insights
Myocardial bridging (MB) with severe systolic compression is linked to increased myocardial fibrosis in hypertrophic cardiomyopathy (HCM) patients. Comprehensive management of severe MB may improve prognosis in HCM.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac Pathology
Background:
- Myocardial bridging (MB) is frequently observed in patients with hypertrophic cardiomyopathy (HCM).
- Limited data exist on the impact of MB on myocardial fibrosis within the context of HCM.
- This study investigates the association between MB and myocardial fibrosis in obstructive HCM.
Purpose of the Study:
- To evaluate the relationship between myocardial bridging and myocardial fibrosis in patients with obstructive hypertrophic cardiomyopathy.
- To determine if the degree of systolic compression in MB correlates with the extent of myocardial fibrosis.
- To assess the prognostic implications of MB in obstructive HCM.
Main Methods:
- Retrospective cohort study including 492 patients with obstructive HCM who underwent septal myectomy.
- Preoperative cardiac magnetic resonance (CMR) imaging was used to assess myocardial fibrosis (late gadolinium enhancement - LGE) and systolic compression.
- Data were collected from 2011 to 2018 at a high-volume HCM center.
Main Results:
- 76 patients (15.5%) had MB, predominantly in the left anterior descending artery.
- A significant correlation was found between the degree of systolic compression and the global extent of LGE (r=0.33, p=0.003).
- Severe MB (compression ratio ≥80%) was associated with a significantly greater LGE fraction in specific myocardial segments compared to mild to moderate MB.
Conclusions:
- Severe myocardial bridging with significant systolic compression is independently associated with a higher extent of myocardial fibrosis in obstructive HCM.
- Surgical interventions like myotomy or bypass grafting in patients with MB may lead to survival rates comparable to those without MB.
- Identifying and managing patients with severe MB is crucial for potentially improving outcomes in HCM.
Background:
Myocardial bridging (MB) is common in patients with hypertrophic cardiomyopathy (HCM). There are sparse data on the impact of MB on myocardial fibrosis in HCM. This study was designed to evaluate the relationship between MB and myocardial fibrosis in patients with obstructive HCM.
Methods:
In this cohort study, retrospective data were collected from a high-volume HCM center. Patients with obstructive HCM who underwent septal myectomy and preoperative cardiac magnetic resonance (CMR) were screened from 2011 to 2018.
Results:
Finally, 492 patients were included in this study, with an average age of 45.7 years. Of these patients, 76 patients had MB. MB occurred mostly in the left anterior descending artery (73/76). The global extent of late gadolinium enhancement (LGE) was correlated with the degree of systolic compression (r = 0.33, p = 0.003). Multivariable linear regression analysis revealed that the degree of systolic compression was an independent risk factor for LGE (β = 0.292, p = 0.007). The LGE fraction of basal and mid anteroseptal segments in patients with severe MB (compression ratio ≥ 80%) was significantly greater than that in patients with mild to moderate MB (compression ratio < 80%). During a median follow-up of 28 (IQR: 15-52) months, 15 patients died. Kaplan-Meier analysis did not identify differences in all-cause death (log-rank p = 0.63) or cardiovascular death (log-rank p = 0.72) between patients undergoing MB-related surgery and those without MB.
Conclusions:
MB with severe systolic compression was significantly associated with a high extent of fibrosis in patients with obstructive HCM. Concomitant myotomy or coronary artery bypass grafting might provide excellent survival similar to that of patients without MB. Identification of patients with severe MB and providing comprehensive management might help improve the prognosis of patients with HCM.
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