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The relation between myocardial bridging and atherosclerotic coronary
artery disease in an angiographic series
Roxana Darabont,
Nicolae Florescu,
Ştefania Magda,
Diana Baghilovici,
Alexandru Dan Corlan,
Roxana Sisu,
Dragoş Vinereanu,
European Heart Journal 28:318-319, 2007
ABSTRACT
Purpose: We sought to evaluate the prevalence of myocardial bridging
(MB) and to analyze the relationship between MB coronary artery
disease (CAD) and myocardial ischemia (MI).
Methods: A retrospective study was performed on 1963 consecutive
coronary angiographies done between 2003- 2006. We selected two
subgroups matched in age and sex: Group no. 1- all patients with MB
(n=41) and Group no. 2- formed by a random selection of cases without
MB (n=87). We compared the clinical manifestations which represented
the indications for coronary angiogram and we analyzed the presence of
CAD (coronary artery lesions were considered significant if higher
than 60%).
Results: The prevalence of MB in our study was 2% (41/1963). Location
on the mid-segment of the left anterior descending coronary artery
(LAD) was documented in 975% of subjects with MB. A statistically
non-significant predominance of male sex was noted in the MB group
(36/5). The classic cardiovascular risk factors were similar in the
two subgroups. Coronary angiograms were performed in the two subgroups
for similar indications.
In group no: 1 61% (25/41) of subjects had significant CAD in
variable territories but only two cases had atherosclerosis
contiguous to the MB. The number of coronary arteries with significant
atherosclerotic lesions was significantly lower in the group with MB
(75/123) than in the control group (246/261) (p<0.005). 39% (16/41) of
cases with MB had normal coronary arteries or with nonsignificant
atherosclerotic lesions compared to only 4.5% (4/87) of cases in group
no. 2 (p$<$ 0.0001). Coronary angiographies were performed due to MI in
69% (11/16) of the cases with MB associated to normal or slightly
affected epicardial arteries.
Conclusions:
1. MB is a lesion with low prevalence possibly more frequent in men
and with dominant location in the midsegment of LAD.
2. In the studied subgroups which had similar indications for
coronary angiography CAD was less frequent and less extensive in
the presence of MB.
3. The clinical manifestations of MI which represented the reason for
performing a coronary angiography in 2/3 of those with MB and
normal epicardial coronary arteries or with minor atherosclerotic
lesions can be attributed most probably to the MB. This relation
of causality needs confirmation through supplementary
investigations (such as intravascular ultrasonography or fractional
flow reserve).
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