Coexistent Coronary Artery Disease or Myocardial Bridging in Patients with Hypertrophic Cardiomyopathy Using Coronary CT Angiography

Abstract

Purpose:To evaluate the prevalence of coexistent coronary artery disease (CAD) or myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) using coronary CT angiography (CCTA) and assess the role of CCTA. Materials and Methods: The prevalence of obstructive CAD (> 50% luminal reduction) and MB (partial and full encasement) were assessed in 150 patients with HCM diagnosed by clinical findings, electrocardiography, and echocardiography of 19588 consecutive patients who underwent CCTA for suspected CAD. Results: The overall feasibility of coronary artery visualization was 98.9% with CCTA. In patients with HCM, the prevalence of obstructive CAD and MB (14.7% partial and 28.0% full encasement) were 23.3% and 42.7%, respectively. Age, hypertension, family history of premature CAD, Framingham risk score and severe chest pain were associated with CAD, whereas male gender and septal type were associated with MB (all p < 0.05). In comparison to invasive coronary angiography (n = 37), the diagnostic accuracy of CCTA for the detection of CAD and full encasement MB was 89.2% and 86.5%, respectively. Conclusion: One-quarter of patients with HCM had coexistent obstructive CAD or full encasement MB. CCTA can be a feasible and accurate noninvasive imaging modality for the detection of CAD and MB in patients with HCM.

Frequency and Significance of Coronary Artery Disease and Myocardial Bridging in Patients With Hypertrophic Cardiomyopathy

“…The prevalence of obstructive CAD in our study was 19%, which is similar to other cohorts with low or intermediate PTP. 4,5 Concomitant CAD in HC is associated with decreased survival, demonstrating the importance of a prompt, and accurate diagnostic work-up. In HC patients presenting with chest pain, this work-up is similar to non-HC patients.…”

“…Higher detection rates of MB are expected with CCTA due to its capability to show the anatomical course of the coronary arteries with quantification of length and depth of MB. 5 Invasive coronary angiography generally relies on the presence of systolic compression of the affected segment (i.e., the milking effect), which makes it more likely for smaller or noncompressing MBs to not be recognized. 7 Detection of MB may be relevant to explain the cause of chest pain, but currently no scientifically proven therapy is available.…”

“…1,4 HC patients with concomitant CAD are at a higher risk of cardiac death compared with those without coexistent CAD. 4,5 Therefore, early diagnosis of CAD is important in symptomatic HC patients. Coronary computed tomography angiography (CCTA) is an excellent tool in the evaluation of chest pain, particularly to rule out CAD, especially in patients with low-to-intermediate risk for CAD.…”