Comparison of detection percentage and morphology of myocardial bridge between conventional coronary angiography and coronary CT angiography

Abstract

Introduction: Myocardial bridge (MB) is a congenital anomaly in which a segment of a coronary artery is surrounded by myocardium. In our study, we want to use conventional coronary angiography (CCA) to describe morphologic characteristics of MB (unidentified or identified) in the patients with documented evidence of MB in coronary computed tomography angiography (CCTA). Methods: The present study was designed as cross-sectional and was conducted on 47 patients with documented evidence of MB in CCTA, who were referred to Nemazee and Faghihi hospitals for performing coronary angiography during a one year period. We compared the morphologic characteristics of tunneled segments, which were missed at CCA (unidentified), and the tunneled segments which were identified with CCA. Results: In sum, MB was found in 16 (34%) patients at CCA (identified), and it was not found in 31 (66%) patients (unidentified) based on compression sign. No significant correlation was found between the percentage of systolic compression and the length and depth of the tunneled segment in identified group (r=0.73, P = 0.18; r=1.09, P = 0.15; respectively). Degree of atherosclerotic plaque formation (diameter stenosis, percentage) (mean, 0.25 (25%) ±0.29; range, 0-0.98) of the tunneled segments in unidentified group was significantly more than the same degree (mean, 0.07 (7%) ±0.13; range, 0-0.41) of the identified group (P = 0.03). The measurement of the trapezoid area under the tunneled segment with this formula [(MB length+ intramyocardial segment) ×depth/2] had significant relation with systolic compression (r=0.304, P = 0.03) and defined the cut-off value of 250 mm2 as the value of significant difference in detecting myocardial bridging with CCA. Conclusion: Our results showed that in most of identified MBs in CCA the tunneled segment area was equal and more than 250 mm2. In addition, the degree of atherosclerotic plaque of the tunneled segments at CCA was significantly more in unidentified group.

Myocardial bridges: A meta‐analysis

“…Fifty‐four (54) articles gave prevalence data on myocardial bridges identified by CCTA: (Aiyappan, Vadanika, Karpagam, Vinayagam, & Saravanan, 2015; Arjmand Shabestari, Akhlaghpoor, Tayebivaljozi, & Fattahi, 2012; Atar et al, 2007; Aydin et al, 2015; Cademartiri et al, 2008; Chen et al, 2010; Chen, Wu, Sheu, & Chang, 2009; De Rosa et al, 2008; Dogan et al, 2016; Duran et al, 2006; Eftekhar‐Vaghefi et al, 2019; Erol & Seker, 2012; Fujioka et al, 2009; Ghadri et al, 2014; Girzadas, Varga, & Dajani, 2009; Hwang et al, 2010; Jacobs, Bod, Kim, Hecht, & Srichai, 2008; Jeong et al, 2010; Jodocy et al, 2010; Johansen, Kirsch, Araoz, & Williamson, 2008; Juan, Hwang, Lee, & Meng, 2011; Jukić et al, 2017; Kantarci et al, 2006; Karabay, Yildiz, Bagirtan, Geceer, & Uysal, 2013; Kawawa et al, 2007; Kim et al, 2010; Ko, Choi, Nam, & Hur, 2008; Konen et al, 2007; Kosar, Ergun, Ozturk, & Kosar, 2009; La Grutta et al, 2011; La Grutta et al, 2009; Lazoura, Kanavou, Vassiou, Gkiokas, & Fezoulidis, 2010; Leschka et al, 2008; Li et al, 2016; Liu et al, 2016; Liu et al, 2010; Lu, Zhang, Guo, Huang, & Merges, 2008; Lubarsky, Gupta, & Hecht, 2007; Ma, Ma, Yu, Wu, & Li, 2013; Marcos‐Alberca et al, 2011; Nakaura et al, 2014; Niu, Zhang, Cao, & Leng, 2013; Pargaonkar et al, 2020; Rubinshtein et al, 2013; Sheu et al, 2011; Sirasapalli, Christopher, & Ravilla, 2018; Smettei & Abazid, 2016; Takamura et al, 2011; Türkvatan, Güray, & Altınsoy, 2013; Van Der Velde et al, 2020; Verhagen et al, …”

“…Thirty‐six (36) articles gave prevalence data on myocardial bridges identified by conventional angiography: (Altin et al, 2015; Angelini et al, 1983 cited by Möhlenkamp et al, 2002; Aydar et al, 2011; Aydinlar et al, 2005; Cay, Oztürk, Cihan, Kisacik, & Korkmaz, 2006; Channer, Bukis, Hartnell, & Rees, 1989; Chourasiya, Karna, Parikh, Chaudhari, & Patel, 2020; Çiçek, Kalay, & Müderrisoğlu, 2011; Eftekhar‐Vaghefi et al, 2019; Fazliogullari et al, 2009; Gaibazzi, Rigo, & Reverberi, 2011; Ghadri et al, 2014; Greenspan et al, 1980 cited by Möhlenkamp et al, 2002; Harikrishnan et al, 1999 cited by Möhlenkamp et al, 2002; Hongo et al, 1999; Ishimori, Raizner, Chahine, Awdeh, & Luchi, 1977; Juillière et al, 1995; Kramer, Kitazume, Proudfit, & Sones, 1982; Lee, Kim, Park, & Kim, 2014; Leschka et al, 2008; Lu et al, 2008; Mavi et al, 2008; Mohiddin et al, 2000; Pelliccia et al, 2016; Rossi et al, 1980; Somanath et al, 1989 cited by Möhlenkamp et al, 2002; Sorajja et al, 2003; Sun et al, 2013; Teragawa et al, 2003; Tripathy et al, 2015; Tsujita et al, 2008; Wang et al, 2015; Wymore et al, 1989; Xiang, Gong, He, Ruan, & Xie, 2009; Yano et al, 2001 cited by Möhlenkamp et al, 2002; Yetman, McCrindle, MacDonald, Freedom, & Gow, 1998).…”

“…Four (4) articles gave prevalence data on myocardial bridges identified by both CCTA and conventional angiography: (Eftekhar‐Vaghefi et al, 2019; Ghadri et al, 2014; Leschka et al, 2008, Lu et al, 2008).…”

High Prevalence of Myocardial Bridging Detected in an Indonesian Population Using Multi-Detector Computed Tomography

“…Coronary angiography tends to underestimate the prevalence of MB because investigators must depend on indirect indicators to assess the vessel. While systolic compression, the milking effect, and the step-down-step-up phenomenon serve as diagnostic signs, they exhibit limited sensitivity in shallow variants of MB [16]. Furthermore, Indonesia is a country characterised by substantial limitations in infrastructure, human capital, and financial resources in terms of conducting advanced cardiovascular research.…”

Prevalence of myocardial bridge in angiographic population—A study from rural part of western India

“…[ 8 ] Although coronary angiography is considered as a gold standard for diagnosing this entity, other modalities like intravascular sonography and multidetector computed tomography (MDCT) are also useful for diagnosis. [ 9 10 ]…”