Histological Characteristics of Myocardial Bridge With an Ultrasonic Echolucent Band

Yamada, Ryotaro; Turcott, Robert G.; Connolly, Andrew J.; Ikeno, Fumiaki; McConnell, Michael V.; Schnittger, Ingela; Fitzgerald, Peter J.; Honda, Yasuhiro

doi:10.1253/circj.cj-13-0708

Cited by 16 publications

(9 citation statements)

References 13 publications

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“…This halo is pathognomonic for an MB, 4 and has been shown to represent the muscle bands overlying the artery. 15 In this study, the coverage of an MB by CCTA correlated well with the halo thickness by IVUS, highlighting that any degree of coverage on CCTA, even partial, signifies the presence of an MB. Although there was a larger spread in halo thickness among MBs that were considered partially covered by CCTA, our findings demonstrate that some individuals have a significant MB by IVUS, even if CCTA shows partial coverage.…”

Section: Study Limitationssupporting

confidence: 63%

Myocardial Bridges on Coronary Computed Tomography Angiography　― Correlation With Intravascular Ultrasound and Fractional Flow Reserve ―

Forsdahl

Rogers

Schnittger

et al. 2017

Circ J

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Background: Myocardial bridges (MB) are commonly seen on coronary CT angiography (CCTA) in asymptomatic individuals, but in patients with recurrent typical angina symptoms, yet no obstructive coronary artery disease (CAD), evaluation of their potential hemodynamic significance is clinically relevant. The aim of this study was to compare CCTA to invasive coronary angiography (ICA), including intravascular ultrasound (IVUS), to confirm MB morphology and estimate their functional significance in symptomatic patients. Methods and Results:We retrospectively identified 59 patients from our clinical databases between 2009 and 2014 in whom the suspicion for MB was raised by symptoms of recurrent typical angina in the absence of significant obstructive CAD on ICA. All patients underwent CCTA, ICA and IVUS. MB length and depth by CCTA agreed well with length (0.6±23.7 mm) and depth (CT coverage) as seen on IVUS. The product of CT length and depth (CT coverage), (MB muscle index (MMI)), ≥31 predicted an abnormal diastolic fractional flow reserve (dFFR) ≤0.76 with a sensitivity and specificity of 74% and 62% respectively (area under the curve=0.722). Conclusions:In patients with recurrent symptoms of typical angina yet no obstructive CAD, clinicians should consider dynamic ischemia from an MB in the differential diagnosis. The product of length and depth (i.e., MMI) by CCTA may provide some noninvasive insight into the hemodynamic significance of a myocardial bridge, as compared with invasive assessment with dFFR.

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Section: Study Limitationssupporting

confidence: 63%

Myocardial Bridges on Coronary Computed Tomography Angiography　― Correlation With Intravascular Ultrasound and Fractional Flow Reserve ―

Forsdahl

Rogers

Schnittger

et al. 2017

Circ J

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“…However, IVUS is generally regarded as a more definitive invasive modality for the anatomic detection of MBs, which are characterized on IVUS as a echolucent “half‐moon” area (Figure ) immediately adjacent to the lumen throughout the cardiac cycle . Although there has been uncertainty as to the nature of the “half‐moon” echolucency, Yamada et al demonstrated in a post‐mortem heart utilizing IVUS, pathologic assessment, and histologic assessment, that the echolucency identified by IVUS did indeed represent overlying muscle band …”

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confidence: 99%

“…26 Although there has been uncertainty as to the nature of the "half-moon" echolucency, Yamada et al demonstrated in a postmortem heart utilizing IVUS, pathologic assessment, and histologic assessment, that the echolucency identified by IVUS did indeed represent overlying muscle band. 27 Intravascular ultrasound can also demonstrate the degree of systolic compression within a bridged segment, as well as the extent of plaque progression proximal to the bridged segment, which might predispose patients with an MB to myocardial infarction. 13 In addition to the anatomic assessment provided by IVUS, pressure and flow can be assessed proximal to, within, and distal to a bridged segment prior to and during invasive dobutamine stress with a simultaneous Doppler flow and pressure wire to confirm the physiologic significance of an MB (Figure 3).…”

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confidence: 99%

Myocardial bridges: Overview of diagnosis and management

Rogers

Tremmel

Schnittger

2017

Congenital Heart Disease

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A myocardial bridge is a segment of a coronary artery that travels into the myocardium instead of the normal epicardial course. Although it is general perception that myocardial bridges are normal variants, patients with myocardial bridges can present with symptoms, such as exertional chest pain, that cannot be explained by a secondary etiology. Such patients may benefit from individualized medical/ surgical therapy. This article describes the prevalence, clinical presentation, classification, evaluation, and management of children and adults with symptomatic myocardial bridges.intramyocardial coronary artery, myocardial bridge, myocardial ischemia, sudden cardiac death A myocardial bridge (MB) is defined as an intramyocardial segment of an epicardial coronary artery. Perhaps first described by Reyman in 1737, one of the first descriptions of an MB in the modern literature was published by Geiringer in 1951.1 Geiringer noted that, although this "trivial and slight deviation from normal" had been largely overlooked as a potential etiology for pathology, this altered anatomic course might influence the development of atherosclerosis. In an unselected human autopsy series of 100 patients, he identified myocardial bridging in 23 hearts, and detailed the myocardial fiber orientation and relative relationships among the coronary arteries, epicardial fat, and myocardium observed in these patients.The case examples reported in this series reflect observations made in subsequent reports, namely that MBs can range greatly in length as well as depth, that a coronary artery may have more than one bridged segment, and that the overlying fiber orientation may impact the functional significance of a bridge. Ferreira et al. reported a necropsy series of 90 consecutive hearts and found two distinctive patterns of fiber orientation. 2 In the more common superficial orientation, the myocardial fibers cross the artery transversely toward the apex of the heart at an acute angle or perpendicularly. In the deeper orientation, the fibers crossed the left anterior descending (LAD) coronary artery and surrounded it by a muscle bundle that arose from the right ventricular apical trabeculae and crossed the artery transversely, obliquely, or helically before terminating in the interventricular septum.They postulated that the deeper orientation could twist the vessel and compromise diastolic flow, resulting in ischemia.It is understood that MBs are common, however, the estimations of the prevalence of MBs vary. It is important to consider that estimations will vary at least in part as a result of several key variables, including the means of identification (eg, computed tomography (CT), intravascular ultrasound (IVUS), or autopsy), which vessels are examined, and which definition of a bridge is applied (eg, only a "deep" bridge vs both "superficial" and "deep" bridges). Perhaps the most fundamental variable is whether an MB is even considered. Unlike hypertrophic cardiomyopathy, which will usually be obvious to the pathologist, MBs c...

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“…According to our previous IVUS report with histological validation, an MB was defined as an echolucent band (halo) partially surrounding the artery (Figure 1). 5, 12, 13, 14 Anatomic IVUS assessment of the MB included length of the MB segment, halo thickness, location of the MB, and the presence of branches arising within the MB segment. The MB length was measured from the first proximal appearance of the halo (MB entrance) to its distal end (MB exit), and the halo thickness was measured at the thickest part above the artery during systole (Figure 1B).…”

Section: Methodsmentioning

confidence: 99%

Functional Versus Anatomic Assessment of Myocardial Bridging by Intravascular Ultrasound: Impact of Arterial Compression on Proximal Atherosclerotic Plaque

Yamada

Tremmel

Tanaka

et al. 2016

JAHA

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BackgroundThe presence of a myocardial bridge (MB) has been shown to promote atherosclerotic plaque formation proximal to the MB, presumably because of hemodynamic disturbances provoked by retrograde blood flow toward this segment in cardiac systole. We aimed to determine the anatomic and functional properties of an MB related to the extent of atherosclerosis assessed by intravascular ultrasound.Methods and ResultsWe enrolled 100 patients with angina but no significant obstructive coronary artery disease who had an intravascular ultrasound–detected MB in the left anterior descending artery (median age 54 years, 36% male). The MB was identified with intravascular ultrasound by the presence of an echolucent band (halo). Anatomically, the MB length was 22±13 mm, and halo thickness was 0.7±0.6 mm. Functionally, systolic arterial compression was 23±12%. The maximum plaque burden up to 20 mm proximal to the MB entrance was significantly greater than the maximum plaque burden within the MB segment. Among the intravascular ultrasound–defined MB properties, arterial compression was the sole MB parameter that demonstrated a significant positive correlation with maximum plaque burden up to 20 mm proximal to the MB entrance (r=0.254, P=0.011 overall; r=0.545, P<0.001 low coronary risk). In multivariate analysis, adjusting for clinical characteristics and coronary risk factors, arterial compression was independently associated with maximum plaque burden up to 20 mm proximal to the MB entrance.ConclusionsIn patients with an MB in the left anterior descending artery, the percentage of arterial compression is related directly to the burden of atherosclerotic plaque located proximally to the MB, particularly in patients who otherwise have low coronary risk. This may prove helpful in identifying high‐risk MB patients.

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Histological Characteristics of Myocardial Bridge With an Ultrasonic Echolucent Band

Cited by 16 publications

References 13 publications

Myocardial Bridges on Coronary Computed Tomography Angiography　― Correlation With Intravascular Ultrasound and Fractional Flow Reserve ―

Myocardial Bridges on Coronary Computed Tomography Angiography　― Correlation With Intravascular Ultrasound and Fractional Flow Reserve ―

Myocardial bridges: Overview of diagnosis and management

Functional Versus Anatomic Assessment of Myocardial Bridging by Intravascular Ultrasound: Impact of Arterial Compression on Proximal Atherosclerotic Plaque

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Histological Characteristics of Myocardial Bridge With an Ultrasonic Echolucent Band

Cited by 16 publications

References 13 publications

Myocardial Bridges on Coronary Computed Tomography Angiography ― Correlation With Intravascular Ultrasound and Fractional Flow Reserve ―

Myocardial Bridges on Coronary Computed Tomography Angiography ― Correlation With Intravascular Ultrasound and Fractional Flow Reserve ―

Myocardial bridges: Overview of diagnosis and management

Functional Versus Anatomic Assessment of Myocardial Bridging by Intravascular Ultrasound: Impact of Arterial Compression on Proximal Atherosclerotic Plaque

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Myocardial Bridges on Coronary Computed Tomography Angiography　― Correlation With Intravascular Ultrasound and Fractional Flow Reserve ―

Myocardial Bridges on Coronary Computed Tomography Angiography　― Correlation With Intravascular Ultrasound and Fractional Flow Reserve ―