Histopathologic profiles of coronary atherosclerosis by myocardial bridge underlying myocardial infarction

Ishikawa, Yukio; Akasaka, Yoshikiyo; Akishima-Fukasawa, Yuri; Iuchi, Ami; Suzuki, Koyu; Uno, Mieko; Abe, Eriko; Yang, Yang; Li, Chin-Ping; Mukai, Kiyoshi; Niino, Hitoshi; Tanaka, Michio; Kawahara, Yutaka; Sugiura, Hiroaki; Shinagawa, Toshihito; Morinaga, Soichiro; Ogata, Kentaro; Onuma, Junko; Yanagida-Iida, Maki; Taki, Kazuhiro; Komatsu, Akio; Satoh, Hideaki; Yamada, Kazuo; Shimokawa, Reiko; Shibuya, Kazutoshi; Takahashi, Kei; Ishii, Toshiharu

doi:10.1016/j.atherosclerosis.2012.10.037

Cited by 47 publications

(38 citation statements)

References 19 publications

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“…While the vast majority of MBs are likely asymptomatic, numerous case reports and series have documented the association between MBs and angina or anginal‐equivalent symptoms, including exertional chest pain and exertional dyspnea . In addition to symptoms, there are also a number of reports in the literature that have associated MBs with ventricular arrhythmia, myocardial infarction, syncope, and sudden cardiac death …”

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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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confidence: 99%

Myocardial bridges: Overview of diagnosis and management

Rogers

Tremmel

Schnittger

2017

Congenital Heart Disease

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“…A recent autopsy series of 150 patients with LAD‐related infarction (with or without MB) and 100 normal hearts with MB suggested that plaques in the LAD proximal to the MB are prone to rupture, resulting in myocardial infarction at a younger age 27. Although the present study demonstrated noncalcified plaques in the majority of the enrolled patients, detailed assessment of plaque vulnerability using advanced tissue characterization techniques, including radiofrequency IVUS analysis,28, 29 or hybrid IVUS with near‐infrared diffuse reflectance spectroscopy30 may be informative.…”

Section: Discussionmentioning

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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“…There is no artery in the human body other respectively) ( Table 2). 48) The impact of such a large difference in age at MI onset by MB is rather surprising. Although long-term follow-up studies of patients with MB indicated a good prognosis, controls were limited to patients without coronary disease.…”

Section: Discussionmentioning

confidence: 99%

“…Microscopic structural changes underlying such topographic shift of atherosclerosis in the LAD include the tendency for unstable plaque-related lesions to be located proximally in MI with MB, and they are frequently 2.0 cm or more proximal to the entrances of MB in MI. 48) Among them, the frequency of the most advanced lesion of plaque fi ssure/rupture in the proximal LAD is signifi cantly higher in MI cases than without MB ( Table 4). 48) Microscopic observation further corroborates the fundamental evidence of the relationship between MB and the occurrence of MI.…”

Section: Effect Of Mb On the Occurrence Of Myocardial Ischemiamentioning

confidence: 99%

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Myocardial Bridge as a Structure of “Double-Edged Sword” for the Coronary Artery

Ishii

Ishikawa

Akasaka

2014

Annals of Vascular Diseases

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Myocardial bridge (MB) is a chance anatomical structure, comprised of the myocardial tissue, with which the coronary artery running in epicardial adipose tissue is partly covered. It is predominantly present in the left anterior descending artery (LAD) and recognizable through imaging techniques as changes in blood fl ow within the LAD that arises from MB contraction at cardiac systole. Such changes in blood fl ow infl uence the pathophysiology of coronary circulation and atherosclerosis development, thus generating controversy as to whether MB predisposes individual to myocardial infarction (MI). However, recent histomorphometric studies have shown that the individual anatomic properties of MB, such as location, length and thickness, consistently play a critical role in the occurrence of MI. This review article comprehensively addresses the pathophysiological mechanisms of MI occurrence together with the benign suppressive effect of coronary atherosclerosis by MB.

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Histopathologic profiles of coronary atherosclerosis by myocardial bridge underlying myocardial infarction

Cited by 47 publications

References 19 publications

Myocardial bridges: Overview of diagnosis and management

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

Myocardial Bridge as a Structure of “Double-Edged Sword” for the Coronary Artery

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