Impact of Clinical and Morphological Factors on Long-Term Mortality in Patients with Myocardial Bridge

Abstract

Although myocardial bridging (MB) has been intensively investigated using different methods, the effect of bridge morphology on long-term outcome is still doubtful. We aimed at describing the anatomical differences in coronary angiography between symptomatic and non-symptomatic LAD myocardial bridges and to investigate the influence of clinical and morphological factors on long-term mortality. In our retrospective, long-term, single center study we found relevant MB on the left anterior descendent (LAD) coronary artery in 146 cases during a two-year period, when 11,385 patients underwent coronary angiography due to angina pectoris. Patients were divided into two groups: those with myocardial bridge only (LAD-MBneg, n = 78) and those with associated obstructive coronary artery disease (LAD-MBpos, n = 68). Clinical factors, morphology of bridge by quantitative coronary analysis and ten-year long mortality data were collected. The LAD-MBneg group was associated with younger age and decreased incidence of diabetes mellitus, as well as with increased minimal diameter to reference diameter ratio (LAD-MBneg 54.5 (13.1)% vs. LAD-MBpos 46.5 (16.4)%, p = 0.016), while there was a tendency towards longer lesions and higher vessel diameter values compared to the LAD-MBpos group. The LAD-MBpos group was associated with increased mortality compared to the LAD-MBneg group. The analysis of our data showed that morphological parameters of LAD bridge did not influence long-term mortality, either in the overall population or in the LAD-MBneg patients. Morphological parameters of LAD bridge did not influence long-term mortality outcomes; therefore, it suggests that anatomical differences might not predict long-term outcomes and should not influence therapy.

The Intramyocardial Left Anterior Descending Artery: Prevalence, Early and Mid-Term Surgical Outcomes After Coronary Artery Bypass Procedures: A Retrospective Single-Center Study

“…Vanker et al observed IMLAD in 293 of 1,349 patients undergoing CABG and reported a prevalence of 21.7%, while other similar studies reported lower prevalence rates ranging between 1-2%. 2,6,9,10 Our study demonstrates that patients with IM-LADs have comparable early and mid-term outcomes to the matched control group. Cross-clamp and CPB times did not differ significantly between groups, despite the additional time required to locate the LAD which in turn reflects the comparable postoperative outcomes in both groups.…”

Myocardialis izomhíd: a tüneteket befolyásoló morfológiai faktorok vizsgálata

“…Saját retrospektív kutatásunkban [22] a myocardialis izomhíd koronarográfia során meghatározható morfológiai jellemzőit kerestük, amelyek angina pectorishoz vezettek. Azt is vizsgáltuk, hogy az így meghatározott morfológiai faktorok befolyásolják-e a hosszú távú túlélést.…”

Ponte Miocárdica: Amiga, Inimiga ou Ambas?

“…Globally, these findings imply that population diversity and inclusion in analyses always matter, as numbers keep varying both on autopsy [14][15][16][17] and angiogram. [18][19][20][21] MBs tend to be localized more in the left system, and Loukas et al 15 found it to be coronary artery dominance-dependent in their sample; however, MBs over the right coronary artery are also described, 22 while concomitant presence with a quadricuspid aortic valve, 23 transposition of great arteries, 24 hamartoma, 25 Takotsubo and spontaneous coronary artery dissection 26,27 have recently been reported.…”

“…Como as ferramentas de diagnóstico avançaram substancialmente nas últimas duas décadas, 28 a avaliação de pacientes PM que se apresentaram a um cardiologista permanece em função da logística local 17 , 20 , 29 - 32 e da experiência em manejo de longo prazo. No entanto, antes de chegarmos à decisão de tratamento, o quando, o onde e como as PMs se tornam amigas, inimigas ou ambas, de nossos pacientes em função de seu papel na aterogênese permanece o ponto central.…”

“…O achado prevalente de aterosclerose proximal a PM é confirmado por numerosos autores, 6 , 14 , 19 , 34 - 36 confirmando diferentes influências de longo prazo nos resultados. 20 , 37 No entanto, com um relatório recente perturbador de PM sendo um preditor independente de arritmia fatal em pacientes com HCMP. 38 Ao mesmo tempo, naqueles livres de CMPH, Zhang et al, 36 encontraram correlação positiva entre compressão sistólica e eventos coronarianos adversos maiores e aterosclerose proximal à PM.…”