Left anterior descending myocardial bridge: Angiographic prevalence and its association to atherosclerosis

Abstract

Objective Left anterior descending Myocardial Bridge (LADMB) is considered a benign condition and actually becomes a forgotten cause of serious cardiac events. This study was conducted to estimate the prevalence of LADMB and its association to atherosclerosis. Methods An observational retrospective study was conducted on patients referred for coronary angiography between June 2012 and June 2020. Coronary angiography database was revisedand studied population was divided into 2 groups: LADMB group versus Non-LADMB group. Results LADMB was detected in 510 patients out of 35813 included in the study resulting in a prevalence at 1.42%. The mean age was 66.5 years. Male gender was more common than female (70vs30%). The prevalence of significant atherosclerotic LAD disease was more than two times higher in the non-LADMB group compared to the LADMB group. Statistical analysis revealed a significant negative association between LADMB and atherosclerosis (p < 0.001). A significant greater rate of MINOCA cases was observed in acute coronary syndrome LADMB patients. Conclusions LADMB is an inborn anatomic variation associated to atherosclerotic risk reduction in LAD. Physicians must be aware about the potential complications and pay attention to those classified at high risk for cardiovascular events.

Is myocardial bridge more frequently detected on radial access coronary angiography?

“…Ural et al 's study has shown that MBs can cause stable angina, unstable angina, and non-anginal symptoms [33]. As in the current study, Matta et al have reported that MB can cause myocardial infarction in patients without significant CAD and may be a cause of MINOCA [34]. Most of the MBs in our study were mild, but it should be kept in mind that the severity of MB may be dynamic depending on the hemodynamic status and the drugs used.…”

Non-Invasive Assessment of Endothelial Shear Stress in Myocardial Bridges Using Coronary Computed Tomography Angiography

“…Atherosclerosis has been suggested to be mainly located proximal to MBs, yet recent large studies have demonstrated that the disease burden is comparable to arteries without bridged segments, while others have reported a negative association of MBs in LAD and global atherosclerotic burden. 24–26 These observations could potentially be explained by our findings suggesting that local and global ESS in MBs might not play a role in atherosclerosis formation proximally to MBs, at least a different one than in arteries without bridged segments. In line with our results, observations from autopsy studies have suggested that although MBs can potentially promote atherosclerosis in the proximal arterial segments, this most probably is facilitated by other systematic factors.…”

Management of myocardial infarction with Nonobstructive Coronary Arteries (MINOCA): a subset of acute coronary syndrome patients

“…Recently, a correlation between MINOCA and myocardial bridge has been hypothesized by our group via a large observational cohort [58]. In fact, myocardial bridge has the potential to activate and enhance the all suggested pathophysiological mechanisms of MINOCA.…”

“…The continuous transient dynamic compression of vascular wall results in increasing the shear wall stress which harm endothelial cells [62,63]. Data from literature showed that myocardial infarction could be a pertinent clinical manifestation of myocardial bridge with milking effect [64][65][66] and recent published study revealed a significantly higher angiographic prevalence of myocardial bridge in MINOCA rather than CAD-AMI (coronary artery disease acute myocardial infarction) populations [58,66]. It is worthy to mention that myocardial bridge is associated with proximal atherosclerotic plaque despite sparing of the bridge, so it remains to be seen if the bridge and/or combination of bridge and non-obstructive CAD result in MINOCA.…”