Myocardial Bridge: Harmless or Harmful

Hayashi, Tetsuo; Ishikawa, Kinji

doi:10.2169/internalmedicine.43.1097

Cited by 15 publications

(27 citation statements)

References 22 publications

(34 reference statements)

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“…The presence of MB, characterized by the transient narrowing of the epicardial coronary artery, due to myocardial compression during systole, is associated with cardiovascular system abnormalities [13][14][15][16][17][18][19]34,35]. In the present study, MB was more frequently observed in VSA patients with chest symptoms during exercise, and this finding was confirmed using a logistic regression analysis.…”

Section: Discussionsupporting

confidence: 79%

“…The myocardial bridge (MB), which is characterized with the systolic narrowing of epicardial coronary artery due to myocardial compression during systole, is reportedly associated with abnormalities of cardiovascular system, including exertional angina or acute coronary syndrome [13,14]. The presence of MB is associated with coronary spasms [15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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What Factors Contribute to Chest Symptoms during Exercise in Patients with Vasospastic Angina?

Teragawa¹,

Fujii²,

Oshita³

et al. 2017

Angiol

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Objective: Chest symptoms in patients with vasospastic angina (VSA) typically occur during rest. However, we have occasionally experienced patients with VSA who have had chest symptoms even during exercise. However, factors contributing to the chest symptoms during exercise in patients with VSA remain unclear. Therefore, we investigated this relationship. Methods:We investigated 101 patients with VSA (median age: 69 years, 51 males and 50 females). We completed detailed chest symptom examinations at rest (n=85), during exercise (n=2), and both at rest and during exercise (n=14). Patients were divided into the two groups: Group I consisted of patients with VSA whose chest symptoms occurred only at rest (n=85, 84%) and Group II consisted of patients with VSA whose chest symptoms occurred during exercise (n=16, 16%). On a coronary angiography, the presence of atherosclerosis (% stenosis>25%), significant coronary stenosis (% stenosis>50%), and myocardial bridging (MB), defined as the narrowing of the coronary artery during systole, were checked. Clinical parameters, including angiographic findings, were assessed in the two groups.Results: There were no significant differences in coronary risk factors between the two groups. The presence of atherosclerosis (Group I: 58% vs. group II: 75%) and significant coronary stenosis (Group I: 10% vs. group II: 25%) did not differ between-groups. The presence of MB was significantly higher in Group II (50%) than in Group I (12%, p=0.0002). Logistic regression analysis showed that the presence of MB was associated with patients in Group II.Conclusions: MB, rather than coronary atherosclerosis or significant coronary stenosis, may contribute to chest symptoms during exercise in patients with VSA.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

What Factors Contribute to Chest Symptoms during Exercise in Patients with Vasospastic Angina?

Teragawa¹,

Fujii²,

Oshita³

et al. 2017

Angiol

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“…The frequency of MB ranges from 5.4% to 85% in autopsy series [2][3][4] and from 0.5% to 29.4% on coronary angiography [4][5][6][7][8][9][10] . It has been accepted that MB might affect the cardiovascular system [1,8,[11][12][13] . In addition, the presence of MB is associated with myocardial infarction [14][15][16][17] and sudden cardiac death [18][19][20] .…”

Section: Introductionmentioning

confidence: 99%

Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging

Teragawa

Fujii

Ueda

et al. 2015

WJC

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We present a case of a 71-year-old male who had chest symptoms at rest and during effort. He had felt chest oppression during effort for 1 year, and his chest symptoms had recently worsened. One month before admission he felt chest squeezing at rest in the early morning. He presented at our institution to evaluate his chest symptoms. Electrocardiography and echocardiography failed to show any specific changes. Because of the possibility that his chest symptoms were due to myocardial ischemia, he was admitted to our institution for coronary angiography (CAG). An initial CAG showed mild atherosclerotic changes in the proximal segment of the left anterior descending coronary artery (LAD) and mid-segment of the left circumflex coronary artery. Subsequent spasm provocation testing using acetylcholine revealed a bilateral coronary vasospasm, which was relieved after the intracoronary infusion of nitroglycerin. Finally, a CAG showed myocardial bridging (MB) of the mid-distal segments of the LAD. Fractional flow reserve using the intravenous administration of adenosine triphosphate was positive at 0.77, which jumped up to 0.90 through the myocardial bridging segments when the pressure wire was pulled back. Thus, coronary vasospasm and MB might have contributed to his chest symptoms at rest and during effort. Interventional cardiologists should consider the presence of MB as a potential cause of myocardial ischemia. Core tip: Myocardial bridging (MB), an anomaly in which the myocardium overlies the intramural course of segments of the epicardial coronary arteries, is associated with cardiac events. This may be explained by myocardial ischemia, coronary spasms, and/or mechanical compression of the coronary artery by the MB itself. We encountered a patient with angina pectoris both at rest and during exercise, which was caused by both coronary spasm and MB-induced direct myocardial ischemia. The latter finding was revealed using a pressure wire. MB sometimes causes two vascular characteristics, coronary spasms and direct myocardial ischemia, whose management is quite different.Teragawa H, Fujii Y, Ueda T, Murata D, Nomura S. Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging.

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“…(1) There is even considerable disagreement about its incidence, with discrepant results when angiographic findings are compared to pathologic diagnoses. (2) Although ultrasound and intracoronary Doppler techniques have enhanced the knowledge of ischemia mechanisms, these have not yet been completely explained.…”

Section: Introductionmentioning

confidence: 99%

“…However, reports on angina, coronary spasms, ventricular arrhythmias, acute myocardial infarction, and sudden death among patients with myocardial bridge indicate the existence of a subgroup of patients with a higher risk for adverse events 1 . The lack of controlled prospective studies makes it difficult to establish definite prognostic factors for this condition.…”

Section: Introductionmentioning

confidence: 99%