Myocardial bridges are free from atherosclerosis: Overview of the underlying mechanisms

Chatzizisis, Yiannis S.; Giannoglou, George D.

doi:10.1016/s0828-282x(09)70065-0

Cited by 40 publications

(30 citation statements)

References 28 publications

(39 reference statements)

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“…Conversely, there was no significant association between the adipose tissue ratio of perivascular space beneath the MB with atherosclerosis suppression ratio [16]. Rare occurrence of atherosclerosis in the arterial segments under and distal to the MB due to a decreased tensile stress, increased endothelial shear stress and decreased wall motion during cardiac cycle [8].…”

Section: Discussionmentioning

confidence: 85%

“…From the histopathological and clinical points of view, the presence of MB protects the tunnelled segment of coronary artery from the development of atherosclerosis by 3 main mechanisms, including: low tensile stress, high shear stress and decrease tension of the coronary wall [8]. Thus, the MB are considered as atheroprotective factor through the surrounding myocardium that acts as haemodynamic microenvironment within the bridges [15].…”

Section: Introductionmentioning

confidence: 99%

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Myocardial bridge and coronary arteries: morphological study and clinical significance

Nasr

2014

Folia Morphol

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Myocardial bridge and coronary arteries: morphological study and clinical significance

Nasr

2014

Folia Morphol

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“…3). Factors that may play a role in causing the atherosclerotic lesions include flow disturbances (such as retrograde flow during systole), pressure disturbances that may cause endothelial injury, high wall stress proximal to the bridge and tensile stress; conversely development of atherosclerosis may be prevented in the tunnelled and distal segments by inhibition of coronary artery wall motion of the tunnelled segment and lower pressures [5,19,31,34,35].…”

Section: Pathophysiologymentioning

confidence: 99%

Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights?

et al. 2012

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The clinical significance of myocardial bridging has been a subject of discussion and controversy since the introduction of coronary arteriography (CAG) in the early 1960s. More recently computed tomography coronary angiography (CTCA) has made it possible to visualise the overlying muscular bands and appears to have a higher sensitivity for detecting myocardial bridging than CAG. Combining CTCA with invasive techniques such as CAG should make it possible to improve our understanding of the pathophysiology of myocardial bridging and to provide answers to hitherto unresolved questions. This paper critically reviews the outcomes of previous studies and defines remaining questions that should be answered to optimise the management of the presumably fast growing number of patients in whom a diagnosis of myocardial bridging has been made. Keywords Myocardial bridging . Computed tomography angiography . Coronary arteriographyAccording to the original definitions the term 'myocardial bridging' is used for an anatomic variation in which a band of cardiac muscle overlies a segment of an epicardial coronary artery while the artery involved is referred to as being 'tunnelled'. Initially the diagnosis could only be made at autopsy but soon after coronary arteriography (CAG) had become an established clinical diagnostic tool systolic compression of a coronary artery, usually the left anterior descending artery (LAD), was occasionally observed and correctly interpreted as evidence of myocardial bridging [1,2]. Since then the clinical significance of myocardial bridging has been a subject of discussion and controversy. In the last decade it was shown that myocardial bridging can be very well depicted by computed tomography coronary angiography (CTCA) [3,4] which has rekindled the interest in this anomaly. We expect that in the near future increasing numbers of patients with myocardial bridging will be detected by CTCA which may significantly enhance our understanding of the pathology and clinical consequences. At the same time, to ensure that these patients receive optimal treatment it is imperative that we stay aware of what previous studies have taught us. It is the purpose of this paper to critically review the outcomes of previous studies and to define remaining questions of clinical relevance that hopefully can be resolved with newer diagnostic modalities. DiagnosisAlthough myocardial bridging has been held responsible for a variety of symptoms in individual cases, ranging from atypical chest pain to sudden death, thus far clinical studies have been unable to identify specific diagnostic features that allow a diagnosis of myocardial bridging without visualisation of the coronary arteries [5][6][7][8][9][10][11]. The diagnosis is usually established by chance in patients who are examined by CAG or CTCA for various reasons but not because they are suspected of having myocardial bridging. It should be noted that there are essential differences between the diagnostic information provided by each of the two visualisati...

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“…9 In addition, the higher shear stress in the MB segment lowers lipid transmigration and monocyte invasion to endothelia and therefore results in purged endothelia. [10][11][12] Ge et al reported the presence of atherosclerotic plaque on intracoronary ultrasound in 90% of MB patients prior to MB segment. 7 An autopsy series proved that there is more endothelial damage in the segment prior to myocardial bridge compared to other arterial endothelial surfaces.…”

Section: Discussionmentioning

confidence: 99%

The relationship between neutrophil to lymphocyte ratio and myocardial bridge

2016

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Myocardial bridges are free from atherosclerosis: Overview of the underlying mechanisms

Cited by 40 publications

References 28 publications

Myocardial bridge and coronary arteries: morphological study and clinical significance

Myocardial bridge and coronary arteries: morphological study and clinical significance

Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights?

The relationship between neutrophil to lymphocyte ratio and myocardial bridge

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