Two Cases of Variant Form Angina Pectoris Associated with Myocardial Bridge. A Possible Relationship Among Coronary Vasospasm, Atherosclerosis and Myocardial Bridge.

Munakata, Kazuo; Sato, Naoki; Sasaki, Yoshimichi; Yasutake, Masahiro; Kusama, Yoshiki; Takayama, Morimasa; Kuroda, Hiroshi; Hayakawa, Hirokazu

doi:10.1253/jcj.56.1248

Cited by 24 publications

(14 citation statements)

References 18 publications

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“…Coronary spasm and myocardial bridging cardial infarction [14][15][16][17] and sudden cardiac death [18][19][20] . Myocardial ischemia has been suggested to be the main cause of MB-related cardiac events due to mechanical compression of the coronary artery by the MB [21,22] and/or coronary spasm at the MB segments [12,[23][24][25] . It is possible that coronary spasms frequently occur at MB segments because of endothelial dysfunction and/or vascular dysfunction of the coronary artery at MB segments [11,12] .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the presence of MB is associated with myocardial infarction [14][15][16][17] and sudden cardiac death [18][19][20] . Myocardial ischemia due to compression of the coronary artery by MB [21,22] and/or coronary spasm at the MB segments [12,[23][24][25] has been considered a major factor responsible for MB-related cardiac events. In this study, we report a case of angina pectoris at both rest and during exercise due to both coronary spasm and MB-related myocardial ischemia, which was documented using a pressure wire.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…Finally, it has been reported that coronary spasm is associated with MB-related cardiac events. 13,22,23 These publications were all case reports, and the effect of MB on coronary spasm has not been investigated in a series of patients. Although we showed that coronary spasm is induced more frequently in patients with MB, especially in the MB segments, we did not measure the intracoronary hemodynamics or perform stress myocardial imaging in all patients and therefore were unable to show a direct relationship between MB and myocardial ischemia.…”

Section: Cardiac Events Associated With Myocardial Bridgingmentioning

confidence: 99%

“…1,[6][7][8][9][10][11] Although it remains to be determined how MB affects the cardiovascular system, MB has been associated with myocardial infarction [12][13][14][15][16][17] and sudden cardiac death, [18][19][20][21] and coronary spasm is thought to be one factor connecting cardiac events and MB. 13,22,23 However, it has yet to be verified that coronary spasm is more frequent in patients with MB. This study attempted to determine whether MB increases vulnerability to coronary spasm in patients who underwent a spasm-provocation test.…”

Section: Introductionmentioning

confidence: 99%

Myocardial bridging increases the risk of coronary spasm

Teragawa

Fukuda

Matsuda

et al. 2003

Clinical Cardiology

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SummaryBackground: Myocardial bridging (MB) has been associated with cardiac events. Whether coronary spasm is one factor contributing to those events is unknown.Hypothesis: This study investigated whether the likelihood of coronary spasm is increased in patients with MB.Methods: A spasm-provocation test was performed by infusing acetylcholine into the left coronary artery in 114 Japanese patients with chest pain. The test result was defined as positive when the diameter of the coronary artery was reduced by ≥ 50% and ST-segment changes were documented. Myocardial bridging was defined as a > 15% reduction in coronary arterial diameter during systole after intracoronary injection of nitroglycerin.Results: Myocardial bridging was identified in 41 patients (36%) and was located in the mid-segment of the left anterior descending coronary artery (LAD) in all patients. Patients with MB experienced coronary spasm more frequently than patients without MB (MB+: 73%; MBϪ: 40%, p = 0.0006). Furthermore, among patients with a positive spasm-provocation test, coronary spasm occurred more frequently in the midsegment of the LAD in patients with MB than in those without MB (MB+: 73%; MBϪ: 45%, p = 0.0259). Multivariate regression analysis demonstrated that MB was a predictor of coronary spasm (odds ratio: 3.478, p = 0.0088).

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“…The presence of MB is associated with coronary spasms [15][16][17][18][19]. Thus, it is possible that MB may influence chest symptoms during exercise in VSA patients.…”

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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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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Two Cases of Variant Form Angina Pectoris Associated with Myocardial Bridge. A Possible Relationship Among Coronary Vasospasm, Atherosclerosis and Myocardial Bridge.

Cited by 24 publications

References 18 publications

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

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

Myocardial bridging increases the risk of coronary spasm

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

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