Frequency of Myocardial Bridges and Dynamic Compression of Epicardial Coronary Arteries : A Comparison Between Computed Tomography and Invasive Coronary Angiography

• Published in: Circulation (New York, N.Y.) Vol. 119; no. 10; pp. 1408 - 1416
• Main Authors: PYUNG JIN KIM, HUR, Gham, SU YOUNG KIM, NAMGUNG, June, SEONG WAN HONG, YONG HOON KIM, WON RO LEE
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 17-03-2009
• Subjects: Aged; Angina Pectoris - etiology; Angina Pectoris - physiopathology; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Coronary Angiography - methods; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart; Humans; Image Processing, Computer-Assisted; Male; Medical sciences; Middle Aged; Myocardial Bridging - complications; Myocardial Bridging - diagnostic imaging; Myocardial Bridging - pathology; Myocardial Bridging - physiopathology; Myocardial Contraction; Pressure; Retrospective Studies; Single-Blind Method; Tomography, Spiral Computed; Angiography; Coronary artery; Cardiovascular disease; myocardium; Coronary arteriography; Coronary heart disease; Arterial disease; Vascular disease; Bridges; coronary disease; Artery compression; Tomography; heart defects, congenital; Computerized axial tomography; Congenital cardiopathy; Comparative study
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.108.788901

The objective of the present study was to describe the relative frequency of myocardial bridging and dynamic compression of the coronary arteries as assessed by CT angiography and conventional angiography.
A total of 311 patients (208 men, 103 women; mean age 63 years) who received both 64-section CT angiography and conventional angiography were reviewed retrospectively for myocardial bridging of the left anterior descending coronary artery. Myocardial bridging was considered when the left anterior descending coronary artery was within the interventricular gorge and was classified as either myocardial bridging with partial encasement or myocardial bridging with full encasement, according to the extent of vessel encasement by the myocardium. The length, location, and depth of myocardial bridging were correlated with the presence, length, and degree of dynamic compression observed at conventional angiography. Among the 300 patients studied (11 were excluded), myocardial bridging was observed at CT angiography in 174 (58%) as partial encasement (n=57) or full encasement (n=117). Conventional angiography revealed dynamic compression in 40 patients (13.3%; partial encasement in 1 patient and full encasement in 39). The length of the dynamic compression was considerably longer than the respective tunneled segment in all patients. Total length correlated (P=0.003) with the dynamic compression, but depth did not (P=0.283).
The frequency of myocardial bridging observed by CT angiography was 58%, and conventional angiography revealed dynamic compression in 13.3% of total patients. Dynamic compression occurred almost exclusively (97.5% of the time) in patients with full encasement of the left anterior descending coronary artery, regardless of the presence of overlying muscle.