Invasive Assessment of Myocardial Bridging in Patients with Angina and No Obstructive Coronary Artery Disease. EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology Pargaonkar, V. S., Kimura, T., Kameda, R., Tanaka, S., Yamada, R., Schwartz, J. G., Perl, L., Rogers, I. S., Honda, Y., Fitzgerald, P., Schnittger, I., Tremmel, J. A. 2020


AIMS: Angina and no obstructive CAD (ANOCA) is common. A potential cause of angina in this patient population is a myocardial bridge (MB). We studied the anatomical and hemodynamic characteristics of an MB in patients with angina and no obstructive CAD.METHODS AND RESULTS: Using intravascular ultrasound (IVUS), we identified 184 MBs in 154 patients. We evaluated MB length, arterial compression, and halo thickness. MB muscle index (MMI) was defined as MB length*halo thickness. Hemodynamic testing of the MB was performed using an intracoronary pressure/Doppler flow wire at rest and during dobutamine stress. We defined an abnormal diastolic fractional flow reserve (dFFR) as =0.76 during stress. The median MB length was 22.9 mm, arterial compression 30.9%, and halo thickness 0.5mm. The median MMI was 12.1. Endothelial and microvascular dysfunction were present in 85.4% and 22.1%, respectively. At peak dobutamine stress, 94.2% of patients had a dFFR=0.76 within and/or distal to the MB. MMI was associated with an abnormal dFFR.CONCLUSIONS: In select patients with ANOCA who have an MB by IVUS, a majority have evidence of a hemodynamically significant dFFR during dobutamine stress, suggesting the MB as a cause of their angina. A comprehensive invasive assessment of such patients during coronary angiography provides important diagnostic information that can guide management.

View details for DOI 10.4244/EIJ-D-20-00779

View details for PubMedID 33074153