Coronary artery disease
Comparison of Angiographic and Intravascular Ultrasonic Detection of Myocardial Bridging of the Left Anterior Descending Coronary Artery

https://doi.org/10.1016/j.amjcard.2008.07.054Get rights and content

The purpose of this study was to determine the incidence, location, and clinical features of myocardial bridging (MB) detected by intravascular ultrasound (IVUS) and to compare IVUS-detectable versus angiographically detectable MBs. IVUS images were analyzed in 331 consecutive patients with de novo coronary lesions located in the left anterior descending coronary artery (LAD). MB was defined as a segment of coronary artery having systolic compression and echocardiographically lucent muscle surrounding the artery (IVUS) or systolic milking (angiography). Although angiography detected MB in only 3% of patients (11 of 331), 75 MB segments (23%, 75 of 331, p <0.001) were identified by IVUS. Maximum plaque burden within the MB segment measured only 25 ± 7%, and abnormal intimal thickness (defined as ≥0.5 mm) was not observed within the bridged segment of any patient with MB, although the study population had advanced atherosclerosis. Vessel and lumen areas in the MB segment were significantly smaller than those in adjacent proximal and even distal reference segments. Angiographically detectable MB was significantly longer, located more proximally in the LAD, and had more severe systolic compression by IVUS. Angiographically silent MB more often occurred in the presence of an adjacent proximal stenosis and lower left ventricular ejection fraction. In conclusion, IVUS may provide useful anatomic information for the accurate diagnosis of MBs that are largely angiographically silent. IVUS-detectable MBs were observed in approximately 14 of patients undergoing LAD imaging at our center.

Section snippets

Methods

From May 2003 to October 2007, 331 patients with de novo coronary lesions located in the LAD underwent diagnostic or preinterventional IVUS at the Columbia University Medical Center (New York, New York). IVUS studies of these patients were reviewed, and 75 MBs were identified. This study was approved by the institutional review board; written informed consent was obtained from all patients. Patient demographics were confirmed by hospital chart review at the time of the procedure. Coronary risk

Results

Clinical characteristics and indications for coronary angiography are listed in Table 1. In general, these patients had advanced atherosclerosis with multiple coronary risk factors.

IVUS-detectable MB segments, i.e., echocardiographically lucent muscle band surrounding the LAD and systolic compression of the LAD (Figure 1, Figure 2, Figure 3), were present in 23% of patients (75 of 331). Comparing the IVUS images with the corresponding angiograms, the location of MB was in the middle segment of

Discussion

Although the criteria for detection of an MB differ among pathology, IVUS, and angiography, the main findings of the present study follow. (1) IVUS-detectable MBs were present in 23% of LADs in patients with advanced coronary atherosclerosis. This is similar to the frequency of an autopsy-detectable intramyocardial course of the LAD. (2) Most IVUS-detected MBs were angiographically silent with a normal LAD appearance. (3) Angiographically silent MBs were more often located distal to an

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