LAD Coronary Artery Myocardial Bridging and Apical Ballooning Syndrome

JACC-CARDIOVASCULAR IMAGING

卷:6

Article

Migliore, Federico¹  Maffei, Erica²  Marra, Martina Perazzolo¹  Bilato, Claudio¹  Napodano, Massimo¹  Corbetti, Francesco³  Zorzi, Alessandro¹  Andres, Anto Luigi³  Sarais, Cristiano¹  Cacciavillani, Luisa¹  Favaretto, Enrico¹  Martini, Chiara⁴  Seitun, Sara⁴  Cademartiri, Filippo^2,4  Corrado, Domenico¹  Iliceto, Sabino¹  Tarantini, Giuseppe¹ 

[1] Univ Padua, Dept Cardiac Thorac & Vasc Sci, I-35128 Padua, Italy

[2] Erasmus Med Ctr Univ, Dept Radiol, Rotterdam, Netherlands

[3] Giovanni XXIII Clin, Cardiovasc Imaging Unit, Treviso, Italy

[4] Hosp Padova, Dept Radiol, Padua, Italy

关键词: apical ballooning syndrome;    computed tomography angiography;    coronary angiography;    myocardial bridging;    takotsubo cardiomyopathy;   

DOI  :  10.1016/j.jcmg.2012.08.013

来源: Elsevier

【 摘 要 】

OBJECTIVES This study sought to evaluate the prevalence and potential role of myocardial bridging in the pathogenesis of apical ballooning syndrome (ABS). BACKGROUND ABS is characterized by reversible left ventricular dysfunction, frequently precipitated by a stressful event, but the pathogenesis remains still unclear. METHODS Forty-two consecutive patients (40 female, mean age 66 +/- 7 years) with ABS underwent echocardiography, cardiac magnetic resonance, coronary angiography (CA) with intravascular ultrasound, and computed tomography angiography (CTA). Myocardial bridging was diagnosed by CA when a dynamic compression phenomenon was observed in the coronary artery and by CTA when a segment of coronary artery was completely (full encasement) or incompletely (partial encasement) surrounded by the myocardium. The prevalence of myocardial bridging detected by CTA and CA in ABS patients was compared with 401 controls without ABS who underwent both CTA and CA. RESULTS Myocardial bridging by CTA was observed in 32 ABS patients (76%): 23 with partial encasement and 9 with full encasement. All myocardial bridging was located in the mid segment of the left anterior descending coronary artery (LAD) with a mean length of 17 +/- 9 mm. CA revealed myocardial bridging in 17 subjects (40%) (9 with partial encasement and 8 with full encasement by CTA). All subjects in which dynamic compression was observed by CA showed myocardial bridging by CTA, while none of the subjects with negative findings for myocardial bridging by CTA revealed dynamic compression by CA. Compared with controls, ABS patients showed a significant higher prevalence of myocardial bridging in the LAD either by CA (40% vs. 8%; p < 0.001) or by CTA (76% vs. 31%; p < 0.001). CONCLUSIONS Our study showed that myocardial bridging of the LAD is a frequent finding in ABS patients as revealed both by CA and, mostly, by CTA, suggesting a role of myocardial bridging as potential substrate in the pathogenesis of ABS. (J Am Coll Cardiol Img 2013;6:32-41) (C) 2013 by the American College of Cardiology Foundation

【 授权许可】

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