Coronary interventions - Mini focus on ischaemia with non-obstructed coronary arteries

Invasive assessment of myocardial bridging in patients with angina and no obstructive coronary artery disease

EuroIntervention 2021;16:1070-1078. DOI: 10.4244/EIJ-D-20-00779

Vedant Pargaonkar
Vedant Satish Pargaonkar1, MD; Takumi Kimura1, MD, PhD; Ryo Kameda1, MD; Shigemitsu Tanaka1, MD; Ryotaro Yamada1, MD; Jonathan G. Schwartz1, MD; Leor Perl1, MD; Ian S. Rogers1, MD, MPH; Yasuhiro Honda1, MD; Peter Fitzgerald1, MD, PhD; Ingela Schnittger1, MD; Jennifer Ann Tremmel1, MD, MS
1. Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA

Aims: Angina and no obstructive coronary artery disease (ANOCA) is common. A potential cause of angina in this patient population is a myocardial bridge (MB). We aimed to study the anatomical and haemodynamic characteristics of an MB in patients with ANOCA.

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. Haemodynamic 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 0.5 mm. 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, the majority have evidence of a haemodynamically significant dFFR during dobutamine stress, suggesting the MB as being a cause of their angina. A comprehensive invasive assessment of such patients during coronary angiography provides important diagnostic information that can guide management.

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fractional flow reserveintravascular ultrasoundstable angina
Coronary interventionsStable CADOther coronary interventions
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