Skip to main content
Download PDF

Myocardial Bridge Anatomical Characteristics Relationship with ECG Changes and Markers

Artery Research volume 26, pages 84–88 (2020)Cite this article

Abstract

Background

The clinical significance of coronary Myocardial Bridge (MB) anatomical characteristics is controversial in the literature. It is not clear whether MB has a benign or malignant clinical outcome.

Objectives

To investigate the possible relationship between MB characteristics (depth, length and volume index) with ECG markers [T Peak-to-End interval (Tp-e), transmural dispersion of repolarization and Index of Cardiac Electrical Balance (iCEB)] and changes (ST-T and S/R ratio changes in V1 and aVL leads).

Patients and Methods

Forty-one patients who were diagnosed as having MB at multi-detector CT exam were enrolled in the study.

Results

MB depth and volume index were associated with notched QRS (p = 0.001 and 0.003 respectively) in the whole sample. The association of notched QRS with MB depth and volume index was more significant in patients with coronary atherosclerosis (p = 0.001 and 0.01 respectively). There was a statistically significant association between MB length (p = 0.006) and volume index (p = 0.001) with an increased S/R ratio in aVL lead in patients free from coronary atherosclerosis. No statistically significant association was observed between MB anatomical characteristics with ECG markers of increased arrhythmia (p > 0.01), including TDR, Tp-e and iCEB.

Conclusion

MB depth and volume index showed a statistically significant association with notched QRS, particularly in patients with coronary atherosclerosis.

Highlights

  • The clinical significance of coronary Myocardial Bridge (MB) anatomical characteristics is controversial in the literature.

  • It is not clear whether MB has benign or malignant clinical outcome.

  • The results of the present study showed that some MB anatomical characteristics are associated with significant ECG changes.

References

  1. Rovai D, Di Bella G, Pingitore A, Coceani M. Myocardial bridging: a review with emphasis on electrocardiographic findings. Ann Noninvasive Electrocardiol 2015;20:103–7.

    Google Scholar 

  2. Nafakhi H, Al-Mosawi AA, Hassan MB, Hameed F, Alareedh M, Al-Shokry W. ECG changes and markers of increased risk of arrhythmia in patients with myocardial bridge. J Electrocardiol 2019;56:90–3.

    Google Scholar 

  3. Nakanishi R, Rajani R, Ishikawa Y, Ishii T, Berman DS. Myocardial bridging on coronary CTA: an innocent bystander or a culprit in myocardial infarction? J Cardiovasc Comput Tomogr 2012;6:3–13.

  4. Ishikawa Y, Akasaka Y, Suzuki K, Fujiwara M, Ogawa T, Yamazaki K, et al. Anatomic properties of myocardial bridge predisposing to myocardial infarction. Circulation 2009;120:376–83.

    Google Scholar 

  5. Ishii T, Ishikawa Y, Akasaka Y. Myocardial bridge as a structure of “double-edged sword” for the coronary artery. Ann Vasc Dis 2014;7:99–108.

    Google Scholar 

  6. Seo J, Park J, Oh J, Uhm JS, Sung JH, Kim JY, et al. High prevalence and clinical implication of myocardial bridging in patients with early repolarization. Yonsei Med J 2017;58:67–74.

    Google Scholar 

  7. Brodsky SV, Roh L, Ashar K, Braun A, Ramaswamy G. Myocardial bridging of coronary arteries: a risk factor for myocardial fibrosis? Int J Cardiol 2008;124:391–2.

  8. Ishikawa Y, Kawawa Y, Kohda E, Shimada K, Ishii T. Significance of the anatomical properties of a myocardial bridge in coronary heart disease. Circ J 2011;75:1559–66.

    Google Scholar 

  9. Yukio I, Yoko K, Ehiichi K, Toshiharu I. (1) coronary events caused by myocardial bridge. Ann Vasc Dis 2009;2:79–94.

    Google Scholar 

  10. Cetin MS, Ozcan Cetin EH, Canpolat U, Cay S, Topaloglu S, Temizhan A, et al. Usefulness of fragmented QRS complex to predict arrhythmic events and cardiovascular mortality in patients with noncompaction cardiomyopathy. Am J Cardiol 2016;117:1516–23.

    Google Scholar 

  11. Deveci M, Babaoğlu K, Kayabey Ö. A rare cause of early repolarisation in an adolescent boy with chest pain: myocardial bridging. Cardiovasc J Afr 2017;28:e5–e7.

    Google Scholar 

  12. Hostiuc S, Rusu MC, Hostiuc M, Negoi RI, Negoi I. Cardiovascular consequences of myocardial bridging: a meta-analysis and meta-regression. Sci Rep 2017;7:14644.

    Google Scholar 

  13. Ak R, Doganay F, Onur OO, Akoglu EU. Electrocardiographic clue for a mid-LAD lesion. BMJ Case Rep 2016;2016:pii: bcr2015213046.

  14. Migliore F, Zorzi A, Marra MP, Basso C, Corbetti F, De Lazzari M, et al. Myocardial edema underlies dynamic T-wave inversion (Wellens’ ECG pattern) in patients with reversible left ventricular dysfunction. Heart Rhythm 2011;8:1629–34.

    Google Scholar 

  15. Hostiuc S, Curca GC, Dermengiu D, Dermengiu S, Hostiuc M, Rusu MC. Morphological changes associated with hemodynamically significant myocardial bridges in sudden cardiac death. Thorac Cardiovasc Surg 2011;59:406–10.

    Google Scholar 

  16. Yıldırım E, İpek E, Kalkan K, Öztürk M, Cengiz M, Hamur H. The relationship between myocardial bridge and electrocardiographic Tp-e interval, Tp-e/QT and Tp-e/QTc ratio. Med Bull Haseki 2017;55:21–6.

    Google Scholar 

  17. Nguyen TH, Burnside PR, Dieter RS, Nanjundappa A. Right coronary artery distribution of myocardial bridging: an unusual case presenting with ST-elevation myocardial infarction. Tex Heart Inst J 2007;34:489–91.

    Google Scholar 

  18. Riezzo I, Monciotti F, Pomara C, Fineschi V. Myocardial bridging of the right coronary artery and emotional stress: a fatal link? Int J Cardiol 2007;115:e99–e101.

Download references

Author information

Authors and Affiliations

  1. Internal Medicine Department, Medicine College, University of Kufa, Najaf, Iraq

    Hussein Nafakhi & Samet Kasim

  2. Radiology Department, Medicine College, University of Kufa, Najaf, Iraq

    Abdulameer A. Al-Mosawi

Authors
  1. Hussein Nafakhi
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Abdulameer A. Al-Mosawi
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Samet Kasim
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Hussein Nafakhi.

Additional information

Peer review under responsibility of the Association for Research into Arterial Structure and Physiology

Data availability statement: The data that support the findings of this study are available from the corresponding author (HN), upon reasonable request.

Rights and permissions

This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nafakhi, H., Al-Mosawi, A.A. & Kasim, S. Myocardial Bridge Anatomical Characteristics Relationship with ECG Changes and Markers. Artery Res 26, 84–88 (2020). https://doiorg.publicaciones.saludcastillayleon.es/10.2991/artres.k.200502.001

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.2991/artres.k.200502.001

Keywords

Artery Research

ISSN: 1876-4401

Contact us