title: Comparison of angiographic and intravascular ultrasonic detection of myocardial bridging of the left anterior descending coronary artery.
abstract: 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 >or=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 1/4 of patients undergoing LAD imaging at our center.
authors.affiliation: Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York, USA.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Tsujita
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Doi
authors.forename: Takashi
authors.initials: T
authors.lastname: Kubo
authors.forename: Celia
authors.initials: C
authors.lastname: Castellanos
authors.forename: Jian
authors.initials: J
authors.lastname: Liu
authors.forename: Junqing
authors.initials: J
authors.lastname: Yang
authors.forename: Carlos
authors.initials: C
authors.lastname: Oviedo
authors.forename: Theresa
authors.initials: T
authors.lastname: Franklin-Bond
authors.forename: Neil
authors.initials: N
authors.lastname: Dasgupta
authors.forename: Sinan
authors.initials: S
authors.lastname: Biro
authors.forename: Lokesh
authors.initials: L
authors.lastname: Dani
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Edward M
authors.initials: EM
authors.lastname: Kreps
authors.forename: Michael B
authors.initials: MB
authors.lastname: Collins
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054084:Myocardial Bridging / Q000150:complications / Q000000981:diagnostic imaging*; D018709:Statistics, Nonparametric; D018084:Ultrasonography, Interventional