LAD Coronary Artery Myocardial Bridging and Apical Ballooning Syndrome

F Migliore, E Maffei, MP Marra, C Bilato, M Napodano, F Corbetti, A Zorzi, AL Andres, C Sarais, L Cacciavillani, E Favaretto, CH Martini, S Seitun, F. Cademartiri, D Corrado, S Iliceto, G Tarantini

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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. 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 t 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
Original languageUndefined/Unknown
Pages (from-to)32-41
Number of pages10
JournalJACC-cardiovascular imaging
Issue number1
Publication statusPublished - 2013

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