Abstract
Background: We observed marked myocardial bridging of the left anterior descending coronary artery (LAD) in the acute stages of inferior wall myocardial infarction (MI) in a group of patients who developed shock despite successful reperfusion of the infarct‐related lesion (IRL).
Hypothesis: The purpose of this study was to elucidate the clinical significance of myocardial bridging in patients with inferior wall MI and shock.
Methods: The study group consisted of 53 patients with single‐vessel disease of the right coronary artery, who underwent coronary angiography for acute inferior wall MI. Clinical characteristics, coronary angiographic findings, and left ventricular function during the chronic phase were compared between the patients who developed shock (the shock group) and those who did not (the non‐shock group). In addition, a multiple logistic analysis was performed to identify independent predictors of shock in patients with acute inferior wall MI.
Results: Reperfusion of the IRL was obtained in all 53 patients. The incidence of myocardial bridging of the LAD, the incidence of right ventricular MI, the peak creatine phospho‐kinase (CPK‐MB), the pulmonary capillary wedge pressure, and the prevalence of pulmonary congestion seen on chest roentgenogram were significantly higher in the shock group than in the non‐shock group. Myocardial bridging (p = 0.0018), right ventricular MI (p = 0.0374), and peak CPK‐MB (p = 0.0189) were identified as independent predictors of shock in acute inferior wall MI.
Conclusion: This study suggests that myocardial bridging plays a role in left ventricular function in the acute stage of inferior wall MI.
Keywords: myocardial bridging, inferior wall myocardial infarction, coronary angiography
Full Text
The Full Text of this article is available as a PDF (1.1 MB).
References
- 1. Edwards JC, Burnsides C, Swarm RL, Lansing AI: Arteriosclerosis in the intramural and extramural portions of coronary arteries in human heart. Circulation 1956; 13: 235–241 [DOI] [PubMed] [Google Scholar]
- 2. Polacek P, Kralove H: Relation of myocardial bridges and loops on the coronary arteries to coronary occlusions. Am Heart J 1961; 61: 44–52 [DOI] [PubMed] [Google Scholar]
- 3. Angelini P, Trivellato M, Donis J, Leachman RD: Myocardial bridges: A review. Prog Cardiovasc Dis 1983; 26: 75–88 [DOI] [PubMed] [Google Scholar]
- 4. Geiringer E: The mural coronary. Am Heart J 1951; 41: 359–368 [DOI] [PubMed] [Google Scholar]
- 5. Kramer JR, Kitazume H, Proudfit WL, Sones FM: Clinical significance of isolated coronary bridges. Am Heart J 1982; 103: 283–288 [DOI] [PubMed] [Google Scholar]
- 6. Ishimori T, Raizner AE, Chahine RA, Awdeh M, Luchi RJ: Myocardial bridges in man: Clinical correlations and angiographic accentuation with nitroglycerin. Cathet Cardiovasc Diagn 1977; 3: 59–65 [DOI] [PubMed] [Google Scholar]
- 7. Greenspan M, Iskandrian AS, Catherwood E, Kimbiris D, Bernis CE, Segal BL: Myocardial bridging of the left anterior descending artery: Evaluation using exercise thallium‐201 myocardial scintigraphy. Cathet Cardiovasc Diagn 1980; 6: 173–180 [DOI] [PubMed] [Google Scholar]
- 8. Mazzu A, Di Tano G, Cogode R, Lo Presti G: Myocardial bridging involving more than one site of the left anterior descending coronary artery: An uncommon cause of acute ischemic syndrome. Cathet Cardiovasc Diagn 1995; 34: 329–332 [DOI] [PubMed] [Google Scholar]
- 9. Munakata K, Sato N, Sasaki Y, Yasutaka M, Kusama Y, Takayama M: Two cases of variant form angina pectoris associated with myocardial bridge—a possible relationship among coronary vasospasm. Jpn Circ J 1992; 56: 1248–1252 [DOI] [PubMed] [Google Scholar]
- 10. Bestetti RB, Finzi LA, Amaral FT, Seeches AL, Oliveira JS: Myocardial bridging of coronary arteries associated with an impending acute myocardial infarction. Clin Cardiol 1987; 10: 129–131 [DOI] [PubMed] [Google Scholar]
- 11. Guidelines Sub‐Committee : 1993 Guidelines for the Management of Mild Hypertension: Memorandum from a World Health Organization/International Society of Hypertension meeting. J Hypertens 1993; 11: 905–918 [DOI] [PubMed] [Google Scholar]
- 12. Zehender M, Kasper W, Kauder E, Schonthaler M, Geible A, Olschewsky M: Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328: 981–988 [DOI] [PubMed] [Google Scholar]
- 13. Klein HO, Tordjman T, Ninio R, Sareli P, Oren V, Lang R: The early recognition of right ventricular infarction: Diagnostic accuracy of the electrocardiographic V4R lead. Circulation 1983; 67: 558–565 [DOI] [PubMed] [Google Scholar]
- 14. Lopez‐Sendon J, Coma‐Canella I, Alcasena S, Seoane J, Gamallo C: Electrocardiographic findings in acute right ventricular infarction: Sensitivity and specificity of electrocardiographic alterations in right precordial leads V4R, V3R, V1, and V3. J Am Coll Cardiol 1985; 6: 1273–1279 [DOI] [PubMed] [Google Scholar]
- 15. AHA Committee Report : A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for grading of coronary artery disease, Council on Cardiovascular Surgery, American Heart Association. News from the American Heart Association. Circulation 1975; 51: 5–40 [DOI] [PubMed] [Google Scholar]
- 16. Rentrop KP, Cohen M, Blanke H, Phillips RA: Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol 1985; 5: 587–592 [DOI] [PubMed] [Google Scholar]
- 17. Sheehan FH, Bolson EL, Dodge HT, Mathey DG, Schofer J, Woo H‐W: Advantages and applications of the center‐line method for characterizing regional function. Circulation 1986; 74: 293–305 [DOI] [PubMed] [Google Scholar]
- 18. Adams JE III, Abendschein DR, Jaffe AS: Biochemical markers of myocardial injury. Is MB creatine kinase the choice for the 1990? Circulation 1993; 88: 750–763 [DOI] [PubMed] [Google Scholar]
- 19. Geltman EM, Ehsani AA, Campbell MK, Schechtman K, Roberts R, Sobel BE: The influence of location and extent of myocardial infarction on long‐term ventricular dysrhythmia and mortality. Circulation 1979; 60: 805–814 [DOI] [PubMed] [Google Scholar]
- 20. Rogers WJ, McDaniel HG, Smith LR, Mantle JA, Russell RO Jr, Rackley CE: Correlation of angiographic estimates of myocardial infarct size and accumulated release of creatine kinase MB isoenzyme in man. Circulation 1977; 56: 199–205 [DOI] [PubMed] [Google Scholar]
- 21. Porstmann W, Iwig J: Die intramurale Koronarie im Angiogram. Fortschr Rontgenstr 1960; 92: 129–132 [PubMed] [Google Scholar]
- 22. Bestetti RB, Costa RS, Zucolotto S, Oliveira JS: Fatal outcome associated with autopsy proven myocardial bridging of the left anterior descending coronary artery. Eur Heart J 1989; 10: 573–576 [DOI] [PubMed] [Google Scholar]
- 23. Chee TP, Jensen DP, Padnick MB, Cornell WP, Desser KB: Myocardial bridging of the left anterior descending coronary artery resulting in subendocardial infarction. Arch Intern Med 1981; 141: 1703–1704 [PubMed] [Google Scholar]
- 24. Bestetti RB, Costa RS, Kazava DK, Oliveira JS: Can isolated myocardial bridging of the left anterior descending coronary artery be associated with sudden death during exercise? Acta Cardiol 1991; 46: 27–30 [PubMed] [Google Scholar]
- 25. Chambers JD, Johns JP, Berndt TB, Davee TS: Myocardial stunning resulting from systolic coronary artery compression by myocardial bridging. Am Heart J 1994; 128: 1036–1038 [DOI] [PubMed] [Google Scholar]
- 26. Raizner AE, Ishimori T, Verani M, Spencer WH, Guinn G, Chahin RA, Howell JF, Miller RR: Surgical relief of ischemia due to myocardial bridges (abstr). Am J Cardiol 1980; 45: 417 [Google Scholar]
- 27. Grondin P, Bourassa MG, Noble J, Petitclerc R, Dydra I: Successful course after supraarterial myotomy for myocardial bridging and milking effect of the left anterior descending artery. Ann Thorac Surg 1977; 24: 422–429 [DOI] [PubMed] [Google Scholar]
- 28. Faruqui AMA, Maloy WC, Felner JM, Schlant RC, Logan WD, Symbas P: Symptomatic myocardial bridging of the coronary artery. Am J Cardiol 1978; 41: 1305–1310 [DOI] [PubMed] [Google Scholar]
- 29. Betriu A, Tubau J, Sanz G, Magrina J, Navarro‐Lopez F: Relief of angina by periarterial muscle resection of myocardial bridges. Am Heart J 1980; 100: 223–226 [DOI] [PubMed] [Google Scholar]
- 30. Noble J, Bourassa MG, Petitclec R, Dydra I: Myocardial bridging and milking effect of the left anterior descending coronary artery: Normal variant or obstruction? Am J Cardiol 1976; 37: 993–999 [DOI] [PubMed] [Google Scholar]
- 31. Endo M, Lee YW, Hayashi H, Wada J: Angiographic evidence of myocardial squeezing accompanying tachyarrhythmia as a possible cause of myocardial infarction. Chest 1978; 73: 431–433 [DOI] [PubMed] [Google Scholar]
- 32. Hill RC, Chitwood WR, Bashore TM, Sink JD, Cox JL, Wechsler AS: Coronary flow and regional function before and after supraarterial myotomy for myocardial bridging. Ann Thorac Surg 1981; 31: 176–181 [DOI] [PubMed] [Google Scholar]
- 33. Mouratidis B, Lomas FE, McGill D: Thallium‐201 myocardial SPECT in myocardial bridging. J Nucl Med 1995; 36: 1031–1033 [PubMed] [Google Scholar]
- 34. Sueda T, Matsuura Y, Ishihara H, Hamanaka Y, Shikata H, Nakashima Y, Hayashi S, Nakagawa H, Kawagoe T, Tsuchioka Y, Okamoto M: WPW syndrome complicated by another cardiac disorder. Hiroshima J Med Sci 1991; 40: 47–51 [PubMed] [Google Scholar]
- 35. Ahmad M, Merry SL, Haibach H: Evidence of impaired myocardial perfusion and abnormal left ventricular function during exercise in patients with isolated systolic narrowing of the left anterior descending coronary artery. Am J Cardiol 1981; 48: 832–836 [DOI] [PubMed] [Google Scholar]
- 36. Ishimori T: Myocardial bridges: A new horizon in the evaluation of ischemic heart disease. Cathet Cardiovasc Diagn 1980; 6: 355–357 [DOI] [PubMed] [Google Scholar]
- 37. Ge J, Erbel R, Rupprecht HJ, Koch L, Kearny P, George G, Haude M, Meyer J: Comparison of intravascular ultrasound and angiography in the assessment of myocardial bridging. Circulation 1994; 89: 1725–1732 [DOI] [PubMed] [Google Scholar]