CTCA : Non Invasive tool to detect myocardial bridging in CAD

1. Computed Tomography Coronary Angiography (CTCA):
Trustable Non-invasive Imaging Tool to Detect Myocardial
Bridging in Coronary Artery Disease
1.CPE Institute of Cardiology , Multan ,Punjab , Pakistan
2. Member of Clinical and Research Working Groups, European Society of
Cardiology, Sophia Antipolis, France
Syed Haseeb Raza1, Han Naung Tun2 , Masood Ahmed Khan1, Tariq Abbas1, Nisar Ahmed1,
Muhammad Zubair Zaffar1

2. Conflict of Interest
▪ I have noting to declare

3. INTRODUCTION AND BACKGROUND
Myocardial bridging (MB) is an inborn
abnormality of coronary vessel. It occurs when a
segment of a coronary artery or its major branch
travels through the myocardium instead of on the
surface of the myocardium, resulting in a
tunnelled arterial segment. The reported
frequency of MB varies greatly in the exiting
literature which might be attributable to hardware
and population differences.
Bridging of the middle portion of the LAD seen in 3-D
(panel a) and curved multiplanar reconstruction (panel
b).
Donkol RH, Saad Z. Myocardial bridging analysis by coronary
computed tomographic angiography in a Saudi population. World
J Cardiol 2013;5(11):434-41.

4. Myocardial bridging is clinically significant when associated with regional
hemodynamic alterations, and studies have shown that such instances of
myocardial bridging are linked to clinical complications that include
ischemia, acute coronary syndrome, coronary spasm, arrhythmia, and
sudden death, although in the vast majority of cases, myocardial bridging
remains clinically silent.
Because the clinical significance of myocardial bridging lies in the related
regional hemodynamic changes that occur almost exclusively in the left
anterior descending coronary artery (LAD) the depiction of myocardial
bridging in the LAD that is likely to cause dynamic compression appears
to be clinically important.
Circulation. 2002; 106: 2616–2622.
Am J Cardiol. 2007; 100: 1083–1086.
J Pathol. 1998; 185

5. CTA showing normal epicardial course of the LAD in a
63-year-old woman. The 5-mm-thick long-axis curved
multiplanar reformation image (left) of the LAD reveals
an epicardial location. Visualization of the septal
branches (arrowhead) entering the septum indicates
the optimal angle of the plane. Short-axis images
(right), obtained at 0.5-mm thickness with a gap of 0.9
mm perpendicular to the long axis of the LAD, depict
this vessel at some distance from the interventricular
gorge (g). A septal branch arising from the proximal
segment of the LAD (arrows) travels deep into the
septum along its outer margin. The LAD is at the center
of the short-axis images. RV indicates right ventricle;
LV, left ventricle.

6. OBJECTIVE
▪ To determine the frequency of myocardial bridging by computed
tomographic coronary angiography in patients with coronary
artery disease.

7. MATERIALS AND METHOD
Two hundred and nineteen (219) patients having age 40-70 years suffering
from coronary artery disease were included in this study. The study was done
at CPE Institute of Cardiology in Multan, Pakistan . All these patients
underwent CT angiography.
Presence of myocardial bridge was recorded. Data regarding age, gender,
factors i.e. positive family history, smoking, controlled and uncontrolled
hypertension, controlled and uncontrolled diabetes mellitus and
hyperlipidaemia and duration of CAD was also collected.

8. .

9. The preparation of patients included an oral dose of 50 to 75 mg of
atenolol if the heart rate was >65 bpm 1 hour before examination and
sublingual nitroglycerin (0.3 mg) immediately before scanning.
Patients with uncontrollable arrhythmia or tachycardia (heart rate >80
bpm) and those who cooperated poorly were excluded. After
prospective precontrast scanning, an Aquillion 64 (Toshiba Medical
Systems, Tokyo, Japan) was used to retrospectively obtain ECG-
gated spiral postcontrast scans (0.5-mm section thickness; pitch of
0.225 to 0.24; 0.4-second rotation time; 180-cm field of view; and
120-kV tube potential
CT Coronary Angiography

10. RESULTS
Mean age of the patients was 51.53+7.05
years. There were 175 (79.9%) male
patients and 44 (20.1%) females. There
were 55 (25.1%) patients who were having
a positive family history of coronary artery
disease, 86 (39.3%) were smokers,
Dyslipidaemia was diagnosed in 25
(11.4%) patients, 93 (42.5%) patients were
hypertensive, 82 (37.6%) patients were
suffering from diabetes mellitus.
Myocardial bridging (MB) was diagnosed in
only 18 (8.2%) patients. There was no
effect of confounder variables on the
frequency of MB.

12. CONCLUSION
▪ Using these advantages of CTCA, frequency of myocardial bridging in
our study was 8.2% in coronary artery disease patients.
▪ We can visualize the length and depth of the bridging artery and also
measure the percentage and diameter of stenosis in the segment
presenting myocardial bridging in diastolic and systolic phases.
▪ CTCA is an emerging non-invasive alternative test for the diagnosis of
myocardial bridging.

13. ▪ No correlation with age, sex, underlying risk factors , duration of
symptoms and family history to MB was noted in our analysis
▪ LAD is most effected coronary artery in our study
▪ One out of every 12 patients has MB in our statical analysis by CCTA

14. Study Limitation and Future Direction
To determine the true incidence of myocardial bridging, one that is in
accordance with its incidence at autopsy, both groups of myocardial
bridging revealed by CTA should be included; nonetheless, the results
of the present study suggest that full encasement of the LAD by
myocardium, regardless of measurable overlying muscle, is useful for
more accurately detecting the type of myocardial bridging that is likely
to produce dynamic compression

15. Acknowledgment
▪ Syed Haseeb Raza MBBS, FCPS
▪ Han Naung Tun MBBS, MD
▪ Masood Ahmed Khan , MBBS, FCPS
▪ Tariq Abbas1,MBBS, FRCP,FCPS
▪ Nisar Ahmed, MBBS, FCPS
▪ Muhammad Zubair Zaffar, MBBS, FCPS

16. Thank You