Myocardial Bridging: Diagnosis, Functional Assessment, and Management
Why the study?
Although traditionally considered benign, specific subsets of myocardial bridging are associated with ischemic symptoms, and contemporary imaging modalities have dramatically improved the understanding of its dynamic pathophysiology.
Structured PICO
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Population
Patients with myocardial bridging
This review provides a contemporary overview of the epidemiology, pathobiology, diagnosis, functional assessment, and management of myocardial bridging.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
JGJoanna GhobrialInterventional director, Adult Congenital Heart Disease, Cleveland Clinic
“Our understanding of this condition has certainly evolved from the days of assuming most cases to be benign, but now that we have more accurate tests and treatments, we need larger-scale data to guide clinicians on when and how to treat.”
“Previous studies have established coronary CTA as far superior to invasive coronary angiography in determining the anatomy of the bridging. The jury is still out on the best functional testing approach.”
“A good number of people are born with this condition, and yet many of them never present with symptoms, and we only find out incidentally or after death. For those who do present with symptoms, we should perform both anatomic and functional testing to determine whether they are a fit for surgery.”
Implication
Symptomatic MB warrants nuanced evaluation beyond anatomy; leaves open optimal functional testing and management pending larger trials.
Abstract
Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of the epicardial coronary artery traverses through the myocardium for a portion of its length. The muscle overlying the artery is termed a myocardial bridge, and the intramyocardial segment is referred to as a tunneled artery. MB can occur in any coronary artery, although is most commonly seen in the left anterior descending artery. Although traditionally considered benign in nature, increasing attention is being given to specific subsets of MB associated with ischemic symptomatology. The advent of contemporary functional and anatomic imaging modalities, both invasive and noninvasive, have dramatically improved our understanding of dynamic pathophysiology associated with MBs. This review provides a contemporary overview of epidemiology, pathobiology, diagnosis, functional assessment, and management of MBs.
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Cite This Study
Sternheim et al. (2021) studied this question.