Symptomatic myocardial bridges in youngs and middle age patients: clinical presentation, risk factors and prognosis - single center experience

Abstract Abstract Muscular bridge (MB) has traditionally being considered benign in nature. Increasing attention is being given to those associated with ischemic symptomatology. The advent of imaging modalities both invasive and noninvasive, have dramatically improved knowledge. Little is known of risk factors and prognosis. We aimed to investigate presence and control of risk factors, clinical presentation and prognosis of MB in symptomatic patient population under 50 years in Our Institute. Methods and results We conducted a retrospective study from 20211 to 2024. Out of 468 patients with MB, 38 were under the age of 50. The majority were males (18pts). MB were presented as ANOCA (33 pts), STEMI ( in three pts) and NSTEMI in three. Concomitant atherosclerotic cardiovascular disease was present in 4 patients in whom percutaneous coronary intervention with stent implantation was performed in right coronary artery. In 3 patients atrial fibrillation ablation was performed and alcohol septal ablation for HCM in one. Majority ANOCA pts had positive exercise test for ischemia and/or MB detected by MsCT angiography. Coronary angiography detected systolic narrowing of medial LAD from 30 to 90% in 99% of pts. One patient had 40% of systolic narrowing of RCA. All pts were presented to our heart team. Medical therapy was adviced (beta blockers and calcium channel blockers if tolerated. Among risk factors, smoking was highly present( 82%) followed by dyslipidemia (72%, poor control with mean LDL 3.1 ± 0.86mmol/l) and hypertension (45%). In the follow up, 25% of patients return for chest pain reevaluation. None had MACE. Conclusions MB may present underlying etiology in symptomatic young and middle age patients. Better risk factors control and individual physical activity prescription might be of help. Further studies are needed.