Key result
In patients with apical hypertrophic cardiomyopathy, myocardial bridging was associated with a higher rate of cardiovascular events (26.5% vs. 12%; p=0.016) and emerged as an independent risk factor.
Why the study?
Does the presence of myocardial bridging increase cardiovascular events and mortality in patients with apical hypertrophic cardiomyopathy?
Cohort (n=168)
Does the presence of myocardial bridging increase cardiovascular events and mortality in patients with apical hypertrophic cardiomyopathy?
In patients with apical hypertrophic cardiomyopathy, the presence of myocardial bridging is an independent risk factor for cardiovascular events and is associated with more severe symptoms and structural abnormalities.
Answers are grounded in this paper and cite their sources.
MB in AHCM signals higher CV event risk; extends evidence for bridging as a prognostic modifier.
Objective: We sought to determine the prevalence and clinical effects of myocardial bridging in patients with apical hypertrophic cardiomyopathy (AHCM). Methods: Angiograms or multidetector computed tomography from 213 patients with AHCM were reviewed to determine whether myocardial bridging (MB) was present and they were classified into two groups: AHCM with MB and AHCM without MB. We also reviewed patients' information regarding cardiovascular (CV) risk factors, symptoms, and occurrence of CV events and mortality. Results: Of the 213 AHCM patients, 68 patients with MB and 100 patients without MB were included while 45 patients with coronary artery disease (CAD) were excluded. The diagnostic age (48.8±10.1 vs. 54.6±9.5 y; p=0.43) and males (82.4% vs. 79%; p=0.5913) were similar between AHCM patients with MB and without MB. Patients with MB were accompanied with more serious symptoms, including higher rates of stethalgia (63.2% vs. 40%; p=0.003) and New York Heart Association (NYHA) III/IV (14.7% vs. 4%; p=0.01), and induced a higher misdiagnosis rate of non-ST-elevation myocardial infarction (NSTEMI) (32.4% vs. 4%) than patients without MB. And patients with MB were associated with higher prevalence of mixed type of AHCM (52.9% vs. 31%; p=0.002), apical aneurysm (5.9% vs. 0%; p=0.025), apical hypokinesis (16.2% vs. 1%; p=0.0006), apical obliteration (27.9% vs. 12%; p=0.04), deep T-wave inversion (TWI) (70% vs. 46%; p=0.001) and late Gadolinium Enhancement (LGE) positive (28.6% vs. 12.3%; p=0.02). The mean follow-up periods (56.9±49.9 vs. 55.7±45 months, p=0.378) and cardiovascular mortality (2.9% vs. 2%; p=0.9) were similar between AHCM patients with MB and without MB. Patients with MB had higher rates of CV events (26.5% vs. 12%; p=0.016) and readmission (32.4% vs. 3) than patients without MB. The presence of MB, female and LGE emerged as independent risk factors for CV events in univariate and multivariate Cox regression analysis after adjusting for other CV risk factors.
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Zhai et al. (2017) conducted a cohort in Apical hypertrophic cardiomyopathy (AHCM) (n=168). Myocardial bridging vs. No myocardial bridging was evaluated on Cardiovascular events (p=0.016). In patients with apical hypertrophic cardiomyopathy, myocardial bridging was associated with a higher rate of cardiovascular events (26.5% vs. 12%; p=0.016) and emerged as an independent risk factor.
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