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Incidence and OCT characteristics of myocardial bridge and its cyclic changes

Session Poster session 1

Speaker Akihiko Okamura

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : H Okura (Kashihara,JP), A Okamura (Kashihara,JP), T Ueda (Kashihara,JP), D Kamon (Kashihara,JP), Y Kita (Kashihara,JP), T Isojima (Kashihara,JP), T Soeda (Kashihara,JP), M Watanabe (Kashihara,JP), Y Saito (Kashihara,JP)

H. Okura1 , A. Okamura1 , T. Ueda1 , D. Kamon1 , Y. Kita1 , T. Isojima1 , T. Soeda1 , M. Watanabe1 , Y. Saito1 , 1Nara Medical University, First Department of Internal Medicine - Kashihara - Japan ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 184

Background: Recently, myocardial bridge (MB) has been recognized as one of the pathophysiological conditions responsible for dynamic myocardial ischemis in patients without organic coronary artery stenosis. Previous intravascular ultrasound (IVUS) study demonstrated that IVUS may detect MB more frequently than angiography alone. Although intracoronary optical coherence tomography (OCT) has become frequently used, role of OCT in detectiong MB has not been elucidated.

Purpose: The aim of this study was to investigate incidence and characteristics of MB detected by optical coherence tomography (OCT). Furthermore, cyclic changes in coronary vessel wall was also studied.

Methods: A total of 86 distal left anterior descending artery (LAD) were enrolled and imaged by OCT. Angiography detectable myocardial bridge (MB-A) was defined as a “squeezing” of the LAD characterized by systolic compression and complete or partial release of the compression in diastole. By OCT, MB was defined as a segment of epicardial coronary artery having perivascular intermediate intensity (similar to that of media), fine band surrounding the artery (MB-O) (Figure). Length and arc of the band were measured by OCT. To further assess cyclic changes of the coronary vessel wall, vessel diameter (VD), lumen diameter (LD), adventitial thickness (AT), medial thickness (MT) and intimal thickness (IT) were measured at diastole and systole in 5 cases with MB-A.

Results: MB-A and MB-O were detected in 16 (19%) and 44 (51%) vessels, respectively. MB-O was present 16 of 16 vessels (100%) with MB-A and in 28 of 70 vessels (40%) without MB-A (P<0.01). Arc of MB was significantly larger and length was singnificantly longer (both P=0.01) in vessels with MB-A. During systole, VA and LA decreased significantly (both P<0.05). Although AT and IT did not change, MT increased significantly (0.08±0.01 vs. 0.12±0.01 mm, P<0.05). As a result, MT/AT ratio was significantly higher in systole than in diastole.

Conclusions: OCT more frequenty detects MB than angiography. Longitudinal and axial distribution of the MB were related to angiopgraphically detectable MB. In MB lesion, vessel and lumen size decrease during systole with increased medial thickness. Impact of OCT detectable MB on plaque vulnerability as well as clinical outcome needs further investigation.

Figure 1

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