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Relation between severity of myocardial bridge and vasospasm

Session Poster session 1

Speaker Yuichi Saito

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 : Y Saito (Chiba,JP), H Kitahara (Chiba,JP), T Shoji (Chiba,JP), S Tokimasa (Chiba,JP), T Nakayama (Chiba,JP), K Sugimoto (Chiba,JP), Y Fujimoto (Chiba,JP), Y Kobayashi (Chiba,JP)

Authors:
Y. Saito1 , H. Kitahara1 , T. Shoji1 , S. Tokimasa1 , T. Nakayama1 , K. Sugimoto1 , Y. Fujimoto1 , Y. Kobayashi1 , 1Chiba University Graduate School of Medicine, Department of Cardiovascular Medicine - Chiba - Japan ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 188-189

Background: Myocardial bridge (MB) was reported to induce cardiac complications including coronary vasospasm. Although MB has some anatomical and morphological variations, the association of these variations with vasospasm is unclear.

Purpose: The aim of this study was to investigate the relation between morphological severity of MB and vasospasm induced by acetylcholine (ACh) provocation test.

Methods: A total of 392 patients without coronary stent in the left anterior descending artery (LAD) undergoing intracoronary ACh provocation test were included. Angiographic coronary artery vasospasm was defined as total or subtotal occlusion induced by ACh provocation. MB was identified on coronary angiography as a milking effect. The bridged length and percent systolic compression of MB in the LAD were analyzed quantitatively.

Results: MBs in the LAD were identified in 140 patients (36%), mostly in the mid segment. Patients with MB in the LAD had greater number of provoked vasospasm in the LAD compared to those without (61% vs. 39%, p<0.001). The bridged length positively correlated with percent systolic compression of MB (r=0.37, p<0.001). In the receiver operating characteristic curve analysis, both bridged length and percent systolic compression of MB significantly predicted the provoked LAD spasm (AUC 0.74, p<0.001, and AUC 0.68, p<0.001). Multivariate regression analysis demonstrated these factors as independent predictors for the provoked LAD spasm.

Conclusion: MB, especially severe MB, may induce more coronary vasospasm.

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