Abstract
In myocardial bridging (MB) a segment of the coronary artery is covered by the myocardium. MB can be seen as a systolic compression by invasive coronary angiography (ICA) or as an intramural course by computed tomography angiography (CTA). Intramural course is a common incidental finding in CTA studies. Only minority of the bridging segments are associated with systolic compression causing a possible impairment of myocardial perfusion. The relationship between myocardial blood flow and MB is complex and poorly evaluated by anatomic imaging. Furthermore, provocation tests are frequently needed to uncover systolic compression. Fractional flow reserve can be used to assess the hemodynamic significance of MB. Nuclear perfusion imaging can demonstrate flow abnormalities associated with MB. Stress echocardiography can demonstrate ischemic wall motion abnormalities. They can be complemented by hybrid imaging with CTA to distinguish epicardial coronary artery disease and MB. This article will review different imaging modalities for the evaluation of the physiologic significance of MB.
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Acknowledgments
The study was financially supported by the Academy of Finland Centre of Excellence on Cardiovascular and Metabolic Diseases, the Finnish Foundation for Cardiovascular Research, and the Turku University Hospital.
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Valtteri Uusitalo declares no conflict of interest.
Antti Saraste reports personal fees from GE, Novartis, Abbott, Actelion, and Lilly.
Juhani Knuuti reports grants from Cardirad Oy and personal fees from GE Healthcare.
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Uusitalo, V., Saraste, A. & Knuuti, J. Multimodality Imaging in the Assessment of the Physiological Significance of Myocardial Bridging. Curr Cardiol Rep 18, 2 (2016). https://doi.org/10.1007/s11886-015-0685-6
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DOI: https://doi.org/10.1007/s11886-015-0685-6