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Non-invasive imaging of myocardial bridge by coronary computed tomography angiography: the value of transluminal attenuation gradient to predict significant dynamic compression

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Abstract

Objectives

To study the diagnostic value of transluminal attenuation gradient (TAG) measured by coronary computed tomography angiography (CCTA) for identifying relevant dynamic compression of myocardial bridge (MB).

Methods

Patients with confirmed MB who underwent both CCTA and ICA within one month were retrospectively included. TAG was defined as the linear regression coefficient between luminal attenuation and distance. The TAG of MB vessel, length and depth of MB were measured and correlated with the presence and degree of dynamic compression observed at ICA. Systolic compression ≧50 % was considered significant.

Results

302 patients with confirmed MB lesions were included. TAG was lowest (-17.4 ± 6.7 HU/10 mm) in patients with significant dynamic compression and highest in patients without MB compression (-9.5 ± 4.3 HU/10 mm, p < 0.001). Linear correlation revealed relation between the percentage of systolic compression and TAG (Pearson correlation, r = -0.52, p < 0.001) and no significant relation between the percentage of systolic compression and MB depth or length. ROC curve analysis determined the best cut-off value of TAG as -14.8HU/10 mm (area under curve = 0.813, 95 % confidence interval = 0.764-0.855, p < 0.001), which yielded high diagnostic accuracy (82.1 %, 248/302).

Conclusions

The degree of ICA-assessed systolic compression of MB significantly correlates with TAG but not MB depth or length.

Key Points

• TAG is associated with the extent of dynamic compression of MB.

• TAG is superior to depth and length for identifying dynamic compression.

• Cut-off value of TAG as -14.8HU/10 mm yielded high predictive value.

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Abbreviations

CCTA:

Coronary computed tomography angiography

CPR:

Curved planar reformation

ICA:

Invasive coronary angiography

LAD:

Left anterior descending

MB:

Myocardial bridge

PCI:

Percutaneous coronary intervention

TAG:

Transluminal attenuation gradient

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Acknowledgments

This study is funded by National Development Project of Key Clinical Department. The scientific guarantor of this publication is Dr. Jiayin Zhang. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by National Natural Science Foundation of China (Grant No.: 81301219) and Shanghai Committee of Science and Technology, China (Grant No.: 13ZR1431500). No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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    Authors and Affiliations

    1. Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No.600, Yishan Rd, Shanghai, 200233, China

      Yuehua Li, Mengmeng Yu, Jiayin Zhang & Minghua Li

    2. Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, #600, Yishan Rd, Shanghai, China

      Zhigang Lu & Meng Wei

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    1. Yuehua Li
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    2. Mengmeng Yu
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    3. Jiayin Zhang
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    4. Minghua Li
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    Correspondence to Jiayin Zhang.

    Additional information

    Mengmeng Yu is the co-first author

    Yuehua Li and Mengmeng Yu contributed equally to this work.

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    Li, Y., Yu, M., Zhang, J. et al. Non-invasive imaging of myocardial bridge by coronary computed tomography angiography: the value of transluminal attenuation gradient to predict significant dynamic compression. Eur Radiol 27, 1971–1979 (2017). https://doi.org/10.1007/s00330-016-4544-7

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    • DOI: https://doi.org/10.1007/s00330-016-4544-7

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