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Fractional flow reserve derived from CCTA may have a prognostic role in myocardial bridging



To evaluate the feasibility of fractional flow reserve (cFFR) derivation from coronary CT angiography (CCTA) in patients with myocardial bridging (MB), its relationship with MB anatomical features, and clinical relevance.


This retrospective study included 120 patients with MB of the left anterior descending artery (LAD) and 41 controls. MB location, length, depth, muscle index, instance, and stenosis rate were measured. cFFR values were compared between superficial MB (≤ 2 mm), deep MB (> 2 mm), and control groups. Factors associated with abnormal cFFR values (≤ 0.80) were analyzed.


MB patients demonstrated lower cFFR values in MB and distal segments than controls (all p < 0.05). A significant cFFR difference was only found in the MB segment during systole between superficial (0.94, 0.90–0.96) and deep MB (0.91, 0.83–0.95) (p = 0.018). Abnormal cFFR values were found in 69 (57.5%) MB patients (29 [49.2%] superficial vs. 40 [65.6%] deep; p = 0.069). MB length (OR = 1.06, 95% CI 1.03–1.10; p = 0.001) and systolic stenosis (OR = 1.04, 95% CI 1.01–1.07; p = 0.021) were the main predictors for abnormal cFFR, with an area under the curve of 0.774 (95% CI 0.689–0.858; p < 0.001). MB patients with abnormal cFFR reported more typical angina (18.8% vs 3.9%, p = 0.023) than patients with normal values.


MB patients showed lower cFFR values than controls. Abnormal cFFR values have a positive association with symptoms of typical angina. MB length and systolic stenosis demonstrate moderate predictive value for an abnormal cFFR value.

Key Points

• MB patients showed lower cFFR values than controls.

• Abnormal cFFR values have a positive association with typical angina symptoms.

• MB length and systolic stenosis demonstrate moderate predictive value for an abnormal cFFR value .

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Area under the curve


Coronary artery disease


Coronary computed tomography angiography


Computational fluid dynamics


CCTA-derived fractional flow reserve




Left anterior descending coronary artery


Myocardial bridging


Odds ratio


Receiver operating characteristic


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This study has received funding by The National Key Research and Development Program of China (2017YFC0113400 for L.J.Z.).

Author information



Corresponding author

Correspondence to Long Jiang Zhang.

Ethics declarations


The scientific guarantor of this publication is Long Jiang Zhang.

Conflict of interest

UJS is a consultant for and/or receives research support from Astellas, Bayer, General Electric, Guerbet, HeartFlow, and Siemens Healthineers. The other authors have no conflicts of interest to disclose.

Statistics and biometry

Meng Jie Lu has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational

• performed at one institution

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Cite this article

Zhou, F., Tang, C.X., Schoepf, U.J. et al. Fractional flow reserve derived from CCTA may have a prognostic role in myocardial bridging. Eur Radiol 29, 3017–3026 (2019).

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  • Computed tomography angiography
  • Fractional flow reserve
  • Myocardial bridging