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Detection of myocardial bridge by optical coherence tomography

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Abstract

Myocardial bridge (MB) is less commonly documented by angiography than autopsy. Optical coherence tomography (OCT) may be useful to detect angiographically undetectable MB. To investigate OCT characteristics of MB, 86 LAD vessels were imaged by OCT. MB was defined as presence of intermediate optical intensity, “fine” layer surrounding coronary artery by OCT. Frequency and characteristics of the angio-detectable and angio-undetectable but OCT-detectable MB were investigated. In a subset of patients with angio-detectable MB, cyclic changes in coronary arterial dimensions were analyzed. OCT detected MB in 44 of 86 (51%). Arc of the MB was significantly larger (334.8 ± 58.5° vs. 268.4 ± 92.1°, P = 0.008) and length was significantly longer (22.6 ± 11.7 mm vs. 14.5 ± 8.1 mm, P = 0.014) in angio-detectable MB than OCT-detectable but angio-undetectable MB. Both vessel (6.8 ± 1.5 to 5.3 ± 1.0 mm2, P = 0.035) and lumen area (4.4 ± 1.5 to 3.1 ± 0.7 mm2, P = 0.040) decreased significantly from diastole to systole. Adventitial (0.08 ± 0.03 to 0.08 ± 0.02 mm, P = 0.828) and intima + plaque thickness (0.12 ± 0.05 to 0.10 ± 0.03 mm, P = 0.398) did not change significantly during cardiac cycle. On the other hand, medial thickness increased significantly from diastole to systole (0.08 ± 0.03 to 0.12 ± 0.03 mm, P = 0.022). In conclusion, MB is frequently detected as intermediate intensity, fine layer by OCT. During systole, vessel and lumen size decrease with increased medial thickness. Therefore, we should be careful for OCT interpretation of the coronary arteries with MB.

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  1. Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan

    Akihiko Okamura, Hiroyuki Okura, Saki Iwai, Atsushi Kyodo, Daisuke Kamon, Yukihiro Hashimoto, Tomoya Ueda, Tsunenari Soeda, Makoto Watanabe & Yoshihiko Saito

  2. Department of Cardiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan

    Hiroyuki Okura

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  1. Akihiko Okamura
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Video 1. Fixed OCT/OFDI image of the coronary arterial segment with MB. Fixed (=no pullback) OFDI image of the coronary arterial segment with myocardial bridge showing cyclic compression and deformation of the coronary artery. Supplementary material 1 (MP4 915.8 kb)

Video 2. Coronary angiogram showing MB of the distal LAD. Supplementary material 2 (MP4 571.3 kb)

Video 3. OCT pullback image of the LAD with MB. Lumen narrowing was evident by OCT pullback imaging. Note that the stenotic lesions were surrounded by myocardial tissue (intermediate optical intensity, fine layer similar to media) and thickening of the media. Supplementary material 3 (MP4 956.7 kb)

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Okamura, A., Okura, H., Iwai, S. et al. Detection of myocardial bridge by optical coherence tomography. Int J Cardiovasc Imaging 38, 1169–1176 (2022). https://doi.org/10.1007/s10554-021-02497-5

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