Published online Aug 6, 2019. doi: 10.12998/wjcc.v7.i15.1986
Peer-review started: March 28, 2019
First decision: May 31, 2019
Revised: June 12, 2019
Accepted: July 3, 2019
Article in press: July 3, 2019
Published online: August 6, 2019
Myocardial bridge (MB) will compress the mural coronary artery (MCA) during the systole and cause myocardial ischemia. In the diagnosis of coronary heart disease (CHD), because the structure of MB is difficult to be observed by coronary angiography (CAG), the clinical study of the influence of MB on CHD is lacking. With the advancement of computed tomography coronary angiography technology, detailed observations of the MB anatomy have realized.
To explore the main influencing factors of MB-related CHD and to find potential indicators for predicting MB-related CHD.
A total of 1718 patients with suspected CHD due to the symptoms of myocardial ischemia were enrolled as subjects. Patients diagnosed with CHD were included in a CHD group, and patients with no significant abnormalities were included in a control group. In the CHD group, patients were divided into an MB-CHD subgroup if MB-related CHD was found. In the control group, patients were divided into a simple MB subgroup if MB was found. The patient's clinical data and MB-related indicators, including the branch of MB, MB type (superficial/deep type), MB length, MB thickness, systolic and diastolic compression of the MCA, and MCA systolic stenosis rate were recorded and compared. Logistic regression analysis was used to explore the independent influencing factors of MD-related CHD. ROC curve was used to analyze the diagnostic efficacy of potential indicators for MB-related CHD.
There were 1060 cases in the CHD group and 658 cases in the control group, and there were 236 cases in the MB-CHD subgroup and 52 cases in the simple MB subgroup. Multivariate logistic regression analysis showed that the combined MB had a significant effect on the occurrence of CHD (P < 0.05). MB thickness, systolic compression, diastolic compression, and MCA systolic stenosis rate had significant effects on the occurrence of MB-related CHD (P < 0.05). The area under the curve (AUC) of the combination of these influencing factors for the diagnosis of MB-related CHD was 0.959, which was significantly higher than the AUCs of the four indicators separately (P < 0.05). The sensitivity was 97.06% and the specificity was 87.63%.
MB thickness, systolic compression, diastolic compression, and MCA systolic stenosis are independent influencing factors for MB-related CHD. The combination of these factors has potential diagnostic value for MB-related CHD.
Core tip: With the deep understanding of myocardial bridge (MB), it is considered to be the reason of such complications as acute myocardial infarction, ventricular tachycardia, syncope, and sudden cardiac death. Currently, how MB affects coronary heart disease remains unclear. Computed tomography coronary angiography can directly measure MB-related coronary heart disease (CHD), which was used to explore the relationship between MB and CHD. In this study, MB thickness, systolic compression, diastolic compression, and mural coronary artery systolic stenosis were proved to be the independent influencing factors for MB-related CHD. The combination of these factors has potential diagnostic value for MB-related CHD.