Cầu cơ động mạch vành tỷ lệ hiện mắc, đặc điểm lâm sàng và cận lâm sàng ở người việt nam

Prevalence and characteristics of myocardial
bridge in patients undergoing percutaneous

coronary angiography

BS Nguyễn Văn Tuấn - BVQY 103


INTRODUCTION
Myocardial bridge (MB): a muscle bridge over a segment of
the coronary arteries that leads to narrowing of coronary artery

Systolic

Diastolic


INTRODUCTION
 Prevalence:
• Autopsy: 5,4% ~ 85,7%*
• Angiography: 0,5% ~ 16%
 Clinical significance:

* Jorge R. Alegria (2005): Myocardial bridging, European Heart Journal 26, 1159-1168.


INTRODUCTION


INTRODUCTION

INTRODUCTION
Treatment of symptomatic patients:

• Negative inotropic and/or negative chronotropic agents: Betablocker, calcium antagonists.


OBJECTIVE

To investigate the prevalence, clinical and
paraclinical characteristics of myocardial bridge

in patients undergoing PCA


SUBJECTS AND METHODS
 SUBJECTS
1386 patients underwent PCA in Department of
Cardiology, Military Hospital 103 from 1/2013 to 3/2016

 METHODS
• Descriptive, cross – sectional.
• Clinical and paraclinical examination
• Percutaneous coronary angiography (PCA)


SUBJECTS AND METHODS
• Diagnosis of MB: Systolic compression of the artery
with narrowing of the lumen and diastolic relaxation.

• Grading of angina pectoris: Canadian Cardiovascular
Society (CCS) (1976)
• Assessment of coronary artery stenosis *
Mild: < 50%
Moderate: 50 – 74%
Severe: ≥ 75%
*Kern MJ (2013), “The interventional cardiac catheterization handbook third edition”.


RESULTS
Chart 1. Myocardial bridge prevalence
1291 pts
(93.2%)

no MB
MB

95 pts (6.8%)
. John R. Kramer (1982): 12% (PCA)
. Atar E (2007): 17% (MSCT)
. Lazoura O (2010): 21% (MSCT)


RESULTS
Table 1. General characteristic of participants (n = 95)
Variable

X ± SD or n (%)

Age (year)

61.85 ± 12.45

Male

77 (81.1%)

Concomitant
diseases

Hypertension

55 (57.9%)

Type 2 Diabetes
Mellitus

13 (13.7%)

Stable ischemic
heart disease

14 (14.73%)


RESULTS
Table 2. Grading of angina pectoris according to CCS (n = 81)

CCS

n (%)

1

35 (43.2%)

2

30 (37%)

3

15 (18.6%)

4

1 (1.2%)

Total

81 (100%)


RESULTS
Table 3. ECG characteristic (n = 81)

Variable
ECG

X ± SD or n (%)

Normal

61 (75.3%)

ST depression, T (-)

12 (14.8%)

ST elevation

8 (9.9%)

Li Wan (2005): Abnormal ECG occurred in 10% patients.


RESULTS
Table 4. Echocardiography characteristic (n = 81)
X ± SD or n (%)

Variable

Echocardiography

LVDd (mm)

46.74 ± 5.98

LVDs (mm)

29.95 ± 6.38

EF (%)

63.76 ± 10.50

Regional wall dyskinesia

6 (7.4%)

LV dilatation

17 (20.9%)


RESULTS
Chart 2. MB locations (n = 81)
1.20%
2.40%
LAD1
LAD2
LAD3
LCX
RCA
OTHERS

2.40% 3.60%

30.10%

Atar E (2007): 60% MB in LAD
Lazoura O (2010): 100% MB in LAD, 68% in LAD2

60.30%


RESULTS
Table 5. The degree of systolic coronary stenosis caused by MB (n = 81)

Degree

n (%)

Mild (< 50%)

52 (64.19%)

Moderate (50-74%)

20 (24.69%)

Severe
Total

75-89%

4 (4.95%)

≥ 90%

5 (6.17%)
81 (100%)


RESULTS
Table 6. The relation between angina and coronary artery stenosis degree
(n = 81)

CCS 1-2

Mild and
Moderate
stenosis (n(%))

Severe stenosis
(n(%))

58 (71.6%)

7 (8.6%)

p

> 0.05
CCS 3-4

14 (17.3%)

2 (2.5%)

CONCLUSION
 The prevalence of MB is 6.8% of patients
undergoing percutaneous coronary angiography.
 Most of MB was found in LAD
 There was no relation between angina and
coronary artery stenosis degree