Brief Article
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World J Cardiol. Nov 26, 2013; 5(11): 434-441
Published online Nov 26, 2013. doi: 10.4330/wjc.v5.i11.434
Myocardial bridging analysis by coronary computed tomographic angiography in a Saudi population
Ragab Hani Donkol, Zizi Saad
Ragab Hani Donkol, Radiology Department, Aseer Central Hospital, Abha, Saudi Arabia and Faculty of Medicine, Cairo University, 11559, Cairo, Egypt
Ragab Hani Donkol, Department of Radiology, Faculty of Medicine, Cairo University and Assir Central Hospital, Abha 61321, Saudi Arabia
Zizi Saad, Cardiology Department, Aseer Central Hospital, Abha, Saudi Arabia and Faculty of Medicine, Zagazig University, 44519 Zagazig, Egypt
Author contributions: Donkol RH designed the study, performed CCTA studies, analyzed the data and wrote the manuscript; Saad Z shared in the manuscript writing, selection of cases, clinical and echocardiographic assessment, as well as collected data and interpreted CCTA scans.
Correspondence to: Ragab Hani Donkol, MD, Department of Radiology, Faculty of Medicine, Cairo University and Assir Central Hospital, PO Box 34, Abha 61321, Saudi Arabia. ragabhani@hotmail.com
Telephone: +966-72-291169 Fax: +966-38-552244
Received: April 24, 2013
Revised: October 11, 2013
Accepted: October 17, 2013
Published online: November 26, 2013
Processing time: 223 Days and 10.1 Hours
Abstract

AIM: To assess the incidence, location, morphology and clinical association of myocardial bridging in a Saudi population using coronary computed tomographic angiography (CCTA).

METHODS: A total of 350 CCTA of Saudi patients were included in this study (236 men, 114 women) with a mean age of 56.3 years. All patients were examined for appropriateness criteria of CCTA indications (typical chest pain, recent onset cardiomyopathy, left bundle branch block, etc.). The scans were retrospectively reviewed for the presence of myocardial bridging and any other pathological association.

RESULTS: Myocardial bridging was found in 89 of 350 (22.5%) patients. Most of the intramuscular segments were of the superficial type and found in the mid left anterior descending (LAD) (24.6%), followed by distal LAD (3.7%), diagonal branches (2%), ramus intermedius artery (1.4%) and obtuse marginal artery (0.8%). No myocardial bridging was detected in the right coronary or circumflex arteries. No significant differences were found between males and females (P = 0.14). Coronary artery atherosclerosis was found in 51 of 89 (57.3%) patients with MB. Atherosclerotic plaques were not detected in the intramuscular or distal segment of bridging arteries. Dynamic compression was observed in 35 (94.5%) patients with full encasement. No evidence of myocardial hypoperfusion was found in the territories supplied by the bridging arteries.

CONCLUSION: CCTA is excellent in analyzing myocardial bridging in a Saudi population and the results are comparable to other populations. However, finding the real incidence may need a large multicenter study.

Keywords: Coronary heart disease, Myocardial bridging, Coronary computed tomographic angiography, Coronary arteries anatomy, Coronary atherosclerosis

Core tip: A great revolution has happened in imaging of coronary arteries with multi-detector computed tomography. Myocardial bridging is considered a benign anomaly, but in exceptional incidences, it is associated with clinical manifestations. By reviewing the current literature, there is no research studying the prevalence of myocardial bridging (MB) in a Saudi population. This study is considered the first to investigate the prevalence of MB in a Saudi population and its clinical significance in 350 patients. The study highlighted that coronary computed tomographic angiography offers an excellent way to detect and characterize MB and the national prevalence of MB and its anatomical and clinical findings in Saudi Arabia is comparable to worldwide prevalence.