Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2019; 7(15): 1986-1995
Published online Aug 6, 2019. doi: 10.12998/wjcc.v7.i15.1986
Myocardial bridge-related coronary heart disease: Independent influencing factors and their predicting value
Dong-Hui Zhao, Qian Fan, Jun-Xia Ning, Xin Wang, Jia-Yu Tian
Dong-Hui Zhao, Qian Fan, Xin Wang, Jia-Yu Tian, Department of Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing 100029, China
Jun-Xia Ning, Department of Cardiology, The First People's Hospital of Pingyuan County, Dezhou 253100, Shandong Province, China
Author contributions: Zhao DH, Fan Q, and Ning JX designed the research; Zhao DH, Wang X, and Tian JY performed the research; Fan Q and Ning JX contributed new reagents/analytic tools; Zhao DH, Wang X, and Tian JY analyzed the data; and Zhao DH, Ning JX, and Tian JY wrote the paper.
Institutional review board statement: The study was approved by the Ethics Committee of Beijing Anzhen Hospital Affiliated to Capital Medical University.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Dong-Hui Zhao, MD, Doctor, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China. zhaodonghui3486@126.com
Telephone: +86-10-64456548
Received: March 26, 2019
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
Processing time: 134 Days and 4.7 Hours
Abstract
BACKGROUND

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.

AIM

To explore the main influencing factors of MB-related CHD and to find potential indicators for predicting MB-related CHD.

METHODS

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.

RESULTS

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%.

CONCLUSION

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.

Keywords: Myocardial bridge; Coronary heart disease; Mural coronary artery; Computed tomography coronary angiography; Independent influencing factor

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.