Prevalence and Characteristics of Intramural Coronary Artery in Hypertrophic Obstructive Cardiomyopathy: a Coronary Computed Tomography and Invasive Angiography Study

Overview

Journal Quant Imaging Med Surg

Specialty Radiology

Date 2021 Jan 4

PMID 33392019

Citations 2

Authors

Changsheng Zhu

Shuiyun Wang

Shengwei Wang

Yanhai Meng

Qiulan Yang

Changrong Nie

Hongtao Sun

Affiliations

Soon will be listed here.

Abstract

Background: The prevalence and morphologic characteristics of intramural coronary artery (ICA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) have yet to be fully illuminated. Our study aimed to investigate the prevalence and morphologic characteristics of ICA in patients with HOCM using coronary computed tomography (CT) angiography and invasive coronary angiography.

Methods: Patients with a diagnosis of HOCM who were admitted for selective myectomy in Fuwai Hospital were prospectively enrolled between September 2015 and June 2019. Both preoperative coronary CT and invasive angiography were scheduled for all participants.

Results: Coronary CT angiography detected ICA in 106 (23.3%) out of 455 patients. Dynamic compression of coronary arteries was observed in 87 patients (19.1%) by invasive coronary angiography. We found ICA covered with complete myocardial encasement in 98 patients (92.5%), with deep myocardial bridging (MB) observed most frequently (P=0.005). All patients with dynamic compression of coronary arteries had ICA. Dynamic luminal reduction ≥50% was present in 77 (16.9%) of the study participants. Pearson's correlation analysis revealed that the length and degree of dynamic compression were significantly related with MB length and depth (Pearson's correlation r=0.241, 0.581, 0.316, and 0.209; P=0.014, <0.001, 0.002, and 0.032, respectively).

Conclusions: Patients with HOCM commonly present with ICA and it can be visualized well by coronary CT angiography. Deep or extensive MB is more likely to produce coronary artery dynamic compression. Preoperative identification of this congenital coronary artery variant may be helpful for surgical planning.

Citing Articles

Morphology of hypertrophied basal septum contributes to left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a retrospective case-control study.

Tao J, Li H, Yang P, Meng Q, Duan F, Wang H Quant Imaging Med Surg. 2023; 13(7):4117-4129.

PMID: 37456278 PMC: 10347344. DOI: 10.21037/qims-22-1034.

Prognostic value of regional strain by cardiovascular magnetic resonance feature tracking in hypertrophic cardiomyopathy.

Chen X, Pan J, Shu J, Zhang X, Ye L, Chen L Quant Imaging Med Surg. 2022; 12(1):627-641.

PMID: 34993107 PMC: 8666725. DOI: 10.21037/qims-21-42.

References

Konen E, Goitein O, Sternik L, Eshet Y, Shemesh J, Segni E . The prevalence and anatomical patterns of intramuscular coronary arteries: a coronary computed tomography angiographic study. J Am Coll Cardiol. 2007; 49(5):587-93. DOI: 10.1016/j.jacc.2006.09.039. View

Mohiddin S, Begley D, Shih J, Fananapazir L . Myocardial bridging does not predict sudden death in children with hypertrophic cardiomyopathy but is associated with more severe cardiac disease. J Am Coll Cardiol. 2000; 36(7):2270-8. DOI: 10.1016/s0735-1097(00)00987-6. View

Shariat M, Thavendiranathan P, Nguyen E, Wintersperger B, Paul N, Rakowski H . Utility of coronary CT angiography in outpatients with hypertrophic cardiomyopathy presenting with angina symptoms. J Cardiovasc Comput Tomogr. 2014; 8(6):429-37. DOI: 10.1016/j.jcct.2014.09.007. View

Lu J, Lv B, Chen X, Tang X, Jiang S, Dai R . What is the best contrast injection protocol for 64-row multi-detector cardiac computed tomography?. Eur J Radiol. 2009; 75(2):159-65. DOI: 10.1016/j.ejrad.2009.04.035. View

Kitazume H, Kramer J, Krauthamer D, El Tobgi S, Proudfit W, SONES F . Myocardial bridges in obstructive hypertrophic cardiomyopathy. Am Heart J. 1983; 106(1 Pt 1):131-5. DOI: 10.1016/0002-8703(83)90450-7. View

Sorajja P, Ommen S, Nishimura R, Gersh B, Tajik A, Holmes D . Myocardial bridging in adult patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 2003; 42(5):889-94. DOI: 10.1016/s0735-1097(03)00854-4. View

Elliott P, Anastasakis A, Borger M, Borggrefe M, Cecchi F, Charron P . 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014; 35(39):2733-79. DOI: 10.1093/eurheartj/ehu284. View

Yetman A, McCrindle B, MacDonald C, Freedom R, Gow R . Myocardial bridging in children with hypertrophic cardiomyopathy--a risk factor for sudden death. N Engl J Med. 1998; 339(17):1201-9. DOI: 10.1056/NEJM199810223391704. View

Corban M, Hung O, Eshtehardi P, Rasoul-Arzrumly E, McDaniel M, Mekonnen G . Myocardial bridging: contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies. J Am Coll Cardiol. 2014; 63(22):2346-2355. PMC: 4065198. DOI: 10.1016/j.jacc.2014.01.049. View

10.

Basso C, Thiene G, Mackey-Bojack S, Frigo A, Corrado D, Maron B . Myocardial bridging, a frequent component of the hypertrophic cardiomyopathy phenotype, lacks systematic association with sudden cardiac death. Eur Heart J. 2009; 30(13):1627-34. DOI: 10.1093/eurheartj/ehp121. View

11.

Tian T, Wang Y, Wang J, Sun K, Zou Y, Zhang W . Myocardial bridging as a common phenotype of hypertrophic cardiomyopathy has no effect on prognosis. Am J Med Sci. 2013; 347(6):429-33. DOI: 10.1097/MAJ.0000000000000194. View

12.

Gersh B, Maron B, Bonow R, Dearani J, Fifer M, Link M . 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011; 124(24):2761-96. DOI: 10.1161/CIR.0b013e318223e230. View

13.

Rubinshtein R, Gaspar T, Lewis B, Prasad A, Peled N, Halon D . Long-term prognosis and outcome in patients with a chest pain syndrome and myocardial bridging: a 64-slice coronary computed tomography angiography study. Eur Heart J Cardiovasc Imaging. 2013; 14(6):579-85. DOI: 10.1093/ehjci/jet010. View

14.

Maron B . Clinical Course and Management of Hypertrophic Cardiomyopathy. N Engl J Med. 2018; 379(7):655-668. DOI: 10.1056/NEJMra1710575. View

15.

Tarantini G, Cademartiri F . Myocardial bridging and prognosis: more evidence but jury still out. Eur Heart J Cardiovasc Imaging. 2013; 14(6):515-7. DOI: 10.1093/ehjci/jet021. View

16.

Yetman A, Hamilton R, Benson L, McCrindle B . Long-term outcome and prognostic determinants in children with hypertrophic cardiomyopathy. J Am Coll Cardiol. 1998; 32(7):1943-50. DOI: 10.1016/s0735-1097(98)00493-8. View

17.

Kunkala M, Schaff H, Burkhart H, Sandhu G, Spoon D, Ommen S . Outcome of repair of myocardial bridging at the time of septal myectomy. Ann Thorac Surg. 2013; 97(1):118-23. DOI: 10.1016/j.athoracsur.2013.07.079. View

18.

Dimitriu-Leen A, van Rosendael A, Smit J, van Elst T, van Geloven N, Maaniitty T . Long-Term Prognosis of Patients With Intramural Course of Coronary Arteries Assessed With CT Angiography. JACC Cardiovasc Imaging. 2017; 10(12):1451-1458. DOI: 10.1016/j.jcmg.2017.02.013. View

19.

Kim P, Hur G, Kim S, Namgung J, Hong S, Kim Y . Frequency of myocardial bridges and dynamic compression of epicardial coronary arteries: a comparison between computed tomography and invasive coronary angiography. Circulation. 2009; 119(10):1408-16. DOI: 10.1161/CIRCULATIONAHA.108.788901. View

20.

Tarantini G, Migliore F, Cademartiri F, Fraccaro C, Iliceto S . Left Anterior Descending Artery Myocardial Bridging: A Clinical Approach. J Am Coll Cardiol. 2016; 68(25):2887-2899. DOI: 10.1016/j.jacc.2016.09.973. View