Yonsei Med J.  2017 Jan;58(1):67-74. 10.3349/ymj.2017.58.1.67.

High Prevalence and Clinical Implication of Myocardial Bridging in Patients with Early Repolarization

• Seo J
• Park J
• Oh J
• Uhm JS
• Sung JH
• Kim JY
• Pak HN
• Lee MH
• Joung B

• KMID: 2374190
• DOI: http://doi.org/10.3349/ymj.2017.58.1.67

Abstract

PURPOSE
Recent evidence suggests that early repolarization (ER) is related with myocardial ischemia. Compression of coronary artery by a myocardial bridging (MB) can be associated with clinical manifestations of myocardial ischemia. This study aimed to evaluate the associations of MB in patients with ER.
MATERIALS AND METHODS
In consecutive patients (n=1303, age, 61±12 years) who had undergone coronary angiography, we assessed the prevalence and prognostic implication of MB in those with ER (n=142) and those without ER (n=1161).
RESULTS
MB was observed in 54 (38%) and 196 (17%) patients in ER and no-ER groups (p<0.001). In multivariate analysis, MB was independently associated with ER (odd ratio: 2.9, 95% confidence interval: 1.98-4.24, p<0.001). Notched type ER was more frequently observed in MB involving the mid portion of left anterior descending coronary artery (LAD) (69.8% vs. 30.2%, p=0.03). Cardiac event was observed in nine (6.3%) and 22 (1.9%) subjects with and without ER, respectively. MB was more frequently observed in sudden death patients with ER (2 out of 9, 22%) than in those without ER (0 out of 22).
CONCLUSION
MB was independently associated with ER in patients without out structural heart disease who underwent coronary angiography. Notched type ER was closely related with MB involving the mid portion of the LAD. Among patients who had experienced cardiac events, a higher prevalence of MB was observed in patients with ER than those without ER. Further prospective studies on the prognosis of MB in ER patients are required.

Keyword

Early repolarization; myocardial bridging; sudden cardiac death; tachycardia; ventricular; ventricular fibrillation

MeSH Terms

Aged
Coronary Angiography
Electrocardiography
Electrophysiological Phenomena
Female
Humans
Male
Middle Aged
Myocardial Bridging/*complications/*diagnostic imaging/epidemiology/physiopathology
Myocardial Ischemia/*etiology/physiopathology
Odds Ratio
Prevalence
Prognosis
Prospective Studies

Figure

• 

  Fig. 1 Coronary angiography in a 58-year-old male patient, who had chest pain caused by myocardial bridging. (A) Diastole, (B) Systole. Note the systolic compression of LAD coronary artery. LAD, left anterior descending coronary artery.

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  Fig. 2 The relationship between the location of MB and type of ER. (A) ECG of another sudden cardiac death patient who had prominent notched J point elevation (black arrows) and MB in the mid LAD (white arrows). (B) Early repolarization in a 29-year-old female patient, who had aborted sudden cardiac death caused by ventricular fibrillation. An ECG shows the prominent slurred J point elevation (black arrows) and MB in the distal LAD (white arrows). MB, myocardial bridging; ER, early repolarization; ECG, electrocardiography; LAD, left anterior descending coronary artery.

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