Comprehensive functional and anatomic assessment of myocardial bridging: Unlocking the Gordian Knot
Myocardial bridging (MB) is the most frequent congenital coronary anomaly in which a segment of an epicardial coronary artery takes a tunneled course under a bridge of the myocardium. This segment is compressed during systole, resulting in the so-called “milking effect” at coronary angiography. As c...
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-11-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.970422/full |
| _version_ | 1798023295976603648 |
|---|---|
| author | Giuseppe Ciliberti Renzo Laborante Marco Di Francesco Attilio Restivo Gaetano Rizzo Mattia Galli Mattia Galli Francesco Canonico Andrea Zito Giuseppe Princi Rocco Vergallo Rocco Vergallo Antonio Maria Leone Antonio Maria Leone Francesco Burzotta Francesco Burzotta Carlo Trani Carlo Trani Vincenzo Palmieri Vincenzo Palmieri Paolo Zeppilli Paolo Zeppilli Filippo Crea Filippo Crea Domenico D’Amario Domenico D’Amario |
| author_facet | Giuseppe Ciliberti Renzo Laborante Marco Di Francesco Attilio Restivo Gaetano Rizzo Mattia Galli Mattia Galli Francesco Canonico Andrea Zito Giuseppe Princi Rocco Vergallo Rocco Vergallo Antonio Maria Leone Antonio Maria Leone Francesco Burzotta Francesco Burzotta Carlo Trani Carlo Trani Vincenzo Palmieri Vincenzo Palmieri Paolo Zeppilli Paolo Zeppilli Filippo Crea Filippo Crea Domenico D’Amario Domenico D’Amario |
| author_sort | Giuseppe Ciliberti |
| collection | DOAJ |
| description | Myocardial bridging (MB) is the most frequent congenital coronary anomaly in which a segment of an epicardial coronary artery takes a tunneled course under a bridge of the myocardium. This segment is compressed during systole, resulting in the so-called “milking effect” at coronary angiography. As coronary blood flow occurs primarily during diastole, the clinical relevance of MB is heterogeneous, being usually considered an asymptomatic bystander. However, many studies have suggested its association with myocardial ischemia, anginal symptoms, and adverse cardiac events. The advent of contemporary non-invasive and invasive imaging modalities and the standardization of intracoronary functional assessment tools have remarkably improved our understanding of MB-related ischemia, suggesting the role of atherosclerotic lesions proximal to MB, vasomotor disorders and microvascular dysfunction as possible pathophysiological substrates. The aim of this review is to provide a contemporary overview of the pathophysiology and of the non-invasive and invasive assessment of MB, in the attempt to implement a case-by-case therapeutic approach according to the specific endotype of MB-related ischemia. |
| first_indexed | 2024-04-11T17:44:01Z |
| format | Article |
| id | doaj.art-1beb41efbea34819a2730785b738ada4 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T17:44:01Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-1beb41efbea34819a2730785b738ada42022-12-22T04:11:25ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-11-01910.3389/fcvm.2022.970422970422Comprehensive functional and anatomic assessment of myocardial bridging: Unlocking the Gordian KnotGiuseppe Ciliberti0Renzo Laborante1Marco Di Francesco2Attilio Restivo3Gaetano Rizzo4Mattia Galli5Mattia Galli6Francesco Canonico7Andrea Zito8Giuseppe Princi9Rocco Vergallo10Rocco Vergallo11Antonio Maria Leone12Antonio Maria Leone13Francesco Burzotta14Francesco Burzotta15Carlo Trani16Carlo Trani17Vincenzo Palmieri18Vincenzo Palmieri19Paolo Zeppilli20Paolo Zeppilli21Filippo Crea22Filippo Crea23Domenico D’Amario24Domenico D’Amario25Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyMaria Cecilia Hospital, Gruppo Villa Maria (GVM) Care and Research, Cotignola, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalySports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalySports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, ItalyDepartment of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyMyocardial bridging (MB) is the most frequent congenital coronary anomaly in which a segment of an epicardial coronary artery takes a tunneled course under a bridge of the myocardium. This segment is compressed during systole, resulting in the so-called “milking effect” at coronary angiography. As coronary blood flow occurs primarily during diastole, the clinical relevance of MB is heterogeneous, being usually considered an asymptomatic bystander. However, many studies have suggested its association with myocardial ischemia, anginal symptoms, and adverse cardiac events. The advent of contemporary non-invasive and invasive imaging modalities and the standardization of intracoronary functional assessment tools have remarkably improved our understanding of MB-related ischemia, suggesting the role of atherosclerotic lesions proximal to MB, vasomotor disorders and microvascular dysfunction as possible pathophysiological substrates. The aim of this review is to provide a contemporary overview of the pathophysiology and of the non-invasive and invasive assessment of MB, in the attempt to implement a case-by-case therapeutic approach according to the specific endotype of MB-related ischemia.https://www.frontiersin.org/articles/10.3389/fcvm.2022.970422/fullmyocardial bridgingmyocardial ischemiainvasive intracoronary assessmentintracoronary physiologyintracoronary imagingnon-invasive tests |
| spellingShingle | Giuseppe Ciliberti Renzo Laborante Marco Di Francesco Attilio Restivo Gaetano Rizzo Mattia Galli Mattia Galli Francesco Canonico Andrea Zito Giuseppe Princi Rocco Vergallo Rocco Vergallo Antonio Maria Leone Antonio Maria Leone Francesco Burzotta Francesco Burzotta Carlo Trani Carlo Trani Vincenzo Palmieri Vincenzo Palmieri Paolo Zeppilli Paolo Zeppilli Filippo Crea Filippo Crea Domenico D’Amario Domenico D’Amario Comprehensive functional and anatomic assessment of myocardial bridging: Unlocking the Gordian Knot Frontiers in Cardiovascular Medicine myocardial bridging myocardial ischemia invasive intracoronary assessment intracoronary physiology intracoronary imaging non-invasive tests |
| title | Comprehensive functional and anatomic assessment of myocardial bridging: Unlocking the Gordian Knot |
| title_full | Comprehensive functional and anatomic assessment of myocardial bridging: Unlocking the Gordian Knot |
| title_fullStr | Comprehensive functional and anatomic assessment of myocardial bridging: Unlocking the Gordian Knot |
| title_full_unstemmed | Comprehensive functional and anatomic assessment of myocardial bridging: Unlocking the Gordian Knot |
| title_short | Comprehensive functional and anatomic assessment of myocardial bridging: Unlocking the Gordian Knot |
| title_sort | comprehensive functional and anatomic assessment of myocardial bridging unlocking the gordian knot |
| topic | myocardial bridging myocardial ischemia invasive intracoronary assessment intracoronary physiology intracoronary imaging non-invasive tests |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.970422/full |
| work_keys_str_mv | AT giuseppeciliberti comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT renzolaborante comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT marcodifrancesco comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT attiliorestivo comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT gaetanorizzo comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT mattiagalli comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT mattiagalli comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT francescocanonico comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT andreazito comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT giuseppeprinci comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT roccovergallo comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT roccovergallo comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT antoniomarialeone comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT antoniomarialeone comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT francescoburzotta comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT francescoburzotta comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT carlotrani comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT carlotrani comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT vincenzopalmieri comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT vincenzopalmieri comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT paolozeppilli comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT paolozeppilli comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT filippocrea comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT filippocrea comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT domenicodamario comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot AT domenicodamario comprehensivefunctionalandanatomicassessmentofmyocardialbridgingunlockingthegordianknot |