TY - JOUR
T1 - Exercise strain echocardiography in patients with a hemodynamically significant myocardial bridge assessed by physiological study
AU - Kobayashi, Yukari
AU - Tremmel, Jennifer A.
AU - Kobayashi, Yuhei
AU - Amsallem, Myriam
AU - Tanaka, Shigemitsu
AU - Yamada, Ryotaro
AU - Rogers, Ian S.
AU - Haddad, Francois
AU - Schnittger, Ingela
N1 - Publisher Copyright:
© 2015 The Authors.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - Background-Although a myocardial bridge (MB) is often regarded as a benign coronary variant, recent studies have associated MB with focal myocardial ischemia. The physiological consequences of MB on ventricular function during stress have not been well established. Methods and Results-We enrolled 58 patients with MB of the left anterior descending artery, diagnosed by intravascular ultrasound. Patients underwent invasive physiological evaluation of the MB by diastolic fractional flow reserve during dobutamine challenge and exercise echocardiography. Septal and lateral longitudinal strain (LS) were assessed at rest and immediately after exercise and compared with strain of matched controls. Absolute and relative changes in strain were also calculated. The mean age was 42.5±16.0 years. Fifty-five patients had a diastolic fractional flow reserve ≤ 0.76. At rest, there was no significant difference between the 2 groups in septal LS (19.0±1.8% for patients with MB versus 19.2±1.5% for control, P=0.53) and lateral LS (20.1±2.0% versus 20.0±1.6%, P=0.83). With stress, compared with controls, patients with MB had a lower peak septal LS (18.9±2.6% versus 21.7±1.6%, P < 0.001) and lower absolute (-0.1±2.1% versus 2.5±1.3%, P < 0.001) and relative change (-0.6±11.2% versus 13.1±7.8%, P < 0.001) in septal LS, whereas there was no significant difference in lateral LS. In multivariate analysis, diastolic fractional flow reserve and length were independent determinants of lower changes in septal LS. Conclusions-Patients with a hemodynamically significant MB, determined by invasive diastolic fractional flow reserve, have significantly lower change in septal LS on exercise echocardiography, suggesting that septal LS may be useful for noninvasively assessing the hemodynamic significance of an MB.
AB - Background-Although a myocardial bridge (MB) is often regarded as a benign coronary variant, recent studies have associated MB with focal myocardial ischemia. The physiological consequences of MB on ventricular function during stress have not been well established. Methods and Results-We enrolled 58 patients with MB of the left anterior descending artery, diagnosed by intravascular ultrasound. Patients underwent invasive physiological evaluation of the MB by diastolic fractional flow reserve during dobutamine challenge and exercise echocardiography. Septal and lateral longitudinal strain (LS) were assessed at rest and immediately after exercise and compared with strain of matched controls. Absolute and relative changes in strain were also calculated. The mean age was 42.5±16.0 years. Fifty-five patients had a diastolic fractional flow reserve ≤ 0.76. At rest, there was no significant difference between the 2 groups in septal LS (19.0±1.8% for patients with MB versus 19.2±1.5% for control, P=0.53) and lateral LS (20.1±2.0% versus 20.0±1.6%, P=0.83). With stress, compared with controls, patients with MB had a lower peak septal LS (18.9±2.6% versus 21.7±1.6%, P < 0.001) and lower absolute (-0.1±2.1% versus 2.5±1.3%, P < 0.001) and relative change (-0.6±11.2% versus 13.1±7.8%, P < 0.001) in septal LS, whereas there was no significant difference in lateral LS. In multivariate analysis, diastolic fractional flow reserve and length were independent determinants of lower changes in septal LS. Conclusions-Patients with a hemodynamically significant MB, determined by invasive diastolic fractional flow reserve, have significantly lower change in septal LS on exercise echocardiography, suggesting that septal LS may be useful for noninvasively assessing the hemodynamic significance of an MB.
KW - Coronary physiology
KW - Deformation imaging
KW - Myocardial bridge
KW - Myocardial strain
UR - http://www.scopus.com/inward/record.url?scp=85006219573&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85006219573&partnerID=8YFLogxK
U2 - 10.1161/JAHA.115.002496
DO - 10.1161/JAHA.115.002496
M3 - Article
C2 - 26581225
AN - SCOPUS:85006219573
SN - 2047-9980
VL - 4
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 11
M1 - e002496
ER -