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Relationship between myocardial bridging and fatal ventricular arrhythmias in patients with hypertrophic cardiomyopathy: the HCM-MB study

Zusammenhang zwischen myokardialem Bridging und letalen ventrikulären Arrhythmien bei Patienten mit hypertropher Kardiomyopathie: die HCM-MB-Studie

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Abstract

Background

Myocardial bridging (MB) and hypertrophic cardiomyopathy (HCM) are associated with the risk of fatal ventricular arrhythmias (VAs). The goal of the study was to determine the relationship between MB and fatal VAs in HCM patients with implantable cardiac defibrillators (ICD).

Methods

A total of 108 HCM patients (mean age: 46.6 ± 13.6 years; male: 73) were enrolled in this retrospective study. All patients underwent transthoracic echocardiography and coronary computed tomography angiography. Fatal VAs including sustained ventricular tachycardia and ventricular fibrillation were documented in ICD records.

Results

There were documented fatal VAs in 29 (26.8%) patients during a mean follow-up time of 71.3 ± 30.9 months. Compared with the other groups, the fatal VA group had a higher incidence of the following: presence of MB (82.8 vs. 38%, p < 0.001), deep MB (62.1 vs. 6.3%, p < 0.001), very deep MB (24.1 vs. 0%, p < 0.001), long MB (65.5 vs. 11.4%, p < 0.001), presence of > 1 MB (17.2 vs. 0%, p = 0.001), and MB of the left anterior descending artery (79.3 vs. 17.7%, p < 0.001) . Sudden cardiac death (SCD) risk score (hazard ratio: 1.194; 95% CI: 1.071–1.330; p = 0.001) and presence of MB (hazard ratio: 3.815; 95% CI: 1.41–10.284; p = 0.008) were found to be independent predictors of fatal VAs in HCM patients.

Conclusions

The current data suggest that the SCD risk score and presence of MB were independent risk factors for fatal VAs in patients with HCM. In addition to conventional risk factors, the coronary anatomical course can provide clinicians with valuable information when assessing the risk of fatal VAs in HCM patients.

Zusammenfassung

Hintergrund

Myokardiales Bridging (MB) und hypertrophe Kardiomyopathie (HCM) gehen einher mit dem Risiko letaler ventrikulärer Arrhythmien (VA). Ziel der vorliegenden Studie war es, den Zusammenhang zwischen MB und letalen VA bei Patienten mit HCM und implantierbaren kardialen Defibrillatoren (ICD) zu untersuchen.

Methoden

In diese retrospektive Studie wurden insgesamt 108 HCM-Patienten (Durchschnittsalter: 46,6 ± 13,6 Jahre; männlich: 73) einbezogen. Bei allen Patienten wurde eine transthorakale Echokardiographie und eine koronare Computertomographie-Angiographie durchgeführt. Letale VA einschließlich anhaltender ventrikulärer Tachykardie und Kammerflimmern wurden per ICD dokumentiert.

Ergebnisse

Während einer durchschnittlichen Nachbeobachtungsdauer von 71,3 ± 30,9 Monaten gab es bei 29 (26,8%) Patienten dokumentierte letale VA. Im Vergleich zu anderen Gruppen wies die Gruppe mit letalen VA eine höhere Inzidenz für folgende Parameter auf: Vorliegen von MB (82,8 vs. 38%; p < 0,001), tiefes MB (62,1 vs. 6,3%; p < 0,001), sehr tiefes MB (24,1 vs. 0%; p < 0,001), langes MB (65,5 vs. 11,4%; p < 0,001), Vorliegen von > 1 MB (17,2 vs. 0%; p = 0,001) und MB des Ramus interventricularis anterior (79,3 vs. 17,7%; p < 0,001). Der Risikoscore für plötzlichen Herztod (Hazard Ratio: 1,194; 95%-Konfidenzintervall, 95%-KI: 1,071–1,330; p = 0,001) und Vorliegen von MB (Hazard Ratio: 3,815; 95%-KI: 1,41–10,284; p = 0,008) stellten sich als unabhängige Prädiktoren letaler VA bei HCM-Patienten heraus.

Schlussfolgerung

Die aktuellen Daten deuten darauf hin, dass der Risikoscore für plötzlichen Herztod und das Vorliegen von MB unabhängige Risikofaktoren für letale VA bei Patienten mit HCM sind. Zusammen mit konventionellen Risikofaktoren bietet der anatomische Verlauf der Koronarien den behandelnden Ärzten wertvolle Informationen, wenn es um die Beurteilung des Risikos letaler VA bei HCM-Patienten geht.

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Abbreviations

HCM:

Hypertrophic cardiomyopathy

ICD:

Implantable cardiac defibrillators

MB:

Myocardial bridging

SCD:

Sudden cardiac death

VA:

Ventricular arrhythmia

References

  1. Sternheim D, Power DA, Samtani R et al (2021) Myocardial bridging: diagnosis, functional assessment, and management: JACC state-of-the-art review. J Am Coll Cardiol 78:2196–2212

    Article  PubMed  Google Scholar 

  2. Olivotto I, Cecchi F, Yacoub MH (2009) Myocardial bridging and sudden death in hypertrophic cardiomyopathy: salome drops another veil. Eur Heart J 30:1549–1550

    Article  PubMed  Google Scholar 

  3. Gori F, Basso C, Thiene G (2000) Myocardial infarction in a patient with hypertrophic cardiomyopathy. N Engl J Med 342:593–594

    Article  CAS  PubMed  Google Scholar 

  4. Yetman AT, McCrindle BW, MacDonald C, Freedom RM, Gow R (1998) Myocardial bridging in children with hypertrophic cardiomyopath—a risk factor for sudden death. N Engl J Med 339:1201–1209

    Article  CAS  PubMed  Google Scholar 

  5. Nie C, Zhu C, Yang Q, Xiao M, Meng Y, Wang S (2021) Myocardial bridging of the left anterior descending coronary artery as a risk factor for atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy: a matched case-control study. BMC Cardiovasc Disord 21:382

    Article  PubMed  PubMed Central  Google Scholar 

  6. Elliott PM, Anastasakis A, Borger MA et al (2014) 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 35:2733–2779

    Article  PubMed  Google Scholar 

  7. van der Velde N, Huurman R, Yamasaki Y et al (2020) Frequency and significance of coronary artery disease and myocardial bridging in patients with hypertrophic cardiomyopathy. Am J Cardiol 125:1404–1412

    Article  PubMed  Google Scholar 

  8. Maron BJ (2002) Hypertrophic cardiomyopathy: a systematic review. JAMA 287:1308–1320

    Article  PubMed  Google Scholar 

  9. Konen E, Goitein O, Sternik L et al (2007) The prevalence and anatomical patterns of intramuscular coronary arteries: a coronary computed tomography angiographic study. J Am Coll Cardiol 49:587–593

    Article  PubMed  Google Scholar 

  10. Leipsic J, Abbara S, Achenbach S et al (2014) SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the society of cardiovascular computed tomography guidelines committee. J Cardiovasc Comput Tomogr 8:342–358

    Article  PubMed  Google Scholar 

  11. Geske JB, Ommen SR, Gersh BJ (2018) Hypertrophic cardiomyopathy: clinical update. JACC Heart Fail 6:364–375

    Article  PubMed  Google Scholar 

  12. Williams B, Mancia G, Spiering W et al (2018) ESC scientific document group. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 39:3021–3104

    Article  PubMed  Google Scholar 

  13. McDonagh TA, Metra M, Adamo M et al (2021) ESC scientific document group. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 42:3599–3726

    Article  CAS  PubMed  Google Scholar 

  14. Mach F, Baigent C, Catapano AL et al (2020) ESC scientific document group. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 41:111–188

    Article  PubMed  Google Scholar 

  15. McDonagh TA, Metra M, Adamo M et al (2021) 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 42:3599–3726

    Article  CAS  PubMed  Google Scholar 

  16. Anderson J, Glynn LG (2011) Definition of chronic kidney disease and measurement of kidney function in original research papers: a review of the literature. Nephrol Dial Transplant 26:2793–2798

    Article  PubMed  Google Scholar 

  17. Mark DG, Huang J, Chettipally U, Kene MV, Anderson ML, Hess EP et al (2018) Performance of coronary risk scores among patients with chest pain in the emergency department. J Am Coll Cardiol 71:606–616

    Article  PubMed  Google Scholar 

  18. O’Mahony C, Jichi F, Pavlou M, Monserrat L, Anastasakis A, Rapezzi C, Biagini E et al (2014) Hypertrophic cardiomyopathy outcomes investigators. A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM risk-SCD). Eur Heart J 35:2010–2020

    Article  PubMed  Google Scholar 

  19. Agatston AS, Janowitz WR, Hildner FJ et al (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832

    Article  CAS  PubMed  Google Scholar 

  20. Maron BJ, Maron MS (2013) Hypertrophic cardiomyopathy. Lancet 381:242–255

    Article  PubMed  Google Scholar 

  21. Tower-Rader A, Kramer CM, Neubauer S, Nagueh SF, Desai MY (2020) Multimodality imaging in hypertrophic cardiomyopathy for risk stratification. Circ Cardiovasc Imaging 13:e9026

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ramchand J, Fava AM, Chetrit M, Desai MY (2020) Advanced imaging for risk stratification of sudden death in hypertrophic cardiomyopathy. Heart 106:793–801

    Article  CAS  PubMed  Google Scholar 

  23. Wang W, Lian Z, Rowin EJ et al (2017) Prognostic implications of nonsustained ventricular tachycardia in high-risk patients with hypertrophic cardiomyopathy. Circ Arrhythm Electrophysiol 10:e4604

    Article  PubMed  Google Scholar 

  24. Raphael CE, Cooper R, Parker KH, Collinson J, Vassiliou V, Pennell DJ et al (2016) Mechanisms of myocardial ischemia in hypertrophic cardiomyopathy: insights from wave intensity analysis and magnetic resonance. J Am Coll Cardiol 68:1651–1660

    Article  PubMed  PubMed Central  Google Scholar 

  25. Chan RH, Maron BJ, Olivotto I et al (2014) Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation 130:484–495

    Article  PubMed  Google Scholar 

  26. Geiringer E (1951) The mural coronary. Am Heart J 41:359–368

    Article  CAS  PubMed  Google Scholar 

  27. Möhlenkamp S, Hort W, Ge J, Erbel R (2002) Update on myocardial bridging. Circulation 106:2616–2622

    Article  PubMed  Google Scholar 

  28. Lazoura O, Kanavou T, Vassiou K, Gkiokas S, Fezoulidis IV (2010) Myocardial bridging evaluated with 128-multi detector computed tomography coronary angiography. Surg Radiol Anat 32:45–50

    Article  PubMed  Google Scholar 

  29. Hwang JH, Ko SM, Roh HG, Song MG, Shin JK, Chee HK et al (2010) Myocardial bridging of the left anterior descending coronary artery: depiction rate and morphologic features by dual-source CT coronary angiography. Korean J Radiol 11:514–521

    Article  PubMed  PubMed Central  Google Scholar 

  30. Nishikii-Tachibana M, Pargaonkar VS, Schnittger I et al (2018) Myocardial bridging is associated with exercise-induced ventricular arrhythmia and increases in QT dispersion. Ann Noninvasive Electrocardiol 23:e12492

    Article  PubMed  Google Scholar 

  31. Cay S, Oztürk S, Cihan G, Kisacik HL, Korkmaz S (2006) Angiographic prevalence of myocardial bridging. Anadolu Kardiyol Derg 6:9–12

    PubMed  Google Scholar 

  32. Murtaza G, Mukherjee D, Gharacholou SM et al (2020) An updated review on myocardial bridging. Cardiovasc Revasc Med 21:1169–1179

    Article  PubMed  Google Scholar 

  33. Feld H, Guadanino V, Hollander G et al (1991) Exercise-induced ventricular tachycardia in association with a myocardial bridge. Chest 99:1295–1296

    Article  CAS  PubMed  Google Scholar 

  34. Kurath-Koller S, Sallmon H, Scherr D et al (2020) Wearable cardioverter-defibrillator as bridging to ICD in pediatric hypertrophic cardiomyopathy with myocardial bridging—a case report. BMC Pediatr 20:207

    Article  PubMed  PubMed Central  Google Scholar 

  35. Juillière Y, Berder V, Suty-Selton C et al (1995) Isolated myocardial bridges with angiographic milking of the left anterior descending coronary artery: a long-term follow-up study. Am Heart J 129:663–665

    Article  PubMed  Google Scholar 

  36. Cecchi F, Olivotto I, Gistri R et al (2003) Coronary microvascular dysfunction and prognosis in hypertrophic cardiomyopathy. N Engl J Med 349:1027–1035

    Article  CAS  PubMed  Google Scholar 

  37. Hostiuc S, Rusu MC, Hostiuc M, Negoi RI, Negoi I (2017) Cardiovascular consequences of myocardial bridging: a meta-analysis and meta-regression. Sci Rep 7:14644

    Article  PubMed  PubMed Central  Google Scholar 

  38. Bruce C, Ubhi N, McKeegan P, Sanders K (2023) Systematic review and meta-analysis of cardiovascular consequences of myocardial bridging in hypertrophic cardiomyopathy. Am J Cardiol 188:110–119

    Article  PubMed  Google Scholar 

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The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey

    Ahmet Güner MD, Sezgin Atmaca MD, İrem Türkmen MD, Ender Öner MD, Özgür Sürgit MD, Arda Güler MD, Fatih Uzun MD, Gamze Babür Güler MD, Serkan Kahraman MD, Mustafa Yıldız MD & Mehmet Ertürk MD

  2. Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey

    İsmail Balaban MD, Doğancan Çeneli MD & Selçuk Pala MD

  3. Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Radiology, University of Health Sciences, Istanbul, Turkey

    Aysel Türkvatan MD

  4. Koşuyolu Kartal Heart Training and Research Hospital, Department of Radiology, University of Health Sciences, Istanbul, Turkey

    Nuri Havan MD

  5. Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Turgut Özal Bulvari No. 11, 34303, Kucukcekmece, Istanbul, Turkey

    Ahmet Güner MD

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  1. Ahmet Güner MD
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Correspondence to Ahmet Güner MD.

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Conflict of interest

A. Güner, S. Atmaca, İ. Balaban, İ. Türkmen, D. Çeneli, A. Türkvatan, E. Öner, Ö. Sürgit, A. Güler, F. Uzun, G. Babür Güler, S. Kahraman, S. Pala, N. Havan, M. Yıldız and M. Ertürk declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Güner, A., Atmaca, S., Balaban, İ. et al. Relationship between myocardial bridging and fatal ventricular arrhythmias in patients with hypertrophic cardiomyopathy: the HCM-MB study. Herz 48, 399–407 (2023). https://doi.org/10.1007/s00059-023-05171-9

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  • DOI: https://doi.org/10.1007/s00059-023-05171-9

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