Author + information
- Received April 11, 2012
- Revision received July 30, 2012
- Accepted August 23, 2012
- Published online January 1, 2013.
- Federico Migliore, MD⁎,
- Erica Maffei, MD†,
- Martina Perazzolo Marra, MD, PhD⁎,
- Claudio Bilato, MD⁎,
- Massimo Napodano, MD⁎,
- Francesco Corbetti, MD‡,
- Alessandro Zorzi, MD⁎,
- Anto Luigi Andres, MD‡,
- Cristiano Sarais, MD⁎,
- Luisa Cacciavillani, MD⁎,
- Enrico Favaretto, MD⁎,
- Chiara Martini, MD§,
- Sara Seitun, MD§,
- Filippo Cademartiri, MD, PhD†,§,
- Domenico Corrado, MD, PhD⁎,
- Sabino Iliceto, MD⁎ and
- Giuseppe Tarantini, MD, PhD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Giuseppe Tarantini, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Via N. Giustiniani 2, 35128 Padova, Italy
Objectives This study sought to evaluate the prevalence and potential role of myocardial bridging in the pathogenesis of apical ballooning syndrome (ABS).
Background ABS is characterized by reversible left ventricular dysfunction, frequently precipitated by a stressful event, but the pathogenesis remains still unclear.
Methods Forty-two consecutive patients (40 female, mean age 66 ± 7 years) with ABS underwent echocardiography, cardiac magnetic resonance, coronary angiography (CA) with intravascular ultrasound, and computed tomography angiography (CTA). Myocardial bridging was diagnosed by CA when a dynamic compression phenomenon was observed in the coronary artery and by CTA when a segment of coronary artery was completely (full encasement) or incompletely (partial encasement) surrounded by the myocardium. The prevalence of myocardial bridging detected by CTA and CA in ABS patients was compared with 401 controls without ABS who underwent both CTA and CA.
Results Myocardial bridging by CTA was observed in 32 ABS patients (76%): 23 with partial encasement and 9 with full encasement. All myocardial bridging was located in the mid segment of the left anterior descending coronary artery (LAD) with a mean length of 17 ± 9 mm. CA revealed myocardial bridging in 17 subjects (40%) (9 with partial encasement and 8 with full encasement by CTA). All subjects in which dynamic compression was observed by CA showed myocardial bridging by CTA, while none of the subjects with negative findings for myocardial bridging by CTA revealed dynamic compression by CA. Compared with controls, ABS patients showed a significant higher prevalence of myocardial bridging in the LAD either by CA (40% vs. 8%; p < 0.001) or by CTA (76% vs. 31%; p < 0.001).
Conclusions Our study showed that myocardial bridging of the LAD is a frequent finding in ABS patients as revealed both by CA and, mostly, by CTA, suggesting a role of myocardial bridging as potential substrate in the pathogenesis of ABS.
- apical ballooning syndrome
- computed tomography angiography
- coronary angiography
- myocardial bridging
- takotsubo cardiomyopathy
Dr. Cademartiri is a consultant for Guerbet and a speaker for Bracco. Dr. Maffei is a recipient of a GEHC grant. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 11, 2012.
- Revision received July 30, 2012.
- Accepted August 23, 2012.
- American College of Cardiology Foundation