New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler

J. Ge (Corresponding Author), A. Jeremias, A. Rupp, M. Abels, D. Baumgart, F. Liu, M. Haude, G. Görge, C. Von Birgelen, S. Sack, R. Erbel

Research output: Contribution to journalArticleAcademicpeer-review

218 Citations (Scopus)

Abstract

Background. Large discrepancies exist concerning the incidence of myocardial bridging. This has been reported to be 0.5%-2.5% following coronary angiography but 15%-85% following autopsy. The purpose of the study was to use intravascular ultrasound and intracoronary Doppler to study the morphology and flow characteristics of myocardial bridging in order to and feasible parameters of this syndrome. Methods and Results. Intravascular ultrasound was performed in 62/69 patients in whom typical angiographic 'milking effects' were present. In 48 patients, intracoronary Doppler was performed. A specific, echolucent 'half moon' phenomenon surrounding the myocardial bridge was found in all the patients. The thickness of the half moon area was 0.47 ± 0.19 mm in diastole and 0.52 ± 0.23 mm in systole. There was systolic compression of the myocardial bridge with a lumen reduction during systole of 36.4 ± 8.8%. Using intracoronary Doppler, a characteristic early diastolic 'finger tip' phenomenon was observed in 42 (87%) of the patients. All patients showed no or reduced antegrade systolic flow. Coronary flow velocity reserve was 2.03 ± 0.54. After intracoronary nitroglycerin injection, retrograde systolic flow occurred in 37 (77%) of the 48 patients, with a velocity of -22.2 ± 13.2 cm.s-1. Intravascular ultrasound revealed atherosclerotic involvement of the proximal segment in 61 (88%) of the 69 patients, with an area stenosis of 42 ± 13%. No plaques were found in the bridge or distal segments in the 62 patients in whom it was possible to introduce the ultrasound catheter throughout the bridging segment. Conclusion. Myocardial bridging is characterized by the following morphological and functional signs: a specific, echolucent half moon phenomenon over the bridge segment, which exists throughout the cardiac cycle; systolic compression of the bridge segment of the coronary artery; accelerated flow velocity at early diastole (finger-tip phenomenon); no or reduced systolic antegrade flow; decreased diastolic/systolic velocity ratio; retrograde flow in the proximal segment, which is provoked and enhanced by nitroglycerin injection.

Original languageEnglish
Pages (from-to)1707-1716
Number of pages10
JournalEuropean heart journal
Volume20
Issue number23
DOIs
Publication statusPublished - 1 Jan 1999
Externally publishedYes

Fingerprint

Myocardial Bridging
Doppler Ultrasonography
Diastole
Systole
Nitroglycerin
Fingers
Injections
Coronary Angiography
Autopsy
Coronary Vessels
Pathologic Constriction
Catheters

Keywords

  • Atherogenesis
  • Coronary artery disease
  • Coronary flow
  • Intracoronary Doppler
  • Intracoronary ultrasound
  • Myocardial bridging

Cite this

Ge, J., Jeremias, A., Rupp, A., Abels, M., Baumgart, D., Liu, F., ... Erbel, R. (1999). New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler. European heart journal, 20(23), 1707-1716. https://doi.org/10.1053/euhj.1999.1661
Ge, J. ; Jeremias, A. ; Rupp, A. ; Abels, M. ; Baumgart, D. ; Liu, F. ; Haude, M. ; Görge, G. ; Von Birgelen, C. ; Sack, S. ; Erbel, R. / New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler. In: European heart journal. 1999 ; Vol. 20, No. 23. pp. 1707-1716.
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title = "New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler",
abstract = "Background. Large discrepancies exist concerning the incidence of myocardial bridging. This has been reported to be 0.5{\%}-2.5{\%} following coronary angiography but 15{\%}-85{\%} following autopsy. The purpose of the study was to use intravascular ultrasound and intracoronary Doppler to study the morphology and flow characteristics of myocardial bridging in order to and feasible parameters of this syndrome. Methods and Results. Intravascular ultrasound was performed in 62/69 patients in whom typical angiographic 'milking effects' were present. In 48 patients, intracoronary Doppler was performed. A specific, echolucent 'half moon' phenomenon surrounding the myocardial bridge was found in all the patients. The thickness of the half moon area was 0.47 ± 0.19 mm in diastole and 0.52 ± 0.23 mm in systole. There was systolic compression of the myocardial bridge with a lumen reduction during systole of 36.4 ± 8.8{\%}. Using intracoronary Doppler, a characteristic early diastolic 'finger tip' phenomenon was observed in 42 (87{\%}) of the patients. All patients showed no or reduced antegrade systolic flow. Coronary flow velocity reserve was 2.03 ± 0.54. After intracoronary nitroglycerin injection, retrograde systolic flow occurred in 37 (77{\%}) of the 48 patients, with a velocity of -22.2 ± 13.2 cm.s-1. Intravascular ultrasound revealed atherosclerotic involvement of the proximal segment in 61 (88{\%}) of the 69 patients, with an area stenosis of 42 ± 13{\%}. No plaques were found in the bridge or distal segments in the 62 patients in whom it was possible to introduce the ultrasound catheter throughout the bridging segment. Conclusion. Myocardial bridging is characterized by the following morphological and functional signs: a specific, echolucent half moon phenomenon over the bridge segment, which exists throughout the cardiac cycle; systolic compression of the bridge segment of the coronary artery; accelerated flow velocity at early diastole (finger-tip phenomenon); no or reduced systolic antegrade flow; decreased diastolic/systolic velocity ratio; retrograde flow in the proximal segment, which is provoked and enhanced by nitroglycerin injection.",
keywords = "Atherogenesis, Coronary artery disease, Coronary flow, Intracoronary Doppler, Intracoronary ultrasound, Myocardial bridging",
author = "J. Ge and A. Jeremias and A. Rupp and M. Abels and D. Baumgart and F. Liu and M. Haude and G. G{\"o}rge and {Von Birgelen}, C. and S. Sack and R. Erbel",
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Ge, J, Jeremias, A, Rupp, A, Abels, M, Baumgart, D, Liu, F, Haude, M, Görge, G, Von Birgelen, C, Sack, S & Erbel, R 1999, 'New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler' European heart journal, vol. 20, no. 23, pp. 1707-1716. https://doi.org/10.1053/euhj.1999.1661

New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler. / Ge, J. (Corresponding Author); Jeremias, A.; Rupp, A.; Abels, M.; Baumgart, D.; Liu, F.; Haude, M.; Görge, G.; Von Birgelen, C.; Sack, S.; Erbel, R.

In: European heart journal, Vol. 20, No. 23, 01.01.1999, p. 1707-1716.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler

AU - Ge, J.

AU - Jeremias, A.

AU - Rupp, A.

AU - Abels, M.

AU - Baumgart, D.

AU - Liu, F.

AU - Haude, M.

AU - Görge, G.

AU - Von Birgelen, C.

AU - Sack, S.

AU - Erbel, R.

PY - 1999/1/1

Y1 - 1999/1/1

N2 - Background. Large discrepancies exist concerning the incidence of myocardial bridging. This has been reported to be 0.5%-2.5% following coronary angiography but 15%-85% following autopsy. The purpose of the study was to use intravascular ultrasound and intracoronary Doppler to study the morphology and flow characteristics of myocardial bridging in order to and feasible parameters of this syndrome. Methods and Results. Intravascular ultrasound was performed in 62/69 patients in whom typical angiographic 'milking effects' were present. In 48 patients, intracoronary Doppler was performed. A specific, echolucent 'half moon' phenomenon surrounding the myocardial bridge was found in all the patients. The thickness of the half moon area was 0.47 ± 0.19 mm in diastole and 0.52 ± 0.23 mm in systole. There was systolic compression of the myocardial bridge with a lumen reduction during systole of 36.4 ± 8.8%. Using intracoronary Doppler, a characteristic early diastolic 'finger tip' phenomenon was observed in 42 (87%) of the patients. All patients showed no or reduced antegrade systolic flow. Coronary flow velocity reserve was 2.03 ± 0.54. After intracoronary nitroglycerin injection, retrograde systolic flow occurred in 37 (77%) of the 48 patients, with a velocity of -22.2 ± 13.2 cm.s-1. Intravascular ultrasound revealed atherosclerotic involvement of the proximal segment in 61 (88%) of the 69 patients, with an area stenosis of 42 ± 13%. No plaques were found in the bridge or distal segments in the 62 patients in whom it was possible to introduce the ultrasound catheter throughout the bridging segment. Conclusion. Myocardial bridging is characterized by the following morphological and functional signs: a specific, echolucent half moon phenomenon over the bridge segment, which exists throughout the cardiac cycle; systolic compression of the bridge segment of the coronary artery; accelerated flow velocity at early diastole (finger-tip phenomenon); no or reduced systolic antegrade flow; decreased diastolic/systolic velocity ratio; retrograde flow in the proximal segment, which is provoked and enhanced by nitroglycerin injection.

AB - Background. Large discrepancies exist concerning the incidence of myocardial bridging. This has been reported to be 0.5%-2.5% following coronary angiography but 15%-85% following autopsy. The purpose of the study was to use intravascular ultrasound and intracoronary Doppler to study the morphology and flow characteristics of myocardial bridging in order to and feasible parameters of this syndrome. Methods and Results. Intravascular ultrasound was performed in 62/69 patients in whom typical angiographic 'milking effects' were present. In 48 patients, intracoronary Doppler was performed. A specific, echolucent 'half moon' phenomenon surrounding the myocardial bridge was found in all the patients. The thickness of the half moon area was 0.47 ± 0.19 mm in diastole and 0.52 ± 0.23 mm in systole. There was systolic compression of the myocardial bridge with a lumen reduction during systole of 36.4 ± 8.8%. Using intracoronary Doppler, a characteristic early diastolic 'finger tip' phenomenon was observed in 42 (87%) of the patients. All patients showed no or reduced antegrade systolic flow. Coronary flow velocity reserve was 2.03 ± 0.54. After intracoronary nitroglycerin injection, retrograde systolic flow occurred in 37 (77%) of the 48 patients, with a velocity of -22.2 ± 13.2 cm.s-1. Intravascular ultrasound revealed atherosclerotic involvement of the proximal segment in 61 (88%) of the 69 patients, with an area stenosis of 42 ± 13%. No plaques were found in the bridge or distal segments in the 62 patients in whom it was possible to introduce the ultrasound catheter throughout the bridging segment. Conclusion. Myocardial bridging is characterized by the following morphological and functional signs: a specific, echolucent half moon phenomenon over the bridge segment, which exists throughout the cardiac cycle; systolic compression of the bridge segment of the coronary artery; accelerated flow velocity at early diastole (finger-tip phenomenon); no or reduced systolic antegrade flow; decreased diastolic/systolic velocity ratio; retrograde flow in the proximal segment, which is provoked and enhanced by nitroglycerin injection.

KW - Atherogenesis

KW - Coronary artery disease

KW - Coronary flow

KW - Intracoronary Doppler

KW - Intracoronary ultrasound

KW - Myocardial bridging

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U2 - 10.1053/euhj.1999.1661

DO - 10.1053/euhj.1999.1661

M3 - Article

VL - 20

SP - 1707

EP - 1716

JO - European heart journal

JF - European heart journal

SN - 0195-668X

IS - 23

ER -