The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Alteration of Left Ventricular Function with Dobutamine Challenge in Patients with Myocardial Bridge

  • Jhi, Joon-Hyung (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Cho, Kyoung-Im (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Ha, Jong-Kun (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Jung, Chan-Woo (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Kim, Bong-Jae (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Park, Seong-Oh (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Jo, A-Ra (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Kim, Seong-Man (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Lee, Hyeon-Gook (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Kim, Tae-Ik (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center)
  • Published : 2011.12.01
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Abstract

Background/Aims: The aim of this study was to identify changes in left ventricular (LV) performance in patients with a myocardial bridge (MB) in the left anterior descending coronary artery during resting and in an inotropic state. Methods: Myocardial strain measurement by speckle-tracking echocardiography and conventional LV wall-motion scoring was performed in 18 patients with MB (mean age, 48.1 ${\pm}$ 1.7 years, eight female) during resting and intravenous dobutamine challenge (10 and 20 ${\mu}$g/kg/min). Results: Conventional LV wall-motion scoring was normal in all patients during resting and in an inotropic state. Peak regional circumferential strain increased dose dependently upon dobutamine challenge. Longitudinal strains of the anterior and anteroseptal segments were, however, reduced at 20 ${\mu}$g/kg/min and showed a dyssynchronous pattern at 20 ${\mu}$g/kg/min. Although there were no significant differences in radial strain and displacement of all segments at rest compared with under 10 ${\mu}$g/kg/min challenge, radial strain and displacement of anterior segments at 20 ${\mu}$g/kg/min were significantly reduced compared with posterior segments at the papillary muscle level (44.8 ${\pm}$ 14.9% vs. 78.4 ${\pm}$ 20.1% and 5.3 ${\pm}$ 2.3 mm vs. 8.5 ${\pm}$ 1.8 mm, respectively; all p < 0.001), and showed plateau (40%) or biphasic (62%) patterns. Conclusions: Reduced LV strain of patients with MB after inotropic stimulation was identified. Speckle-tracking strain echocardiography identified a LV myocardial dyssynchrony that was not demonstrated by conventional echocardiography in patients with MB.

Keywords

References

  1. Angelini P, Trivellato M, Donis J, Leachman RD. Myocardial bridges: a review. Prog Cardiovasc Dis 1983;26:75-88. https://doi.org/10.1016/0033-0620(83)90019-1
  2. Bourassa MG, Butnaru A, Lesperance J, Tardif JC. Symptomatic myocardial bridges: overview of ischemic mechanisms and current diagnostic and treatment strategies. J Am Coll Cardiol 2003;41:351-359.
  3. Tauth J, Sullebarger T. Myocardial infarction associated with myocardial bridging: case history and review of the literature. Cathet Cardiovasc Diagn 1997;40:364-367. https://doi.org/10.1002/(SICI)1097-0304(199704)40:4<364::AID-CCD9>3.0.CO;2-7
  4. Bauters C, Chmait A, Tricot O, Lamblin N, Van Belle E, Lablanche JM. Images in cardiovascular medicine: coronary thrombosis and myocardial bridging. Circulation 2002;105:130. https://doi.org/10.1161/hc0102.100421
  5. Gowda RM, Khan IA, Ansari AW, Cohen RA. Acute ST segment elevation myocardial infarction from myocardial bridging of left anterior descending coronary artery. Int J Cardiol 2003;90:117-118. https://doi.org/10.1016/S0167-5273(02)00518-1
  6. Schwarz ER, Klues HG, vom Dahl J, Klein I, Krebs W, Hanrath P. Functional, angiographic and intracoronary Doppler flow characteristics in symptomatic patients with myocardial bridging: effect of short-term intravenous beta-blocker medication. J Am Coll Cardiol 1996;27:1637-1645. https://doi.org/10.1016/0735-1097(96)00062-9
  7. Schwarz ER, Klues HG, vom Dahl J, Klein I, Krebs W, Hanrath P. Functional characteristics of myocardial bridging: a combined angiographic and intracoronary Doppler flow study. Eur Heart J 1997;18:434-442. https://doi.org/10.1093/oxfordjournals.eurheartj.a015263
  8. Klues HG, Schwarz ER, vom Dahl J, et al. Disturbed intracoronary hemodynamics in myocardial bridging: early normalization by intracoronary stent placement. Circulation 1997;96:2905-2913. https://doi.org/10.1161/01.CIR.96.9.2905
  9. Kuhn FE, Reagan K, Mohler ER 3rd, Satler LF, Lu DY, Rackley CE. Evidence for endothelial dysfunction and enhanced vasoconstriction in myocardial bridges. Am Heart J 1991;122:1764-1766. https://doi.org/10.1016/0002-8703(91)90296-T
  10. Cho KI, Park JH, Park JR, et al. Assessment of left ventricular function in symptomatic patients with myocardial bridge using two-dimensional strain. Korean Circ J 2006;36:617-625. https://doi.org/10.4070/kcj.2006.36.9.617
  11. Tops LF, Suffoletto MS, Bleeker GB, et al. Speckle-tracking radial strain reveals left ventricular dyssynchrony in patients with permanent right ventricular pacing. J Am Coll Cardiol 2007;50:1180-1188. https://doi.org/10.1016/j.jacc.2007.06.011
  12. Ge J, Erbel R, Rupprecht HJ, et al. Comparison of intravascular ultrasound and angiography in the assessment of myocardial bridging. Circulation 1994;89:1725-1732. https://doi.org/10.1161/01.CIR.89.4.1725
  13. Ge J, Erbel R, Gorge G, Haude M, Meyer J. High wall shear stress proximal to myocardial bridging and atherosclerosis: intracoronary ultrasound and pressure measurements. Br Heart J 1995;73:462-465. https://doi.org/10.1136/hrt.73.5.462
  14. Rossi L, Dander B, Nidasio GP, et al. Myocardial bridges and ischemic heart disease. Eur Heart J 1980;1:239-245. https://doi.org/10.1093/oxfordjournals.eurheartj.a061125
  15. Pichard AD, Casanegra P, Marchant E, Rodriguez JA. Abnormal regional myocardial flow in myocardial bridging of the left anterior descending coronary artery. Am J Cardiol 1981;47:978-982. https://doi.org/10.1016/0002-9149(81)90201-0
  16. Gallet B, Adams C, Saudemont JP, Fruchaud J, Hiltgen M. Myocardial bridge of the left anterior descending coronary artery and myocardial infarction: does coronary spasm play a part? Arch Mal Coeur Vaiss 1991;84:517-523.
  17. Frazier OH, Macris MP, Myers TJ, et al. Improved survival after extended bridge to cardiac transplantation. Ann Thorac Surg 1994;57:1416-1422. https://doi.org/10.1016/0003-4975(94)90094-9
  18. Ge J, Jeremias A, Rupp A, et al. New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler. Eur Heart J 1999;20:1707-1716. https://doi.org/10.1053/euhj.1999.1661
  19. Escaned J, Cortes J, Flores A, et al. Importance of diastolic fractional flow reserve and dobutamine challenge in physiologic assessment of myocardial bridging. J Am Coll Cardiol 2003;42:226-233. https://doi.org/10.1016/S0735-1097(03)00588-6
  20. Kukulski T, Jamal F, D'Hooge J, Bijnens B, De Scheerder I, Sutherland GR. Acute changes in systolic and diastolic events during clinical coronary angioplasty: a comparison of regional velocity, strain rate, and strain measurement. J Am Soc Echocardiogr 2002;15:1-12. https://doi.org/10.1067/mje.2002.114844
  21. Stoylen A, Heimdal A, Bjornstad K, et al. Strain rate imaging by ultrasonography in the diagnosis of coronary artery disease. J Am Soc Echocardiogr 2000;13:1053-1064. https://doi.org/10.1067/mje.2000.106573
  22. Edvardsen T, Urheim S, Skulstad H, Steine K, Ihlen H, Smiseth OA. Quantification of left ventricular systolic function by tissue Doppler echocardiography: added value of measuring pre- and postejection velocities in ischemic myocardium. Circulation 2002;105:2071-2077. https://doi.org/10.1161/01.CIR.0000014614.63980.BA
  23. Abraham TP, Nishimura RA, Holmes DR Jr, Belohlavek M, Seward JB. Strain rate imaging for assessment of regional myocardial function: results from a clinical model of septal ablation. Circulation 2002;105:1403-1406. https://doi.org/10.1161/01.CIR.0000013423.33806.77
  24. Dagdelen S, Yuce M, Emiroglu Y, et al. Correlation between the tissue Doppler, strain rate, strain imaging during the dobutamine infusion and coronary fractional flow reserve during catheterization: a comparative study. Int J Cardiol 2005;102:127-136. https://doi.org/10.1016/j.ijcard.2004.05.012
  25. Weidemann F, Jung P, Hoyer C, et al. Assessment of the contractile reserve in patients with intermediate coronary lesions: a strain rate imaging study validated by invasive myocardial fractional flow reserve. Eur Heart J 2007;28:1425-1432.
  26. Reisner SA, Lysyansky P, Agmon Y, Mutlak D, Lessick J, Friedman Z. Global longitudinal strain: a novel index of left ventricular systolic function. J Am Soc Echocardiogr 2004;17:630-633. https://doi.org/10.1016/j.echo.2004.02.011
  27. Abraham TP, Belohlavek M, Thomson HL, et al. Time to onset of regional relaxation: feasibility, variability and utility of a novel index of regional myocardial function by strain rate imaging. J Am Coll Cardiol 2002;39:1531-1537. https://doi.org/10.1016/S0735-1097(02)01768-0
  28. Park TH, Tayan N, Takeda K, Jeon HK, Quinones MA, Zoghbi WA. Supine bicycle echocardiography improved diagnostic accuracy and physiologic assessment of coronary artery disease with the incorporation of intermediate stages of exercise. J Am Coll Cardiol 2007;50:1857-1863. https://doi.org/10.1016/j.jacc.2007.05.053

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