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We aim to investigate if myocardial bridging (MB) provides predictive value beyond its association with non-obstructive coronary artery disease (CAD) burden in a long-term follow-up and multicenter study. This study included 4176 consecutive patients with suspected CAD underwent coronary computed tomography angiography (CTA) at two hospitals in Wuhan, China, between September 2016 and December 2017 for finial analysis. Kaplan-Meier method was used to estimate the cumulative event-free survival of non-obstructive CAD burden and MB burden classifications, respectively. Further, cox regression models were applied to calculate hazard ratios (HR) for increasing non-obstructive CAD and MB burden classifications. In total, during the 6.04 years (interquartile range 5.73–6.32) follow-up, 276 (6.61%) patients occurred main adverse cardiovascular events (MACE). MB was found in 44% of patients without CAD and in 40.5% of those with non-obstructive CAD. The annualized MACE rate was 1.07 (95% confidence interval (CI): 0.92–1.24) for the no MB group and 1.13 (95% CI: 0.95–1.34) for the MB group. Univarite and Multivariate Cox regression showed that neither the depth nor the length of MB was associated with the risk of MACE. However, after adjusting with sex, age, smoke, drink, hypertension and diabetes, 2-vessel non-obstructive CAD and 3-vessel non-obstructive CAD showed significant association with the risk of MACE, with HR of 1.53 (95% CI: 1.06–2.21, P  = 0.023) and 1.93 (95% CI: 1.32–2.82, P  = 0.001), respectively, using no CAD as the reference group. Non-obstructive CAD, not presence of MB, is the main predictor of risk for future MACE in patients without obstructive CAD. Prospective registries in the future should include validated quality of life measures and CT-FFR with long-term outcomes to enhance the understanding of symptomatic burden and functional assessment in MB risk stratification.

Background Myocardial bridging is a cardiac anomaly where a segment of epicardial coronary arteries runs through the myocardium and can rarely cause MI. Takotsubo syndrome is a stress-induced cardiomyopathy that can mimic MI. Catecholamine surge during stress can contribute to Takotsubo syndrome, but whether this surge can trigger an inconspicuous myocardial bridging to manifest symptomatically remains unclear, and alternately, whether a myocardial bridge might cause worsening of Takotsubo syndrome is also a matter that needs further research. Case presentation We report the case of a patient who initially presented with features of acute exacerbation of bronchiectasis and subsequently developed symptoms and ECG features suggestive of acute myocardial infarction. Echocardiography revealed features of takotsubo syndrome, and complete myocardial bridging was revealed via coronary angiography. The patient was managed conservatively with pharmacological treatment, and after a few days, echocardiographic features were reversed. As such, the diagnosis shifted toward Takotsubo syndrome with myocardial stunning due to co-existent myocardial bridging. Conclusion We report a rare case of a patient with acute bronchiectasis exacerbation with features suggestive of acute myocardial infarction who had findings of Takotsubo syndrome and complete myocardial bridging. In the beginning, it was difficult to determine whether the symptoms arose due to acute MI resulting from myocardial bridging or were solely due to takotsubo syndrome because of stress from bronchiectasis. Although myocardial bridging is often overlooked as an etiology for acute MI, this case highlights the importance of expanding the differential diagnosis to myocardial bridging in the work-up for the cause of acute MI and how Takotsubo syndrome can mimic acute MI and pose a diagnostic challenge.

Background Myocardial bridging (MB) is common in patients with hypertrophic cardiomyopathy (HCM). There are sparse data on the impact of MB on myocardial fibrosis in HCM. This study was designed to evaluate the relationship between MB and myocardial fibrosis in patients with obstructive HCM. Methods In this cohort study, retrospective data were collected from a high-volume HCM center. Patients with obstructive HCM who underwent septal myectomy and preoperative cardiac magnetic resonance (CMR) were screened from 2011 to 2018. Results Finally, 492 patients were included in this study, with an average age of 45.7 years. Of these patients, 76 patients had MB. MB occurred mostly in the left anterior descending artery (73/76). The global extent of late gadolinium enhancement (LGE) was correlated with the degree of systolic compression ( r  = 0.33, p  = 0.003). Multivariable linear regression analysis revealed that the degree of systolic compression was an independent risk factor for LGE ( β  = 0.292, p  = 0.007). The LGE fraction of basal and mid anteroseptal segments in patients with severe MB (compression ratio ≥ 80%) was significantly greater than that in patients with mild to moderate MB (compression ratio < 80%). During a median follow-up of 28 (IQR: 15–52) months, 15 patients died. Kaplan–Meier analysis did not identify differences in all-cause death (log-rank p  = 0.63) or cardiovascular death (log-rank p  = 0.72) between patients undergoing MB-related surgery and those without MB. Conclusions MB with severe systolic compression was significantly associated with a high extent of fibrosis in patients with obstructive HCM. Concomitant myotomy or coronary artery bypass grafting might provide excellent survival similar to that of patients without MB. Identification of patients with severe MB and providing comprehensive management might help improve the prognosis of patients with HCM.

Myocardial bridging (MB) is a kind of congenital coronary abnormality. The functional impact of MB on coronary artery remains a subject of debate. This study aimed to assess the hemodynamic effects of MB using coronary angiography-derived fractional flow reserve (caFFR) and elucidate the relationship between MB anatomical parameters and diastolic caFFR (dcaFFR) in patients with isolated MB (iMB) and MB combined with proximal coronary atherosclerosis (MB+AS). A total of 683 patients diagnosed with MB located on left anterior descending (LAD) via coronary angiography (CAG) were retrospectively enrolled and categorized into two groups: iMB (n = 377) and MB+AS (n = 306). The dcaFFR was calculated to evaluate the hemodynamic impact of MB. Multivariate linear regression and mediation analysis were performed to identify predictors of dcaFFR. In the iMB group, diastolic minimal lumen diameter (MLD) of MB segment was the sole independent predictor of dcaFFR (B = 0.036, β = 0.253, p <0.001). In the group of MB+AS, the severity of proximal stenosis emerged as the only independent predictor of dcaFFR (B = −0.004, β = −0.674, p <0.001), with the hemodynamic effects of MB fully mediated by proximal stenosis. In conclusion, the hemodynamic impact of MB depends on the presence of proximal coronary atherosclerosis. In iMB cases, the diastolic MLD of MB segment directly determines hemodynamic impairment. However, the hemodynamic impact of MB is nonsignificant in cases of MB+AS, as its effect is fully mediated through proximal stenosis severity.

Myocardial bridging (MB) is a phenomenon that occurs when coronary arteries course through myocardial tissue rather than, as is normal, on the surface of the myocardium. Although often asymptomatic, contraction of the myocardium in the presence of a myocardial bridge can sometimes occlude the lumen of coronary arteries that penetrate the myocardium, resulting in symptoms, signs, and electrocardiographic changes indistinguishable from those associated with acute coronary syndromes (ACS) caused by intraluminal narrowing of coronary arteries or coronary artery plaque rupture. In this monograph, we present the case of a 45-year-old man who presented to the emergency department with typical chest pain accompanied by electrocardiographic changes consistent with acute occlusion of the left anterior descending artery. During percutaneous coronary intervention, fluoroscopically–obtained cine image loops revealed evidence of dynamic coronary artery narrowing due to myocardial bridging. There was no evidence of static coronary artery occlusion. Myocardial bridging is typically managed medically when symptomatic, although refractory cases may ultimately require invasive or surgical intervention. Given that emergency physicians are frequently the first providers to evaluate patients with acute coronary syndromes, myocardial bridging as an etiology for ACS is a clinical entity of which emergency physicians should be aware.

Background Clinical events such as angina pectoris, acute coronary syndrome, and sudden death caused by myocardial bridge (MB) have attracted increasing attention. It is still a challenge to diagnose whether MB can cause the symptoms of patients with MB. For most MB patients, medication remains the primary treatment. Case presentation This article reports a case of chest pain in a patient with MB in the middle segment of the left anterior descending artery (LAD m ) with moderate stenosis in the proximal segment (LAD p ). Through functional assessment, we found that neither MB nor fixed stenosis had sufficient effect on coronary blood flow to cause myocardial ischemia, but their synergistic effect resulted in myocardial ischemia. Finally, a stent was implanted in LAD p and good clinical results were achieved. Conclusions For symptomatic patients with MB combined with fixed stenosis, functional evaluation may be necessary, which has significant guiding significance for treatment strategy selection. For asymptomatic patients, early detection of myocardial ischemia may also improve the prognosis of patients.

PurposeTo evaluate the feasibility of fractional flow reserve (cFFR) derivation from coronary CT angiography (CCTA) in patients with myocardial bridging (MB), its relationship with MB anatomical features, and clinical relevance.MethodsThis retrospective study included 120 patients with MB of the left anterior descending artery (LAD) and 41 controls. MB location, length, depth, muscle index, instance, and stenosis rate were measured. cFFR values were compared between superficial MB (≤ 2 mm), deep MB (> 2 mm), and control groups. Factors associated with abnormal cFFR values (≤ 0.80) were analyzed.ResultsMB patients demonstrated lower cFFR values in MB and distal segments than controls (all p < 0.05). A significant cFFR difference was only found in the MB segment during systole between superficial (0.94, 0.90–0.96) and deep MB (0.91, 0.83–0.95) (p = 0.018). Abnormal cFFR values were found in 69 (57.5%) MB patients (29 [49.2%] superficial vs. 40 [65.6%] deep; p = 0.069). MB length (OR = 1.06, 95% CI 1.03–1.10; p = 0.001) and systolic stenosis (OR = 1.04, 95% CI 1.01–1.07; p = 0.021) were the main predictors for abnormal cFFR, with an area under the curve of 0.774 (95% CI 0.689–0.858; p < 0.001). MB patients with abnormal cFFR reported more typical angina (18.8% vs 3.9%, p = 0.023) than patients with normal values.ConclusionMB patients showed lower cFFR values than controls. Abnormal cFFR values have a positive association with symptoms of typical angina. MB length and systolic stenosis demonstrate moderate predictive value for an abnormal cFFR value.Key Points• MB patients showed lower cFFR values than controls.• Abnormal cFFR values have a positive association with typical angina symptoms.• MB length and systolic stenosis demonstrate moderate predictive value for an abnormal cFFR value.

Mounting evidence suggests an associated between myocardial bridging (MB) and coronary vasospasm (CVS); however, no consensus has been established on whether CVS worsens clinical outcomes in patients with MB. Therefore, this retrospective study aimed to compare the long-term clinical outcomes in patients with MB based on CVS presence. This retrospective study enrolled 254 consecutive patients with MB undergoing provocative testing for coronary reactivity between January 1, 2009 and December 30, 2015, and stratified them into 2 groups: (a) group A (with CVS, n = 168); and (b) group B (without CVS, n = 86). The primary endpoints were major adverse cardiovascular events (MACEs), a composite of cardiac death, cardiac arrest, non-fatal myocardial infarction, ischemia-driven revascularization, ischemia-driven coronary angiography, and ischemia-related hospitalization. Diverse Cox models were used to determine whether CVS independently influenced MACE. The mean age of study participants was 50.8 years, and 60.2% of them were male. The median follow-up period was 8.15 years. The rate of MACE was 35.1% and 26.7% in groups A and B, respectively. Group A had a significantly higher risk of MACE than group B (the reference group) in model 3 (hazard ratio [HR]:1.92; 95% confidence interval [CI]:1.12-3.29) and model 4 (adjusted HR: 1.94; 95% CI: 1.04-3.59). The presence of CVS adversely affects clinical outcomes in patients with MB. Further prospective clinical studies are required to confirm this association.

PurposeWe aimed to determine the prevalence and radiological characteristics of myocardial bridging (MB) and intra-atrial course anomaly (IARCA), which are rare course variations of the right coronary artery (RCA), in the adult patient population.MethodsRadiological images of cases over the age of 18 who underwent coronary CT angiography (CTA) examination in our clinic were scanned from the archives retrospectively, and cases with MB of the RCA and IARCA detection were included in the study. The number, age and gender distribution of the cases, whether there were any other accompanying vascular anomalies, whether there was atherosclerosis in the coronary arteries (calculation of Agatston total calcium score, calculation of atherosclerotic stenosis as a percentage, if any) were evaluated.ResultsThe prevalence of MB in the RCA was 2.06%, and the prevalence of IARCA was 0.44%. In one case, both anomalies were detected together. The average MB segment length in RCA was 21.9 mm, and the average IARCA segment length was 37.9 mm. There was no atherosclerotic disease in the RCA segment where anomaly was detected.ConclusionRecognition of rare course anomalies of RCA before treatment procedures such as ablation and surgery is important to prevent complications that may have potentially fatal consequences.

Electrocatalytic N₂ reduction reaction (NRR) into ammonia (NH₃), especially if driven by renewable energy, represents a potentially clean and sustainable strategy for replacing traditional Haber–Bosch process and dealing with climate change effect. However, electrocatalytic NRR process under ambient conditions often suffers from low Faradaic efficiency and high overpotential. Developing newly regulative methods for highly efficient NRR electrocatalysts is of great significance for NH₃ synthesis. Here, we propose an interfacial engineering strategy for designing a class of strongly coupled hybrid materials as highly active electrocatalysts for catalytic N₂ fixation. X-ray absorption near-edge spectroscopy (XANES) spectra confirm the successful construction of strong bridging bonds (Co–N/S–C) at the interface between CoSₓ nanoparticles and NS-G (nitrogen- and sulfurdoped reduced graphene). These bridging bonds can accelerate the reaction kinetics by acting as an electron transport channel, enabling electrocatalytic NRR at a low overpotential. As expected, CoS₂/NS-G hybrids show superior NRR activity with a high NH₃ Faradaic efficiency of 25.9%at −0.05 V versus reversible hydrogen electrode (RHE). Moreover, this strategy is general and can be extended to a series of other strongly coupled metal sulfide hybrids. This work provides an approach to design advanced materials for ammonia production.