Koroner Arter Hastalığı ile Myokardiyal Köprüleşme Arasındaki İlişki

Yıl 2019, Cilt: 21 Sayı: 2, 195 - 201, 31.08.2019

Levent Cerit

https://doi.org/10.24938/kutfd.539647

Öz

Amaç: Miyokardiyal
köprüleşme, bir epikardiyal koroner arterin bir bölümünün intramüsküler bir
seyir içine girdiği bir koroner arterin konjenital varyantıdır. İyi huylu
olarak görülmesine rağmen, miyokard iskemisi, akut koroner sendromlar, koroner
spazm, egzersize bağlı aritmiler ve hatta ani ölüm gibi komplikasyonlara yol
açabilir. SYNTAX skoru anjiyografik skorlama sistemidir ve genellikle koroner
arter hastalığının yaygınlık ve ciddiyetini değerlendirmek için kullanılır. Bu
çalışma, myokard köprüleşmesi ve SYNTAX skoru arasındaki ilişkiyi
değerlendirmek amacıyla yapıldı.

Gereç ve Yöntemler: Koroner arter
bypass greft ameliyatı yapılan ardışık hastaların tıbbi kayıtları retrospektif
olarak incelendi. Çalışma grubu 267 hastadan oluşuyordu. Myokardial köprüleşme
prevalansı %13.4 saptandı. Tüm hastalarda biyokimyasal, klinik,
ekokardiyografik parametreler ve SYNTAX skoru değerlendirildi. Hastalar SYNTAX
skoruna göre iki gruba ayrıldı (≥23: yüksek, <23 düşük).

Bulgular: Yüksek SYNTAX
skoru grubu daha yaşlıydı ve hiperlipidemi, sigara içme ve diabet prevalansı
daha yüksekti. Tek değişkenli analizlerde yaş, diabet, sigara içme ve
hiperlipidemi yüksek SS ile ilişkiliydi. Çok değişkenli analizlerde diabet ve
hiperlipidemi yüksek SYNTAX skoru’nun bağımsız belirleyicileriydi (OR 2.957;
95% CI: 1.391–5.183; p<0.001, OR 3.267; 95% CI: 1.973-6.739; p<0.001; sırasıyla).

Sonuç: Çalışmamızda,
diabet ve hiperlipideminin yüksek SYNTAX skoru’nun bağımsız belirleyicileri
olduğunu bulduk. Her iki grup arasında myokardiyal köprüleşme varlığı yönünden
anlamlı fark yoktu.

Anahtar Kelimeler

Koroner arter hastalığı, myokardiyal köprüleşme, diyabet, hiperlipidemi

ASSOCIATION BETWEEN MYOCARDIAL BRIDGING AND CORONARY ARTERY DISEASE

Öz

Objective: Myocardial bridging is a congenital variant of a coronary
artery in which a portion of an epicardial coronary artery takes an
intramuscular course. Although it is considered
as benign, it may lead to complications such as myocardial ischemia, acute
coronary syndromes, coronary spasm, exercise-induced
dysrhythmias or even sudden death. SYNTAX score is the angiographic scoring
system and is commonly used to evaluate the severity and complexity of coronary
artery disease. This study was conducted
with the aim to evaluate the association between myocardial bridging and SYNTAX
score.

Material and Methods: The medical records of consecutive
patients, who underwent coronary artery bypass graft surgery, were
retrospectively reviewed. The study group consisted of 267 patients. The
prevalence of myocardial bridging was found to
be 13.4%. Biochemical, clinical, echocardiographic parameters and SYNTAX score were evaluated in all patients. The patients were divided into two groups according to the SYNTAX score (≥23: high, <23 low).

Results: The High SYNTAX score group was older and had higher prevalence of hyperlipidemia, smoking, and diabetes
mellitus. On univariate analysis age, diabetes mellitus, smoking, and
hyperlipidemia were associated with
higher SYNTAX score. On multivariate analysis diabetes mellitus and hyperlipidemia were
independent predictors of higher SYNTAX score (OR 2.957; 95% CI: 1.391–5.183; p<0.001,
OR 3.267; 95% CI: 1.973-6.739; p<0.001;
respectively).

Conclusion: In our study, we have found that
diabetes mellitus and hyperlipidemia were independent
predictors of high SS. There was no
significant difference between both groups regarding the presence of myocardial
bridging.

Anahtar Kelimeler

Coronary artery disease, myocardial bridging, diabetes mellitus, hyperlipidemia

Kaynakça

• 1. Geiringer E. The mural coronary. Am Heart J. 1951;41(3):359-68.
• 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(3):351-9.
• 3. Alegria JR, Herrmann J, Holmes DR Jr, Lerman A, Rihal CS. Myocardial bridging. Eur Heart J. 2005;26(12):1159-68.
• 4. De Giorgio F, Grassi VM, Polacco M, Pascali VL, d'Aloja E, Arena V. Myocardial bridging and sudden cardiac death: is the actual classification exhaustive? Int J Cardiol. 2014;172(3):383-4.
• 5. Migliore F, Maffei E, Perazzolo Marra M, Bilato C, Napodano M, Corbetti F et al. LAD coronary artery myocardial bridging and apical ballooning syndrome. JACC Cardiovasc Imaging. 2013;6(1):32-41.
• 6. Cerit L, Duygu H, Gulsen K. A case of doxazosin-induced acute coronary syndrome in a patient with myocardial bridging. Postepy Kardiol Interwencyjnej. 2016;12(1):75-6.
• 7. Uusitalo V, Saraste A, Pietila M, Kajander S, Bax JJ, Knuuti J. The functional effects of intramural course of coronary arteries and its relation to coronary atherosclerosis. JACC Cardiovasc Imaging. 2015:8(6):697-704.
• 8. Ishikawa Y, Akasaka Y, Ito K, Akishima Y, Kimura M, Kiguchi H et al. Significance of anatomical properties of myocardial bridge on atherosclerosis evolution in the left anterior descending coronary artery. Atherosclerosis. 2006:186(2):380-9.
• 9. Nakaura T, Nagayoshi Y, Awai K, Utsunomiya D, Kawano H, Ogawa H et al. Myocardial bridging is associated with coronary atherosclerosis in the segment proximal to the site of bridging. J Cardiol. 2014;63(2):134-9.
• 10. Yadav M, Palmerini T, Caixeta A, Madhavan MV, Sanidas E, Kirtane AJ et al. Prediction of coronary risk by SYNTAX and derived scores: synergy between percutaneous coronary intervention with taxus and cardiac surgery. J Am Coll Cardiol. 2013;62(14):1219-30.
• 11. Cerit L, Duygu H, Gulsen K, Kemal HS, Ozcem B, Balcioglu O et al. Is SYNTAX Score Predictive of Atrial Fibrillation after On-Pump Coronary Artery Bypass Graft Surgery? Korean Circ J. 2016;46(6):798-803.
• 12. Cerit L, Duygu H, Gulsen K, Kemal H, Tosun O, Ozcem B et al. The relation between vitamin B12 and SYNTAX score. Kardiol Pol. 2017;75(1):65-70.
• 13. Cerit L. Chicken or the egg: ST elevation in lead aVR or SYNTAX score. Cardiovasc J Afr. 2017;28(2):100-3.
• 14. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7(2):79-108.
• 15. Reiner Z. Statins in the primary prevention of cardiovascular disease. Nat Rev Cardiol. 2013;10(8):453-64.
• 16. Graham I, Cooney MT, Bradley D, Dudina A, Reiner Z. Dyslipidemias in the prevention of cardiovascular disease: risks and causality. Curr Cardiol Rep. 2012;14(6):709-20.
• 17. Reiner Z. Management of patients with familial hypercholesterolaemia. Nat Rev Cardiol. 2015;12(10):565-75.
• 18. Keymel S, Heinen Y, Balzer J, Rassaf T, Kelm M, Lauer T et al. Characterization of macro- and microvascular function and structure in patients with type 2 diabetes mellitus. Am J Cardiovasc Dis. 2011;1(1):68-75.
• 19. Baris N, Akdeniz B, Uyar S, Ozel E, Kirimli O, Badak O et al. Are complex coronary lesions more frequent in patients with diabetes mellitus? Can J Cardiol. 2006;22(11):935-57.
• 20. 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(7):1637-45.
• 21. Herrmann J, Higano ST, Lenon RJ, Rihal CS, Lerman A. Myocardial bridging is associated with alteration in coronary vasoreactivity. Eur Heart J. 2004;25(23):2134-42.
• 22. Uusitalo V, Saraste A, Pietilä M, Kajander S, Bax JJ, Knuuti J. The functional effects of ıntramural course of coronary arteries and its relation to coronary atherosclerosis. JACC Cardiovasc Imaging. 2015;8(6):697-704.
• 23. Yamada R, Tremmel JA, Tanaka S, Lin S, Kobayashi Y, Hollak MB et al. Functional versus anatomic assessment of myocardial bridging by ıntravascular ultrasound: Impact of arterial compression on proximal atherosclerotic plaque. J Am Heart Assoc. 2016;5(4):e001735.
• 24. Ishikawa Y, Akasaka Y, Suzuki K, Fujiwara M, Ogawa T, Yamazaki K et al. Anatomic properties of myocardial bridge predisposing to myocardial infarction. Circulation. 2009;120(5):376-83.
• 25. Jodocy D, Aglan I, Friedrich G, Mallouhi A, Pachinger O, Jaschke W et al. Left anterior descending coronary artery myocardial bridging by multislice computed tomography: correlation with clinical findings. Eur J Radiol. 2010;73(1):89-95.
• 26. Lubarsky L, Gupta MP, Hecht HS. Evaluation of myocardial bridging of the left anterior descending coronary artery by 64-slice multidetector computed tomographic angiography. Am J Cardiol. 2007;100(7):1081-2.
• 27. Ishii T, Asuwa N, Masuda S, Ishikawa Y. The effects of a myocardial bridge on coronary atherosclerosis and ischaemia. J Pathol. 1998;185(1):4-9.