European Heart Journal Advance Access originally published online on April 30, 2009
European Heart Journal 2009 30(13):1627-1634; doi:10.1093/eurheartj/ehp121
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Myocardial bridging, a frequent component of the hypertrophic cardiomyopathy phenotype, lacks systematic association with sudden cardiac death
1 Department of Medico-Diagnostic Sciences, Pathological Anatomy, University of Padua Medical School, Padova, Italy
2 Jesse E. Edwards Registry of Cardiovascular Diseases, St Paul, MN, USA
3 Department of Environmental Medicine and Public Health, University of Padua Medical School, Padova, Italy
4 Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Padova, Italy
5 Hypertropic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
Received 17 August 2008; revised 4 March 2009; accepted 10 March 2009; online publish-ahead-of-print 30 April 2009.
* Corresponding author. Tel: +39 049 827 2283, Fax: +39 049 827 2284, Email: gaetano.thiene{at}unipd.it
See page 1549 for the editorial comment on this article (doi:10.1093/eurheartj/ehp216)
Aims: The clinical significance attributable to myocardial bridging of left anterior descending coronary artery in hypertrophic cardiomyopathy (HCM) remains controversial.
Methods and results: Prevalence and depth of coronary artery bridges (CBs) were assessed in 255 hearts, including 115 with HCM (median age 29, range 5–90; 75% male), and 140 controls. Coronary artery bridges were more common in HCM (47/115; 41%) than in patients who died of a variety of non-HCM-related causes (21/100; 21%; P = 0.002), or in patients with congenital aortic stenosis and left ventricular (LV) hypertrophy (5/40; 12%; P = 0.001). Among the HCM hearts, CBs were present in 33 of 77 patients (43%) with sudden death, in 10 of 27 (37%) with heart failure death (or heart transplantation), and in 4 of 11 (36%) with other modes of death (P = 0.826). Deeply embedded CBs (
2 mm) occurred with similar frequency in HCM patients with sudden (21 of 77; 27%) or heart failure death (5 of 27; 13%; P = 0.191). In sudden death patients, the presence of CB was unrelated to gender (33% in women and 45% in men, P = 0.406) and age (41% <18 years vs. 44% 18 years; P = 0.827).
Conclusion: In this morphological analysis of more than 250 hearts, CBs are a frequent component of phenotypically expressed HCM, and more common than in other disorders with or without LV hypertrophy. Although no systematic association with HCM-related sudden death is evident, our findings do not exclude the possibility that CB could contribute to increased risk in some individual patients, potentially impacting management decision-making on a case-by-case basis.
Key Words: Hypertrophic cardiomyopathy • Myocardial bridge • Congenital coronary anomalies • Sudden death
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EHJ 2009 30: 1549-1550.[Extract] [Full Text]
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  I. Olivotto, F. Cecchi, and M. H. Yacoub Myocardial bridging and sudden death in hypertrophic cardiomyopathy: Salome drops another veil Eur. Heart J., July 1, 2009; 30(13): 1549 - 1550. [Full Text] [PDF]
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