A case report of a coronary myocardial bridge with impaired full-cycle ratio during dobutamine challenge

Abstract Background A myocardial bridge (MB) is a coronary variant in which an epicardial coronary artery tunnels through the myocardial band. Although MBs have been reported to cause ischaemia, physiological assessment of an MB has not been fully established. Case summary We encountered a case with exertional chest pain who underwent coronary angiography showing an MB at the mid-left anterior descending artery with systolic compression. Optical coherence tomography showed an MB defined as a homogeneous intermediate intensity surrounding the epicardial artery. The full-cycle ratio, defined as the lowest ratio of distal coronary pressure (Pd) to aortic pressure (Pa) during the entire cardiac cycle, measured 0.89 at rest and 0.73 with intravenous dobutamine of 20 µg/kg/min with a distinctive waveform pattern (early diastolic Pd drop) during a dobutamine challenge. Metoprolol succinate dosage was increased. The patient has been free from chest pain for 7 months after the discharge. Discussion Optical coherence tomography may contribute to anatomical detections of MBs. Because a systolic compression of the MB and release of the vascular lumen during early diastole leads to an early steep pressure loss, early diastolic Pd drop should be one of the specific haemodynamic characteristics of MBs. On the other hand, in a severe atherosclerotic stenosis, Pd drop is typically observed in late diastole, which could be differentiated from that of MBs. Because full-cycle ratio reflects the whole cardiac cycle including early diastole, this might be more useful than other physiological indices for detection of MB-related ischaemia induced by a dobutamine challenge.

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Multiple-cardiac-cycle noise reduction in dynamic optical coherence tomography of the embryonic heart and vasculature

Optics Letters ◽

10.1364/ol.34.003704 ◽

2009 ◽

Vol 34 (23) ◽

pp. 3704 ◽

Cited By ~ 29

Author(s):

Sandeep Bhat ◽

Irina V. Larina ◽

Kirill V. Larin ◽

Mary E. Dickinson ◽

Michael Liebling

Keyword(s):

Optical Coherence Tomography ◽

Noise Reduction ◽

Cardiac Cycle ◽

Embryonic Heart ◽

Optical Coherence

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Single cardiac cycle three-dimensional intracoronary optical coherence tomography

Biomedical Optics Express ◽

10.1364/boe.7.004847 ◽

2016 ◽

Vol 7 (12) ◽

pp. 4847 ◽

Cited By ~ 8

Author(s):

Tae Shik Kim ◽

Hyun-Sang Park ◽

Sun-Joo Jang ◽

Joon Woo Song ◽

Han Saem Cho ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Cardiac Cycle ◽

Three Dimensional ◽

Optical Coherence ◽

Single Cardiac Cycle

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100Culprit plaque morphology in patients with and without preinfarction angina: an optical coherence tomography imaging study

European Heart Journal ◽

10.1093/eurheartj/ehz747.0028 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Vergallo ◽

I Porto ◽

A Ricchiuto ◽

A Buonpane ◽

F Coletti ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Chest Pain ◽

Plaque Rupture ◽

Imaging Study ◽

Coronary Intervention ◽

Plaque Morphology ◽

Optical Coherence ◽

Thrombolytic Activity ◽

Oct Imaging ◽

Macrophage Accumulation

Abstract Background The relation between culprit plaque morphology and the clinical presentation of an acute myocardial infarction (AMI) has not been examined in detail. Purpose To study the culprit plaque morphology in patients with AMI with or without preinfarction angina using optical coherence tomography (OCT) imaging. Methods A total of 102 patients with AMI (32 STEMI, 70 NSTEMI) who underwent OCT imaging before percutaneous coronary intervention were enrolled. Patients were classified as: i) having either intermittent chest pain in the six hours preceding the final episode of pain, or unstable angina (or both) in the week preceding AMI (preinfarction angina group); or ii) having a single episode of chest pain without unstable symptoms in the preceding week (no preinfarction angina group). Culprit plaque was classified as plaque rupture (PR) or intact fibrous cap (IFC), as previously described. Prati thrombus score was calculated, and the prevalence of calcification, neovascularization, and OCT-defined macrophage accumulation was assessed. Results Patients with preinfarction angina showed a significantly higher prevalence of IFC than PR, while those without preinfarction angina showed a significantly higher prevalence of PR than IFC (Figure). PR in patients with preinfarction angina were more frequently associated with macrophage accumulation, while those in patients without preinfarction angina were not (Figure). White thrombus tended to be more frequent in patients with preinfarction angina than in those without (85.7% vs. 63.6%, p=0.097), and Prati thrombus score tended to be lower [22.0 (15.8–30.3) vs. 38.5 (12.8–67.5), p=0.145]. Calcifications were significantly less frequent in patients with preinfarction angina than in those without (22.0% vs. 40.4%, p=0.045), while neovascularization tended to be more frequent (58.0% vs. 42.3%, p=0.113). Conclusions Patients with preinfarction angina have a distinct culprit plaque phenotype, frequently characterized by IFC and a relatively lower thrombotic burden, probably reflecting a prevalence of reparative mechanisms and spontaneous thrombolytic activity in these patients.

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Absence of adventitial vasa vasorum formation at the coronary segment with myocardial bridge - An optical coherence tomography study

International Journal of Cardiology ◽

10.1016/j.ijcard.2017.09.211 ◽

2018 ◽

Vol 250 ◽

pp. 275-277 ◽

Cited By ~ 6

Author(s):

Kensuke Nishimiya ◽

Yasuharu Matsumoto ◽

Hongxin Wang ◽

Zhonglie Piao ◽

Kazuma Ohyama ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Vasa Vasorum ◽

Optical Coherence ◽

Myocardial Bridge ◽

Coronary Segment

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Extremely tortuous coronary arteries - when optical coherence tomography and fractional flow reserve did not help us much

Vojnosanitetski pregled ◽

10.2298/vsp160316213m ◽

2018 ◽

Vol 75 (1) ◽

pp. 100-103

Author(s):

Vladimir Miloradovic ◽

Dusan Nikolic ◽

Miodrag Sreckovic ◽

Ivana Djokic-Nikolic

Keyword(s):

Optical Coherence Tomography ◽

Coronary Artery ◽

Fractional Flow Reserve ◽

Stable Angina ◽

Stress Test ◽

Optical Coherence ◽

Fractional Flow ◽

Coronary Pressure ◽

Flow Reserve ◽

Coronary Tortuosity

Introduction. Extreme coronary tortuosity may lead to flow alteration resulting in a reduction in coronary pressure distal to the tortuous segment, subsequently leading to ischemia. Therefore the detection of a true cause of ischemia, i.e. whether a fixed stenosis or tortuosity by itself is responsible for its creation, with non-invasive and invasive methods is a real challenge. Case report. We presented a case of a patient with a history of stable angina [Canadian Cardiovascular Society (CCS class II)], an abnormal stress test and coronary tortuosity without hemodynamically significant stenosis. Due to suspected linear lesion between the two bends in proximal segment of Right coronary artery (RCA) we performed optical coherence tomography (OCT), minimum lumen area (MLA)-13.19 mm2) and fractional flow reserve (FFR) RCA (0.94). We opted for conservative treatment for stable angina. Conclusion. When tortuosities are associated with atherosclerosis in coronary artery for determination of true cause of ischemia invasive methods can be used, such as OCT and FFR. This article has been corrected. Link to the correction <a href="http://dx.doi.org/10.2298/VSP1912304E">10.2298/VSP1912304E</a>

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Detection of myocardial bridge by optical coherence tomography

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02497-5 ◽

2022 ◽

Author(s):

Akihiko Okamura ◽

Hiroyuki Okura ◽

Saki Iwai ◽

Atsushi Kyodo ◽

Daisuke Kamon ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Optical Coherence ◽

Myocardial Bridge

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Neovascularization in Human Intracranial Atherosclerotic In-Stent Restenosis

Diagnostics ◽

10.3390/diagnostics11020322 ◽

2021 ◽

Vol 11 (2) ◽

pp. 322

Author(s):

Yiding Feng ◽

Adam A. Dmytriw ◽

Bin Yang ◽

Liqun Jiao

Keyword(s):

Optical Coherence Tomography ◽

High Resolution ◽

Optical Coherence ◽

Critical Pathway ◽

Stent Restenosis ◽

Atherosclerotic Stenosis ◽

In Stent Restenosis

Optical coherence tomography (OCT) has seen widespread use in cardiovascular and interventional endovascular imaging. While scattered reports of intracranial usage have been reported for the assessment of atherosclerotic stenosis, nutrifying neovasculature supplying plaque and neointima have not been demonstrated until now. We report the first in-vivo illustration of this phenomenon, which is a high-resolution depiction of a critical pathway for in-stent restenosis.

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Derivation and validation of myocardial bridge characteristics by optical coherence tomography: a prospective multimodality imaging study

European Heart Journal ◽

10.1093/eurheartj/ehab724.0273 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

T Otsuka ◽

Y Ueki ◽

S Losdat ◽

S Baer ◽

L Raeber

Keyword(s):

Optical Coherence Tomography ◽

Light Intensity ◽

Predictive Value ◽

Vessel Wall ◽

Multimodality Imaging ◽

Subsequent Treatment ◽

Optical Coherence ◽

Imaging Data ◽

Myocardial Bridge ◽

Derivation Cohort

Abstract Background Optical coherence tomography (OCT) findings of myocardial bridge (MB) have not been established. Purpose We aimed to establish the OCT appearance of MB compared with the half-moon sign derived by intravascular ultrasound (IVUS) and to assess the prevalence among patients undergoing coronary angiography and OCT in clinical practice. Methods For derivation of the OCT appearance of MB, imaging data obtained from 122 patients undergoing OCT and IVUS for the left anterior descending artery (LAD) enrolled in two prospective imaging studies were analyzed. To assess the prevalence of OCT-derived MB, 470 patients undergoing OCT for LAD in clinical routine were analyzed. Results We found a homogeneous band with intermediate light intensity surrounding the vessel wall as assessed by OCT corresponding to half-moon sign derived by IVUS. Mean length, angle, and thickness of OCT-MB were 21.2±10.8mm, 205.7±56.5°, and 0.39±0.06mm, respectively. Mean length of IVUS-MB was significantly longer as compared with OCT-MB (23.7±11.9, P=0.010), while there were no significant differences in angle and thickness. MB angle was >180° in approximately 50% of frames with MB. There was a strong/moderate correlation between OCT-MB and half-moon sign (MB length: r=0.81, P=0.001, MB angle: r=0.58, P=0.001). In the derivation cohort, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of OCT-MB for the milking effect by angiography were 96.3%, 62.1%, 41.9%, 98.3%, and 69.7%, respectively, and much comparable with the IVUS half-moon sign. In the validation cohort, OCT-detected MB was observed in 139 (29.6%) patients, of whom 57.6% (n=80) did not have angiographic evidence of milking effect. Conclusion OCT is able to identify IVUS-defined MB as homogenous band with intermediate light intensity surrounding the vessel wall. There was a high concordance in terms of MB angle and thickness between OCT and IVUS. In clinically-indicated OCT cases of the LAD, more than half of OCT-MBs were angiographically silent. OCT assessment of MB may facilitate the accurate diagnosis of MB and thus provide useful information in determining the subsequent treatment strategy for the patients with MB. FUNDunding Acknowledgement Type of funding sources: None. Representative imaging of MB Case of OCT-MB without milking effect

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Utility of Saline-Induced Resting Full-Cycle Ratio Compared with Resting Full-Cycle Ratio and Fractional Flow Reserve

Journal of Interventional Cardiology ◽

10.1155/2020/5787439 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Takao Sato ◽

Sonoka Goto ◽

Yusuke Ohta ◽

Yuji Taya ◽

Sho Yuasa ◽

...

Keyword(s):

Fractional Flow Reserve ◽

Operating Characteristic ◽

Cardiac Cycle ◽

Characteristic Curve ◽

Pressure Ratio ◽

Aortic Pressure ◽

Relative Pressure ◽

Fractional Flow ◽

Coronary Pressure ◽

Flow Reserve

Background. The saline-induced distal coronary pressure/aortic pressure ratio predicted fractional flow reserve (FFR). The resting full-cycle ratio (RFR) represents the maximal relative pressure difference in a cardiac cycle. Therefore, the present study aimed to compare the results of saline-induced RFR (sRFR) with FFR. Methods. Seventy consecutive lesions with only moderate stenosis were included. The FFR, RFR, and sRFR values were compared. The sRFR was assessed using an intracoronary bolus infusion of saline (2 mL/s) for five heartbeats. The FFR was obtained after an intravenous injection of papaverine. Results. Overall, the FFR, sRFR, and RFR values were 0.78 ± 0.12, 0.79 ± 0.13, and 0.83 ± 0.14, respectively. With regard to anatomical morphology were 40, 18, and 12 cases of focal, diffuse, and tandem lesion. There was a significant correlation between the sRFR and FFR (R = 0.96, p<0.01). There were also significant correlations between the sRFR and FFR in the left coronary and right coronary artery (R = 0.95, p<0.01 and R = 0.98, p<0.01). Furthermore, significant correlations between sRFR and FFR were observed in not only focal but also in nonfocal lesion including tandem and diffuse lesions (R = 0.93, p<0.01 and R = 0.97, p<0.01). A close agreement on FFR and sRFR was shown using the Bland–Altman analysis (95% CI of agreement: −0.08–0.07). In the receiver operating characteristic curve analysis, the cutoff value of sRFR to predict an FFR of 0.80 was 0.81 (area under curve, 0.97; sensitivity 90.6%; and specificity 98.2%). Conclusion. The sRFR can accurately and safely predict the FFR and might be effective for diagnosing ischemia.

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