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Combined Computed Tomography Angiography-Computed Tomography Perfusion in the Identification and Prognostic Assessment of Myocardial Bridging from the CORE320 Study: 5-Year Follow-Up - 03/11/23

Doi : 10.1016/j.amjcard.2023.08.040 
Michael P. Gannon, MD a, b, , Rodrigo J. Cerci, MD c, Carolina Valdiviezo, MD d, Mohammad R. Ostovaneh, MD, MPH e, Andrea L. Vavere, MPH e, Henrique Doria de Vasconcellos, MD, MSc e, Matthew B. Matheson, MS e, f, Christopher Cox, PhD f, Julie M. Miller, MD e, Marcelo di Carli, MD g, Armin Arbab-Zadeh, MD e, Richard T. George, MD e, João A.C. Lima, MD e, Marcus Y. Chen, MD b
a Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania 
b National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, Maryland 
c Quanta Diagnóstico e Terapia, Curitiba, Brazil 
d Medstar Heart and Vascular Institute, Georgetown University, Washington, District of Columbia 
e Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland 
f Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 
g Brigham and Women's Hospital, Boston, Massachusetts 

Corresponding author: Tel: 215-707-8484; fax: 215-707-3946.

Riassunto

Our objective is to use computed tomography angiography (CTA) and computed tomography perfusion (CTP) to identify the ischemic significance of myocardial bridging (MB). We also seek to determine the long-term prognostication of MB in the presence or absence of obstructive coronary artery disease (CAD). The CORE320, a prospective, multicenter study including 381 patients with known or suspected CAD clinically referred for invasive coronary angiography who underwent combined (CTA-CTP) and single-photon emission computed tomography before conventional coronary angiography. The incidence of MB was identified in 135 patients (35.4%) with 93.9% identified in the left anterior descending artery. MB were divided as partially encased versus fully encased. There was no difference in ischemia identified between partially encased MB and fully encased MB (37 [40%] vs 25 [35%], p = 0.54]. Ischemia was identified at similar rates in partially versus fully encased MB by single-photon emission computed tomography at (8 [9%] vs 8 [11%], p = 0.57] and CTP (34 [37%] vs 21 [30%], p = 0.33]. There was no difference in the primary outcome of 5-year outcome of combined incidence of myocardial infarction or death. The restricted mean survival time in patients with CTA with <50% stenosis with or without a MB was 4.906 years (95% confidence interval 4.759 to 5.000) and 4.891 years (95% confidence interval 4.718 to 5.000), respectively (p = 0.824). Cardiac computed tomography perfusion imaging can assess both anatomic and functional significance of myocardial bridging with diagnostic accuracy similar to current standard imaging. Furthermore, 5-year cardiovascular events were not different with the presence of MB in both obstructive and non-obstructive CAD.

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Keywords : cardiac CT perfusion, coronary artery disease, myocardial bridging, myocardial ischemia, coronary computed tomography angiography


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 Funding: The main trial, the CORE320 study, was funded by Canon (formerly Toshiba) Medical Systems Corporation (Tokyo, Japan). Dr. Vavere reports financial support was provided by AstraZeneca Pharmaceuticals LP (Wilmington, Delaware). Dr. Lima reports financial support was provided by Canon Medical Systems Corporation. Dr. Chen reports financial support was provided by National Heart Lung and Blood Institute (Bethesda, Maryland).


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Vol 207

P. 314-321 - novembre 2023 Ritorno al numero
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