New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler

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Abstract
Background Large discrepancies exist concerning the incidence of myocardial bridging. This has been reported to be 0·5%–2·5% following coronary angiography but 15%–85% following autopsy. The purpose of the study was to use intravascular ultrasound and intracoronary Doppler to study the morphology and flow characteristics of myocardial bridging in order to find feasible parameters of this syndrome. Methods and Results Intravascular ultrasound was performed in 62/69 patients in whom typical angiographic ‘milking effects’ were present. In 48 patients, intracoronary Doppler was performed. A specific, echolucent ‘half moon’ phenomenon surrounding the myocardial bridge was found in all the patients. The thickness of the half moon area was 0·47±0·19mm in diastole and 0·52±0·23mm in systole. There was systolic compression of the myocardial bridge with a lumen reduction during systole of 36·4±8·8%. Using intracoronary Doppler, a characteristic early diastolic ‘finger tip’ phenomenon was observed in 42 (87%) of the patients. All patients showed no or reduced antegrade systolic flow. Coronary flow velocity reserve was 2·03±0·54. After intracoronary nitroglycerin injection, retrograde systolic flow occurred in 37 (77%) of the 48 patients, with a velocity of −22·2±13·2cm.s−1. Intravascular ultrasound revealed atherosclerotic involvement of the proximal segment in 61 (88%) of the 69 patients, with an area stenosis of 42±13%. No plaques were found in the bridge or distal segments in the 62 patients in whom it was possible to introduce the ultrasound catheter throughout the bridging segment. Conclusion Myocardial bridging is characterized by the following morphological and functional signs: a specific, echolucent half moon phenomenon over the bridge segment, which exists throughout the cardiac cycle; systolic compression of the bridge segment of the coronary artery; accelerated flow velocity at early diastole (finger-tip phenomenon); no or reduced systolic antegrade flow; decreased diastolic/systolic velocity ratio; retrograde flow in the proximal segment, which is provoked and enhanced by nitroglycerin injection.