Ken Kato1, Hideki Kitahara2, Yuichi Saito2, Yoshihide Fujimoto2, Yoshiaki Sakai3, Iwao Ishibashi3, Toshiharu Himi4, Yoshio Kobayashi2. 1. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. Electronic address: kkatou0424@yahoo.co.jp. 2. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. 3. Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan. 4. Division of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan.
Abstract
BACKGROUND: Prevalence of myocardial bridging of the left anterior descending coronary artery (LAD) in patients with takotsubo syndrome (TTS) has been demonstrated. However, the impact of myocardial bridging on in-hospital outcome has not been fully evaluated. METHODS: A total of 144 consecutive patients with TTS were enrolled. Coronary angiography and left ventriculography were performed in all patients and absence of obstructive coronary disease explaining the left ventricular contraction abnormality was confirmed. Myocardial bridging was diagnosed when a dynamic compression in systole, so-called "milking effect", was observed in the LAD. We evaluated differences in the clinical characteristics and in-hospital outcome between patients with and without myocardial bridging. Furthermore, multiple logistic regression analysis was performed to predict in-hospital death. RESULTS: Myocardial bridging was observed in 33 patients (23%). In-hospital death was more frequent in patients with myocardial bridging (21% vs. 6%, p=0.02), which was due mainly to a higher non-cardiac death in those patients (15% vs. 5%, p=0.049). Multiple logistic regression analysis demonstrated myocardial bridging (odds ratio=12.0, 95% CI=2.52-78.5, p<0.01) as one of the independent predictors of in-hospital death. CONCLUSION: Myocardial bridging is an independent predictor of in-hospital death in patients with TTS.
BACKGROUND: Prevalence of myocardial bridging of the left anterior descending coronary artery (LAD) in patients with takotsubo syndrome (TTS) has been demonstrated. However, the impact of myocardial bridging on in-hospital outcome has not been fully evaluated. METHODS: A total of 144 consecutive patients with TTS were enrolled. Coronary angiography and left ventriculography were performed in all patients and absence of obstructive coronary disease explaining the left ventricular contraction abnormality was confirmed. Myocardial bridging was diagnosed when a dynamic compression in systole, so-called "milking effect", was observed in the LAD. We evaluated differences in the clinical characteristics and in-hospital outcome between patients with and without myocardial bridging. Furthermore, multiple logistic regression analysis was performed to predict in-hospital death. RESULTS: Myocardial bridging was observed in 33 patients (23%). In-hospital death was more frequent in patients with myocardial bridging (21% vs. 6%, p=0.02), which was due mainly to a higher non-cardiac death in those patients (15% vs. 5%, p=0.049). Multiple logistic regression analysis demonstrated myocardial bridging (odds ratio=12.0, 95% CI=2.52-78.5, p<0.01) as one of the independent predictors of in-hospital death. CONCLUSION: Myocardial bridging is an independent predictor of in-hospital death in patients with TTS.
Authors: Yoichi Imori; Ken Kato; Jelena R Ghadri; Christian Templin; Victoria L Cammann; Konrad A Szawan; Manfred Wischnewsky; Sara Dreiding; Michael Würdinger; Maximilian Schönberger; Vanya Petkova; David Niederseer; Rena A Levinson; Davide Di Vece; Sebastiano Gili; Burkhardt Seifert; Masaki Wakita; Noriko Suzuki; Rodolfo Citro; Eduardo Bossone; Susanne Heiner; Maike Knorr; Thomas Jansen; Thomas Münzel; Fabrizio D'Ascenzo; Jennifer Franke; Ioana Sorici-Barb; Hugo A Katus; Annahita Sarcon; Jerold Shinbane; L Christian Napp; Johann Bauersachs; Milosz Jaguszewski; Reiko Shiomura; Shunichi Nakamura; Hitoshi Takano; Michel Noutsias; Christof Burgdorf; Iwao Ishibashi; Toshiharu Himi; Wolfgang Koenig; Heribert Schunkert; Holger Thiele; Behrouz Kherad; Carsten Tschöpe; Burkert M Pieske; Lawrence Rajan; Guido Michels; Roman Pfister; Shingo Mizuno; Alessandro Cuneo; Claudius Jacobshagen; Gerd Hasenfuß; Mahir Karakas; Hiroki Mochizuki; Alexander Pott; Wolfgang Rottbauer; Samir M Said; Ruediger C Braun-Dullaeus; Adrian Banning; Toshiaki Isogai; Akihisa Kimura; Florim Cuculi; Richard Kobza; Thomas A Fischer; Tuija Vasankari; K E Juhani Airaksinen; Yasuhiro Tomita; Monika Budnik; Grzegorz Opolski; Rafal Dworakowski; Philip MacCarthy; Christoph Kaiser; Stefan Osswald; Leonarda Galiuto; Filippo Crea; Wolfgang Dichtl; Tsutomu Murakami; Yuji Ikari; Klaus Empen; Daniel Beug; Stephan B Felix; Clément Delmas; Olivier Lairez; Tetsuo Yamaguchi; Ibrahim El-Battrawy; Ibrahim Akin; Martin Borggrefe; John D Horowitz; Martin Kozel; Petr Tousek; Petr Widimský; Ekaterina Gilyarova; Alexandra Shilova; Mikhail Gilyarov; Michael Neuhaus; Philippe Meyer; Jose David Arroja; Christina Chan; Paul Bridgman; Jan Galuszka; Gregor Poglajen; Pedro Carrilho-Ferreira; Fausto J Pinto; Christian Hauck; Lars S Maier; Kan Liu; Carlo Di Mario; Carla Paolini; Claudio Bilato; Matteo Bianco; Lucas Jörg; Hans Rickli; David E Winchester; Christian Ukena; Michael Böhm; Jeroen J Bax; Abhiram Prasad; Charanjit S Rihal; Shigeru Saito; Yoshio Kobayashi; Thomas F Lüscher; Frank Ruschitzka; Wataru Shimizu Journal: Clin Res Cardiol Date: 2021-05-19 Impact factor: 5.460