Increased TIMI frame count of coronary arteries in patients with myocardial bridging

Year 2019, Volume: 5 Issue: 3, 490 - 496, 04.05.2019

Ekrem Aksu Hakan Güneş

https://doi.org/10.18621/eurj.388556

Abstract

Objectives: Myocardial bridging (MB) is associated with recurrent chest pain and
cardiovascular events. Recently it has been proposed that MB has the features
of vasospastic coronary artery characterized with reduced coronary flow reserve
and endothelial dysfunction. In this study, an evaluation was made of the
angiographic Thrombolysis in
Myocardial Infarction (TIMI) frame
counts (TFCs) of patients with normal angiogram and those with MB.

Methods: The study was conducted as a retrospective analysis of the demographic,
laboratory, and angiographic features of consecutive patients who underwent
coronary angiography between January 2014 and December 2017 in Necip Fazıl City
Hospital and Sütçü Imam University, Kahramanmaraş, Turkey.

Results: The except for
age (51.1 ± 11.6 years vs 56.8 ± 11.4 years) (p = 0.011), no difference was determined between the groups in
respect of laboratory parameters and demographic features. TFCs of LAD (42.9 ± 6.1
vs 54.5 ± 11.5. p < 0.001), Cx (19.4
± 4.5 vs 24.4 ± 7.1, p < 0.001),
and RCA (26.8 ± 6.2 vs 32.5 ± 8.9, p <
0.001), and corrected TFC of LAD artery (25.2 ± 3.6 vs 32.0 ± 6.8, p < 0.001) were observed to be
significantly increased in patients with MB compared to patients with normal
coronary flow. Multiple regression analysis revealed that MB was the only
determinant of increased corrected TFC of LAD artery (r=0.537, Adjusted r=0.281, p < 0.001).

Conclusions: Patients with MB had
abnormally slow coronary flow demonstrated by increased TFC. This finding may
explain the recurrent angina and cardiovascular events of patients with MB. It
may also explain the reversible myocardial perfusion defects which are
associated with recurrent cardiovascular events in patients with MB. 

Keywords

Myocardial bridging, thrombolysis in myocardial infarction, TIMI frame count, coronary flow, recurrent angina

References

• [10] Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996;93:879-88.
• [11] Kunadian V, Harrigan C, Zorkun C, Palmer AM, Ogando KJ, Biller LH, et al. Use of the TIMI frame count in the assessment of coronary artery blood flow and microvascular function over the past 15years. J Thromb Thrombolysis 2009;27:316-28.
• [12] Barutcu I, Sezgin AT, Gullu H, Turkmen M, Esen AM. Assessing coronary blood flow with TIMI frame count method in isolated myocardial bridging. Angiology 2007; 58:283-8.
• [13] Durukan M, Aksu T, Çolak A, Güray Ü. [Augmentation of vessel narrowing by nitroglycerine in a case with myocardial bridge]. Anadolu Kardiyol Derg 2011;11:464-6. [Article in Turkish]
• [14] Van De Wiele C, Rimbu A, Belhocine T, DE Spiegeleer B, Sathekge M, Maes A. Reversible mycordial perfusion defects in patients not suffering from obstructive epicardial coronary artery disease as assessed by coronary angiography: a review of the literature. Q J Nucl Med Mol Imaging 2016 Mar 23.
• [15] Brolin EB, Brismar TB, Collste O, Y-Hassan S, Henareh L, Tornvall P et al. Prevalence of myocardial bridging in patients with myocardial infarction and nonobstructed coronary arteries. Am J Cardiol 2015;116:1833-9.
• [16] Wieneke H, Zander C, Eising EG, Haude M, Bockisch A, Erbel R. Non-invasive characterization of cardiac microvascular disease by nuclear medicine using single-photon emission tomography. Herz 1999;24:515-21.
• [17] Kim SS, Jeong MH, Kim HK, Kim MC, Cho KH, Lee MG, et al. Long-term clinical course of patients with isolated myocardial bridge. Circ J 2010;74:538-43.
• [18] Nardi F, Verna E, Secco GG, Rognoni A, Sante Bongo A, Iraghi G,et al. Variant angina associated with coronary artery endothelial dysfunction and myocardial bridge: a case report and review of the literature. Intern Med 2011;50:2601-6.
• [19] Aparci M, Yalcin M, Isilak Z. Accumulation of Ca+2 at arterial segments proximal to myocardial bridging may influence the vascular dynamics of coronary artery. Int J Cardiol 2016;202:782-83.
• [1] Bourassa MG, Butnaru A, Lespérance J, Tardif JC. Symptomatic myocardial bridges: overview of ischemic mechanisms and current diagnostic and treatment strategies. J Am Coll Cardiol 2003;41:351-9.
• [20] Loukas M, Bhatnagar A, Arumugam S, Smith K, Matusz P, Gielecki J, et al. Histologic and immunohistochemical analysis of the antiatherogenic effects of myocardial bridging in the adult human heart. Cardiovasc Pathol 2014;23:198-203.
• [21] Cay S, Oztürk S, Cihan G, Kisacik HL, Korkmaz S. Angiographic prevalence of myocardial bridging. Anadolu Kardiyol Derg 2006;6:9-12.
• [2] Klues HG, Schwarz ER, vom Dahl J, Reffelmann T, Reul H, Potthast K, et al. Disturbed intracoronary hemodynamics in myocardial bridging: early normalization by intracoronary stent placement. Circulation 1997;96:2905-13.
• [3] Im SI, Rha SW, Choi BG, Choi SY, Kim SW, Na JO, et al. Angiographic and clinical characteristics according to intracoronary acetylcholine dose in patients with myocardial bridge. Cardiology 2013;125:250-7.
• [4] Tohno Y, Tohno S, Minami T, Pakdeewong-Ongkana N, Suwannahoy P, Quiggins R. Different accumulation of elements in proximal and distal parts of the left anterior descending artery beneath the myocardial bridge. Biol Trace Elem Res 2016;171:17-25.
• [5] Zoghi M, Duygu H, Nalbantgil S, Kirilmaz B, Turk U, Ozerkan F, et al. Impaired endothelial function in patients with myocardial bridge. Echocardiography 2006;23:577-81.
• [6] Farag A, Al-Najjar Y, Eichhöfer J. Adenosine-induced vasospasticity in a myocardial bridge. Endothelial dysfunction? JACC Cardiovasc Interv 2015;8:21-2.
• [7] Radico F, Ciccihitti V, Zimarino M, De Caterina R. Angina pectoris and myocardial ischemia in the absence of obstructive coronary artery disease: practical considerations for diagnostic tests. J Am Coll Cardiol Intv 2014;7:453-63.
• [8] Vijayalakshmi K, De Belder MA. Angiographic and physiologic assessment of coronary flow and myocardial perfusion in the cardiac catheterization laboratory. Acute Card Care 2008;10:69-78.
• [9] Maddox TM, Stanislawski MA, Grunwald GK, Bradley SM, Ho PM, Tsai TT, et al. Nonobstructive coronary artery disease and risk of myocardial infarction. JAMA 2014;312:1754-63.