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. 2021 Jan;11(1):162-171.
doi: 10.21037/qims-20-362.

Prevalence and characteristics of intramural coronary artery in hypertrophic obstructive cardiomyopathy: a coronary computed tomography and invasive angiography study

Changsheng Zhu  1 , Shuiyun Wang  1 , Shengwei Wang  1 , Yanhai Meng  1 , Qiulan Yang  1 , Changrong Nie  1 , Hongtao Sun  1
Affiliations

Prevalence and characteristics of intramural coronary artery in hypertrophic obstructive cardiomyopathy: a coronary computed tomography and invasive angiography study

Changsheng Zhu et al. Quant Imaging Med Surg. 2021 Jan.

Abstract

Background: The prevalence and morphologic characteristics of intramural coronary artery (ICA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) have yet to be fully illuminated. Our study aimed to investigate the prevalence and morphologic characteristics of ICA in patients with HOCM using coronary computed tomography (CT) angiography and invasive coronary angiography.

Methods: Patients with a diagnosis of HOCM who were admitted for selective myectomy in Fuwai Hospital were prospectively enrolled between September 2015 and June 2019. Both preoperative coronary CT and invasive angiography were scheduled for all participants.

Results: Coronary CT angiography detected ICA in 106 (23.3%) out of 455 patients. Dynamic compression of coronary arteries was observed in 87 patients (19.1%) by invasive coronary angiography. We found ICA covered with complete myocardial encasement in 98 patients (92.5%), with deep myocardial bridging (MB) observed most frequently (P=0.005). All patients with dynamic compression of coronary arteries had ICA. Dynamic luminal reduction ≥50% was present in 77 (16.9%) of the study participants. Pearson's correlation analysis revealed that the length and degree of dynamic compression were significantly related with MB length and depth (Pearson's correlation r=0.241, 0.581, 0.316, and 0.209; P=0.014, <0.001, 0.002, and 0.032, respectively).

Conclusions: Patients with HOCM commonly present with ICA and it can be visualized well by coronary CT angiography. Deep or extensive MB is more likely to produce coronary artery dynamic compression. Preoperative identification of this congenital coronary artery variant may be helpful for surgical planning.

Keywords: Hypertrophic obstructive cardiomyopathy (HOCM); coronary computed tomographic angiography; intramural coronary artery (ICA).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-20-362). SW reports grants from National Natural Science Foundation of China, grants from Beijing Science and Technology Program of China, during the conduct of the study. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Different morphological types of intramural coronary artery in cross sectional view. (A) Coronary computed tomography angiography axial plane view of ICA with partial myocardial encasement, (B,C) complete encasement by superficial and deep MB (D) penetrating into the right ventricular intracavity. Red arrows indicate intramural coronary artery in cross section. CT, computed tomography; ICA, intramural coronary artery; MB, myocardial bridging; RV, right ventricle; LV, left ventricle.
Figure 2
Figure 2
Flowchart of the study population. ICA, intramural coronary artery; MB, myocardial bridging.
Figure 3
Figure 3
Coronary CT angiography demonstrating ICA with dynamic compression on invasive coronary angiography (A) partially encased by myocardium (B) deeply encased by myocardium. Red arrows indicate intramural coronary artery in cross section. White arrows indicate intramural coronary artery at end-diastole and end-systole from left to right, respectively. CT, computed tomography; ICA, intramural coronary artery.
Figure 4
Figure 4
Receiver operating characteristic curve. Myocardial bridging with a depth of ≥3 mm could produce coronary compression. Red circle indicates the best cut-off value of 3 mm.
See this image and copyright information in PMC

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