Unveiling the Masquerading of Myocardial Bridging in Cardiovascular Diseases

Abstract

Myocardial bridging (MB) is a congenital coronary artery anomaly initially regarded as a benign anatomical variant. However, an increasing number of studies have revealed the association between MB and various cardiovascular diseases. The primary pathological mechanisms underlying the relationship include dynamic mechanical compression leading to myocardial ischemia, coronary vasospasm, and the development of proximal atherosclerosis. Advancement of coronary artery imaging technology has enhanced the understanding of the anatomical and hemodynamic features of MB. Although treatment strategies are primarily symptom-driven, morphological and functional evaluation of MB in patients with asymptomatic concomitant cardiovascular diseases is recommended. Pharmacological therapy and management of cardiovascular conditions are the first-line approach. Invasive treatments strategies should be tailored to individual circumstances. This review examines the relationship between MB and other cardiovascular conditions, such as hypertrophic cardiomyopathy (HCM), coronary atherosclerosis, and myocardial ischemia with non-obstructive coronary arteries (INOCA) or myocardial infarction with non-obstructive coronary arteries (MINOCA). It provides an overview of the underlying mechanisms, diagnostic assessments, and treatment strategies. However, large-scale randomized controlled trials are needed to validate these findings.

Keywords: INOCA; MINOCA; atherosclerosis; hypertrophic cardiomyopathy; myocardial bridging.