Evaluation of the diagnostic values of coronary angiography to detect intramyocardial left anterior descending artery: an objective approach.

Objective: The Left anterior descending artery is the most involved vessel in intramyocardial bridging of the coronary arteries. Revascularization of the left anterior descending artery is considered an essential component of coronary artery bypass grafting procedures. This study aims to evaluate the correlation between angiographic views of the coronary artery and intraoperative findings of intramyocardial left anterior descending artery. Methods: Between January 2015 and October 2022, 468 patients underwent coronary artery bypass grafting. Patients were divided into two groups based on the presence of an intramyocardial left anterior descending artery on coronary angiography group or intraoperatively. A total of 349 patients were included in the the study The correlation between the sign of depression of the left anterior descending artery on coronary angiography and intraoperative observations was investigated. Results: In the coronary angiography group 50 patients had signs of depression on coronary angiography, of which 35 had an intramyocardial left anterior descending artery intraoperatively. In the CABG group, 40 patients were found to have an intramyocardial left anterior descending artery intraoperatively and 5 had normal coronary angiography images. The prevalence of intramyocardial left anterior descending artery was 11.5%. The sensitivity of coronary angiography was measured as 87.5% [95% CI: 73.20% to 95.81%] and specificity was 95.15% [ 95% CI: 92.12% to 97.26%], positive predictive value was 70% [ 95% CI: 58.51% to 79.55%], and negative predictive value was 98.32% [ 95% CI: 96.27% to 99.25%]. Conclusion: The depression sign of the left anterior descending artery on coronary angiography correlates with intraoperative observations with high sensitivity and specificity

Keywords:

Coronary Artery Bypass, Coronary Angiography, sensitivity specificity,

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Vanker EA, Ajayi NO, Lazarus L, Satyapal KS. The intramyocardial left anterior descending artery: Prevalence and surgical considerations in coronary artery bypass grafting. South African J Surg. 2014;52(1):18-21.
Ge J, Erbel R, Rupprecht HJ, et al. Comparison of intravascular ultrasound and angiography in the assessment of myocardial bridging. Circulation. 1994;89(4):1725-1732.
Bandyopadhyay M, Das P, Baral K, Chakroborty P. Morphological study of myocardial bridge on the coronary arteries. Indian J Thorac Cardiovasc Surg. 2010;26(3):193-197.
Aydin U, Kocogullari CU. A method for locating embedded left anterior descending coronary arteries. Ann Thorac Surg. 2013;95(1):360-361.
Sanders LHA, Soliman HMA, van Straten BH. Management of right ventricular injury after localization of the left anterior descending coronary artery. Ann Thorac Surg. 2009;88(2):665-667.
Tarantini G, Migliore F, Cademartiri F, Fraccaro C, Iliceto S. Left anterior descending artery myocardial bridging: a clinical approach. J Am Coll Cardiol. 2016;68(25):2887-2899.
Ochsner JL, Mills NL. Surgical management of diseased intracavitary coronary arteries. Ann Thorac Surg. 1984;38(4):356-362.
Konen E, Goitein O, Sternik L, Eshet Y, Shemesh J, Di Segni E. The prevalence and anatomical patterns of intramuscular coronary arteries. a coronary computed tomography angiographic study. J Am Coll Cardiol. 2007;49(5):587-593.
Mahmoud AF. Intra-myocardial LAD: Is it a contraindication for off-pump coronary artery bypass grafting? J Egypt Soc Cardio-Thorac Surg. 2018;26(1):8-16.
Huang XH, Wang SY, Xu JP, et al. Surgical outcome and clinical follow-up in patients with symptomatic myocardial bridging. Chin Med J (Engl). 2007;120(18):1563-1566.
Apostolakis E, Koletsis E, Leivaditis V, Lozos V, Dougenis D. A safe technique of exposing of a “hidden” left anterior descending artery. J Card Surg. 2007;22(6):505-506.
de Salvatore S, Segreto A, Chiusaroli A, Congiu S, Bizzarri F. Surgical management of intramyocardial left anterior descending artery. J Card Surg. 2015;30(11):805-807.
de Rosa R, Sacco M, Tedeschi C, et al. Prevalence of coronary artery intramyocardial course in a large population of clinical patients detected by multislice computed tomography coronary angiography. Acta Radiol. 2008;49(8):895-901.
Angelini P, Velasco JA, Flamm S. Coronary anomalies: Incidence, pathophysiology, and clinical relevance. Circulation. 2002;105(20):2449-2454.
Çiçek D, Kalay N, Müderrisolu H. Incidence, clinical characteristics, and 4-year follow-up of patients with isolated myocardial bridge: a retrospective, single-center, epidemiologic, coronary arteriographic follow-up study in southern Turkey. Cardiovasc Revasc Med. 2011;12(1):25-28.
Ferreira AG, Trotter SE, Konig B, Decourt LV, Fox K, Olsen EGJ. Myocardial bridges: morphological and functional aspects. Br Heart J. 1991;66(5):364-367.
Lee MS, Chen CH. Myocardial bridging: an up-to-date review. J Invasive Cardiol. 2015;27(11):521-528.
Bárczi G, Becker D, Sydó N, et al. Impact of clinical and morphological factors on long-term mortality in patients with myocardial bridge. J Cardiovasc Dev Dis. 2022;9(5):129.
Matta A, Canitrot R, Nader V, et al. Left anterior descending myocardial bridge: angiographic prevalence and its association to atherosclerosis. Indian Heart J. 2021;73(4):429-433.
Lu GM, Zhang LJ, Guo H, Huang W, Merges RD. Comparison of myocardial bridging by dual-source CT with conventional coronary angiography. Circ J. 2008;72(7):1079-1085.
Şenöz O, Yapan Emren Z. Is myocardial bridge more frequently detected on radial access coronary angiography? BMC Cardiovasc Disord. 2021;21(1):1-7.
Oylumlu M, Doğan A, Astarcıoğlu MA, et al. Angiographic prevalence of myocardial bridging in our department. Kosuyolu Kalp Derg. 2014;17(2):114-117.
Soran O, Pamir G, Erol C, Kocakavak C, Sabah I. The incidence and significance of myocardial bridge in a prospectively defined population of patients undergoing coronary angiography for chest pain. Tokai J Exp Clin Med. 2000;25(2):57-60.
Ferreira AG, Trotter SE, Konig B, Decourt LV, Fox K, Olsen EGJ. Myocardial bridges: morphological and functional aspects. Br Heart J. 1991;66(5):364-367.
Alegria JR, Herrmann J, Holmes DR, Lerman A, Rihal CS. Myocardial bridging. Eur Heart J. 2005;26(12):1159-1168.
Leschka S, Koepfli P, Husmann L, et al. Myocardial bridging: depiction rate and morphology at CT coronary angiography--comparison with conventional coronary angiography. Radiology. 2008;246(3):754-762.
Hwang JH, Ko SM, Roh HG, et al. Myocardial bridging of the left anterior descending coronary artery: depiction rate and morphologic features by dual-source CT coronary angiography. Korean J Radiol. 2010;11(5):514-521.
Sajjadieh A, Hekmatnia A, Keivani M, Asoodeh A, Pourmoghaddas M, Sanei H. Diagnostic performance of 64-row coronary CT angiography in detecting significant stenosis as compared with conventional invasive coronary angiography. ARYA Atheroscler. 2013;9(2):157-163.
Tarantini G, Migliore F, Cademartiri F, Fraccaro C, Iliceto S. Left anterior descending artery myocardial bridging: a clinical approach. J Am Coll Cardiol. 2016;68(25):2887-2899.
Eftekhar-Vaghefi SH, Pourhoseini S, Movahedi M, et al. Comparison of detection percentage and morphology of myocardial bridge between conventional coronary angiography and coronary CT angiography. J Cardiovasc Thorac Res. 2019;11(3):203-208.
Cao HM, Jiang JF, Deng B, Xu JH, Xu WJ. Evaluation of myocardial bridges with optical coherence tomography. J Int Med Res. 2010;38(2):681-685.
Kurtoglu N, Mutlu B, Soydinc S, et al. Normalization of coronary fractional flow reserve with successful intracoronary stent placement to a myocardial bridge. J Interv Cardiol. 2004;17(1):33-36.
Tsujita K, Maehara A, Mintz GS, et al. Comparison of angiographic and intravascular ultrasonic detection of myocardial bridging of the left anterior descending coronary artery. Am J Cardiol. 2008;102(12):1608-1613.
Hakeem A, Cilingiroglu M, Leesar MA. Hemodynamic and intravascular ultrasound assessment of myocardial bridging: fractional flow reserve paradox with dobutamine versus adenosine. Catheter Cardiovasc Interv. 2010;75(2):229-236.
Escaned J, Cortés J, Flores A, et al. Importance of diastolic fractional flow reserve and dobutamine challenge in physiologic assessment of myocardial bridging. J Am Coll Cardiol. 2003;42(2):226-233.
Konen E, Goitein O, Sternik L, Eshet Y, Shemesh J, Di Segni E. The prevalence and anatomical patterns of intramuscular coronary arteries: a coronary computed tomography angiographic study. J Am Coll Cardiol. 2007;49(5):587-593.
Kim PJ, Hur G, Kim SY, et al. Frequency of myocardial bridges and dynamic compression of epicardial coronary arteries: a comparison between computed tomography and invasive coronary angiography. Circulation. 2009;119(10):1408-1416.
La Grutta L, Runza G, Lo Re G, et al. Prevalence of myocardial bridging and correlation with coronary atherosclerosis studied with 64-slice CT coronary angiography. Radiol Med. 2009;114(7):1024-1036.
Danad I, Szymonifka J, Twisk JWR, et al. Diagnostic performance of cardiac imaging methods to diagnose ischaemia-causing coronary artery disease when directly compared with fractional flow reserve as a reference standard: a meta-analysis. Eur Heart J. 2017;38(13):991-998.
Parachuri R v., Chattuparambil B, Hasabettu PK, et al. Marsupialization of intramyocardial left anterior descending artery: A novel approach for easy access during revascularization. Ann Thorac Surg. 2005;80(6):2390-2392.
Mandegar MH, Roshanali F, Saidi B. New Technique for localizing intramyocardial left anterior descending artery. Ann Thorac Surg. 2010;89(4):1342.
Hiratzka LF, McPherson DD, Brandt B, Lamberth WC, Marcus ML, Kerber RE. Intraoperative high-frequency epicardial echocardiography in coronary revascularization: locating deeply embedded coronary arteries. Ann Thorac Surg. 1986;42(6):S9-S11.
Oda K, Hirose K, Fukutomi T, Yamashiro T, Ogoshi S. Intraoperative detection of embedded coronary arteries in MIDCAB using a color Doppler microprobe. Ann Thorac Surg. 1999;68(1):263-264.