SPECIAL SECTION: LETTER TO THE EDITOR
Myocardial bridging in adult and pediatric patients with hypertrophic cardiomyopathy is not associated with poor outcome
Saidi A. Mohiddin, MB, ChB, MRCP and
Lameh Fananapazir, MD, FRCP
Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Room 7B15, Building 10, Bethesda, MD 20892, USA
mohiddis{at}nhlbi.nih.gov
The recent report by Sorajja et al. (1) that myocardial bridging in adults with hypertrophic cardiomyopathy (HCM) is not associated with an increased risk of sudden death is in agreement with our own study conducted in children (2), and is in contrast to the suggestion that systolic coronary compression in pediatric patients results in myocardial ischemia and a poor prognosis (3).
Unfortunately, Sorajja et al. (1) misrepresent our findings. They include our study with references that have associated myocardial bridging with "nuclear perfusion abnormalities, chest pain, ventricular tachycardia and an increased risk of sudden cardiac death." Our conclusions were directly the opposite: we found no association between coronary bridging, symptoms, perfusion abnormalities, ventricular arrhythmias, and sudden death. Rather, in multivariate analyses, perfusion abnormalities were related to the magnitude of left ventricular hypertrophy (LVH) and the presence of septal artery compression. Unfortunately, Sorajja et al. did not evaluate angiograms for septal artery compression, and the association between bridging and severity of LVH is not assessed in patient groups of similar age. Finally, our study was conducted in a group of 57 pediatric patients, and not in only 23 as stated in the current report.
The report by Sorajja et al. emphasizes our conclusions that it is very unlikely that systolic compression of epicardial coronary arteries results in poorer outcome in HCM, and that there is currently no rationale for surgical or catheter-based correction (2). The contribution made by septal artery compression, intraventricular pressure, and LVH to perfusion abnormalities and therefore to symptoms and prognosis should be the focus of further investigation.
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References
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- Sorajja P, Ommen SR, Nishimura RA, et al. Myocardial bridging in adult patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 2003;42:889–894[Abstract/Free Full Text]
- Mohiddin SA, Begley D, Shih J, Fananapazir L. Myocardial bridging does not predict sudden death in children with hypertrophic cardiomyopathy but is associated with more severe cardiac disease. J Am Coll Cardiol. 2000;36:2270–2278[Abstract/Free Full Text]
- Yetman AT, McCrindle BW, MacDonald C, Freedom RM, Gow R. Myocardial bridging in children with hypertrophic cardiomyopathy—a risk factor for sudden death. N Engl J Med. 1998;339:1201–1209[Abstract/Free Full Text]
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