Evaluation and Treatment of Myocardial Bridging by Clinical Phenotype

Abstract

Myocardial bridging (MB), most commonly involving the left anterior descending artery, is an intramyocardial segment of a coronary artery traditionally regarded as a benign anatomical variant. However, in a subset of patients, MB has been implicated in anginal syndromes, myocardial infarction, and even sudden cardiac death. Most cases are asymptomatic and identified incidentally on coronary computed tomography or invasive angiography. Controversy surrounds best practices for management of this entity. This review summarizes current evidence in adult patients with isolated MB on the mechanisms producing ischemia and adverse cardiac outcomes, the value of testing modalities to diagnose ischemia, and treatment strategies based on the patient’s symptoms and clinical presentation (phenotype).