Incidence of myocardial bridging in sports and physically active subjects with cardiac symptoms and signs

• Published in: Hrvatski športskomedicinski vjesnik Vol. 40; no. 1; pp. 32 - 42
• Main Authors: Milošević, Milan, Pavić, Ladislav, Jukić, Mladen, Franćeski, Dalibor, Lovrić, Niko, Babić, Zdravko, Lovrić, Dražen
• Format: Journal Article
• Language: English
• Published: 2025
• ISSN: 0354-0766; 1848-7742
• DOI: 10.69589/hsv.40.1.3

Miokardijalno premoštenje (MB) (od engl. MyocardialBridging) je urođena anatomska anomalija, najčešćebenigna no u nekim slučajevima može dovesti do akutnogkoronarnog sindroma, po život opasne aritmije i iznenadnesmrti kod tjelesno aktivnih osoba. Cilj je ovog ispitivanjautvrditi incidenciju MB u uzorku sportski i tjelesno aktivnihispitanika 20 do 50 g. starosti kod kojih je incidencijakoronarne arterijske bolesti (engl. Coronary Artery Disease(CAD)) srca još vrlo niska. Ispitanici su na koronarnukompjuteriziranu tomografsku angiografiju (CCTA) (engl.Cardiac Computed Tomography Angiography) upućenizbog sumnje na CAD.U petogodišnjem, monocentričnom, retrogradnomispitivanju, u ukupnom broju ispitanika, analizirana jeincidencija MB kod sportski i tjelesno aktivnih osoba tepovezanost s kliničkom slikom i karakteristikama MB.Svi pacijenti su podvrgnuti detaljnom kliničkom pregledu,ergometriji i CCTA. Od ukupno 629 ispitanika u analizuje uključeno 446 ispitanika.U ukupnom uzorku 446 ispitanika pozitivnu dijagnozuMB ima n = 304/446 (68,2%; 95% CI 63,7% - 72,4%).U uzorku 163 sportski i tjelesno aktivnih ispitanikaprevalencija pozitivnog MSCT MB nalaza je n = 108(66.2%). Sudionici s MB bili su značajno mlađi (43 prema45 godina) s nižim indeksom tjelesne mase (26,9 prema27,65 kg/m2) u usporedbi s ispitanicima bez MB. MB najčešće zahvaća LAD (engl. Left Anterior DescendingArtery) 96,1% (P<0,001) i to njen srednji segment (45,7%).Najčešći je plitki MB (n=268/304, 88,2%) s nalazomaterosklerotskog plaka proksimalno od MB (53,0%, P <0,001). Između sudionika s i bez MB nema značajnih razlikau spolu, bavljenju sportom i teškim tjelesnim radom, vrstitreninga niti treningu tijekom bolesti (P > 0,05) kao nititipičnih ili atipičnih kardioloških simptoma (P > 0,05).Podaci o unakrsnim tablicama između simptoma i tjelesneaktivnosti pokazuju u grupi tjelesno aktivnih ispitanikaznačajno rjeđe atipičnu stenokardiju (33,1% prema 50,9%,P<0,001), ali češće sinkopu (8,0% prema 2,1%, P<0,001)u odnosu na tjelesno neaktivne. Korelacija dubine MB ikardioloških simptoma nije pokazala značajne razlike uprisutnosti pojedinog simptoma (P > 0,05).Ovo istraživanje je pokazalo da u ukupnoj populacijiispitanika, kao i u specifičnoj populaciji sportaša i tjelesnoaktivnih ispitanika, postoji visoka incidencija MB (68,2%prema 66,2%) pri čemu je najčešće zahvaćena LAD i to njensrednji segment s plitkim MB dok je atipična stenokardijačešći simptom kod neaktivnih, a sinkopa kod aktivnihpacijenata. Myocardial bridging (MB) is a congenital anatomicalanomaly, most often benign but in some cases can leadto acute coronary syndrome, life-threatening arrhythmia,and sudden death in physically active individuals. Theobjective of this study is to determine the incidence of MBin a sample of athletes and physically active subjects aged20 to 50 years in whom the incidence of coronary arterydisease (CAD) is still very low. The subjects were referredfor Cardiac Computed Tomography Angiography (CCTA)due to suspected CAD.In a five-year, single-center, retrospective study,the incidence of MB in athletes and physically activesubjects and the association with the clinical picture andcharacteristics of MB were analyzed in the total numberof subjects. All patients underwent a detailed clinicalexamination, ergometry, and CCTA. Out of a total of 629subjects, 446 subjects were included in the analysis.In the total sample of 446 subjects, a positive diagnosisof MB was found in n = 304/446 (68.2%; 95% CI 63.7% -72.4%). In the sample of 163 athletes and physically activesubjects, the prevalence of a positive MSCT MB findingwas n = 108 (66.2%). Subjects with MB were significantlyyounger (43 vs. 45 years old) with a lower body mass index(26.9 vs. 27.65 kg/m2) compared to those without MB. MBmost often affects the left anterior descending artery (LAD)96.1% (P<0.001), specifically its middle segment (45.7%). The most common is shallow MB (n=268/304, 88.2%)with the finding of atherosclerotic plaque proximal to MB(53.0%, P < 0.001). There were no significant differencesbetween subjects with and without MB in terms of gender,sports activity and heavy physical work, type of trainingor training during illness (P > 0.05), or typical or atypicalcardiac symptoms (P > 0.05). Cross-tabulation data betweensymptoms and physical activity in the physically activegroup compared to the physically inactive group of subjectsshowed significantly less atypical angina pectoris (33.1%vs. 50.9%, P < 0.001), but more frequent syncope (8.0% vs.2.1%, P < 0.001). The correlation between MB depth andcardiac symptoms did not show significant differences inthe presence of any individual symptom (P > 0.05).This study showed that in the total population ofsubjects, as well as in the specific population of athletesand physically active subjects, there is a high incidenceof MB (68.2% vs. 66.2%), with the LAD most commonlyaffected, specifically its middle segment with shallow MD,while atypical stenocardia is a more common symptom ininactive patients, and syncope in active patients.