Correlates of Left Ventricular Global Longitudinal Strain and Surgical Intervention on Myocardial Bridges

Overview

To examine the changes in left ventricular (LV) global longitudinal strain (GLS), using two-dimensional speckle tracking analysis, after left anterior descending (LAD) unroofing, in myocardial bridges (MBs) refractory to optimal medical therapy (OMT).

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Cross-Sectional
  • Study Primary Completion Date: June 19, 2018

Detailed Description

The present study is enrolling all the MBs-patients who underwent angina surgical relief or medical treatment at the "Ospedali Riuniti" of Ancona, Italy, and the "University Hospital" of Chieti, Italy. All the participants will be examined utilizing echocardiography before and after the treatment. The two-dimensional speckle-tracking analysis will be performed with an off-line dedicated software from the apical 4-chambers-view. All the unroofing procedures will be performed under cardiopulmonary bypass.

Interventions

  • Procedure: Surgical unroofing of muscle-briged coronary artery
    • Medical therapy with beta-blockers or calcium-channels blockers

Arms, Groups and Cohorts

  • Surgical unroofing
    • Refractory angina to medical treatment (beta-blockers or calcium channels blockers)
  • Medical treatment
    • Responders to medical treatment for angina relief

Clinical Trial Outcome Measures

Primary Measures

  • Improvement of myocardial function and contractility
    • Time Frame: 1 to 6 month after the procedure/treatment optimizzation
    • The increment of global longitudinal strain analysis, from pre treatment values, as assessed by speckle-traking echocardiography

Secondary Measures

  • Angina relief after surgical treatment
    • Time Frame: 1-month
    • Defined as the reduction of CCS-Angina Scale, assessed by physicians, from grade I (ordinary physical activity does not cause angina, such as walking and climbing stairs) to grade IV (inability to carry on any physical activity without discomfort, anginal syndrome may be present at rest). The scale comprises 4 degrees in increasing order of angina severity.
  • Improvement in quality of life
    • Time Frame: 1-month
    • Defined as the score increment, from 0 to 100 of the SAQ-7 questionnaire. The SAQ quantifies patients’ physical limitations caused by angina, the frequency of and recent changes in their symptomstheir satisfaction with treatment, and the degree to which they perceive their disease to affect their quality of life. The questionnaire provides 7 different items with 6 different multiple choices. Each scale is transformed to a score of 0 to 100, where higher scores indicate better function (eg, less physical limitation, less angina, and better quality of life).

Participating in This Clinical Trial

Inclusion Criteria

  • Myocardial bridge of the anterior descending left coronary artery

Exclusion Criteria

  • Poor echocardiographic imaging quality

Gender Eligibility: All

Minimum Age: N/A

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • ITAB – Institute for Advanced Biomedical Technologies
  • Collaborator
    • Azienda Ospedaliero, Universitaria Ospedali Riuniti
  • Provider of Information About this Clinical Study
    • Principal Investigator: Francesco Bianco, Medical doctor – ITAB – Institute for Advanced Biomedical Technologies
  • Overall Official(s)
    • Francesco Bianco, MD, Principal Investigator, G. d’Annunzio University
  • Overall Contact(s)
    • Francesco Bianco, MD, francesco.bianco@unich.it

References

Alegria JR, Herrmann J, Holmes DR Jr, Lerman A, Rihal CS. Myocardial bridging. Eur Heart J. 2005 Jun;26(12):1159-68. Epub 2005 Mar 11. Review.

Corban MT, Hung OY, Eshtehardi P, Rasoul-Arzrumly E, McDaniel M, Mekonnen G, Timmins LH, Lutz J, Guyton RA, Samady H. Myocardial bridging: contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies. J Am Coll Cardiol. 2014 Jun 10;63(22):2346-2355. doi: 10.1016/j.jacc.2014.01.049. Epub 2014 Feb 26. Review.

Cerit L, Duygu H. Myocardial bridging and sudden death. Int J Cardiol. 2017 Feb 15;229:11. doi: 10.1016/j.ijcard.2016.11.308. Epub 2016 Dec 1.

Zhang M, Yang J, Ma C, Liu M. Longitudinal strain measured by two-dimensional speckle tracking echocardiography to evaluate left ventricular function in patients with myocardial bridging of the left anterior descending coronary artery. Echocardiography. 2019 Jun;36(6):1066-1073. doi: 10.1111/echo.14357. Epub 2019 May 13.

Alessandri N, Dei Giudici A, De Angelis S, Urciuoli F, Garante MC, Di Matteo A. Efficacy of calcium channel blockers in the treatment of the myocardial bridging: a pilot study. Eur Rev Med Pharmacol Sci. 2012 Jun;16(6):829-34.

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