Hostiuc S, Curca G C, Dermengiu D, Dermengiu S, Hostiuc M, Rusu M C
Department of Forensic Pathology, National Institute of Legal Medicine, Bucharest, Romania.
Thorac Cardiovasc Surg. 2011 Oct;59(7):393-8. doi: 10.1055/s-0030-1270703. Epub 2011 Mar 29.
Although myocardial bridging (MB) is a common coronary anomaly, its cardiovascular consequences are still disputed. A positive link between sudden cardiac death (SCD) and myocardial bridging has not yet been definitively proved, even though many case reports and small scale studies support this association. For myocardial bridging to be associated with sudden cardiac death it must exhibit certain specific characteristics involving coronary or myocardial changes sufficient to explain a terminal cardiac event. In this study we aimed to analyze the morphological changes (both myocardial and coronary) associated with hemodynamically significant myocardial bridging and the morphological differences between hemodynamically significant MB and MB considered to be non-hemodynamically significant.
We analyzed 53 cases of sudden cardiac death, of which 21 cases had hemodynamically significant myocardial bridging, 14 had non-hemodynamically significant myocardial bridging and 20 cases suffered sudden cardiac death without myocardial bridging, using a morphological score with seven histological parameters.
Myocardial fibrosis and interstitial edema were found to be highly correlated with hemodynamically significant myocardial bridging (HSMB), as were interstitial edema and interstitial fibrosis.
Hemodynamically significant myocardial bridging can be discovered during heart dissection by analyzing a series of morphological markers (width, distribution of atherosclerosis, distal hypoplasia). Our study showed that MB was associated with increased myocardial fibrosis and edema, both of which have an increased risk of electrical instability. Compared to non-hemodynamically significant myocardial bridging, HSMB shows a distinct histological pattern, with increased myocardial fibrosis and edema. The main cause of SCD in association with HSMB seems to be electrical due to increased electrical myocardial heterogeneity, but large scale studies are needed to test this.
虽然心肌桥（MB）是一种常见的冠状动脉异常，但其心血管后果仍存在争议。尽管许多病例报告和小规模研究支持心脏性猝死（SCD）与心肌桥之间的关联，但两者之间的正向联系尚未得到明确证实。若心肌桥要与心脏性猝死相关联，它必须表现出某些特定特征，涉及足以解释终末期心脏事件的冠状动脉或心肌变化。在本研究中，我们旨在分析与血流动力学显著的心肌桥相关的形态学变化（包括心肌和冠状动脉），以及血流动力学显著的心肌桥与被认为血流动力学不显著的心肌桥之间的形态学差异。
我们分析了53例心脏性猝死病例，其中21例有血流动力学显著的心肌桥，14例有血流动力学不显著的心肌桥，20例心脏性猝死病例无心肌桥，使用具有七个组织学参数的形态学评分。
发现心肌纤维化和间质水肿与血流动力学显著的心肌桥（HSMB）高度相关，间质水肿和间质纤维化也是如此。
通过分析一系列形态学标志物（宽度、动脉粥样硬化分布、远端发育不全），可在心脏解剖过程中发现血流动力学显著的心肌桥。我们的研究表明，心肌桥与心肌纤维化和水肿增加有关，这两者都增加了电不稳定的风险。与血流动力学不显著的心肌桥相比，HSMB表现出独特的组织学模式，心肌纤维化和水肿增加。与HSMB相关的SCD的主要原因似乎是电方面的，因为心肌电异质性增加，但需要大规模研究来验证这一点。
