{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T05:08:11Z","timestamp":1784092091254,"version":"3.55.0"},"reference-count":10,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>Myocardial bridging is a dynamic coronary anomaly in which systolic compression may extend into early diastole, particularly under conditions of increased heart rate and contractility. In patients with cardiogenic shock, this creates a potential physiological conflict, as catecholaminergic support may worsen coronary flow impairment rather than improve haemodynamics. A 66\u2010year\u2010old man presented with inferolateral ST\u2010segment elevation myocardial infarction due to thrombotic occlusion of the proximal left circumflex artery, successfully treated with primary percutaneous coronary intervention. Coronary angiography also showed a long myocardial bridge involving the mid left anterior descending artery. After revascularization, the patient devoped cardiogenic shock requiring norepinephrine and dobutamine, but remained haemodinamically unstable, with persistent tachycardia, low cardiac index, reduced stroke volume index, and progressive respiratory failure. Given the presence of myocardial bridging, a tachicardia\u2010mediated limitation of dyastolic coronary perfusion was hypothesized. Low\u2010dose landiolol, an ultra\u2010short\u2010acting and highly \u03b21\u2010selective blocker, was introduced under continuous haemodynamic monitoring. Heart rate decreased from 127 to 83 bpm and was accompained by a marked improvement in stroke volume index, cardiac index, and lactate levels, while vasopressor requirements remained stable. This case illustrates an \u201cinotrope paradox\u201d in which adrenergic stimulation may aggravate haemodynamic compromise in the presence of myocardial bridging by increasing heart rate and contractility, thereby intensifying systolic compression and shortening diastolic perfusion time. In this setting, physiology\u2010guided heart rate reduction may restore coronary flow dynamics and improve systemic output. In selected patients with cardiogenic shock and myocardial bridging, ultra\u2010short\u2010acting \u03b21\u2010blockade may represent a targeted strategy to reverse tachycardia\u2010mediated haemodynamic deterioration and support a diastole\u2010centered approach to resuscitation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70757","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T04:45:41Z","timestamp":1784090741000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Physiology\u2010Guided Heart Rate Modulation in Cardiogenic Shock With Myocardial Bridging: Reversing the Inotrope Paradox"],"prefix":"10.1002","author":[{"given":"Giulia","family":"Puglisi","sequence":"first","affiliation":[{"name":"Division of Cardiology, Azienda Ospedaliero\u2010Universitaria Policlinico \u201cG. Rodolico \u2013 San Marco\u201d University of Catania Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3974-3878","authenticated-orcid":false,"given":"Simone","family":"Finocchiaro","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Azienda Ospedaliero\u2010Universitaria Policlinico \u201cG. Rodolico \u2013 San Marco\u201d University of Catania Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Capodanno","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Azienda Ospedaliero\u2010Universitaria Policlinico \u201cG. Rodolico \u2013 San Marco\u201d University of Catania Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"issue":"22","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"2346","DOI":"10.1016\/j.jacc.2014.01.049","article-title":"Myocardial Bridging","volume":"63","author":"Corban M. T.","year":"2014","journal-title":"Journal of the American College of Cardiology"},{"issue":"25","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"2887","DOI":"10.1016\/j.jacc.2016.09.973","article-title":"Left Anterior Descending Artery Myocardial Bridging","volume":"68","author":"Tarantini G.","year":"2016","journal-title":"Journal of the American College of Cardiology"},{"issue":"2","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/S0735-1097(03)00588-6","article-title":"Importance of Diastolic Fractional Flow Reserve and Dobutamine Challenge in Physiologic Assessment of Myocardial Bridging","volume":"42","author":"Escaned J.","year":"2003","journal-title":"Journal of the American College of Cardiology"},{"issue":"16","key":"e_1_2_9_5_1","first-page":"e232","article-title":"Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association","volume":"136","author":"Diepen S.","year":"2017","journal-title":"Circulation"},{"issue":"36","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure","volume":"42","author":"McDonagh T. A.","year":"2021","journal-title":"European Heart Journal"},{"issue":"6","key":"e_1_2_9_7_1","article-title":"Unmasking Myocardial Bridge\u2010Related Ischemia by Intracoronary Functional Evaluation","volume":"11","author":"Tarantini G.","year":"2018","journal-title":"Circulation: Cardiovascular Interventions"},{"issue":"13","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.120.020597","article-title":"Functional Assessment of Myocardial Bridging With Conventional and Diastolic Fractional Flow Reserve: Vasodilator Versus Inotropic Provocation","volume":"10","author":"Aleksandric S. B.","year":"2021","journal-title":"Journal of the American Heart Association"},{"issue":"6","key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1248\/cpb.40.1462","article-title":"Development of a Highly Cardioselective Ultra Short\u2010Acting Beta\u2010Blocker, ONO\u20101101","volume":"40","author":"Iguchi S.","year":"1992","journal-title":"Chemical and Pharmaceutical Bulletin"},{"issue":"9","key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1016\/S2213-2600(20)30037-0","article-title":"Efficacy and Safety of Landiolol, an Ultra\u2010Short\u2010Acting \u03b21\u2010Selective Antagonist, for Treatment of Sepsis\u2010Related Tachyarrhythmia (J\u2010Land 3S): A Multicentre, Open\u2010Label, Randomised Controlled Trial","volume":"8","author":"Kakihana Y.","year":"2020","journal-title":"Lancet Respiratory Medicine"},{"key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"111","DOI":"10.2147\/VHRM.S210561","article-title":"Evaluating the Therapeutic Efficacy and Safety of Landiolol Hydrochloride for Management of Arrhythmia in Critical Settings: Review of the Literature","volume":"16","author":"Matsuishi Y.","year":"2020","journal-title":"Vascular Health and Risk Management"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70757","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.70757","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70757","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T04:45:52Z","timestamp":1784090752000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70757"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":10,"alternative-id":["10.1002\/ccd.70757"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70757","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]},"assertion":[{"value":"2026-04-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ccd.70757"}}