{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T20:05:06Z","timestamp":1779912306492,"version":"3.53.1"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>myocardial bridging (MB), an intramyocardial course of an epicardial coronary segment, is common yet frequently underrecognized on angiography, and can provoke ischaemia via multiple, overlapping mechanisms. High-resolution optical coherence tomography (OCT), paired with targeted physiological testing, may improve in vivo characterization and clinical decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>we report eight contemporary, catheterization-lab cases illustrating the heterogeneous anatomy, physiology, and clinical expression of MB. Clinical presentation ranged from myocardial infarction with\/without ST-elevation to acute heart failure. OCT consistently revealed recurrent morphologies, namely: homogeneous \u2018media-like\u2019 bands abutting the adventitia, sharp-bordered fusiform or \u2018moon-shaped\u2019 perivascular areas, or dynamic and asymmetric vessel distortion tracking with the muscular cuff. Management was individualized: (i) medical therapy with \u03b2-blockers when ischaemia was attributable to MB alone; (ii) OCT-guided percutaneous coronary intervention for adjacent atherosclerotic disease with precise landing-zone selection; (iii) in one case, integrated functional assessment, including dobutamine and acetylcholine testing, to unmask epicardial haemodynamic significance, microvascular dysfunction, and vasospasm, informing agent selection. Clinical outcomes were favourable, with symptom resolution and preserved or improved LV function over follow-up intervals up to 2 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>MB modulates coronary flow, atherogenesis, and procedural risk. An integrated approach that combines structural definition with intravascular imaging, stress state physiology, and vasoreactivity testing is essential to clarify mechanisms, tailor therapy, and mitigate the pitfalls of stenting near tunnelled segments. This real-world series offers a pragmatic roadmap for decoding MB related ischaemia and for translating concordance between imaging and physiology into optimized, individualized management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag357","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T12:05:07Z","timestamp":1778760307000},"source":"Crossref","is-referenced-by-count":0,"title":["Real-world presentation of myocardial bridging in the cath-lab: a case series"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3774-8330","authenticated-orcid":false,"given":"Domenico","family":"D\u2019Amario","sequence":"first","affiliation":[{"name":"Department of Translational Medicine, University of Eastern Piedmont , Via Solaroli 17, Novara 28100 ,","place":["Italy"]},{"name":"Thoraco-Cardio-Vascular Department, Azienda Ospedaliero-Universitaria Maggiore della Carit\u00e0 , Corso Mazzini 18, Novara 28100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5577-081X","authenticated-orcid":false,"given":"Rocco","family":"Vergallo","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino , Largo R. Benzi, 10, Genoa 16132 ,","place":["Italy"]},{"name":"Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa , Viale Benedetto XV, 6, Genoa 16132 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Elia","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, University of Eastern Piedmont , Via Solaroli 17, Novara 28100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, University of Eastern Piedmont , Via Solaroli 17, Novara 28100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Ricchiuto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart , Largo Agostino Gemelli, 8, Rome 00168 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Ciliberti","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart , Largo Agostino Gemelli, 8, Rome 00168 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Italo","family":"Porto","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino , Largo R. Benzi, 10, Genoa 16132 ,","place":["Italy"]},{"name":"Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa , Viale Benedetto XV, 6, Genoa 16132 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5404-3968","authenticated-orcid":false,"given":"Giuseppe","family":"Patti","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, University of Eastern Piedmont , Via Solaroli 17, Novara 28100 ,","place":["Italy"]},{"name":"Thoraco-Cardio-Vascular Department, Azienda Ospedaliero-Universitaria Maggiore della Carit\u00e0 , Corso Mazzini 18, Novara 28100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"2026052715363450800_ytag357-B1","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2022.970422","article-title":"Comprehensive functional and anatomic assessment of myocardial bridging: Unlocking the Gordian Knot","volume":"9","author":"Ciliberti","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"2026052715363450800_ytag357-B2","doi-asserted-by":"crossref","first-page":"2196","DOI":"10.1016\/j.jacc.2021.09.859","article-title":"Myocardial bridging: diagnosis, functional assessment, and management: JACC state-of-the-art review","volume":"78","author":"Sternheim","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2026052715363450800_ytag357-B3","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1093\/eurheartj\/ehi203","article-title":"Myocardial bridging","volume":"26","author":"Alegria","year":"2005","journal-title":"Eur Heart J"},{"key":"2026052715363450800_ytag357-B4","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1038\/s41598-021-04579-9","article-title":"Retrospective analysis of OCT on MB characteristics and 1-year follow-up of the ISR incidence after the DES implantation in patients with MB","volume":"12","author":"Xu","year":"2022","journal-title":"Sci Rep"},{"key":"2026052715363450800_ytag357-B5","article-title":"Myocardial bridge and acute plaque rupture","volume":"4","author":"Perl","year":"2016","journal-title":"J Investig Med High Impact Case Rep"},{"key":"2026052715363450800_ytag357-B6","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.124.040513","article-title":"Antiplatelet therapy in myocardial bridge: insights from the RIALTO registry","volume":"14","author":"Laborante","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"2026052715363450800_ytag357-B7","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1007\/s10554-021-02497-5","article-title":"Detection of myocardial bridge by optical coherence tomography","volume":"38","author":"Okamura","year":"2022","journal-title":"Int J Cardiovasc Imaging"},{"key":"2026052715363450800_ytag357-B8","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1253\/circj.CJ-23-0934","article-title":"Association of coronary computed tomography-defined myocardial bridge with pre- and post-procedural fractional flow reserve in patients undergoing elective percutaneous coronary intervention","volume":"88","author":"Sakamoto","year":"2024","journal-title":"Circ J"},{"key":"2026052715363450800_ytag357-B9","article-title":"Unmasking myocardial bridge\u2013related ischemia by intracoronary functional evaluation","volume":"11","author":"Tarantini","year":"2018","journal-title":"Circ: Cardiovasc Interv"},{"key":"2026052715363450800_ytag357-B10","doi-asserted-by":"crossref","first-page":"H48","DOI":"10.1093\/eurheartjsupp\/suac059","article-title":"Myocardial bridge evaluation towards personalized medicine: study design and preliminary results of the RIALTO registry","volume":"24","author":"D\u2019Amario","year":"2022","journal-title":"Eur Heart J Suppl"},{"key":"2026052715363450800_ytag357-B11","doi-asserted-by":"crossref","DOI":"10.3390\/life12101560","article-title":"The impact of myocardial bridging on the coronary functional test in patients with ischaemia with non-obstructive coronary artery disease","volume":"12","author":"Teragawa","year":"2022","journal-title":"Life"}],"container-title":["European Heart Journal - 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