{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:48:00Z","timestamp":1787068080358,"version":"build-2736575974"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2013,3,12]]},"abstract":"\n Background<\/jats:title>\n \n Patients with a myocardial bridge (\n MB<\/jats:styled-content>\n ) and no significant obstructive coronary artery disease (\n CAD<\/jats:styled-content>\n ) may experience angina presumably from ischemia, but noninvasive assessment has been limited and the underlying mechanism poorly understood. This study seeks to correlate a novel exercise echocardiography (\n EE<\/jats:styled-content>\n ) finding for\n MB<\/jats:styled-content>\n s with invasive structural and hemodynamic measurements.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Eighteen patients with angina and an\n EE<\/jats:styled-content>\n pattern of focal end\u2010systolic to early\u2010diastolic buckling in the septum with apical sparing were prospectively enrolled for invasive assessment. This included coronary angiography, left anterior descending artery (\n LAD<\/jats:styled-content>\n ) intravascular ultrasound (\n IVUS<\/jats:styled-content>\n ), and intracoronary pressure and\n D<\/jats:styled-content>\n oppler measurements at rest and during dobutamine stress. All patients were found to have an\n LAD MB<\/jats:styled-content>\n on\n IVUS<\/jats:styled-content>\n . The ratios of diastolic intracoronary pressure divided by aortic pressure at rest (Pd\/Pa) and during dobutamine stress (diastolic fractional flow reserve [\n dFFR<\/jats:styled-content>\n ]) and peak\n D<\/jats:styled-content>\n oppler flow velocity recordings at rest and with stress were successfully performed in 14 patients. All had abnormal\n dFFR<\/jats:styled-content>\n (\u22640.75) at stress within the bridge, distally or in both positions, and on average showed a more than doubling in peak\n D<\/jats:styled-content>\n oppler flow velocity inside the\n MB<\/jats:styled-content>\n at stress. Seventy\u2010five percent of patients had normalization of\n dFFR<\/jats:styled-content>\n distal to the\n MB<\/jats:styled-content>\n , with partial pressure recovery and a decrease in peak\n D<\/jats:styled-content>\n oppler flow velocity.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n A distinctive septal wall motion abnormality with apical sparing on\n EE<\/jats:styled-content>\n is associated with a documented\n MB<\/jats:styled-content>\n by\n IVUS<\/jats:styled-content>\n and a decreased\n dFFR<\/jats:styled-content>\n . We posit that the septal wall motion abnormality on\n EE<\/jats:styled-content>\n is due to dynamic ischemia local to the compressed segment of the\n LAD<\/jats:styled-content>\n from the increase in velocity and decrease in perfusion pressure, consistent with the\n V<\/jats:styled-content>\n enturi effect.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.113.000097","type":"journal-article","created":{"date-parts":[[2013,5,24]],"date-time":"2013-05-24T12:49:31Z","timestamp":1369399771000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":69,"title":["A Novel Stress Echocardiography Pattern for Myocardial Bridge With Invasive Structural and Hemodynamic Correlation"],"prefix":"10.1161","volume":"2","author":[{"given":"Shin","family":"Lin","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Tremmel","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryotaro","family":"Yamada","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian S.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celina Mei","family":"Yong","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Turcott","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael V.","family":"McConnell","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Dash","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingela","family":"Schnittger","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1226492"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.3109\/14017439209099063"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.1810030107"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(76)90414-8"},{"key":"e_1_3_5_6_2","first-page":"347","article-title":"clinical correlations, lactate extraction, coronary venous bloodflow and thallium\u2010201 myocardial imaging in patients with isolated left anterior descending muscle bridges: normal variant or obstruction? (Author's transl)","volume":"69","author":"Voss H","year":"1980","unstructured":"Voss H, Kupper W, Hanrath P, Mathey D, Montz R, Bucking J. clinical correlations, lactate extraction, coronary venous bloodflow and thallium\u2010201 myocardial imaging in patients with isolated left anterior descending muscle bridges: normal variant or obstruction? (Author's transl). Z Kardiol. 1980;69:347\u2013352.","journal-title":"Z Kardiol"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.89.4.1725"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1053\/euhj.1999.1661"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2008.07.054"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00029330-200801010-00004"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12350-011-9406-8"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(03)00588-6"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI102207"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ehj.2004.08.015"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.96.9.2905"},{"key":"e_1_3_5_16_2","volume-title":"Hurst's the Heart","author":"Gross GJ","year":"2011","unstructured":"Gross GJ, Vatner SF, Depre C. Chapter 54. Coronary Blood Flow and Myocardial Ischemia. In: Fuster V, Walsh RA, Harrington RA, eds. Hurst's the Heart. 13th ed. New York: McGraw\u2010Hill; 2011."},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.3904\/kjim.2011.26.4.410"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.113.000097","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:52:37Z","timestamp":1715583157000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.113.000097"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,3,12]]},"references-count":16,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2013,3,12]]}},"alternative-id":["10.1161\/JAHA.113.000097"],"URL":"https:\/\/doi.org\/10.1161\/jaha.113.000097","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,3,12]]},"assertion":[{"value":"2013-01-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-03-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-04-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e000097"}}