{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T00:04:50Z","timestamp":1793059490932,"version":"4.5.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,7,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Functional assessment of myocardial bridging (MB) remains clinically challenging because of the dynamic nature of the extravascular coronary compression with a certain degree of intraluminal coronary reduction. The aim of our study was to assess performance and diagnostic value of diastolic\u2010fractional flow reserve (d\u2010FFR) during dobutamine provocation versus conventional\u2010FFR during adenosine provocation with exercise\u2010induced myocardial ischemia as reference.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This prospective study includes 60 symptomatic patients (45 men, mean age 57\u00b19\u00a0years) with MB on the left anterior descending artery and systolic compression \u226550% diameter stenosis. Patients were evaluated by exercise stress\u2010echocardiography test, and both conventional\u2010FFR and d\u2010FFR in the distal segment of left anterior descending artery during intravenous infusion of adenosine (140\u00a0\u03bcg\/kg per minute) and dobutamine (10\u201350\u00a0\u03bcg\/kg per minute), separately. Exercise\u2013stress\u2010echocardiography test was positive for myocardial ischemia in 19\/60 patients (32%). Conventional\u2010FFR during adenosine and peak dobutamine had similar values (0.84\u00b10.04 versus 0.84\u00b10.06,\n              <jats:italic>P<\/jats:italic>\n              =0.852), but d\u2010FFR during peak dobutamine was significantly lower than d\u2010FFR during adenosine (0.76\u00b10.08 versus 0.79\u00b10.08,\n              <jats:italic>P<\/jats:italic>\n              =0.018). Diastolic\u2010FFR during peak dobutamine was significantly lower in the exercise\u2010stress\u2010echocardiography test \u2013positive group compared with the exercise\u2010 stress\u2010echocardiography test \u2013negative group (0.70\u00b10.07 versus 0.79\u00b10.06,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), but not during adenosine (0.79\u00b10.07 versus 0.78\u00b10.09,\n              <jats:italic>P<\/jats:italic>\n              =0.613). Among physiological indices, d\u2010FFR during peak dobutamine was the only independent predictor of functionally significant MB (odds ratio, 0.870; 95% CI, 0.767\u20130.986,\n              <jats:italic>P<\/jats:italic>\n              =0.03). Receiver\u2010operating characteristics curve analysis identifies the optimal d\u2010FFR during peak dobutamine cut\u2010off \u22640.76 (area under curve, 0.927; 95% CI, 0.833\u20131.000;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) with a sensitivity, specificity, and positive and negative predictive value of 95%, 95%, 90%, and 98%, respectively, for identifying MB associated with stress\u2010induced ischemia.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Diastolic\u2010FFR, but not conventional\u2010FFR, during inotropic stimulation with high\u2010dose dobutamine, in comparison to vasodilatation with adenosine, provides more reliable functional significance of MB in relation to stress\u2010induced myocardial ischemia.<\/jats:p>\n          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