Myocardial Bridging: Peran ct dan mri dalam Diagnosis dan Stratifikasi Risiko
Abstract
PendahuluanMyocardial bridging (MB) adalah anomali kongenital arteri koroner yang paling umum ditemukan. MB adalah bila terdapat sebagian segmen dari arteri koroner yang berjalan epikardial mengambil jalur menukik ke dalam miokard sehingga menciptakan jembatan di atas segmen arteri koroner tersebut. Insidens MB berdasarkan temuan studi-studi otopsi, didapatkan angka terendah adalah 15% dan angka tertinggi 85%.1 Arteri koroner yang paling sering mengalami myocardial bridging adalah Left Anterior Descending (LAD), yang berdasarkan studi-studi didapatkan angka terendah 67% dan angka tertinggi 98% pasien.2,3 MB dikategorikan termasuk varian normal arteri koroner, dan sebagian besar kasus tidak menampilkan gejala, namun terdapat kasus yang menjadi masalah. Gejala dan gambaran elektrokardiografi yang ditimbulkan oleh iskemia pada MB tidak spesifik sehingga sulit dibedakan dengan iskemia akibat aterosklerosis arteri koroner.4 MB menyebabkan kompresi segmen arteri sehingga terjadi perubahan hemodinamika yang mengakibatkan iskemia, sehingga dapat tampil dengan gejala dan tanda khas iskemia seperti angina, atau temuan iskemia miokard berdasarkan uji stres, datang dengan sindrom koroner akut, temuan disfungsi ventrikel kiri, aritmia bahkan hingga kematian jantung mendadak.5
Kemaknaan klinis MB yang tidak spesifik dan rentangnya luas mulai dari dianggap varian normal hingga dapat fatal menjadikan MB perlu mendapatkan perhatian di awal untuk mendapatkan data diagnosis anatomi MB kemudian stratifikasi risiko sesuai kemaknaan fisiologis.
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References
1. Hwang JH, Ko SM, Roh HG, Song MG, Shin JK, Chee HK, Kim JS. Myocardial bridging of the left anterior descending coronary artery: depiction rate and morphologic features by dual-source CT coronary angiography. Korean J Radiol. 2010;11:514–521.
2. Loukas M, Curry B, Bowers M, Louis RG Jr, Bartczak A, Kiedrowski M, Kamionek M, Fudalej M, Wagner T. The relationship of myocardial bridges to coronary artery dominance in the adult human heart. J Anat. 2006;209:43–50.
3. Qian J-Y, Zhang F, Dong M, Ma J-Y, Ge L, Liu X-B, Fan B, Wang Q-B, Cui S-J, Ge J-B. Prevalence and characteristics of myocardial bridging in coronary angiogram--data from consecutive 5525 patients. Chin Med J . 2009;122:632–635.
4. Rovai D, Di Bella G, Pingitore A, Coceani M. Myocardial bridging: a review with emphasis on electrocardiographic findings. Ann Noninvasive Electrocardiol. 2015;20:103–107.
5. Lee MS, Chen C-H. Myocardial Bridging: An Up-to-Date Review. J Invasive Cardiol [Internet]. 2015;Available from: http://www.ncbi.nlm.nih.gov/pubmed/25999138
6. Schwarz ER, Gupta R, Haager PK, Dahl J vom, Klues HG, Minartz J, Uretsky BF. Myocardial bridging in absence of coronary artery disease: proposal of a new classification based on clinical-angiographic data and long-term follow-up. Cardiology. 2009;112:13–21.
7. Konen E, Goitein O, Sternik L, Eshet , Shemesh J, Di Segni E. The prevalence and anatomical patterns of intramuscular coronary arteries: a coronary computed tomography angiographic study. J Am Coll Cardiol. 2007;49:587–593.
8. Kim PJ, Hur G, Kim SY, Namgung J, Hong SW, Kim YH, Lee WR. Frequency of myocardial bridges and dynamic compression of epicardial coronary arteries: a comparison between computed tomography and invasive coronary angiography. Circulation. 2009;119:1408–1416.
9. Task Force Members, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot J-S, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Taggart DP, van der Wall EE, Vrints CJM, ESC Committee for Practice Guidelines, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document Reviewers, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949–3003.
2. Loukas M, Curry B, Bowers M, Louis RG Jr, Bartczak A, Kiedrowski M, Kamionek M, Fudalej M, Wagner T. The relationship of myocardial bridges to coronary artery dominance in the adult human heart. J Anat. 2006;209:43–50.
3. Qian J-Y, Zhang F, Dong M, Ma J-Y, Ge L, Liu X-B, Fan B, Wang Q-B, Cui S-J, Ge J-B. Prevalence and characteristics of myocardial bridging in coronary angiogram--data from consecutive 5525 patients. Chin Med J . 2009;122:632–635.
4. Rovai D, Di Bella G, Pingitore A, Coceani M. Myocardial bridging: a review with emphasis on electrocardiographic findings. Ann Noninvasive Electrocardiol. 2015;20:103–107.
5. Lee MS, Chen C-H. Myocardial Bridging: An Up-to-Date Review. J Invasive Cardiol [Internet]. 2015;Available from: http://www.ncbi.nlm.nih.gov/pubmed/25999138
6. Schwarz ER, Gupta R, Haager PK, Dahl J vom, Klues HG, Minartz J, Uretsky BF. Myocardial bridging in absence of coronary artery disease: proposal of a new classification based on clinical-angiographic data and long-term follow-up. Cardiology. 2009;112:13–21.
7. Konen E, Goitein O, Sternik L, Eshet , Shemesh J, Di Segni E. The prevalence and anatomical patterns of intramuscular coronary arteries: a coronary computed tomography angiographic study. J Am Coll Cardiol. 2007;49:587–593.
8. Kim PJ, Hur G, Kim SY, Namgung J, Hong SW, Kim YH, Lee WR. Frequency of myocardial bridges and dynamic compression of epicardial coronary arteries: a comparison between computed tomography and invasive coronary angiography. Circulation. 2009;119:1408–1416.
9. Task Force Members, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot J-S, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Taggart DP, van der Wall EE, Vrints CJM, ESC Committee for Practice Guidelines, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document Reviewers, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949–3003.
Published
2016-02-16
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How to Cite
Wicaksono, S. (2016). Myocardial Bridging: Peran ct dan mri dalam Diagnosis dan Stratifikasi Risiko. Indonesian Journal of Cardiology, 36(2), 120-4. https://doi.org/10.30701/ijc.v36i2.466
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