Combined CCTA and Stress CTP for Anatomical and Functional Assessment of Myocardial Bridges

Myocardial bridging (MB) is a congenital coronary anomaly whose clinical impact remains controversial. Coronary computed tomography angiography (CCTA) combined with CT myocardial perfusion imaging (CT-MPI) enables a comprehensive anatomical and functional assessment of MB. This study aimed to investigate whether specific high-risk anatomical features of MB are independently associated with myocardial hypoperfusion, using combined CCTA and CT-MPI. We retrospectively analyzed 81 patients with MB showing high-risk anatomical features (depth ≥ 2.0 mm and length ≥ 25 mm) identified by CCTA, all of whom underwent stress dynamic CT-MPI between May 2022 and December 2025. Patients were classified according to the presence or absence of hypoperfusion in MB-related myocardial segments. Clinical and anatomical variables were compared between two groups using non-parametric tests, and multivariable logistic regression was performed to identify independent predictors of hypoperfusion. Among the 81 patients (mean age, 59.3 ± 11.7 years; 54 males), 26 (32.1%) demonstrated perfusion defects. All MBs were located in the left anterior descending artery (LAD). No significant differences were observed in clinical variables between groups. Bridges associated with hypoperfusion were significantly deeper (<i>p</i> < 0.001) and were more frequently located in the mid-LAD (73.1% vs. 38.2%, <i>p</i> = 0.01). In multivariable analysis, bridge depth and mid-LAD location remained independent predictors of hypoperfusion. In patients with MB, greater depth and mid-LAD location are independently associated with myocardial hypoperfusion. The combined use of CCTA and CT-MPI may enhance risk stratification and help guide clinical decision-making in this patient population.