Myocardial bridges and proximal atherosclerosis of the coronary arteries: pathogenetic interrelation and clinical significance

Myocardial bridges (MB) are a congenital anomaly in which the coronary artery is partially immersed in the myocardium. The prevalence of MB varies from 0.5% to 87%, depending on the diagnostic method: selective angiography detects 0.5-18% of cases, whereas CT angiography, up to 73%. An analysis of 22 peer-reviewed papers (1986-2023) showed that in 98% of the cases MB is associated with proximal atherosclerosis due to hemodynamic disorders (turbulent blood flow, high pressure gradient). However, some studies deny a direct link or point to the potential protective effect of MB. Systolic compression of the artery causes myocardial ischemia, especially in cases of left ventricular hypertrophy or microvascular dysfunction. Clinical manifestations range from asymptomatic to angina pectoris, ACS, and sudden death. Treatment includes beta-blockers, stenting, and myotomy, but the lack of randomized trials limits universal recommendations. The contradictions in the data emphasize the need to integrate morphological and functional imaging, as well as to personalize therapy. Long-term cohort studies, risk stratification algorithms using AI, study of the angular anatomy of coronary arteries may be prospective lines of further research.