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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017
182
AFRICA
Assessment of indirect inflammatory markers in patients
with myocardial bridging
Levent Cerit
Abstract
Introduction:
Myocardial bridging (MB) is a congenital vari-
ant of the coronary artery in which a portion of the epicardial
coronary artery takes an intramuscular course. Although it is
considered a benign anomaly, it may lead to such complica-
tions as myocardial ischaemia, acute coronary syndrome,
coronary spasm, exercise-induced dysrhythmias or even
sudden death. MB may be related to increased inflammatory
and atherosclerotic processes. This study was conducted with
the aim of evaluating the relationship between neutrophil/
lymphocyte ratio (NLR) and MB.
Methods:
Taking into consideration the inclusion criteria, 86
patients with MB and 88 with normal coronary angiographies
(control group) were included in the study. The association
between MB and laboratory and other clinical parameters
was evaluated.
Results:
The platelet distribution width (PDW) (17.3
±
0.40 vs
16.1
±
0 .5;
p
<
0.05), NLR (3.2
±
1.3 vs 2.2
±
0.9;
p
<
0.05)
and red cell distribution width (RDW) (14.3
±
1.3 vs 13.1
±
1.1;
p
<
0.05) were significantly higher in the MB group than
in the control group.
Conclusions:
This study demonstrated that compared to
normal coronary arteries, PDW, NLR and RDW were signifi-
cantly higher in MB patients. Further studies are needed to
clarify the increased inflammatory parameters in patients
with MB.
Keywords:
myocardial bridging, platelet distribution width,
neutrophil-to-lymphocyte ratio
Submitted 13/6/16, accepted 10/8/16
Published online 19/9/16
Cardiovasc J Afr
2017;
28
: 182–185
www.cvja.co.zaDOI: 10.5830/CVJA-2016-080
Myocardial bridging (MB) is an anatomical variation
characterised by narrowing during systole of some of the
epicardial coronary arterial segments running in the myocardium.
It may be encountered in 0.5 to 16% of routine coronary
angiographies.
1-3
Although it is considered a benign anomaly, it
may lead to such complications as myocardial ischaemia, acute
coronary syndromes, coronary spasm and exercise-induced
dysrhythmias, such as supraventricular tachycardia, ventricular
tachycardia, syncope or even sudden death.
4,5
Platelet distribution width (PDW) is a direct measure of the
variation in platelet size and a marker of platelet activation.
6
Red
cell distribution width (RDW) is a direct measure of the variation
in erythrocyte size, which is measured as a component of routine
blood counts.
7
The RDW is a well-recognised indicator of
chronic inflammation and oxidative stress, and elevated RDW is
strongly associated with poor clinical outcomes among patients
with coronary artery disease (CAD).
8
The neutrophil/lymphocyte
ratio (NLR), derived from the white blood cell (WBC) count, is a
common prognostic indicator in cardiovascular disease.
9
The aim of this study was to evaluate the relationships
between MB and PDW and other haematological parameters
in an effort to identify useful clinical indicators in patients
undergoing coronary angiography.
Methods
A retrospective evaluation was conducted of consecutive patients
undergoing coronary angiography. Stable angina was defined as
discomfort in the chest, back, shoulder, jaw or arms, typically
elicited by exertion or emotional stress, and relieved by rest or
nitroglycerin.
All patients enrolled in the study underwent coronary
angiography as a result of chest pain and objective signs of
ischaemia during treadmill exercises. Routine laboratory and
clinical parameters (e.g. hypertension, hypercholesterolaemia,
diabetes mellitus, tobacco use, family history of cardiovascular
disease) were obtained from the patients’ medical records.
Study exclusion criteria included CAD, mild-to-severe valve
disease, heart failure, anaemia, renal failure, inflammatory
diseases, coronary ectasia, malignancy, peripheral and
cerebral arterial disease and thyroid gland dysfunction (hypo-
hyperthyroidism).
All patients underwent transthoracic echocardiography using
the Vivid S5 (GE Healthcare) echocardiography device and Mass
S5 probe (2–4 MHz). Standard two-dimensional and colour-flow
Doppler views were acquired according to the guidelines of the
American Society of Echocardiography and European Society
of Echocardiography.
10
The ejection fraction was measured
according to the Simpson’s method.
10
Coronary angiography was performed with the Judkins
technique
11
and Innova 3100-IQ angiographic system (General
Electric, Buc Cedex, France). A typical description of bridging
on angiographyic view involves systolic narrowing, or ‘milking’ of
an epicardial artery, with a ‘step-down’ and ‘step-up’ demarcating
the impacted area. Angiographic views were evaluated based on
these MB criteria, and ≥ 50% systolic narrowing of an epicardial
artery was considered MB. Coronary angiograms were assessed
independently for objective evaluation of MB by two invasive
cardiologists blinded to the clinical findings.
Prior to coronary angiography, eight-hour postprandial
venous bloodwas collected fromall patients for routine laboratory
Department of Cardiology, Near East University, Nicosia,
Cyprus
Levent Cerit, MD,
drcerit@hotmail.com