Correlates of Left Ventricular Global Longitudinal Strain and Surgical Intervention on Myocardial Bridges

Study Overview
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Brief Summary
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To examine the changes in left ventricular (LV) global longitudinal strain (GLS), using two-dimensional speckle tracking analysis, after left anterior descending (LAD) unroofing, in myocardial bridges (MBs) refractory to optimal medical therapy (OMT).

Detailed Description
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The present study is enrolling all the MBs-patients who underwent angina surgical relief or medical treatment at the Ospedali Riuniti of Ancona, Italy, and the University Hospital of Chieti, Italy. All the participants will be examined utilizing echocardiography before and after the treatment. The two-dimensional speckle-tracking analysis will be performed with an off-line dedicated software from the apical 4-chambers-view. All the unroofing procedures will be performed under cardiopulmonary bypass.

Conditions
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Myocardial Bridge of Coronary Artery

Intervention / Treatment
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* Procedure: Surgical unroofing of muscle-briged coronary artery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Myocardial bridge of the anterior descending left coronary artery Exclusion Criteria: Poor echocardiographic imaging quality
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Surgical unroofing<br>Refractory angina to medical treatment (beta-blockers or calcium channels blockers) | Procedure: Surgical unroofing of muscle-briged coronary artery<br>* Medical therapy with beta-blockers or calcium-channels blockers<br>* Other names: Medical treatment;|
| Medical treatment<br>Responders to medical treatment for angina relief | Procedure: Surgical unroofing of muscle-briged coronary artery<br>* Medical therapy with beta-blockers or calcium-channels blockers<br>* Other names: Medical treatment;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement of myocardial function and contractility | The increment of global longitudinal strain analysis, from pre treatment values, as assessed by speckle-traking echocardiography | 1 to 6 month after the procedure/treatment optimizzation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Angina relief after surgical treatment | Defined as the reduction of CCS-Angina Scale, assessed by physicians, from grade I (ordinary physical activity does not cause angina, such as walking and climbing stairs) to grade IV (inability to carry on any physical activity without discomfort, anginal syndrome may be present at rest). The scale comprises 4 degrees in increasing order of angina severity. | 1-month | 
| Improvement in quality of life | Defined as the score increment, from 0 to 100 of the SAQ-7 questionnaire. The SAQ quantifies patients' physical limitations caused by angina, the frequency of and recent changes in their symptomstheir satisfaction with treatment, and the degree to which they perceive their disease to affect their quality of life. The questionnaire provides 7 different items with 6 different multiple choices. Each scale is transformed to a score of 0 to 100, where higher scores indicate better function (eg, less physical limitation, less angina, and better quality of life). | 1-month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Coronary abnormalities, Angina, Global longitudinal strain, Speckle-traking echocardiography, Myocardial ischemia