Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2026
Real-World Invasive Evaluation of Myocardial Bridging: A Multicenter Italian Survey of Interventional Cardiologists' Practices.
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Elia Stefano, Rizzo Gaetano, Laborante Renzo, Paglianiti Donato Antonio, Righetti Stefano, Aurigemma Cristina, Trabattoni Daniela, Andreini Daniele, Cesaro Arturo, Rognoni Andrea, Secco Gioel G, D'Ascenzo Fabrizio, Massaro Gianluca, Scarsini Roberto, Canova Paolo, Vergallo Rocco, Galli Mattia, Musumeci Giuseppe, Patti Giuseppe, D'Amario Domenico
Аннотация
BACKGROUND: Myocardial bridging (MB) is increasingly recognized as a potential cause of ischemia through heterogeneous mechanisms, yet real-world management remains heterogeneous. We surveyed interventional cardiologists to describe contemporary MB practice, focusing on functional assessments, perceived value, and barriers to the "full-physiology" approach, and priorities for standardization and research.
AIMS: To characterize contemporary MB management among interventional cardiologists, focusing on physiology approaches, imaging strategies, and perceived barriers to implementation and treatment.
METHODS: An anonymized online survey was conducted among interventional cardiologists from 28 Italian centers. Items covered MB-specific functional assessment strategies, therapies, implementation barriers, operational infrastructure, and research interest.
RESULTS: Ninety-three cardiologists responded (mean age 38.8 ± 8.6 years; 82.8% male). Pressure-based indices were widely used for epicardial CAD, but phenotyping in MB was uncommon: 57.0% performed physiology in < 10% of MB cases, and 19.4% never did. Epicardial MB assessment relied mainly on adenosine-FFR (33.3%) or iFR (31.2%), whereas stress-enhanced protocols were rarely used. Although intracoronary acetylcholine testing was commonly used in general practice (79.6%), only 49.5% of respondents reported using it to assess MB-related coronary spasm, and most did so in only a small proportion of cases. CMD testing in MB was rare (< 10% in 66.7%). Despite this, most respondents (87.1%) endorsed "full-physiology" as useful for mechanism identification and personalized therapy, but cited evidence uncertainty, procedural time, and limited experience as key barriers. Operational readiness was low (dedicated protocols: 26.9%; registries: 39.8%; routine capture: 34.4%). Willingness to join a randomized trial was high (93.5%).
CONCLUSIONS: Despite the widespread availability of invasive functional assessment tools and operators' recognition of their relevance, their use in MB remains limited and heterogeneous, reflecting the lack of evidence-based guidance and underscoring the need for dedicated mechanistic studies and standardized invasive workflows.
AIMS: To characterize contemporary MB management among interventional cardiologists, focusing on physiology approaches, imaging strategies, and perceived barriers to implementation and treatment.
METHODS: An anonymized online survey was conducted among interventional cardiologists from 28 Italian centers. Items covered MB-specific functional assessment strategies, therapies, implementation barriers, operational infrastructure, and research interest.
RESULTS: Ninety-three cardiologists responded (mean age 38.8 ± 8.6 years; 82.8% male). Pressure-based indices were widely used for epicardial CAD, but phenotyping in MB was uncommon: 57.0% performed physiology in < 10% of MB cases, and 19.4% never did. Epicardial MB assessment relied mainly on adenosine-FFR (33.3%) or iFR (31.2%), whereas stress-enhanced protocols were rarely used. Although intracoronary acetylcholine testing was commonly used in general practice (79.6%), only 49.5% of respondents reported using it to assess MB-related coronary spasm, and most did so in only a small proportion of cases. CMD testing in MB was rare (< 10% in 66.7%). Despite this, most respondents (87.1%) endorsed "full-physiology" as useful for mechanism identification and personalized therapy, but cited evidence uncertainty, procedural time, and limited experience as key barriers. Operational readiness was low (dedicated protocols: 26.9%; registries: 39.8%; routine capture: 34.4%). Willingness to join a randomized trial was high (93.5%).
CONCLUSIONS: Despite the widespread availability of invasive functional assessment tools and operators' recognition of their relevance, their use in MB remains limited and heterogeneous, reflecting the lack of evidence-based guidance and underscoring the need for dedicated mechanistic studies and standardized invasive workflows.