Khawaja, Muzamil

Abstract Myocardial bridging is the most common congenital coronary anomaly, characterized by an intramyocardial course of a segment of an epicardial coronary artery, with considerable variability in its depth and length. In most cases, MB is a benign anatomical variant without clinical significance, often asymptomatic and not requiring treatment. However, with the increasing use of coronary computed tomography angiography for coronary assessment, myocardial bridging is now more frequently identified during non-invasive imaging. It can also be diagnosed via invasive coronary angiography, where it appears as a dynamic systolic compression of the tunnelled artery segment, and further anatomical characterization can be enhanced by intravascular ultrasound or optical coherence tomography. Growing recognition of myocardial bridging’s role in ischaemia with non-obstructive coronary arteries has heightened clinical interest in its prevalence, diagnostic strategies, and management approaches. As such, this narrative review provides clinicians with an updated, evidence-based guide to the diagnosis and therapeutic management of myocardial bridging, while also addressing ongoing controversies and areas of uncertainty.

Background: In animal studies, scallop consumption has been shown to reduce atherosclerotic aortic burden, body weight, visceral adipose tissue, serum lipid, and leptin levels. Data in human models, however, is scarce. We aim to assess baseline demographic and cardiovascular health characteristics of scallop consumers and compare them to non-scallop consumers in the United States. Methods: The National Health and Nutrition Examination Survey (NHANES) data between 1999 and 2016 were analyzed. This descriptive analysis compares baseline characteristics and cardiovascular health risk between scallop-consumers and non-consumers using demographics, comorbidities, laboratory values, dietary and lifestyle factors. Results: Of the total 4,177 individuals in this cross-sectional analysis, 11.6% of individuals report consuming scallops. The data show older individuals tended to consume scallops (p <0.001). Caucasian ethnicity was associated with scallop consumption (p< 0.0001), while Mexican Americans had a significantly negative association with scallop consumption (p< 0.0001). Scallop consumption was more common among married and divorced individuals (p<0.0001)). Regarding medical comorbidities, more scallop consumers had baseline underlying coronary artery disease, hypertension, diabetes mellitus, and hyperlipidemia as compared to those who did not consume (p= 0.0026, p< 0.0001, p=0.0023, p<0.0001). There was notably no significant association with baseline congestive heart failure, asthma or stroke history, and scallop consumption. Conclusion: Scallop consumption is likely associated with the prevalence of coronary artery disease, hypertension, diabetes mellitus, and hyperlipidemia. Prospective studies and clinical trials are needed to determine further the relationship between scallop consumption and cardiovascular health risk.

Abstract Aims Spontaneous coronary artery dissection (SCAD) has become increasingly recognized. It accounts for &lt;1-4% of acute coronary syndrome presentations. Overall, however, it makes up over 40% of pregnancy-associated myocardial infarction. Furthermore, pregnancy-associated spontaneous coronary artery dissection (P-SCAD) is described to have a greater degree of clinical manifestations, including left ventricular dysfunction, shock, and left main or multivessel involvement. The findings are disconcerting, though many studies evaluating P-SCAD are based on case series data or are single centre studies. Methods and results The aim of this study was to evaluate a larger national dataset to evaluate the outcomes of SCAD and specifically P-SCAD in an attempt to better characterize the severity and clinical nature of this condition. To conduct this study, we analysed the National Readmission Database from January 2016 to December 2020. Propensity matching was done using the Greedy 1:1 method. Multivariate logistics and time-to-event Cox regression analysis models were built by including all confounders significantly associated with the outcome on univariable analysis with a cut-off P-value of 0.2. In multivariate regression analysis, P-SCAD patients had a non-propensity matched odds ratio (OR) of 0.21 (0.3-1.54, P = 0.123) of dying and a propensity matched OR of 0.11 (0.02-0.61, P = 0.012) of dying. Thirty-day readmission rate for P-SCAD was 15.8% (n = 93) and for non-pregnant spontaneous coronary artery dissection (NP-SCAD) was 11.2% (n = 2286); non-propensity matched OR for readmission for PSCAD patients was 1.68 (1.24-2.29, P = 0.001) and propensity matched OR was 3.39 (1.93-5.97, P &lt; 0.001). Conclusion Among hospitalized patient, P–SCAD was associated with similar clinical outcomes and reduced incidence of death when compared with NP–SCAD, though had higher rates of 30–day readmission. Larger–scale observational data will be needed to ascertain the true incidence of cardiovascular complications as it relates to P–SCAD.