How to Assess Functional Significance of Myocardial Bridges in Athletes. A Personalized Medicine Approach

Myocardial bridging is a congenital coronary anomaly involving a segment of coronary artery coursing through myocardial wall, in a different depth and length, potentially affected by systolic compression. In athletes, such coronary anomaly is most often an incidental finding, due to increased use of high sensitivity noninvasive diagnostic tests. However, since myocardial bridge might potentially precipitate ischemia and even be responsible for sudden cardiac death, athletes need to be cleared for competition by an appropriate diagnostic test. Which is the ideal diagnostic test in such peculiar condition, in which the pathophysiological mechanism of ischemia is unknown and potentially different in different subjects, remains to be investigated. We focused on different diagnostic tests proposed and classified according to the most likely pathophysiological mechanism of ischemia in myocardial bridge. Accordingly, we analysed and discussed on ideal test in athletes with such condition.