We appreciate the authors’ interest in our study.1 We agree with many of the comments, which are of great help in furthering scientific knowledge of this subject. We would only like to emphasize the following points.
The prevalence of myocardial bridging (MB) varies considerably according to the method used, and this can be explained by the characteristics inherent to each technique. Conventional coronary angiography underestimates the prevalence of MB because the visualization it offers is limited to the vessel lumen, while superficial MB with minimal systolic compression is overlooked. The high incidence obtained in autopsies is likely related to the diagnosis of superficial and very distal MB, which probably have no clinical repercussions. Multidetector computed tomography is an ideal technique because it enables visualization of the coronary artery lumens as well as the artery walls and the neighboring myocardium.2,3 It is true that that the greater the number of detectors, the higher the sensitivity, which increases the prevalence to values close to those obtained in autopsies. The challenge that remains to be resolved is to demonstrate the causal relationship between MB and the patient's symptoms. Only isolated case reports are available, in which the ischemia detection test was positive and/or surgical treatment of the anomaly resolved the symptoms.4 If the relationship between MB and the symptoms is uncertain, that between partial MB and the symptoms is even more so. For this reason, our study included only MB in which the artery was completely surrounded by myocardium in axial images and multiplanar reconstructions.
All patients included in our study consulted for chest pain. We had no control group and we did not evaluate the presence of systolic compression. Therefore, it was impossible to analyze the relationship between the anatomic characteristics of MB (longitude, depth and degree of systolic compression) and the appearance of symptoms.
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