Intramyocardial Bridge in Sports Medicine: Strategies for Correct Follow-Up in Asymptomatic Athletes

Background: Intramyocardial Bridge (MB) is a coronary anomaly where a segment of the artery is tunnelled within the myocardium, often asymptomatic but potentially leading to ischemic events. Though MB was previously considered a disqualifying factor in sports medicine, recent changes in 2023 allow MBs that do not meet certain morpho-logical criteria to be compatible with competitive sports. This study evaluates a com-bined provocative test integrating CPET and myocardial deformation (twist) to assess asymptomatic athletes diagnosed with a "significant" MB. Material and Methods: This retrospective observational study included 18 participants (9 cases, 9 controls), aged 18-78 years, who underwent competitive certification at our facility. The case group consisted of 9 athletes with a "significant" MB, diagnosed through CT coronary angi-ography, while controls were healthy, trained subjects. Both groups underwent resting echocardiography, speckle tracking analysis, and CPET to assess exercise capacity and myocardial function. Results: At rest, no significant differences in echocardiographic parameters were observed. However, during exercise, athletes with MB showed a sig-nificant reduction in GLS and ventricular twist compared to controls, indicating a loss of apical reserve. Conclusions: This study supports the use of combined CPET and myo-cardial deformation analysis as an effective tool for assessing the functional impact of MB in asymptomatic athletes. This approach offers a more comprehensive follow-up strategy for those at risk of ischemic events despite the absence of symptoms.