ABC | Volume 112, Nº1, January 2019

Short Editorial Villeta & Oliveira A new marker of myocardial bridge? Arq Bras Cardiol. 2019; 112(1):18-19 1. Corban MT, Hung OY, Eshtehardi P, Rasoul-Arzrumly E, McDaniel M, Mekonnen G, et al. Myocardial bridging: contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies. J Am Coll Cardiol. 2014; 63(22):2346-55. 2. Akishima-Fukasawa Y, Ishikawa Y, Mikami T, Akasaka Y, Ishii T. Settlement of stenotic site and enhancement of risk factor load for atherosclerosis in left anterior descending coronary artery by myocardial bridge. Arterioscler Thromb Vasc Biol. 2018; 38(6):1407-14. 3. Lee MS, Chen CH. Myocardial bridging: an up todate review. J Invas Cardiol.2015;27(11):521-8. 4. Tarantini G, Migliore F, Cademartiri F, Fraccaro C, Iliceto S. Left Anterior Descending Artery Myocardial Bridging: A Clinical Approach. J Am Coll Cardiol. 2016; 68(25):2887-99. 5. Enhos A, Cosansu K, Huyut MA, Turna F, Karacop E, Bakshaliyev N et al. Assessment of the relationship between monocyte to high-density lipoprotein ratio and myocardial bridge. Arq Bras Cardiol. 2019; 112(1):12-17 6. Ganjali S, Gotto AM Jr, Ruscica M, Atkin SL, Butler AE, Banach M, et al. Monocyte-to-HDL-cholesterol ratio as a prognosticmarker in cardiovascular diseases. J Cell Physiol. 2018; 233(12):9237-46. 7. Korkmaz A, Demir M, Unal S, Yildiz A, Ozyazgan B, Demirtas B, et al. Monocyte-to-high density lipoprotein ratio (MHR) can predict the significance of angiographically intermediate coronary lesions. Int J Cardiovasc Acad. 2017;3(1-2):16-20. 8. AkbogaMK,BalciKG,MadenO,ErtemAG,KirbasO,YaylaC,etal.Usefulness ofmonocytetoHDL-cholesterolratiotopredicthighSYNTAXscore inpatients with stable coronary artery disease. Biomark Med. 2016; 10(4):375-83. 9. Açıkgöz SK, Açıkgöz E, Şensoy B, Topal S, Aydoğdu S. Monocyte to high- density lipoprotein cholesterol ratio is predictive of in-hospital and five- year mortality in ST-segment elevation myocardial infarction. Cardiol J. 2016;23(5):505-12. 10. CetinMS, OzcanCetin EH, Kalender E, Aydin S, Topaloglu S, et al. Monocyte toHDL cholesterol ratio predicts coronary artery disease severity and future major cardiovascular adverse events in acute coronary syndrome. Heart Lung Circ. 2016; 25(11):1077-86. 11. Karatas A, Turkmen E, Erdem E, Dugeroglu H, Kaya Y. Monocyte to high- density lipoprotein cholesterol ratio in patients with diabetes mellitus and diabetic nephropathy. Biomark Med. 2018; 12(9):953-9. 12. Uslu AU, Sekin Y, Tarhan G, Canakcı N, GunduzM, KaragulleM. Evaluation of monocyte to high-density lipoprotein cholesterol ratio in the presence and severity of metabolic syndrome. Clin Appl Thromb Hemost. 2018; 24(5):828-33. 13. Kundi H, Gok M, Kiziltunc E, Cetin M, Cicekcioglu H, Cetin ZG, et al. Relation between monocyte to high-density lipoprotein cholesterol ratio with presence and severity of isolated coronary artery ectasia. Am J Cardiol. 2015; 116(11):1685-9. 14. Dogan A, Oylumlu M. Increased monocyte-to-HDL cholesterol ratio is related to cardiac syndrome X. Acta Cardiol. 2017; 72(5):516-21. References This is an open-access article distributed under the terms of the Creative Commons Attribution License of coronary ectasia, 13 cardiac syndrome X, 14 and smoking. 15 Even though these results derived from observational studies, they suggest a relationship between conditions that cause vascular inflammation and MHR changes. The study by Enhos et al. 5 has several limitations, including a small cohort derived from a single center and an assessment of the MHR measured transversely, although no relevant differences were observed between individuals with MB and controls regarding factors that are known to influence the MHR. Additionally, other potential causes of alterations in this relationship were not evaluated, such as the practice of physical activity, diet, smoking, and the presence of other underlying inflammatory processes. However, a great merit of the study is to present further evidence of a possible association between MBs and inflammation, which should be further evaluated in longitudinal studies verifying if the association relates to increased cardiovascular outcomes. Until such data become available, modification of diagnostic and therapeutic approaches based on the routine determination of this association in patients with MB does not seem relevant, considering that most MBs have a benign course and their treatment is still controversial. 19