Assessment of the coronary venous system in heart failure patients by blood pool agent enhanced whole-heart MRI

Manzke, Robert; Binner, L.; Bornstedt, Axel; Merkle, Nico; Lutz, Anja; Gradinger, Robert; Rasche, Volker

doi:10.1007/s00330-010-1961-x

Cited by 12 publications

(7 citation statements)

References 32 publications

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“…This limits the accessibility of the anterolateral, lateral and posterolateral LV regions. The averaged branch positions in our examination are largely in line with those in previous studies (41,47,48).…”

Section: Significance Of the Coronary Vein Morphology In Crtsupporting

confidence: 91%

Morphometric Characterization of Human Coronary Veins and Subvenous Epicardial Adipose Tissue—Implications for Cardiac Resynchronization Therapy Leads

Keiler

Meinel

Ortak

et al. 2020

Front. Cardiovasc. Med.

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Subvenous epicardial fat tissue (SEAT), which acts as an electrical insulation, and the venous diameter (VD) both constitute histomorphological challenges for optimal application and lead design in cardiac synchronization therapy (CRT). In this study, we characterized the morphology of human coronary veins to improve the technical design of future CRT systems and to optimize the application of CRT leads. We retrospectively analyzed data from cardiac computed tomography (CT) of 53 patients and did studies of 14 human hearts using the postmortem freeze section technique and micro CT. Morphometric parameters (tributary distances, offspring angles, luminal VD, and SEAT thickness) were assessed. The left posterior ventricular vein (VVSP) had a mean proximal VD of 4.0 ± 1.4 mm, the left marginal vein (VMS) of 3.2 ± 1.5 mm and the anterior interventricular vein (VIA) of 3.9 ± 1.3 mm. More distally (5 cm), VDs decreased to 2.4 ± 0.6 mm, 2.3 ± 0.7 mm, and 2.4 ± 0.6 mm, respectively. In their proximal portions (15 mm), veins possessed mean SEAT thicknesses of 3.2 ± 2.4 (VVSP), 3.4 ± 2.4 mm (VMS), and 4.2 ± 2.8 mm (VIA), respectively. More distally (20–70 mm), mean SEAT thicknesses decreased to alternating low levels of 1.3 ± 1.1 mm (VVSP), 1.7 ± 1.1 mm (VMS), and 4.3 ± 2.6 mm (VIA), respectively. In contrast to the VD, SEAT thicknesses alternated along the further distal vein course and did not display a continuous decrease. Besides the CRT responsiveness of different areas of the LV myocardium, SEAT is a relevant electrophysiological factor in CRT, potentially interfering with sensing and pacing. A sufficient VD is crucial for successful CRT lead placement. Measurements revealed a trend toward greater SEAT thickness for the VIA compared to VVSP and VMS, suggesting a superior signal-to-noise-ratio in VVSP and VMS.

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Section: Significance Of the Coronary Vein Morphology In Crtsupporting

confidence: 91%

Morphometric Characterization of Human Coronary Veins and Subvenous Epicardial Adipose Tissue—Implications for Cardiac Resynchronization Therapy Leads

Keiler

Meinel

Ortak

et al. 2020

Front. Cardiovasc. Med.

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“…Previous studies have used magnetic resonance (MR) 4 and CT 5-12 imaging on live patients to assess the anatomies of the cardiac venous system. The main advantage of our study is that there is no danger to live patients due to contrast injection and radiation exposure [13][14] .…”

Section: Discussionmentioning

confidence: 99%

Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens

Spencer

Fitch

Iaizzo

2013

JoVE

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A detailed understanding of the complexity and relative variability within the human cardiac venous system is crucial for the development of cardiac devices that require access to these vessels. For example, cardiac venous anatomy is known to be one of the key limitations for the proper delivery of cardiac resynchronization therapy (CRT) 1 Therefore, the development of a database of anatomical parameters for human cardiac venous systems can aid in the design of CRT delivery devices to overcome such a limitation. In this research project, the anatomical parameters were obtained from 3D reconstructions of the venous system using contrast-computed tomography (CT) imaging and modeling software (Materialise, Leuven, Belgium). The following parameters were assessed for each vein: arc length, tortuousity, branching angle, distance to the coronary sinus ostium, and vessel diameter.CRT is a potential treatment for patients with electromechanical dyssynchrony. Approximately 10-20% of heart failure patients may benefit from CRT 2 . Electromechanical dyssynchrony implies that parts of the myocardium activate and contract earlier or later than the normal conduction pathway of the heart. In CRT, dyssynchronous areas of the myocardium are treated with electrical stimulation. CRT pacing typically involves pacing leads that stimulate the right atrium (RA), right ventricle (RV), and left ventricle (LV) to produce more resynchronized rhythms. The LV lead is typically implanted within a cardiac vein, with the aim to overlay it within the site of latest myocardial activation.We believe that the models obtained and the analyses thereof will promote the anatomical education for patients, students, clinicians, and medical device designers. The methodologies employed here can also be utilized to study other anatomical features of our human heart specimens, such as the coronary arteries. To further encourage the educational value of this research, we have shared the venous models on our free access website: www.vhlab.umn.edu/atlas. Video LinkThe video component of this article can be found at

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“…New imaging methods can be useful in finding an explanation for this phenomenon [5]. There have been several studies which have confirmed the usefulness of MSCT for the visualization of the coronary venous system, but none of them included patients with a previous bypass grafts implantation [6, 7].…”

Section: Introductionmentioning

confidence: 99%

Association between changes in coronary artery circulation and cardiac venous retention: a lesson from cardiac computed tomography

Młynarski

Młynarska

Sosnowski

2012

Int J Cardiovasc Imaging

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To use computed tomography (CT) image data to measure a potential association between the implantation of coronary artery bypass grafts (CABG) and changes in the coronary venous system has not yet been examined. In 112 (aged 59.4 ± 9.0; 45F) patients (pts.), a 64-slice CT angiography was performed. Patients were divided into 2 groups: CABG (56 pts.) and control (56 pts.)-without changes in coronaries. In each case, ten multi-planar reconstructions (MPR) and 3D volume rendering reconstructions using a 2 mm layer with ECG-gating, helical pitch: 12.8; rotation time: 0.4 s and average tube voltage: 135 kV at 380 mA. The visualization of the coronary veins was independently graded by 2 experts trained in CT. In the CABG group, the average number of visible coronary veins was 5.3 ± 1.3, while in the control group it was 3.1 ± 1.1 (p \ 0.001). Statistical differences were also observed for the following coronary veins: posterolateral (control 2.1 ± 1.9 vs. CABG 2.9 ± 1.9; p \ 0.05), lateral (control 2.2 ± 1.7 vs. CABG 3.1 ± 1.3; p \ 0.01) and anterolateral (control 0.5 ± 0.9 vs. CABG 1.3 ± 1.0; p \ 0.001). Implantation of CABG influences the coronary venous system. In patients after CABG, the number of identifiable coronary veins is significantly higher as compared to that in subjects without changes in coronaries. This might suggest an association between changes in coronary artery circulation and cardiac venous retention.

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Assessment of the coronary venous system in heart failure patients by blood pool agent enhanced whole-heart MRI

Abstract: Contrast-enhanced MRI venography appears feasible for non-invasive pre-interventional assessment of the course of the CS and its major tributaries.

Cited by 12 publications

References 32 publications

Morphometric Characterization of Human Coronary Veins and Subvenous Epicardial Adipose Tissue—Implications for Cardiac Resynchronization Therapy Leads

Morphometric Characterization of Human Coronary Veins and Subvenous Epicardial Adipose Tissue—Implications for Cardiac Resynchronization Therapy Leads

Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens

Association between changes in coronary artery circulation and cardiac venous retention: a lesson from cardiac computed tomography

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