Gender-related differences in coronary venous anatomy: a potential basis for various response to cardiac resynchronisation therapy

Abstract

A b s t r a c t Background and aim:We hypothesised that small differences in the anatomy of the coronary venous tree might be one of the factors responsible for the differences in the response for cardiac resynchronisation depending on a patient's gender. Methods:Cardiac computed tomography scans with retrospective gating were performed on 315 subjects (aged 58.3 ± 11.6 years; 117 women) according to the clinical criteria. The standard protocol for coronary arteries was used during scanning. Additional reconstructions that were focused on the coronary veins during post processing were used to analyse the data. Gender-related anatomical variants were identified.Results: The average of 3.6 ± 1.4 veins per case were visualised. The posterolateral vein was visualised more frequently in men than in women (p < 0.05). Eight variants were identified as being more frequent -they were found in 237 out of 315 cases (75.24%). Those variants occurred in 95 (81.19%) of the women and in 142 (71.72%) of the men, p = 0.080. Six variants occurred more frequently in women; however, the differences were not significant. Conclusions:In women a more frequent presence of favourable coronary vein variants in the target area for cardiac resynchronisation can be seen. Anatomical findings may help to explain why women more frequently respond to cardiac resynchronisation therapy compared to men.

Ischaemic aetiology predicts exercise dyssynchrony in patients with heart failure with reduced ejection fraction

“…Despite its positive clinical impact, a significant portion of patients fail to respond sufficiently. Therefore, along with more precise lead positioning [13] and post-implantation device optimisation, Figure 1. Changes in the number of patients with ischaemic aetiology of heart failure with and without dyssynchrony at rest and at exercise Figure 2.…”