Multidetector cardiac tomography: A useful tool before cardiac resynchronization therapy

Abstract

Background: Left ventricular lead placement in a suitable coronary vein is a key determinant of responsiveness to cardiac resynchronization therapy (CRT). Multidetector cardiac tomography (MDCT) is a non-invasive alternative to depict cardiac venous anatomy although coronary sinus (CS) retrograde venography (RV) is the gold standard. The aim of this study was to evaluate the accuracy of MDCT to determine the presence of CS tributaries before CRT. Methods: A retrospective analysis of 41 consecutive patients eligible to CRT was performed. MDCT was assessed in all patients before CRT and RV was achieved in 39 patients. Both methods evaluated the presence of the inferior interventricular vein (IIV), posterior vein (PV) and lateral main vein (LMV). CS ostium diameter and distance between the CS ostium and and supero-inferior was 14.1 mm (p < 0.01). A positive correlation (p < 0.001) between echocardiographic RA area and the distance from CS ostium to the RA lateral wall in the MDCT was observed.

Cardiac CT in CRT as a Singular Imaging Modality for Diagnosis and Patient-Tailored Management

“…Fortunately, global venous anatomy is similar between patients with and without heart failure [32,33]. CT venography can be leveraged to assess the coronary venous system prior to LV lead placement [6,7,15,29,[32][33][34][35][36][37][38][39][40]. The accuracy of CT at detecting the venous branches was shown to be, at least, equally as good as retrograde balloon angiography [35][36][37]41].…”

“…CT venography can be leveraged to assess the coronary venous system prior to LV lead placement [6,7,15,29,[32][33][34][35][36][37][38][39][40]. The accuracy of CT at detecting the venous branches was shown to be, at least, equally as good as retrograde balloon angiography [35][36][37]41]. Additionally, the evaluation of valves in the coronary venous system on CT is difficult, but feasible [42].…”

“…The accuracy of CT at detecting the venous branches was shown to be, at least, equally as good as retrograde balloon angiography [35][36][37]41]. Additionally, the evaluation of valves in the coronary venous system on CT is difficult, but feasible [42].…”