Imaging of the coronary venous system in patients with congestive heart failure: comparison of 16 slice MSCT and retrograde coronary sinus venography

Knackstedt, Christian; Mühlenbruch, Georg; Mischke, Karl; Schimpf, Thomas; Spüntrup, Elmar; Günther, Rolf W.; Sanli, Beyhan; Kelm, Malte; Schauerte, Patrick; Mahnken, Andreas H.

doi:10.1007/s10554-008-9333-1

Cited by 18 publications

(15 citation statements)

References 21 publications

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“…Therefore, efforts have been made over recent years to explore new methods of imaging. For example, multislice spiral computed tomography (MSCT) has become an important tool for noninvasive visualization of the cardiac venous system [2–5]. Recent studies using whole-heart steady-state free precession (SSFP) coronary MRA (CMRA) demonstrates that MR can visualize the anatomy of the cardiac venous system at 1.5T [6–10].…”

Section: Introductionmentioning

confidence: 99%

Contrast-enhanced whole-heart coronary MRA at 3.0T for the evaluation of cardiac venous anatomy

Tang

Yang

et al. 2010

Int J Cardiovasc Imaging

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This study was designed to evaluate the value of contrast-enhanced whole-heart coronary MRA (CMRA) at 3.0T in depicting the cardiac venous anatomy. In cardiac resynchronization therapy (CRT), left ventricular (LV) pacing is achieved by positioning the LV lead in one of the tributaries of the coronary sinus (CS). Pre-implantation knowledge of the venous anatomy may help determine whether transvenous LV lead placement for CRT is feasible. Images of 51 subjects undergoing contrast-enhanced whole-heart CMRA at 3.0T were retrospectively analyzed. Data acquisition was performed using electrocardiography-triggered, navigator-gated, inversion-recovery prepared, segmented gradient-echo sequence. A 32-element cardiac coil was used for data acquisition. The visibility of the cardiac veins was graded visually using a 4-point scale (1: poor–4: excellent). The paired Student t test was used to evaluate differences in diameters of the ostium of the CS in anteroposterior and superoinferior direction. The cardiac veins were finally evaluated in 48 subjects with three anatomic variations. The diameter of the CS ostium in the superoinferior direction (1.13 ± 0.26 cm) was larger than in the anteroposterior direction (0.82 ± 0.19 cm) (P < 0.05). The mean visibility score of CS, posterior interventricular vein, posterior vein of the left ventricle, left marginal vein, and anterior interventricular vein was 4.0 ± 0.0, 3.4 ± 0.5, 3.4 ± 0.5, 3.0 ± 0.8, and 3.3 ± 0.5, respectively. In conclusion, contrast-enhanced whole-heart CMRA at 3.0T can depict the normal and variant cardiac venous anatomy.

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Section: Introductionmentioning

confidence: 99%

Contrast-enhanced whole-heart coronary MRA at 3.0T for the evaluation of cardiac venous anatomy

Tang

Yang

et al. 2010

Int J Cardiovasc Imaging

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“…Once the CS is cannulated, an occlusive balloon catheter would be used for angiography to map the branches of the CS. 29 The CS lead would be advanced into an appropriate branch using over-the wire techniques. A stylet would stiffen the lead against displacement while the introducer is stripped away, and the purse string is tied.…”

Section: Discussionmentioning

confidence: 99%

Introducer Development for Coronary Sinus Access from Parasternal Mediastinotomy

Spotnitz

Yeager

Cabreriza

et al. 2015

Innovations�(Phila)

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Objective Right parasternal mediastinotomy with right atriotomy has been used clinically for pacemaker insertion. A similar approach might facilitate access to the coronary sinus for biventricular pacing and other manipulations when more conventional approaches are not feasible. The primary barrier to this is lack of appropriate introducers and techniques. Methods Anatomically derived introducers were developed in 2 anesthetized domestic pigs using data from computerized axial thoracic tomography. Each digitized tomogram defined a unique introducer shape and was constructed using 3-dimensional (3D) modeling software and printing. Each parent pig then underwent surgery demonstrating coronary sinus lead insertion, using its custom-configured introducer. Next, with institutional review board approval, 65 patients were identified who had undergone conventional endocardial coronary sinus lead insertion followed by thoracic scanning. These tomograms were used to design appropriately curved introducers for human anatomy. Results Fifty-one introducer paths were defined following anatomic pathways and avoiding bends inconsistent with materials used for commercial peel-away introducers. Each path was defined by a bend and distance toward the coronary sinus ostium and a hook and twist out of plane to align with the local orientation of the coronary sinus. The average dimensions were the following: distance, 67 mm; bend angle, 47 degrees; hook angle, 39 degrees; and twist angle, 20 degrees. A prototype cannula was tested for fit in a fresh frozen postmortem human specimen. Conclusions Parasternal mediastinotomy access to the coronary sinus for cardiac resynchronization, mitral annuloplasty, and instrumentation is feasible. Human computerized tomographic scans can be used to define curvatures and dimensions for marketed introducers.

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“…The remaining predictive ability required for ideal accuracy (AUC of 1.0) is likely accounted for by the overall scar burden38, 39, the location of the scar in relation to the LV lead position37, the region of latest activation in relation to the LV lead position45 and co-morbidities such as diabetes, renal failure and atrial fibrillation46. Imaging of the coronary veins will likely be useful to determine potential LV lead positions prior to CRT to ensure placement in viable, dyssynchronous myocardium47, 48. Future studies should work towards addressing all of these factors in a comprehensive manner to predict response to CRT.…”

Section: Towards a Comprehensive Methods To Select Patients For Crtmentioning

confidence: 99%

It's Time for a Paradigm Shift in the Quantitative Evaluation of Left Ventricular Dyssynchrony

Fornwalt

Delfino

Sprague

et al. 2009

Journal of the American Society of Echocardiography

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The acute adverse effects of left ventricular (LV) dyssynchrony on cardiac performance were first described in 1925 by Carl Wiggers 1 . In recent years, the accurate diagnosis of LV dyssynchrony has become the focus of a myriad of publications, driven by the advent of cardiac resynchronization therapy (CRT) to treat heart failure due to severe LV dysfunction in the setting of marked prolongation of the QRS interval 2-4 . In the initial large clinical trials of CRT, QRS duration was used as a measure of dyssynchrony to select patients for treatment 2, 3 . However, sensitivity 5 and specificity 6 of QRS duration to predict response to CRT were less than optimal. Subsequently, numerous "time-to-peak" parameters based directly on the motion of the LV walls were developed to diagnose LV mechanical dyssynchrony with echocardiography in an attempt to improve CRT selection criteria 7 .Echocardiographic mechanical dyssynchrony parameters initially showed promise in predicting response to CRT in single-center studies 8-12 . However, the multicenter Predictors of Response to CRT (PROSPECT) study recently reported that no echocardiographic dyssynchrony parameter could be recommended to improve patient selection for CRT beyond current guidelines 13 . In addition, the Resynchronization Therapy in Narrow QRS (RETHINQ) trial recently reported that patients with narrow QRS and evidence of mechanical dyssynchrony do not benefit from CRT 14 .So where do we go from here? Should selection of patients for CRT based on mechanical dyssynchrony be abandoned in the wake of the negative results from PROSPECT and RETHINQ? We believe that techniques to quantify LV mechanical dyssynchrony need to be refined, not forgotten, and will still play a role in improving CRT selection criteria in the future. This refinement of dyssynchrony quantification requires a paradigm shift. First, time-to-peak methods for quantifying dyssynchrony utilize only a single time point on the velocity or strain curves and should be replaced with more quantitatively sophisticated methods. Utilizing more data reduces variability and increases accuracy. Second, "response to CRT" should no longer

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Imaging of the coronary venous system in patients with congestive heart failure: comparison of 16 slice MSCT and retrograde coronary sinus venography

Cited by 18 publications

References 21 publications

Contrast-enhanced whole-heart coronary MRA at 3.0T for the evaluation of cardiac venous anatomy

Contrast-enhanced whole-heart coronary MRA at 3.0T for the evaluation of cardiac venous anatomy

Introducer Development for Coronary Sinus Access from Parasternal Mediastinotomy

It's Time for a Paradigm Shift in the Quantitative Evaluation of Left Ventricular Dyssynchrony

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