CLINICAL RESEARCH: CARDIAC IMAGING
Non-Invasive Visualization of the Cardiac Venous System in Coronary Artery Disease Patients Using 64-Slice Computed Tomography
Nico R. Van de Veire, MD*, ,*,
Joanne D. Schuijf, MSc*,
Johan De Sutter, MD, PhD,
Dan Devos, MD ,
Gabe B. Bleeker, MD*,
Albert de Roos, MD, PhD ,
Ernst E. van der Wall, MD, PhD*,
Martin J. Schalij, MD, PhD* and
Jeroen J. Bax, MD, PhD*
* Department of cardiology, Leiden University Medical Center, Leiden, the Netherlands
Department of cardiology, Ghent University, Gent, Belgium
Department of Radiology, Ghent University, Gent, Belgium
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
* Reprint requests and correspondence:
Dr. Nico Van de Veire, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. (Email: nico.vandeveire{at}ugent.be).
OBJECTIVES: This study was designed to evaluate the value of 64-slice computed tomography (CT) to visualize the cardiac veins and evaluate the relation between variations in venous anatomy and history of infarction.
BACKGROUND: Cardiac resynchronization therapy (CRT) is an attractive treatment for selected heart failure patients. Knowledge of venous anatomy may help in identifying candidates for successful left ventricular lead implantation.
METHODS: The 64-slice CT of 100 individuals (age 61 ± 11 years, 68% men) was studied. Subjects were divided into 3 groups: 28 control patients, 38 patients with significant coronary artery disease (CAD), and 34 patients with a history of infarction. Presence of the following coronary sinus (CS) tributaries was evaluated: posterior interventricular vein (PIV), posterior vein of the left ventricle, and left marginal vein (LMV). Vessel diameters were also measured.
RESULTS: Coronary sinus and PIV were identified in all individuals. Posterior vein of the left ventricle was observed in 96% of control patients, 84% of CAD patients, and 82% of infarction patients. In patients with a history of infarction, a LMV was significantly less observed as compared with control patients and CAD patients (27% vs. 71% and 61%, respectively, p < 0.001). None of the patients with lateral infarction and only 22% of patients with anterior infarction had a LMV. Regarding quantitative data, no significant differences were observed between the groups.
CONCLUSIONS: Non-invasive evaluation of cardiac veins with 64-slice CT is feasible. There is considerable variation in venous anatomy. Patients with a history of infarction were less likely to have a LMV, which may hamper optimal left ventricular lead positioning in CRT implantation.
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Abbreviations and Acronyms
| | CAD = coronary artery disease | | CRT = cardiac resynchronization therapy | | CS = coronary sinus | | GCV = great cardiac vein | | LMV = left marginal vein | | LV = left ventricular | | MI = myocardial infarction | | MSCT = multi-slice computed tomography | | PIV = posterior interventricular vein | | PVLV = posterior vein of the left ventricle | | 3-D = 3-dimensional |
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