open access

Vol 22, No 5 (2015)
Original articles
Published online: 2015-10-27
Get Citation

Multidetector cardiac tomography: A useful tool before cardiac resynchronization therapy

Maria de la Paz Ricapito, Diego Conde, Marie M. Theriault, Santiago Rivera, Mariano G. Badra-Verdu, Jean F. Roux, Paul Farand, Félix A. Ayala-Paredes, Gerald Gahide
DOI: 10.5603/CJ.a2015.0011
·
Pubmed: 25733321
·
Cardiol J 2015;22(5):590-596.

open access

Vol 22, No 5 (2015)
Original articles
Published online: 2015-10-27

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 right atrium (RA) lateral wall were also measured.

Results: The IIV was identified in 100% of MDCT and in 43.6% of RV. In comparison to RV, the MDCT’s sensitivity to identify PV and LMV was 100% for both, kappa coefficient of 0.792 (CI 95% 0.46–0.93) and 0.69 (CI 95% 0.46–0.91), respectively. There was no significant difference between ischemic and non-ischemic patients regarding the presence of PV or LMV. Median CS antero-posterior diameter was 10.3 mm (IQR 7.5–13) and supero-inferior was 14.1 mm (IQR 11.5–17) (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.

Conclusions: MDCT is as accurate as RV to depict CS and its tributaries (IIV, PV, LMV), and it could be useful as a non-invasive technique before CRT.

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 right atrium (RA) lateral wall were also measured.

Results: The IIV was identified in 100% of MDCT and in 43.6% of RV. In comparison to RV, the MDCT’s sensitivity to identify PV and LMV was 100% for both, kappa coefficient of 0.792 (CI 95% 0.46–0.93) and 0.69 (CI 95% 0.46–0.91), respectively. There was no significant difference between ischemic and non-ischemic patients regarding the presence of PV or LMV. Median CS antero-posterior diameter was 10.3 mm (IQR 7.5–13) and supero-inferior was 14.1 mm (IQR 11.5–17) (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.

Conclusions: MDCT is as accurate as RV to depict CS and its tributaries (IIV, PV, LMV), and it could be useful as a non-invasive technique before CRT.

Get Citation

Keywords

multidetector computed tomography, resynchronization therapy, cardiomyopathy, cardiac veins, pacemaker, heart failure

About this article
Title

Multidetector cardiac tomography: A useful tool before cardiac resynchronization therapy

Journal

Cardiology Journal

Issue

Vol 22, No 5 (2015)

Pages

590-596

Published online

2015-10-27

DOI

10.5603/CJ.a2015.0011

Pubmed

25733321

Bibliographic record

Cardiol J 2015;22(5):590-596.

Keywords

multidetector computed tomography
resynchronization therapy
cardiomyopathy
cardiac veins
pacemaker
heart failure

Authors

Maria de la Paz Ricapito
Diego Conde
Marie M. Theriault
Santiago Rivera
Mariano G. Badra-Verdu
Jean F. Roux
Paul Farand
Félix A. Ayala-Paredes
Gerald Gahide

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl