Abstract 3179: Non-invasive Visualization of the Cardiac Venous System in Coronary Artery Disease Patients Using 64-slice Computed Tomography
Objectives Cardiac resynchronization therapy (CRT) is an attractive treatment for selected heart failure patients. Knowledge on venous anatomy may help identifying candidates for successful left ventricular lead implantation. Our objective was 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.
Methods The 64-slice CT of 100 individuals (age 61±11 years, 68% men) was studied. Subjects were divided in 3 groups: 28 controls, 38 patients with significant coronary artery disease (CAD), 34 patients with a history of infarction. Presence of the following coronary sinus (CS) tributaries was evaluated (Fig 1⇓): posterior interventricular vein (PIV), posterior vein of the left ventricle (PVLV) and left marginal vein (LMV). Vessel diameters were also measured.
Results CS and PIV were identified in all individuals.PVLV was observed in 96% of controls, 84% of CAD and 82% of infarction patients. In patients with a history of infarction, a LMV was significantly less observed as compared to controls and CAD patients (27% versus 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.
Conclusion 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.