Preoperative CT of cardiac veins for planning left ventricular lead placement in cardiac resynchronization therapy
(2019) In Acta Radiologica 60(7). p.859-865- Abstract
Background: Successful cardiac resynchronization therapy (CRT) requires appropriate left ventricular (LV) lead placement on a suitable segment of the free LV wall. Current guidelines suggest targeted lead placement, but the individual anatomy of the cardiac veins is often a limiting factor. Purpose: To map cardiac veins with multidetector computed tomography (MDCT) and plot the veins in cardiac segments to facilitate successful CRT implantation. Material and Methods: Ninety-nine patients were included (mean age = 68 ± 9 years; 26% women; 46% ischemic cardiomyopathy). Contrast-enhanced, ECG-gated, dose-modulated MDCT was used to depict the coronary veins. CT data were reformatted into short-axis view. Veins with diameter ≥1.5 mm and... (More)
Background: Successful cardiac resynchronization therapy (CRT) requires appropriate left ventricular (LV) lead placement on a suitable segment of the free LV wall. Current guidelines suggest targeted lead placement, but the individual anatomy of the cardiac veins is often a limiting factor. Purpose: To map cardiac veins with multidetector computed tomography (MDCT) and plot the veins in cardiac segments to facilitate successful CRT implantation. Material and Methods: Ninety-nine patients were included (mean age = 68 ± 9 years; 26% women; 46% ischemic cardiomyopathy). Contrast-enhanced, ECG-gated, dose-modulated MDCT was used to depict the coronary veins. CT data were reformatted into short-axis view. Veins with diameter ≥1.5 mm and traversing the free LV wall were manually transferred into a 17-segment bulls-eye plot model. Results: In 98 patients, a CT scan with acceptable image quality was obtained. Median radiation dose as dose-length protocol was 231 mGy/cm (interquartile range = 276 mGy/cm). Mean contrast dose, expressed as total iodine load, was 38 ± 8 g. A median of three suitable veins (range = 1–7) covered a mean of 4.4 ± 1.5 relevant LV segments. There was no difference between patients with dilated or ischemic cardiomyopathy in number of veins (2.5 vs. 2.7, P = 0.45) or in number of cardiac segments traversed by suitable veins (4.4 vs. 4.5, P = 0.74). Conclusion: In CRT patients, MDCT can be used for preoperative mapping of the cardiac veins to assess availability of suitable veins in potential target segments for pacemaker-lead placement. Using the 17-segment plot of the left ventricle may improve the clinical usefulness of the data.
(Less)
- author
- Markstad, Hanna LU ; Bakos, Zoltan LU ; Ostenfeld, Ellen LU ; Geijer, Mats LU ; Carlsson, Marcus LU and Borgquist, Rasmus LU
- organization
- publishing date
- 2019
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cardiac resynchronization therapy, coronary sinus anatomy, heart failure, multidetector computed tomography
- in
- Acta Radiologica
- volume
- 60
- issue
- 7
- pages
- 859 - 865
- publisher
- SAGE Publications
- external identifiers
-
- pmid:30304945
- scopus:85060513198
- ISSN
- 0284-1851
- DOI
- 10.1177/0284185118803796
- language
- English
- LU publication?
- yes
- id
- 8901457a-6090-43cb-9c84-9c223fd308cc
- date added to LUP
- 2019-02-08 13:46:50
- date last changed
- 2024-07-23 09:24:27
@article{8901457a-6090-43cb-9c84-9c223fd308cc, abstract = {{<p>Background: Successful cardiac resynchronization therapy (CRT) requires appropriate left ventricular (LV) lead placement on a suitable segment of the free LV wall. Current guidelines suggest targeted lead placement, but the individual anatomy of the cardiac veins is often a limiting factor. Purpose: To map cardiac veins with multidetector computed tomography (MDCT) and plot the veins in cardiac segments to facilitate successful CRT implantation. Material and Methods: Ninety-nine patients were included (mean age = 68 ± 9 years; 26% women; 46% ischemic cardiomyopathy). Contrast-enhanced, ECG-gated, dose-modulated MDCT was used to depict the coronary veins. CT data were reformatted into short-axis view. Veins with diameter ≥1.5 mm and traversing the free LV wall were manually transferred into a 17-segment bulls-eye plot model. Results: In 98 patients, a CT scan with acceptable image quality was obtained. Median radiation dose as dose-length protocol was 231 mGy/cm (interquartile range = 276 mGy/cm). Mean contrast dose, expressed as total iodine load, was 38 ± 8 g. A median of three suitable veins (range = 1–7) covered a mean of 4.4 ± 1.5 relevant LV segments. There was no difference between patients with dilated or ischemic cardiomyopathy in number of veins (2.5 vs. 2.7, P = 0.45) or in number of cardiac segments traversed by suitable veins (4.4 vs. 4.5, P = 0.74). Conclusion: In CRT patients, MDCT can be used for preoperative mapping of the cardiac veins to assess availability of suitable veins in potential target segments for pacemaker-lead placement. Using the 17-segment plot of the left ventricle may improve the clinical usefulness of the data.</p>}}, author = {{Markstad, Hanna and Bakos, Zoltan and Ostenfeld, Ellen and Geijer, Mats and Carlsson, Marcus and Borgquist, Rasmus}}, issn = {{0284-1851}}, keywords = {{Cardiac resynchronization therapy; coronary sinus anatomy; heart failure; multidetector computed tomography}}, language = {{eng}}, number = {{7}}, pages = {{859--865}}, publisher = {{SAGE Publications}}, series = {{Acta Radiologica}}, title = {{Preoperative CT of cardiac veins for planning left ventricular lead placement in cardiac resynchronization therapy}}, url = {{http://dx.doi.org/10.1177/0284185118803796}}, doi = {{10.1177/0284185118803796}}, volume = {{60}}, year = {{2019}}, }