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Preoperative CT of cardiac veins for planning left ventricular lead placement in cardiac resynchronization therapy

Markstad, Hanna LU ; Bakos, Zoltan LU ; Ostenfeld, Ellen LU ; Geijer, Mats LU ; Carlsson, Marcus LU and Borgquist, Rasmus LU (2018) In Acta Radiologica
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.

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author
organization
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type
Contribution to journal
publication status
epub
subject
keywords
Cardiac resynchronization therapy, coronary sinus anatomy, heart failure, multidetector computed tomography
in
Acta Radiologica
publisher
John Wiley & Sons
external identifiers
  • 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
2019-02-27 05:13:09
@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},
  keyword      = {Cardiac resynchronization therapy,coronary sinus anatomy,heart failure,multidetector computed tomography},
  language     = {eng},
  month        = {09},
  publisher    = {John Wiley & Sons},
  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},
  year         = {2018},
}