title: Non-invasive visualization of the cardiac venous system in coronary artery disease patients using 64-slice computed tomography.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of cardiology, Leiden University Medical Center, Leiden, The Netherlands. nico.vandeveire@ugent.be
authors.forename: Nico R
authors.initials: NR
authors.lastname: Van de Veire
authors.forename: Joanne D
authors.initials: JD
authors.lastname: Schuijf
authors.forename: Johan
authors.initials: J
authors.lastname: De Sutter
authors.forename: Dan
authors.initials: D
authors.lastname: Devos
authors.forename: Gabe B
authors.initials: GB
authors.lastname: Bleeker
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D003331:Coronary Vessels / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*