Registration of coronary venous anatomy to the site of the latest mechanical contraction.
OBJECTIVE
Cardiac resynchronization therapy (CRT) provides a therapeutic option for patients with congestive heart failure (CHF). There is evidence that the optimal pacing site (OIS) is vicinal to the region of the latest contraction (RLC). However, the RLC is not identified routinely to guide lead implantation to the coronary venous system (CVS). The aim of this study was: (i) to develop a software over-imposing CVS-anatomy on parametric images of left ventricular dyssynchrony in a 3D-format obtained from computed tomography (CT) and cardiac magnetic resonance imaging (MRI); and (ii) to apply this 3D-software for analysing the possible correlation between functional/ clinical improvement and the distance between final implantation site (FIS) and RLC.


RESULTS
In 20 CHF-patients (11 men, 65.6 +/- 6.8 y, ejection fraction (EF): 27.5 +/- 6.1%) CRT-leads were implanted; follow-up included echocardiographic and exercise evaluation. The OIS and the FIS were noted on 3D-registrations and the distances OIS-RLC and FIS-RLC measured.The target vessel was reached in 14 cases. NYHA class and EF improved significantly with a low rate of non-responders of 3 (15%) (EF) and 4 (20%) (NYHA). Image registration was possible in all patients. Post-process 3D-analysis revealed no correlation between the distance FIS-RLC and functional or echocardiographic improvements.There was a trend towards a shorter distance FIS-RLC in patients classified as responders (EF). NYHA class improved significantly better in patients with target vessel implantation.


CONCLUSIONS
Registration of CT/MRI-images enables efforts to reach the RLC by preoperative identification of corresponding veins. Larger randomized trials must define the definite therapeutic benefit.
Knackstedt
Christian
C
Department of Cardiology, RWTH Aachen University, Germany. c.knackstedt@dshs-koeln.de
Mühlenbruch
Georg
G
Mischke
Karl
K
Schummers
Georg
G
Becker
Michael
M
Kühl
Harald
H
Franke
Andreas
A
Schmid
Michael
M
Spuentrup
Elmar
E
Mahnken
Andreas
A
Lang
Roberto M
RM
Kelm
Malte
M
Günther
Rolf W
RW
Schauerte
Patrick
P
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003331:Coronary Vessels / Q000473:pathology* / Q000503:physiopathology; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome