title: Absence of coronary sinus tributaries in ischemic cardiomyopathy: An insight from multidetector computed tomography cardiac venographic study.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) is an important therapeutic strategy in heart failure. However, there is a high incidence of lead implantation failure and suboptimal response, particularly in ischemic cardiomyopathy. This failure rate may partly be secondary to lack of suitable coronary sinus branches for lead implantation. We sought to assess the presence of coronary sinus (CS) tributaries in patients with ischemic and non-ischemic cardiomyopathy.
  
  
  METHODS
  Multidetector computed tomography (MDCT) was performed in 100 patients: 25 coronary artery bypass graft (CABG) patients with impaired left ventricular ejection fraction (LVEF), 25 CABG patients with preserved LVEF, 25 patients with non-ischemic cardiomyopathy, and 25 controls. The presence of the CS and its tributaries, including the posterior interventricular vein (PIV), posterolateral vein (PLV), left marginal vein (LMV), and the anterior interventricular vein (AIV) was assessed.
  
  
  RESULTS
  The CS, PIV, and AIV were demonstrated in all patients, whereas presence of a PLV and LMV was identified in 68% and 48% of CABG patients with impaired LVEF, 96% and 68% of CABG patients with preserved LVEF, 92% and 80% of patients with non-ischemic cardiomyopathy, and 100% and 80% of controls (p = 0.001 and 0.046 for PLV and LMV, respectively).
  
  
  CONCLUSIONS
  This is the first report to demonstrate that the posterolateral vein and left middle vein, branches of the coronary sinus, are detectable in a significantly smaller number of CABG patients with impaired LVEF compared to controls, CABG with preserved LVEF, and non-ischemic cardiomyopathy. The absence of CS tributary veins in ischemic cardiomyopathy potentially hinders proper lead implantation and results in suboptimal CRT response.
authors: Cardiovascular Imaging Laboratory, Imaging Institute, USA; Division of Cardiology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: drthananyaa@yahoo.com.
authors: Thananya
authors: T
authors: Boonyasirinant
authors: Cardiovascular Imaging Laboratory, Imaging Institute, USA.
authors: Sandra S
authors: SS
authors: Halliburton
authors: Cardiovascular Imaging Laboratory, Imaging Institute, USA; Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors: Paul
authors: P
authors: Schoenhagen
authors: Department of Quantitative Health Sciences, Lerner Research Institute, USA.
authors: Michael L
authors: ML
authors: Lieber
authors: Cardiovascular Imaging Laboratory, Imaging Institute, USA; Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors: Scott D
authors: SD
authors: Flamm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D001026:Coronary Artery Bypass; D054326:Coronary Sinus / Q000002:abnormalities / Q000000981:diagnostic imaging*; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D010690:Phlebography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left
keywords: Cardiac resynchronization therapy; Computed tomography; Coronary sinus; Heart failure; Ischemic cardiomyopathy