| Registration of coronary venous anatomy to the site of the latest mechanical contraction. | |
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MedLine Citation:
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PMID: 20458823 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. METHODS AND 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. |
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Authors:
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Christian Knackstedt; Georg M?hlenbruch; Karl Mischke; Georg Schummers; Michael Becker; Harald K?hl; Andreas Franke; Michael Schmid; Elmar Spuentrup; Andreas Mahnken; Roberto M Lang; Malte Kelm; Rolf W G?nther; Patrick Schauerte |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Acta cardiologica Volume: 65 ISSN: 0001-5385 ISO Abbreviation: Acta Cardiol Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-05-12 Completed Date: 2010-06-11 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0370570 Medline TA: Acta Cardiol Country: Belgium |
Other Details:
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Languages: eng Pagination: 161-70 Citation Subset: IM |
Affiliation:
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Department of Cardiology, RWTH Aachen University, Germany. c.knackstedt@dshs-koeln.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiac Pacing, Artificial / methods* Coronary Vessels / pathology*, physiopathology Echocardiography, Doppler / methods Female Heart Conduction System / physiopathology Heart Failure / diagnosis*, physiopathology, therapy* Heart Ventricles / physiopathology Humans Imaging, Three-Dimensional* Magnetic Resonance Imaging* Male Middle Aged Myocardial Contraction* Pacemaker, Artificial* Retrospective Studies Severity of Illness Index Tomography, X-Ray Computed* Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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