Non-invasive evaluation of the coronary venous system in patients with chronic systolic heart failure by 64-detector computed tomography

Evaluation of the anatomical variations of the coronary venous system in patients with coronary artery calcification using 256-slice computed tomography

The factors that determine the anatomical variations of the coronary venous system (CVS) are poorly understood. The objective of this study was to evaluate the anatomical variations of the CVS in patients with coronary artery calcification. 196 patients underwent non-contrast CT and coronary CT angiography using 256-slice CT. All subjects were divided into four groups based on their coronary artery calcium score (CACS): 50 patients with CACS = 0 Agatston unit (AU), 52 patients with CACS = 1–100 AU, 44 patients with CACS = 101–400 AU, and 50 patients with CACS > 400 AU. The presence of the following cardiac veins was evaluated: the coronary sinus (CS), great cardiac vein (GCV), posterior interventricular vein (PIV), posterior vein of the left ventricle (PVLV), left marginal vein (LMV), anterior interventricular vein (AIV), and small cardiac vein (SCV). Vessel diameters were also measured. We found that the CS, GCV, PIV, and AIV were visualized in all patients, whereas the PVLV and LMV were identified in a certain proportion of patients: 98% and 96% in the CACS = 0 AU group, 100% and 78.8% in the CACS = 1–100 AU group, 93.2% and 77.3% in the CACS = 101–400 AU group, and 98% and 78% in the CACS > 400 AU group, respectively. The LMV was less often identified in the last three groups than in the first group (p < 0.05). The frequency of having either one PVLV or LMV was higher in the last three groups than in the first group (p < 0.05). No significant differences in vessel diameters were observed between the groups. It was concluded that patients with coronary artery calcification were less likely to have the LMV, which might hamper the left ventricular lead implantation in cardiac resynchronization therapy.

Variation in Cardiac Vein System is Associated with Coronary Artery Calcium - A Venous-Atherosclerosis Paradox?

BACKGROUND

The factors that determine the different patterns of venous anatomy are not well understood. This study was designed to evaluate the relationship between variation in the cardiac vein system and the extent of coronary artery calcium score (CACS).

METHODS

We reviewed the results of 64-slice CTs of 226 subjects (age 57.2 ± 11.2; 133M) enrolled in our study. The subjects were divided into 3 groups based on coronary artery calcium: 92 patients. with CACS = 0 AU (Agatston Unit, AU); 56 with CACS = 1-100 AU; and 78 patients with CACS > than 100 AU. The cardiac venous system was reconstructed during the optimal phase of the cardiac cycle in each subject.

RESULTS

Subjects with a higher CACS had a better quality of vein images (p < 0.01). The number of visible veins differed between the groups. Eight subjects (8.7%) in the group with CACS = 0 AU, 7 (12.5%) in the group with CACS = 1-100 AU, and 23 (29.5%) in the group with CACS > 100 AU had five or more visible veins (p < 0.001), whereas the proportion of subjects with less than three visible veins was 56 (60.8%), 31 (55.4%) and 30 (38.4%), respectively (p < 0.05). The number of visible veins correlated with CACS (r = 0.28; p < 0.05). In a multivariate regression analysis, which included age, gender, CACS, LV ejection fraction, myocardial volume and heart rate, the CACS was found to be an independent determinant of the number of visible veins (p < 0.05).

CONCLUSIONS

The results of our study suggested that there is a link between a variation in the cardiac venous system and the extent of atherosclerosis.

KEY WORDS

Coronary artery calcium score (CACS); Computed tomography; Coronary veins.

Coronary venous retention-a feature in heart failure as evidenced by mean of cardiac computed tomography

BACKGROUND

Whether the functional status of the heart can influence the coronary venous system itself has not yet been examined. In order to answer this question, we used multislice computed tomography (CT) imaging.

PURPOSE

To answer the question of whether the heart failure (HF) is associated with significant anatomical changes in the coronary venous system?

METHODS

In 136 (aged 56.6 ± 11.5) patients, a 64-slice CT was performed. Patients were divided into three groups according their ejection fraction. In each case, nine 3D volume rendering reconstructions, using a 2-mm layer with electrocardiographic-gating, were created at 0% to 90% R-R intervals (step 10%). The visualization of coronary veins (CVs) was graded independently by two experts trained in multislice computed tomography on a 0-5 point scale (0-not visible/lack of vein; 5-smoothly bordered vascular structure).

RESULTS

The average number of visible CVs per case was 3.44 in the HF group and 2.72 in patients with a normal ejection fraction (P = 0.0246). The statistical correlation between a reduction in ejection fraction and the increase in the number of veins was found (r =-0.2446, P < 0.05). For two of seven common variants of the coronary venous system at least two target veins (posterolateral and lateral) for cardiac resynchronization were presented.

CONCLUSIONS

The statistically higher number of veins in patients with heart failure may suggest an association between a failing heart and cardiac venous retention.