Imaging of the coronary venous system in patients with congestive heart failure: comparison of 16 slice MSCT and retrograde coronary sinus venography

Abstract

Knowledge of the anatomy of the coronary venous system (CVS) is important for planning of cardiac interventions like cardiac resynchronization therapy or percutaneus mitral annuloplasty. Different methods have been used for preprocedural visualization of the CVS. However, limited data is available comparing invasive retrograde coronary sinus angiography (CSA) and non-invasive multi slice computed tomography (MSCT). Thus, a comparison of retrograde CSA and ECG-gated MSCT for the visualization of the CVS in patients with congestive heart failure (CHF) was performed. 20 patients (male: 11) with CHF underwent CSA and MSCT (16 x 0.75 mm collimation, tube voltage: 120 kV, tube current: 550 mAs(eff)). Both methods were compared with respect to vessel diameter and visibility. Vessel visualization was better using retrograde CSA except for middle cardiac vein and small veins which were better seen with MSCT. Overall, there was a trend that MSCT detected more vessels. Vessel diameters were larger measured using retrograde CSA, but only statistically significant for the coronary sinus and middle cardiac vein. Whereas MSCT is more suitable for an overview, retrograde CSA offers a more detailed visualization of the CVS including marginal and posterior veins than MSCT. Thus, retrograde CSA allows a better display of target vessels commonly used for cardiac interventions. Overall, these two imaging techniques offer complementary information.