Interview with Dr Amgad N. Makaryus

Posted Sun, Oct, 04,2015

This author interview is by Dr. Amgad N. Makaryus, of Nassau University Medical Center. Dr. Makaryus' full paper, Planning and Guidance of Cardiac Resynchronization Therapy - Lead Implantation by Evaluating Coronary Venous Anatomy Assessed with Multidetector Computed Tomography, is available for download in Clinical Medicine Insights: Cardiology.

Please summarize for readers the content of your article
Cardiac resynchronization therapy (CRT) has become a treatment option for highly symptomatic heart failure patients with a wide QRS complex on electrocardiography and depressed left ventricular (LV) systolic function. To improve CRT implant success rate, LV pacing target regions can be assessed before implantation. Ideally, knowledge of the coronary venous anatomy should be assessed before noninvasive implantation, either in the outpatient clinic or in the hospital setting to determine whether a transvenous approach is feasible. The purpose of this study was to determine the utility of preoperative Multidetector Computed Tomography (MDCT) with anatomical characterization of CS dimensions and tributary structure in guiding CS lead implantation in patients undergoing CRT implantation.

How did you come to be involved in your area of study?
North Shore University Hospital in Manhasset, New York, USA, is a busy tertiary care hospital performing a large number of cardiac MDCT in clinical practice. I became involved in this study while directing the cardiology MDCT program at our hospital to evaluate the utility of MDCT in these patients.

What was previously known about the topic of your article?
Prior studies have studied MDCT angiography extensively in the assessment of the coronary arteries. The utility of this technology in the evaluation of the venous system, however, is less proven. Our study focuses on the evaluation of the coronary venous anatomy.

How has your work in this area advanced understanding of the topic?
We found that noninvasive visualization of the coronary venous anatomy before CRT implantation can be used as a guide for lead placement. While no significant differences were noted between the two groups with respect to intraoperative variables, CS os diameter and RA width inversely correlated to a shorter procedure time and LV lead positioning time, respectively. Further clinical trials regarding the utility of MDCT to visualize coronary venous anatomy prior to CRT implantation for procedural planning and lead placement guidance are warranted.

What do you regard as being the most important aspect of the results reported in the article?
Our study demonstrates the capacity of MDCT to delineate large venous structures as well to characterize the environment through which the LV lead must be advanced to achieve optimal LV pacing. By utilizing 3D reconstruction, CS os diameter, angulation, RA, height, and width could be assessed with great accuracy thereby providing a wealth of information prior to introduction of the leads required for CRT. Furthermore, we showed that MDCT can be used to reconstruct coronary venous structures with accurate fidelity compared to intracoronary venograms. The ability to predict availability of appropriate target vessels is an additional utility of MDCT scanning prior to CRT implantation.

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