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Review
. 2023 Sep 26;12(19):6212.
doi: 10.3390/jcm12196212.

Cardiac CT in CRT as a Singular Imaging Modality for Diagnosis and Patient-Tailored Management

Willem Gerrits  1 , Ibrahim Danad  1 , Birgitta Velthuis  2 , Saima Mushtaq  3 , Maarten J Cramer  1 , Pim van der Harst  1 , Frebus J van Slochteren  1   4 , Mathias Meine  1 , Dominika Suchá  2 , Marco Guglielmo  1   5
Affiliations
Review

Cardiac CT in CRT as a Singular Imaging Modality for Diagnosis and Patient-Tailored Management

Willem Gerrits et al. J Clin Med. .

Abstract

Between 30-40% of patients with cardiac resynchronization therapy (CRT) do not show an improvement in left ventricular (LV) function. It is generally known that patient selection, LV lead implantation location, and device timing optimization are the three main factors that determine CRT response. Research has shown that image-guided CRT placement, which takes into account both anatomical and functional cardiac properties, positively affects the CRT response rate. In current clinical practice, a multimodality imaging approach comprised of echocardiography, cardiac magnetic resonance imaging, or nuclear medicine imaging is used to capture these features. However, with cardiac computed tomography (CT), one has an all-in-one acquisition method for both patient selection and the division of a patient-tailored, image-guided CRT placement strategy. This review discusses the applicability of CT in CRT patient identification, selection, and guided placement, offering insights into potential advancements in optimizing CRT outcomes.

Keywords: cardiac resynchronization therapy; computed tomography; heart failure.

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Conflict of interest statement

FJvS is a cofounder and shareholder of CART-Tech BV. MM and FJvS are inventors and beneficiaries of a patent license arrangement between the University Medical Center Utrecht and CART-Tech BV, according to the rules of the University Medical Center Utrecht. MG and BV are both sponsored speakers for Philips. The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Cardiac computed tomography as the all-around imaging modality. A comparison of relevant features that differ between the imaging modalities is shown [15,17,28,29]. A “plus” indicates an association between the imaging modality and the specific factor, whereas a “minus” indicates no association. The “plus/minus” indicates a point could be made for both the presence and absence of an association.
Figure 2
Figure 2
Late iodine enhancement on cardiac tomography. Images are of a 67-year-old male patient suffering from frequent monomorphic ventricular extra systoles. The arrows indicate areas of non-ischemic, subepicardial late iodine enhancement, shown in the short axis view (panel (A)), and the 3-chamber view (panel (B)).
Figure 3
Figure 3
Computed tomography based strain. The circumferential strain measurement of the left ventricle (panel (A)), with the corresponding strain curve (Y−axis) over time (frame number, X−axis) (panel (B)).
Figure 4
Figure 4
CT-based live-guided CRT placement. The maximum radial strain at the end of the cardiac cycle is located in the anterolateral segment (AL) of the left ventricle as is shown on the bulls-eye plot (panel (A)), and the scar is located in the septal-posterolateral (S2-PL) part of the myocardium (panel (B)). These areas are combined with the CT venogram to create a 3D rendering of the bulls-eye plot (with the optimal target in green and scar in red) and the coronary veins, which are projected on top of the angiography image during CRT implantation (panel (C)). The final lead position is within the target area, outside of the scar (which is omitted for clarity in this recording) (panel (D)).
See this image and copyright information in PMC

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