Dual Source CT preceding cardiac resynchronization therapy (CRT)

Case history
66-year-old man with two-vessel coronary artery disease, chronic myocardial infarction, and persistent atrial fibrillation.

Question
Assessment of cardiac morphology and left-ventricular function preceding cardiac resynchronization therapy (CRT) with implantable cardioverter-defibrillator (ICD)

Diagnosis / Differential diagnosis

• Two-vessel coronary artery disease (CAD); chronic myocardial infarction with consecutive aneurysm of left-ventricular apex and adherent calcified thrombi
• Severely reduced left-ventricular ejection fraction

Findings
Aneurysmatic dilatation of left-ventricular apex and thinning of myocardium. Calcified thrombi within the aneurysm. Akinesis of the anterior, septal, and anteroseptal left-ventricular wall, and dyskinesis of left-ventricular apex: LV-EDV 344.9 mL, LV-ESV 268.5 mL, and LV-EF 22.2 %.

Comment
Dual Source CT provides clinically valuable information on left-ventricular morphology and global as well as regional function in patients preceding CRT. As postinterventional cardiac MRI is contraindicated due to ICD, Dual Source CT enables follow-up evaluation of left-ventricular function to monitor any therapy effect.

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[5]	[6]
[1–6] Diastolic (1, 3, 5) and systolic (2, 4, 6) MPRs in horizontal (1, 2) and vertical (3, 4) long-axis as well as in short-axis (5, 6) orientation.	[7] Screenshot from dedicated CT evaluation software (syngo Circulation, Siemens AG) applying a 3D threshold segmentation algorithm: SA and vertical LA CT reformations (left column); Bull’s eye plot, numerical results.

Authors: Kai Uwe Jürgens, Harald Seifarth, Michael Puesken, Roman Fischbach
See corresponding news: Cardiac: Left/Right Ventricular Function
See corresponding procotol: Protocol Left/right ventricular function
See corresponding case: Dual Source CT in left-ventricular hypertrophy [A] & in ARVCM [B]