Pre-operative MRI in heart failure patients scheduled for cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) aims at improving the pumping function of the heart using bi-ventricular pacing. For the lead implantation procedure, knowledge of the heart function, the relevant anatomy (i.e. coro-nary sinus (CS), great cardiac vein (GCV) and its tributaries) and left ventricu-lar (LV) scar formation is of great interest. Previous reports demonstrate feasibility of coronary venous(CV) imaging using magnetic resonance imaging (MRI) mostly in volunteers and coronary artery disease patients. In this report, we evaluate the feasibility of albumin binding contrast (Vasovist and Multi-hance) enhanced cardiac MRI of the CV system in heart failure (HF) patients referred to CRT. These agents remain for a longer time period in the intravascular space, enlarging the MRI window for vascular structures. The images are compared with X-ray (XR) coronary venous angiograms, obtained during the pacer implantation procedure, and with non-contrast magnetization transfer (MTC) MRI images. Furthermore, late enhancement (LE) MRI scar imaging using the same contrast agents is investigated in a limited amount of patients. The CV anatomy can be visualized in HF patients prior to bioventricular pacer implantation using albumin binding contrast agent enhanced cardiac MRI. CS offspring anatomy from the right atrium (RA) and candidate vein branches for LV lead implantation can be indentified pre-operatively, aiding better patient selection for CRT. In ischemic HF patients scheduled for CRT, scar information can be obtained using LE imaging with the Multihance contrast agent further complementing the pre-operative information of the anatomy.