Abilities of cardiac MSCT imaging to provide useful anatomical and functional information for Cardiac Resynchronization Therapy optimization

A main limit of biventricular Cardiac Resynchronization Therapy (CRT) is the high rate of non-responder. A challenging task to carry out remains both the identification of the most effective pacing sites and the left ventricular lead positioning by a venous access. This paper aims to show how cardiac CT imaging can be helpful for the clinician to analyse venous system and cardiac function before the device implantation. 4D CT data have been analyzed in order to extract coronary vein anatomy and global and local left ventricle (LV) function. The proposed process is decomposed in successive steps: (1) the 3D tracking of coronary veins based on a fast-marching technique; (2) the 3D extraction and motion estimation of the LV along the cardiac cycle; (3) the fusion of extracted descriptors with adapted modes of visualization. This approach has been tested on three patients and shows how an optimal use of CT imaging may represent an advance towards CRT planning.