Imaging the Coronary Venous System: Current Trends and Risk Stratification

The coronary venous system has been a rather unique source of investigation over the last 20 years in regard to cardiac imaging, with primary focus/attention on variant anatomy, pre-ablative planning imaging, as well as congenital heart evaluation. Progressive advances in fast imaging using both MDCT and CMR have made the techniques shared below become more widely available. This review highlights the advances in coronary venous imaging over the last 10 years with emphasis on the most up to date clinical treatment options given the advancements in the various imaging modalities. These pre-interventive evaluations in specific patient cohorts are a clinically significant stratification for both cardiac imagers and ordering providers. There are several pre-interventional assessments using MDCT and CMR that highlight the importance of risk stratification before cardiac intervention. This includes scar analysis, coronary venous anomaly, and congenital heart disease including shunt quantification. Pre-interventional MDCT/CMR is a great tool for risk stratification in certain cardiac populations. Specifically in assessment of LGE evaluation in patients with known NYHA heart failure in the setting of pre-CRT evaluation. Current data suggests that known LV scar in areas of potential lead placement can reduce effectiveness of resynchronization and ultimately affect LVRR and MACE outcomes. Pre-TVMR evaluation includes evaluation of aberrant coronary venous anomaly. Some recent data has included coronary sinus reducer therapy for increased myocardial perfusion in patients who are not coronary revascularization candidates.