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Is angiographic ventriculography necessary for the assessment of ischemic patients?
D Katritsis1, C F Shakespeare, C Byrne
1Department of Cardiology, St. Thomas' Hospital, London, England.
Insights
Echocardiography effectively assesses left ventricular function in ischemic heart disease patients, even with poor echo windows. This cardiac imaging technique provides clinical information comparable to angiography, reducing the need for invasive procedures.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Ischemic heart disease (IHD) diagnosis often relies on assessing left ventricular (LV) function.
- Echocardiography and left ventricular cineangiography are common methods for evaluating LV function.
- The utility of echocardiography in patients with suboptimal imaging windows requires further clarification.
Purpose of the Study:
- To compare the accuracy of echocardiography and biplane left ventricular cineangiography in assessing LV ejection fraction and function in IHD patients.
- To determine if echocardiography can provide clinically relevant information in patients with poor echo windows.
Main Methods:
- 53 patients with suspected IHD underwent both echocardiography and biplane left ventricular cineangiography.
- Ejection fraction was calculated using both angiographic (computer-aided) and echocardiographic methods.
- LV size and wall motion were assessed by both modalities.
Main Results:
- A good correlation (r=0.7) was found between angiographic and echocardiographic ejection fraction in 35 patients with good echo windows.
- In 18 patients with poor echo windows, echocardiography allowed limited assessment of LV size and function.
- Echocardiography successfully identified patients with impaired LV function (angiographic EF < 35%) even with poor echo windows.
Conclusions:
- Echocardiography provides clinically relevant information on LV function in IHD patients, comparable to angiography.
- Angiography may not be mandatory for routine IHD investigations, especially when echocardiography can provide sufficient data.
- Echocardiography is a valuable tool for assessing LV function, even in challenging cases with poor acoustic windows.
Abstract:
A total of 53 patients with a provisional diagnosis of ischemic heart disease and without any clinical evidence of valvular, congenital, or primary muscle heart disease were studied by echocardiography and biplane left ventricular cineangiography. For angiographic ejection fraction analysis, a program developed in our department for use on an Apple Macintosh computer interfaced to a digitizing tablet was employed. Echocardiographic outlines of systolic and diastolic images were traced with a digitizing system on the screen and ejection fractions were calculated by a program incorporated in the echo machine. Good echo windows allowing ejection fraction calculations were present in 35 patients. There was a good correlation between angiographic and echocardiographic ejection fraction (r = 0.7, SEE = 0.09), and wall motion assessment revealed no significant discrepancies between the two image modalities. The remaining 18 patients had poor echo windows, preventing accurate echocardiographic determination of the ejection fraction. However, limited assessment of left ventricular size and wall motion was possible in all patients and allowed the identification of those who had impaired left ventricular function as judged by angiography (angiographic ejection fraction < 35%). We conclude that even in patients with poor echo windows echocardiographic assessment of left ventricular function provides clinical information similar to angiography which should not be considered mandatory for the investigation of ordinary ischemic patients.