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[Determination of global left ventricular functional parameters with intraventricular digital subtraction angiography
T Rother1, B Krosse, A Neugebauer
1Abteilung für Kardiologie, Karl-Marx-Universität Leipzig.
Insights
Intraventricular digital subtraction angiography (DSA) is a preferred method for left ventriculography over conventional angiocardiography (ACG) due to reduced patient discomfort and similar diagnostic accuracy for cardiac volumes and ejection fractions.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Procedures
Background:
- Conventional angiocardiography (ACG) is a standard procedure for left ventriculography in patients with coronary heart disease.
- Intraventricular digital subtraction angiography (DSA) offers a potentially less invasive alternative.
Purpose of the Study:
- To compare the diagnostic utility and applicability of ACG and intraventricular DSA for left ventriculography.
- To evaluate differences in patient invasiveness and procedural complications between ACG and DSA.
Main Methods:
- Left heart catheterization, coronarography, and ACG were performed on 86 patients with coronary heart disease.
- Intraventricular DSA was conducted using a Philips-device (DVI 2 CV) in 73 selected examinations.
- Contrast medium volumes and injection flow rates were specified for both ACG and DSA procedures.
Main Results:
- No significant differences were observed in end-diastolic volumes (EDV), end-systolic volumes (ESV), or ejection fractions (EF) between ACG and DSA.
- Correlation coefficients were high: rEDV = 0.85, rESV = 0.93, rEF = 0.80.
- Mean increase in end-diastolic pressure was 7 Torr after ACG versus less than 2 Torr after DSA.
Conclusions:
- Intraventricular DSA is preferred over conventional ACG for ventriculography due to significantly lower invasiveness and fewer provoked extrasystoles.
- DSA allows for faster and easier analysis of ventriculographies with implemented image processing programs.
- Despite occasional volume discrepancies, DSA offers substantial advantages for patient comfort and procedural efficiency.
Abstract:
Left heart catheterisation, coronarography and conventional angiocardiography of the left ventricle (ACG) [30 degrees right anterior oblique; 45 ml contrast medium (Visotrast) with a flow of 12 ml per sec.] was performed in 86 patients with coronary heart disease. Additionally intraventricular digital subtraction angiography (DSA) was performed, using a Philips-device (DVI 2 CV). For DSA 15 ml contrast medium (Visotrast) was injected with a flow of 8 ml per sec. 73 examinations were selected for the study. The aim of the study was to compare the usefulness and applicability of ACG und DSA for ventriculography. There were no significant differences between enddiastolic (EDV) and endsystolic (ESV) volumes as well as ejection fractions (EF) determined by ACG and DSA. Results of the analysis of correlation were rEDV = 0.85;rESV = 0.93;rEF = 0.80. The increase of the end-diastolic pressure after ACG was determined with 7 Torr (mean), after DSA with less than 2 Torr (mean). According to these results we would prefer intraventricular DSA to conventional ACG, provided the technical equipment is available. This is concluded despite the fact that in single cases considerable differences were found between the volumes estimated by ACG and those determined by DSA. These differences were analysed in detail. The main advantages of the DSA are the by far smaller inconvenience for the patients, the rare occurrence of provoked extrasystoles and the fast and easy analysis of the ventriculographies by means of the implemented image processing programmes.