The value of coronary artery visualization during routine intravenous digital subtraction ventriculography

Right anterior oblique intravenous digital subtraction ventriculograms and selective coronary angiograms were performed on 71 consecutive patients. The intravenous ventriculograms were reviewed by two blinded observers with close examination of the right and left anterior descending coronary arteries. These were considered abnormal if they failed to opacify or if luminal irregularities suggested greater than 50% obstruction. Significant (greater than 50% obstruction) occlusions of the right coronary artery were found in 16 patients according to a blinded reading of the selective angiograms. The observers correctly identified 13 of these on the digital subtraction ventriculograms (sensitivity 81%). Of the 55 nondiseased right coronary arteries, correct identification was made in 47 (specificity 85%). Likewise, 17 patients had angiographically significant obstructions of the left anterior descending coronary artery and 15 were correctly identified by digital subtraction ventriculography (sensitivity 88%). However, only 20 of the 54 nondiseased left anterior descending coronary arteries were correctly identified (specificity 37%). Nonopacification or visualization of a severe obstruction of the right coronary artery is a useful finding and should be sought during examination of routine intravenous digital subtraction ventriculograms. This technique is not adequate at the present time to replace selective coronary arteriography in the assessment of coronary anatomy.