Intravenous digital left ventriculography at rest and with atrial pacing as a screening procedure for coronary artery disease
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Intravenous digital ventriculography effectively screens for coronary heart disease. Combining this with atrial pacing enhances detection of coronary artery disease by identifying wall motion abnormalities.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Coronary heart disease (CHD) diagnosis relies on invasive and non-invasive methods.
- Digital subtraction left ventriculography offers a potential non-invasive screening tool.
Purpose of the Study:
- To evaluate intravenous digital subtraction left ventriculography as a screening method for coronary heart disease.
- To assess the diagnostic accuracy of this technique, with and without atrial pacing.
Main Methods:
- 61 patients underwent intravenous ventriculography with contrast injection into a central vein.
- Resting studies were compared to direct left ventriculography in 40 patients.
- Studies were repeated with incremental atrial pacing to induce stress in patients with normal resting scans.
Main Results:
- Intravenous ventriculography showed comparable wall motion abnormality recognition to direct ventriculography at rest.
- In patients with coronary artery disease (n=44), 86% were identified via wall motion abnormalities (10 at rest, 28 with pacing).
- One patient without coronary artery disease was misdiagnosed due to an abnormal resting study.
Conclusions:
- Intravenous digital ventriculography provides diagnostic quality similar to direct ventriculography.
- The combination of intravenous ventriculography and atrial pacing is a sensitive and specific method for detecting coronary artery disease.
Abstract:
Digital subtraction left ventriculography using intravenous contrast injection was evaluated as a screening diagnostic method for coronary heart disease. Intravenous ventriculography was performed in 61 patients with 35 cc of contrast medium injected into a central vein (usually the inferior vena cava). Recognition of regional wall motion abnormalities by this technique was shown to be comparable with direct left ventriculography in 40 patients who underwent both imaging modalities at rest. If the rest digital ventriculogram was normal, it was repeated after incremental atrial pacing to the onset of chest pain or to a maximal heart rate of 150 beats/min. Forty-four of the 61 patients had significant coronary artery disease, of whom 10 had a wall motion abnormality at rest on intravenous ventriculography. With pacing, 28 of the 34 remaining patients developed a new wall motion abnormality. Thus, 38 (86%) of 44 patients with coronary heart disease were identified by wall motion abnormalities. One of the 17 patients without coronary artery disease had an abnormal rest study and was incorrectly assigned a diagnosis of coronary disease. Intravenous digital ventriculograms approximate those obtained by direct ventriculography. When combined with atrial pacing they are a sensitive and specific means of detecting coronary artery disease.