Quantitative variability in regional wall motion during serial left ventricular cineangiography: guidelines for...

To assess the random variation in left ventricular (LV) volume and regional wall motion that occurs with quantitative analysis of LV cineangiography, 15 patients underwent 2 serial biplane LV cineangiograms in the 30 degrees right anterior oblique and 60 degrees left anterior oblique projections. Cineangiograms were separated by a waiting period of at least 15 minutes. Regional wall motion was quantitated with an area ejection fraction (EF) technique that divides the left ventricle into 8 areas. There were no significant changes in heart rate, mean arterial pressure or LV pressure or volume between the first and second angiograms. However, global EF increased from 0.57 +/- 0.11 to 0.58 +/- 0.10 (p = 0.055). Random variability in area EF was greatest in the septal and low posterolateral regions and least in the inferior and inferobasal regions of the left ventricle. Using linear regression analysis to obtain 95% confidence intervals, we determined the amount of absolute increase in area EF that must occur to be considered significant for each LV region. This amount varies from area to area and is as little as +/- 0.06 in the inferior region (area 4) and as high as +/- 0.16 in the septum (area 8). These data provide guidelines for the determination of the influence of interventions on regional wall motion in individual patients with cardiac disease, and indicate that statistically significant changes in regional wall motion are clinically important.