Background: Correct angulation performing invasive retrograde probed left ventriculography in the cath-lab is crucial to define individual patient specific wall motion stress of the left ventricle. Since decades, left ventriculography is assessed in LAO 60° and RAO 30°-this can't be right. This study defines the correct angulations.Methods: We used in total n=1000 cardiac 256 multi-sliced computed tomography 3D heart reconstructions retrospectively and reordered the heart in regard to the invasive left ventriculography angulations -thereby, we got the correct angulation parameters. We assessed additionally LV-hypertrophy, gender, age, body mass index (BMI), electrocardiogram (ECG) and QRS axis to characterize specific predictors.
Results:We got a statistically significant recipe of changed angulations: Older patients need LAO angle tipped to 50°, younger patients flatter to 42°. Male patients change the Caudal_LAO angle more to 20°, whereas female held the Caudal_LAO angle to 16°. In general, the ECG itself and pre-described LV-hypertrophy are without any impact. In regard to the QRS axis of the ECG only marked left axis deviation changes the angles: LAO 50°/ Caudal_LAO 15°, RAO 20°/ Caudal_RAO 5°. LVhypertrophy changes Caudal_LAO more to 18°, BMI over 30 reduces Caudal_LAO to 11°. Only minor changes in the angulation Caudal_RAO: 4° when BMI is more than 30. No significant changes on RAO 30°.
Summary and Conclusion:We declare a recipe for correct angles performing invasive retrograde left ventriculography in the set-up of cath-lab: age-, LV hypertrophy, gender and BMI-dependent. Invasive cardiologists will be forced to follow the recipe of miscellaneous angulations while performing retrograde probed characterization of LV function.