Underestimation of Ejection Fraction with Singleplane Angiography in Coronary Artery Disease: Role of Biplane Angiography

Vogel, John H.K.; Cornish, David; McFadden, R. B.

doi:10.1378/chest.64.2.217

Cited by 39 publications

(5 citation statements)

References 6 publications

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“…Ejection fractions calculated by right anterior oblique single-plane angiograms have been shown to correlate well with those determined by a biplane technique in patients with valvular heart disease in whom left ventricular wall motion would be expected to be relatively uniform [14,18], G entzler et al [11] and Vogel et al [28] have recently shown that in patients with ischemic heart disease, many of whom have segmental wall motion abnormalities, there may be substantial differences in calculated ventricular volumes and ejection fractions when ventriculography is performed in different projections in a given patient.…”

Section: Discussionmentioning

confidence: 85%

A Comparison of Hemodynamic and Angiographic Indices of Left Ventricular Performance in Patients with Coronary Artery Disease

Williamson¹,

Bauman²,

Tsagaris³

1978

Cardiology

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We compared ejection fraction, left ventricular end-diastolic pressure, cardiac index and the relation of left ventricular stroke work index to left ventricular end-diastolic pressure during rest and exercise in 60 patients with coronary artery disease. Left ventricular end-diastolic pressure was usually normal at rest (48/60) and abnormal during exercise (46/60) and did not correlate with ejection fraction. Cardiac index was insensitive, usually remaining normal until ejection fraction was < 0.40. Patients with a normal left ventricular stroke work index response to exercise had higher ejection fractions than those with an abnormal response (p < 0.05). However, 9 patients with normal ejection fractions had an abnormal exercise response. This may reflect loss of left ventricular reserve, abnormal compliance or clinically silent ischemia during exercise. Different indices of left ventricular performance may be widely disparate in coronary artery disease, and abnormalities are frequently apparent only during exercise.

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Section: Discussionmentioning

confidence: 85%

A Comparison of Hemodynamic and Angiographic Indices of Left Ventricular Performance in Patients with Coronary Artery Disease

Williamson¹,

Bauman²,

Tsagaris³

1978

Cardiology

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“…This distortion is significant and must be corrected if ventricular volumes are to be estimated correctly. Most of the methods described in the literature rely either on a linear correction factor based on the catheter diameter [8,9] or on a known surface area placed between a grid and the X-ray picture [ 1~13]. These techniques do not attempt to measure or correct the distortion for each point of the image, but rather lead to a mean factor of area magnification [ 14].…”

Section: Discussionmentioning

confidence: 99%

“…We know nothing about the makeup of their patient population, or about the type of heart patient that is most likely to exhibit the volumetric errors that they describe. It is well known that patients with chronic coronary artery disease and left ventricular asynergy can not be thoroughly evaluated with a single-plane left ventriculography, and that biplane study is needed [7][8][9]. It is totally unclear whether a biplane adaptation of the proposed methodology would significantly alter the conclusions reached by the authors.…”

Section: Commentariesmentioning

confidence: 99%

A New Method for the Precise and Complete Correction of Distortion on Cineangiographic Image: Its Effect on Left Ventricular Measurements

Bonard

Tremblay

LeBlanc

et al. 1978

Catheterization and Cardiovascular Diagnosis

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Some of the problems associated with the precise evaluation of left ventricular volumes from angiographic images are due to the magnification and distortion of the pictures obtained from X‐ray equipment. Magnification errors can be evaluated easily but the distortion (due to pincushion effect) are more difficult to measure. A mathematical method is proposed for a complete point‐by‐point correction of errors due to magnification and X‐ray distortion. This method is applicable to most currently used angiographic equipment. Since more and more angiographic images are processed with local or remote digital computers, the applicability of the proposed technique becomes realistic. Results from this study show that a 5–30% overestimation of usual geometric ventricular parameters is encountered if no correction is made for distortion. End‐diastolic measurements are more affected than end‐systolic ones because of the greater degree of spherical distortion at the periphery of the picture area.

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“…In the 1970's preechocardiogram era, left ventriculography became the gold standard for assessment of left ventricular function. Biplane ventriculography provided more accurate assessment of left ventricular wall motion in patients with coronary artery disease compared with single‐plane imaging . It was also used to evaluate contractility of left ventricular segments, left ventricular volume and mass, pressure‐volume diagrams, wall forces, and compliance .…”

Section: Evolution Of Technique and Use Of Left Ventriculographymentioning

confidence: 99%

Optimal use of left ventriculography at the time of cardiac catheterization: A consensus statement from the society for cardiovascular angiography and interventions

Gigliotti

Babb

Dieter

et al. 2014

Cathet Cardio Intervent

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The rationale to perform left ventriculography at the time of cardiac catheterization has been little studied. The technique and frequency of use of left ventriculography vary by geographic regions, institutions, and individuals. Despite the recent publication of guidelines and appropriate use criteria for coronary angiography, revascularization, and noninvasive imaging, to date there have been no specific guidelines on the performance of left ventriculography. When left ventriculography is performed, proper technique must be used to generate high quality data which can direct patient management. The decision to perform left ventriculography in place of, or in addition to, other forms of ventricular assessment should be made taking into account the clinical context and the type of information each study provides. This paper attempts to show the role of left ventriculography at the time of coronary angiography or left heart catheterization. The recommendations in this document are not formal guidelines but are based on the consensus of this writing group. These recommendations should be tested through clinical research studies. Until such studies are performed, the writing group believes that adoption of these recommendations will lead to a more standardized application of ventriculography and improve the quality of care provided to cardiac patients. Catheterization and Cardiovascular Interventions 85:181-191 (2015) While guidelines and appropriate use criteria (AUC) have addressed the indications for left heart catheterization associated with coronary angiography [2] and to evaluate heart failure [3], they have not addressed the role of left ventriculography. This document attempts to fill that void. It deals only with left ventriculography (invasive imaging of the left ventricle with contrast injection) and does not address left heart catheterization (catheter placement in the left ventricle, usually to assess pressures).Currently, there are no specific guidelines on the performance of left ventriculography at the time of coronary angiography or left heart catheterization. Recent AUC for diagnostic catheterization define clinical scenarios where coronary angiography and/or left heart catheterization is appropriate, uncertain, or inappropriate, but the decision to perform ventriculography is left to the discretion of the operator. Patel et al. have suggested clinical scenarios where cardiac catheterization (defined as including coronary angiography, left heart catheterization, and left ventriculography) is an appropriate imaging modality in the evaluation of a possible ischemic etiology of heart failure [3]. They did not define specifically the appropriateness of left ventriculography alone, particularly when other measurements of LV systolic function are available.Regional variation in the performance of ventriculography in the United States has been noted by several authors. Joffe et al.

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Underestimation of Ejection Fraction with Singleplane Angiography in Coronary Artery Disease: Role of Biplane Angiography

Cited by 39 publications

References 6 publications

A Comparison of Hemodynamic and Angiographic Indices of Left Ventricular Performance in Patients with Coronary Artery Disease

A Comparison of Hemodynamic and Angiographic Indices of Left Ventricular Performance in Patients with Coronary Artery Disease

A New Method for the Precise and Complete Correction of Distortion on Cineangiographic Image: Its Effect on Left Ventricular Measurements

Optimal use of left ventriculography at the time of cardiac catheterization: A consensus statement from the society for cardiovascular angiography and interventions

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