Evaluation of left ventricular performance using digital subtraction angiography

Cardiac applications for digital subtraction angiography appear promising, but few correlative studies with contrast ventriculography have been done. Left ventricular volume, ejection fraction, and regional wall motion by digital subtraction angiography were evaluated after intravenous injection of 40 ml of iodinated contrast medium and after left venticular injection of 5 to 10 ml of contrast medium. A film-based system of the authors' own design was used. Results were compared with those after direct left ventricular injection of 40 ml of contrast medium. The ventriculograms after intravenous injection were of diagnostic quality in 9 of 12 studies, and there were close correlations between intravenous and direct-injection studies for left ventricular ejection fraction (r = 0.89, n = 9, and p = 0.001) and for left ventricular volume (r = 0.91, n = 18, and p <0.001). Regional wall motion scores showed close correspondence in 83% of sectors. After small-volume left ventricular injections, the ventricular image was enhanced considerably by digital subtraction. Correlations between small- and large-volume ventriculograms were close for left ventricular ejection fraction (r = 0.91, n = 8, and p = 0.002) and for left ventricular volume (r = 0.96, n = 16, and p <0.001). There was close correspondence of wall motion scores in 87% of sectors. Thus, digital subtraction angiography improves the visibility of the left ventricle after either intravenous or small-volume direct left ventricular injection. Digital images produce excellent estimates of left ventricular volume and should have considerable usefulness for the study of cardiac performance and anatomy.