Ventriculography in a Single Catheterization Laboratory

Abstract

Catheter based ventriculography has evolved over the last century and in many instances has been replaced by use of cardiac ultrasound. Despite the shift, ventricular function remains an important part of assessing myocardial damage and prognosis. There is no doubt that cardiac ultrasound can evaluate LV size, myocardial wall motion and wall thickening, and is non-invasive, readily available, relatively inexpensive and portable. Poor acoustic windows are the major limitation of cardiac ultrasound as are foreshortened imaging planes. In contrast, catheter based left ventriculography, can evaluate similar attributes of LV function but limitations are that it is invasive requiring arterial access, involves radiation exposure, and the use of iodinated radio-opaque contrast which may result in renal dysfunction. The Society of Cardiovascular angiography and Intervention (SCAI) recommendations for catheter based left ventriculography are consensus opinions which need rigorous prospective evaluation. Probably the most important SCAI recommendation is that local criteria should be developed to decrease variation in performance among operators within individual catheterization laboratories. No data are available to determine which patient gets catheter based left ventriculography or echo assessment of ventricular function. Decision making regarding the use of catheter based or ultrasound based angiography is quite complex because of limitation and interaction of the various determinants, e.g. creatinine, diabetes, gender, contrast volume and fluoro time.