Digital Subtraction Angiocardiography Research Articles

History of cardiovascular imaging procedures

The value of the four main imaging tools: radiology, magnetic resonance imaging, echocardiography and nuclear cardiology depends in the first place on physical properties which determine the spatial, temporal and density resolution and second on the conditions under which the relevant information can be obtained with respect to the diagnostic or therapeutic problem, the comfort of the investigation, the degree of invasivity and the expenses. For several decades radiology was the only available method that allowed a look into the body. Thereby, all relevant information about diseases amenable to any surgical or conservative therapy could be attained. Parallel to the progress of cardiovascular surgery, angiocardiography could provide the anatomic and functional characteristics of congenital and acquired heart diseases. The basic principles for the measurement of total heart size, volume and shape were established already before contrast injection – initially by hand – showed the internal architecture of the heart cavities and the circulatory system. With the invention of film changers, the fundamental knowledge about all kinds of malformations of the heart and vessels was gained. Further technical progress made the procedures faster by cineangiocardiography, more comfortable by simultaneous biplane operation and easier to handle by videotechniques, allowing electronic data processing, storage and retrieval in bright operating theaters. Computer technology favored flexible image processing which, like digital subtraction and functional angiocardiography, could reduce the amount of contrast material to be injected and thereby improve the compatibility, due to better nonionic contrast material and shorter study times. Finally, computer tomography with cross sectional, or spiral data collection enabled a dynamic three-dimensional reconstruction and visualization of the beating heart and to display selected information in ‘measures and numbers’. Inspite all these successes, the ‘stain’ of invasivity remains. Strong competition arose first in echocardiography, which – after some pioneering activities in Germany in the late 1950s – flourished in the 1970s, after being reimported from the US. Most of the rapidly increasing number of ultrasound technologies – from M-mode, via various 2D linear and sector scanning procedures in combination with continuous, pulsed and/or color Doppler methods, new contrast-echo modalities and finally 3D volume scanning procedures – can be applied without any harm in all age groups and from each competent practitioner with comparably small and cheap equipment. Only oesophageal and intravascular approaches retain a touch of invasivity. Consequently not much room remains for other techniques except those, like MRI, which can differentiate tissue properties better and with higher resolution and give unlimited access to all intrathoracic organs noninvasively. Under these conditions the indications for nuclear cardiology are restricted to the small field of myocardial perfusion and metabolic studies, whereas transit time measurements and radionuclide ventriculography are practically obsolete.

Functionally significant changes in the shape of the right ventricle in digital subtraction angiocardiography

Experiences in i.v. digital subtraction angiocardiography (DSAC) including so-called parametric imaging for morphological delineation of the right ventricle are illustrated. 32 patients with different anatomical and haemodynamic disturbances of the right ventricle were subjected to these examinations. Special emphasis is placed on pulmonary stenosis, particularly on its infundibular manifestations. For visualisation of muscular or fibrous bulging or other changes of the outflow tract of the right ventricle, analysis of the amplitudes is very suitable to produce cumulative pictures of ventricular wall motion during a cardiac cycle. Obstructive wall alterations within the infundibular part become visible even if they occur only during certain phases of the myocardial action, usually in late systole than otherwise.

Determination of left ventricular wall thickness and muscle mass by intravenous digital subtractionangiocardiography: validation of the method

Left ventricular (LV) wall thickness and muscle mass are important measures of LV hypertrophy. In 24 patients LV end-diastolic wall thickness and muscle mass were determined (two observers) by digital subtraction angiocardiography (DSA) and conventional LV angiocardiography (LVA). Wall thickness was determined over the anterolateral wall of the left ventricle according to the technique of Rackley (method 1) or by planimetry (method 2). Seventeen patients were studied at rest and seven during dynamic exercise. Wall thickness correlated well between LVA and DSA; the best correlations were obtained by a combined subtraction mode using either method 1 or 2 (method 1, r≥0–80; method2, r≥0. 75). The standard error of estimate of the mean (SEE) was slightly lower for method 2 (≤ 10%) than for method 1 (≤ 13%). DSA significantly overestimated wall thickness by 5–7% with method 1 and underestimated by 12–14% with method 2. Muscle mass correlated well between LVA and DSA; the SEE was ≤ 15% for method 1 and≤ 12% for method 2. Overestimation of muscle mass by DSA was 7–11% with method 1 and underestimation was 13–15% with method 2.It is concluded that LV wall thickness can be determined accurately by DSA with an SEE ranging between 10 and 13%. Determination of LV muscle mass is slightly less accurate and the SEE is slightly larger ranging between 13 to 17%. With method 1, wall thickness and muscle mass were over estimated and with method 2 underestimated.

Determination of left ventricular wall thickness and muscle mass by intravenous digital subtractionangiocardiography: validation of the method

Left ventricular (LV) wall thickness and muscle mass are important measures of LV hypertrophy. In 24 patients LV end-diastolic wall thickness and muscle mass were determined (two observers) by digital subtraction angiocardiography (DSA) and conventional LV angiocardiography (LVA). Wall thickness was determined over the anterolateral wall of the left ventricle according to the technique of Rackley (method 1) or by planimetry (method 2). Seventeen patients were studied at rest and seven during dynamic exercise. Wall thickness correlated well between LVA and DSA; the best correlations were obtained by a combined subtraction mode using either method 1 or 2 (method 1, r greater than or equal to 0.80; method 2, r greater than or equal to 0.75). The standard error of estimate of the mean (SEE) was slightly lower for method 2 (less than or equal to 10%) than for method 1 (less than or equal to 13%). DSA significantly overestimated wall thickness by 5-7% with method 1 and underestimated by 12-14% with method 2. Muscle mass correlated well between LVA and DSA; the SEE was less than or equal to 15% for method 1 and less than or equal to 12% for method 2. Overestimation of muscle mass by DSA was 7-11% with method 1 and underestimation was 13-15% with method 2. It is concluded that LV wall thickness can be determined accurately by DSA with an SEE ranging between 10 and 13%. Determination of LV muscle mass is slightly less accurate and the SEE is slightly larger ranging between 13 to 17%. With method 1, wall thickness and muscle mass were overestimated and with method 2 underestimated.

Left ventricular function during exercise before and after percutaneous transluminal coronary angioplasty using intravenous digital subtraction angiocardiography.

Journal Article Left ventricular function during exercise before and after percutaneous transluminal coronary angioplasty using intravenous digital subtraction angiocardiography Get access J. Jehle, J. Jehle Med. Klinik der Universitaät Düsseldorf, Abteilung für Kardiologie, Angiologie und PneumologieMoorenstr.5, 4000 Düsseldorf, F.R.G. Search for other works by this author on: Oxford Academic PubMed Google Scholar F. K. Schmiel, F. K. Schmiel Med. Klinik der Universitaät Düsseldorf, Abteilung für Kardiologie, Angiologie und PneumologieMoorenstr.5, 4000 Düsseldorf, F.R.G. Search for other works by this author on: Oxford Academic PubMed Google Scholar E. Schwammenthal, E. Schwammenthal Med. Klinik der Universitaät Düsseldorf, Abteilung für Kardiologie, Angiologie und PneumologieMoorenstr.5, 4000 Düsseldorf, F.R.G. Search for other works by this author on: Oxford Academic PubMed Google Scholar P. Spiller, P. Spiller Med. Klinik der Universitaät Düsseldorf, Abteilung für Kardiologie, Angiologie und PneumologieMoorenstr.5, 4000 Düsseldorf, F.R.G. Search for other works by this author on: Oxford Academic PubMed Google Scholar F. Loogen F. Loogen Med. Klinik der Universitaät Düsseldorf, Abteilung für Kardiologie, Angiologie und PneumologieMoorenstr.5, 4000 Düsseldorf, F.R.G. Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal, Volume 8, Issue suppl_G, October 1987, Pages 29–32, https://doi.org/10.1093/eurheartj/8.suppl_G.29 Published: 01 October 1987

Digital subtraction angiocardiography--an alternative to traditional angiocardiography?

Intravenous (i.v.) digital angiography has been extensively and successfully used for studying peripheral arterial vessels. Its application in the heart now results in high resolution images of the cardiac chambers. Accuracy and reproducibility of left ventricular volume determination equal that of conventional cineangiocardiography. Thus, left ventricular regional and global function can be analyzed quantitatively at rest and during exercise with higher simplicity and lower risk even on an outpatient basis by i.v. digital subtraction angiocardiography. To date, however, the coronary artery system cannot be visualized by digital image processing using i.v. injection of contrast medium, i.e., in patients win whom the coronary arteries have to be examined, selective arteriography for the future, too, will be combined with direct left ventricular angiocardiography. Regarding clinical experience till now, digital subtraction angiocardiography must be characterized as a complementary rater than an alternative method to conventional cineangiocardiography.

Right ventricular imaging with digital subtraction angiocardiography using intraventricular contrast injection

Angiocardiography is of considerable value in the dimensional analysis of the right ventricular (RV) cavity, but conventional angiocardiography requires large amounts of contrast medium. In this study digital subtraction angiocardiography was applied to biplane RV projections of 25 children with congenital heart disease after direct injection of a small dose of contrast medium. Volume measurements were compared with those obtained by conventional angiocardiography. The amount of contrast medium required was reduced to 30%, flow rate to 57% and ventricular ectopic activity to 60% of that used in conventional angiocardiography, and the degree of radiation exposure was reduced considerably. There was a good correlation for end-diastolic (r = 0.996) and end-systolic volume (r = 0.990) determined with both techniques. Digital subtraction angiography after selective RV injection allows accurate volume measurements of the right ventricle in children with congenital heart disease. The main benefits of this method are reduction of the amount of contrast medium, flow rate during injection, radiation and ventricular ectopic activity.

Real-time digital angiocardiography using a temporal high-pass filter.

A temporal high-pass filtration technique for digital subtraction angiocardiography was studied, using real-time digital studies performed simultaneously with routine cineangiocardiography (cine) for qualitative image comparison. The digital studies showed increased contrast and suppression of background anatomy and also enhanced detection of wall motion abnormalities when compared with cine. This digital technique is compatible with panning the image intensifier during an injection. The digital images are comparable with, and in some cases better than, cine images. Clinical efficacy of this digital technique is currently being evaluated. Real-time display, as well as potential reductions in radiation and contrast material doses, may make digital angiocardiography an attractive technique.

Left ventricle evaluation by digital video subtraction angiocardiography.

The usefulness of digital video subtraction angiocardiography (DVSA) using the time-interval difference (TID) mode for measuring ejection fraction and wall motion of the left ventricle was assessed in 20 patients after intravenous injection of contrast material. These 20 cases represented the TID examinations with the best image quality, and were selected from a total of 70 TID examinations. Images were obtained using a prototype digital vascular imaging unit. Conventional left ventriculography was also performed. A good correlation was found between the two methods in determining the ejection fraction (0.81) and the motion of the anterior wall and apex (0.89). The correlation was not as good for determining the movement of the inferior ventricular wall (0.62). This was due to the difficulty of separating the inferior ventricular wall from the left hemidiaphragm.