News | November 03, 2014

SCAI Publishes Consensus Statement on Use of Left Ventriculography

Variation and significant changes in use reflect need for evidence-based expert consensus

November 3, 2014 – Once a common procedure, left ventriculography’s role in assessing heart disease has evolved considerably over the decades, leading to significant variations in use. A new expert consensus statement e-published by the Society for Cardiovascular Angiography and Interventions (SCAI) recommends optimal uses for left ventriculography, with the goal of more standardized use of the test and improved quality of care for cardiac patients.

Left ventriculography is a test in which contrast dye is injected in the heart’s left ventricle through a catheter to aid in capturing images of blood flow out of the left ventricle. The imaging technique was refined in the 1960s and 1970s and became the gold standard for assessing left ventricle function. But newer imaging technology – including cardiac magnetic resonance imaging (MRI), echocardiography and cardiac computed tomographic angiography (CCTA)—has led to reduced use of the test. Use today varies widely both geographically and within hospitals, and there were previously no specific guidelines to aid interventional cardiologists in performing left ventriculography at the time of coronary angiography or left heart catheterization.

“Although use of left ventriculography has declined, there are times when it continues to be a good option for some patients. Previously, no guidelines existed to help physicians understand when and how to use it,” said Osvaldo S. Gigliotti, M.D., FSCAI, the document’s lead author. “The new consensus statement fills the void for guidance on when left ventriculography is the appropriate assessment tool and how it compares to newer imaging tests.”

The paper reviews several uses for left ventriculography, including measurement of ejection fraction, an assessment of how much blood leaves the heart with each pump; identification of defects in the motion of the heart wall; and measurement of ventricle volume in patients with heart valve defects. Left ventriculography is also useful for identifying aneurysms in the left ventricle and septal defects, which are openings between the heart’s chambers.

Authors also discussed alternative imaging techniques, including cardiac MRI, echocardiography, radionuclide ventriculography and CCTA. Echocardiography has become the most commonly used alternate tool for left ventricle assessment, due to its real-time imaging, portability and widespread availability, and because it does not expose the patient to radiation as left ventriculography does.

Echocardiography is also preferred for most pediatric patients. However, left ventriculography remains the best option for children with septal defects, and those with significant vessel abnormalities.

“When compared to other imaging options, left ventriculography should be performed selectively and avoided when adequate alternatives are available,” said Gigliotti. “But there are cases where left ventriculography is essential, such as when a catheter-based device is used to close a septal defect.”

The paper also discusses potential complications and proper technique for left ventriculography. It recommends delivery of contrast dye using power injection, use of a multi-sidehole catheter and sufficient contrast volumes; angulated views to best visualize the heart; positioning the left ventricle in the isocenter of the fluoroscopy system; and having patients hold their breath to minimize motion.

The paper, titled “Optimal Use of Left Ventriculography at the Time of Cardiac Catheterization: A Consensus Statement from the Society for Cardiovascular Angiography and Intervention (SCAI),” is e-published in Catheterization and Cardiovascular Interventions.

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