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Consensus statement published on appropriate use of left ventriculography
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Increasing use of cardiac MRI, echocardiography and nuclear cardiology has led to decreased use of left ventriculography over the last few decades. However, the technique is still used, albeit with wide variety depending on the geographic region, institution or individual clinician.
Recently, the Society for Cardiovascular Angiography and Interventions published a consensus paper in Catheterization and Cardiovascular Interventions that highlights the role of left ventriculography at the time of coronary angiography or left heart catheterization and further helps to define its optimal uses.
O. Steven Gigliotti
“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,” O. Steven Gigliotti, MD, FSCAI, the lead author of the document with Seton Heart Institute, Austin, Texas, said in a press release. “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.”
In the document, Gigliotti and colleagues outlined the following recommendations on when and when not to use this modality:
- This approach can be considered when left ventricular function or wall motion is unknown, or mechanical disruption is suspected. Results of a left ventriculography in this case may aid clinicians in selecting therapeutic options. Examples of this situation include ACS without previous noninvasive imaging, or when clinical findings indicate a change in LV function.
- Left ventriculography should be performed selectively and avoided when the patient has undergone an adequate imaging alternative.
- High-risk patient groups — including those with renal insufficiency, elevated end diastolic pressure, known or suspected LV mural thrombus, aortic valvular vegetation and those with a history of high radiation exposure — should not undergo left ventriculography, according to the authors.
In addition, institutions are encouraged to develop local criteria for using left ventriculography, which Gigliotti and colleagues suggested may reduce variation in its performance among operators. They added that a multisidehole catheter with a power injector should be used in performing left ventriculography and that cath lab quality programs should include technique and indication information on left ventriculography case reviews.
Left ventriculography may also be used to measure ejection fraction and ventricular volume in addition to identifying trouble spots in the heart wall, aneurysms in the left ventricle and septal defects.
“The recommendations in this document are not formal guidelines, but are based on the consensus of this writing group,” Gigliotti added. “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.
“When compared to other imaging options, left ventriculography should be performed selectively and avoided when adequate alternatives are available,” Gigliotti continued. “But there are cases where left ventriculography is essential, such as when a catheter-based device is used to close a septal defect.”
Disclosure: The authors report no relevant financial disclosures.
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