New principles for optimum left ventriculography

Left ventriculography has become the single most important procedure in the evaluation of cardiac function. This study reevaluated the refinements of catheter and power injector technology to assess recommendations of past years and establish new principles for optimum ventriculography. Ventriculograms from 102 patients undergoing left heart catheterization and coronary arteriography for coronary, valvular, and myocardial heart disease served as the test sample. Three styles of #7F high‐flow 110‐cm pigtail catheters were utilized. One had 12 sideholes while the other two had six sideholes positioned nearer the base of the curl. Analysis of ventriculographic quality of each angiogram was performed by three of the authors independently and subsequently together. Five variables were analyzed for their effect on the diagnostic quality of the angiogram: (1) 6‐hole catheters, (2) 12‐hole catheters, (3) volume of contrast, (4) flow rate, and (5) location of injection. Once these analyses were complete, the effect of combinations of these variables was tested to determine their effect on angiographic quality. The first combination included contrast volume and flow rate. The second combination compared contrast volume and flow rate when utilized with 6‐ or 12‐hole catheters. The third combination tested the 6‐ and 12‐hole catheters in the apex or inflow locations. A multivariate contingency analysis was used to define relationships between the variables and the quality of the angiogram obtained. As independent variables, catheter style, volume of contrast, flow rate, and location of injection did not influence angiographic quality. However, the apex as a location of injection was the single most consistently important determinant of ventricular angiographic quality. Combination variables of contrast volume and flow rate did not affect angiographic quality. But when these were tested using 6‐ and 12‐hole catheters, high volume and low flow through a 6‐hole catheter achieved a result significantly better than all other combinations. Low flow rates were superior to high flow in nearly all combinations tested. The combination of 6‐hole catheter in the apex was substantially better than the 12‐‐hole in the inflow tract or any of the four other combinations. When total volume of contrast must be limited because of ventricular dysfunction, valvular heart disease, or renal disease, injection of relatively small amounts of contrast using low flow rates through a 6‐hole catheter positioned deep in the ventricle should permit a safe study to be diagnostically superior.