Left Ventricular Angiography as a Function Test

¹ Cardiology Services, Walter Reed General Hospital, Washington, D. C., and Letterman General Hospital, San Francisco

The rise in left ventricular end-diastolic pressure (LVEDP) following left ventricular angiography was studied in 41 patients with coronary artery disease and in 11 "normals" to evaluate its use as a ventricular function test. The response was compared to changes in the pulmonary wedge pressure obtained during exercise in 44 patients. The LVEDP rose in all cases, reached a peak two to three minutes after the left ventricular angiogram, and then slowly fell. In general, the more extensive the coronary artery disease the greater the rise in LVEDP. The most significant separation from normals occurred five minutes after the angiogram (1-vessel disease p < 0.10, 2-vessel disease p < 0.01, 3-vessel disease p < 0.001). The "contrast stress test" increased detection of abnormal left ventricular function (25 percent) to a degree similar to the pulmonary wedge pressure response to exercise (28 percent). The effect of nitroglycerin therapy on the elevation of the LVEDP following angiography is consistent with the premise that increased blood volume produced by the hyperosmolarity of contrast medium is primarily responsible for the observed response; however, alternative explanations are possible. The use of this drug immediately before or after LV angiography precludes the use of the LVEDP response as a form of stress test.