Variability and reproducibility of quantitative left ventricular angiography

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Abstract
To evaluate the reproducibility of left ventricular angiography for the assessment of left ventricular (LV) function and regional wall motion, two ventriculographies were performed in the 30° right anterior oblique (RAO) projection, at 15-minute intervals, in 19 patients undergoing coronary angiography. Heart rate, left ventricular systolic pressure, and end-diastolic pressure were measured 15 minutes after the first angiography returned to the baseline values (71.0 ± 14.1 vs. 72.2 ± 15.5 beats/minute, 153.6 ± 18.0 vs. 152.8 ± 19.9 mm Hg, 21.7 ± 8.6 vs. 20.9 ± 7.3 mm Hg, respectively). Global and regional LV performance was analyzed by two observers with a computer-assisted technique. Intraobserver mean variation of end-diastolic volume and ejection fraction was less than 3% of the control value. Interobserver mean variations for the same parameters were less than 4% of control values. For both observers, there was no significant variation of LV end-diastolic volume and ejection fraction from one study to the other. Under stable hemodynamic conditions, the mean observed variations were, depending on the observer, 5–6% of the control value for LV end-diastolic volume and 5% for ejection fraction. Analysis of segmental wall motion was also highly reproducible. The mean intraobserver variation (% of control value) of wall motion ranged from 4.4% to 9.2%, depending on the sectors studied. The mean interobserver variation, whatever the sector, ranged from 6.9% to 13.5%. The mean interstudy variability for both observers ranged from 6.6% to 15%. In conclusion, any change greater than 6% for end-diastolic volume, 5% for ejection fraction, and 15% for radial shortening should be considered as significant, provided that hemodynamic conditions are unchanged.