Quantitative validation of cineangiographic axial oblique biplane left ventricular volume measurement

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Abstract
Axial oblique left ventriculography allows unique visualization of acquired and congenital cardiac lesions. However, validation of the accuracy of left ventricular (LV) volume with axial oblique projections is limited and clouded by orthogonal violations between biplane projections. Biplane cineradiographic volume measurement of 17 LV casts employing the axial projection 35° right anterior oblique/55° left anterior oblique/30° cranial (35°RAO/55°LAO/30°Cr) was performed and compared to the conventional postero-anterior/lateral (PA/Lat) and 30° right anterior oblique/60° left anterior oblique (30°RAO/60°LAO) views. LV volume was calculated from biplane cineradiograms by area length and Simpson's rule method. True LV volume by water displacement was 33 ± 28 (mean± S.D.), range 15 to 112 ml. LV cast volume calculated by the area length method from cineradiograms was overestimated (p < 0.002) but no different by Simpson's rule method (pNS). The ideal correlation was best approximated by the 35° RAO/55°LAO/30°Cr biplane view calculated by Simpson's rule, r = 0.99, y = 3.5+ 0.9 ×, and standard error of estimate (SEE) = 4.3 ml. Biplane LV angiography with the axial projection permitted accurate LV volume measurement, and Simpson's rule provided the best representation of true volume.