Lemarbre L, Paquet E, Bourassa M G, Lespérance J, Dupras G, Laurier J
J Can Assoc Radiol. 1984 Dec;35(4):349-53.
In this study, two alternative methods of assessing left ventricular (LV) sequential wall motion and ejection fraction (EF) were used in 28 consecutive patients in whom an unstable clinical condition (unstable angina pectoris or severe LV dysfunction) precluded the use of high volume contrast cineventriculography. A new approach, direct small volume contrast digital ventriculography, was compared to radionuclide blood pool ventriculography considered as a "standard" and reliable technique. The qualitative analysis of regional LV contraction by three independent observers showed a complete agreement in 64% of segments studied in the left anterior oblique (LAO) projection and in 69% in the right anterior oblique (RAO) projection; a one-degree disagreement was observed in 13% and 19% respectively, and a discrepancy of two degrees or more in 23% and 12% respectively. Left ventricular ejection fraction calculated from both techniques correlated relatively well (r = 0.82). The radionuclide examination still remains the fastest, easiest and most objective way to appraise global LV function in high risk patients. However, optimal analysis of segmental wall motion requires invasive digital contrast left ventriculography. In future, a more general use of non-ionic contrast media including their intravenous injection and the advent of portable digital devices should permit their widespread use as a safe, rapid and reliable procedure even in the intensive care unit.
在本研究中，对28例连续患者采用了两种评估左心室（LV）节段性壁运动和射血分数（EF）的替代方法，这些患者因临床状况不稳定（不稳定型心绞痛或严重左心室功能障碍）而无法使用大容量对比剂电影心室造影。将一种新方法，即直接小容量对比剂数字心室造影，与被视为“标准”且可靠技术的放射性核素血池心室造影进行了比较。由三名独立观察者对左心室节段性收缩进行的定性分析显示，在左前斜（LAO）投照中研究的节段有64%完全一致，在右前斜（RAO）投照中有69%完全一致；分别有13%和19%观察到一度不一致，分别有23%和12%观察到两度或更大程度的差异。两种技术计算出的左心室射血分数相关性相对较好（r = 0.82）。放射性核素检查仍然是评估高危患者左心室整体功能最快、最简便且最客观的方法。然而，节段性壁运动的最佳分析需要有创数字对比剂左心室造影。未来，包括静脉注射在内的非离子型对比剂的更广泛使用以及便携式数字设备的出现，应能使其作为一种安全、快速且可靠的检查方法得到广泛应用，甚至在重症监护病房也能如此。
