Biplane cineangiographic determinations of left ventricular function: pressure-volume relationships.

Abstract A biplane cineangiocardiographic technique with filming speeds of 30 or 60 frames per second is described to estimate the instant-to-instant changes of left ventricular volume in man. The results of postmortem studies in 13 human hearts and in 6 patients with various forms of heart disease are presented. Ninety-seven volume observations were made in the 13 postmortem hearts over a volume range of 30 to 150 c.c. The volume calculations were based upon the assumption that the chamber could be mathematically represented by the formula for an ellipsoid. The standard error of estimate was ± 5.6 c.c. and the correlation coefficient was 0.986. The angiographic left ventricular stroke volumes in a patient without anatomic left ventricular disease were 55, 60, 54, and 50 c.c., an average of 54.7 c.c. per beat. This compared favorably with the dyedilution stroke volume of 52.2 c.c. per beat. A second patient with a ventricular septal defect and patent ductus arteriosus had consecutive angiographic stroke volumes of 79 and 82 c.c., an average of 80.5 c.c. per beat. This compared favorably to the pulmonary blood flow of 82 c.c. per beat determined by the Fick method. The remaining 4 patients had valvular insufficiency and/or stenosis. The regurgitant flow per beat ranged from 13 to 109 c.c. Pressure and volume were related for the construction of pressure volume loops and the determination of the left ventricular pressure-volume work for ejection. The hemodynamic significance and changes in the contour of the loops in the various pathophysiologic states are described. The pressure-volume work was determined from the loops and compared to the stroke work calculated from conventional laboratory techniques. The determination of the pressure-volume work was demonstrated to be more informative than the conventional calculation of stroke work. The clinical application of ventricular volume measurements will provide additional information concerning the left ventricular hemodynamics of the normal and diseased state.

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