SUMMARY The immediate effect of contrast medium injection on left ventricular (LV) volume, stroke volume (SV) and ejection fraction (EF) was evaluated from postoperative LV biplane cineangiograms of 10 patients with 4-6 epicardial markers placed at the time of coronary artery surgery. After calibrating marker distances with respect to volume (r = 0.97-0.99) over one cardiac cycle for each patient, regression equations were used to compute LV volume from marker measurements for beats prior to, during and following injection.THERE HAS BEEN CONTROVERSY concerning the immediate effects of injected contrast medium as used for ventriculography upon human left ventricular (LV) volume and ejection fraction (EF). In animals, both are significantly increased soon after the onset of injection" 2 and, accordingly, the recommendation has been made that calculation of left ventricular end-diastolic (EDV) and end-systolic (ESV) volumes be made after the period of injection to avoid the immediate volume increase which results from the added volume of the injectate.1 In humans, results from one study suggest that there is a significant volume increase at enddiastole by the third cycle after opacification, leading to the recommendation that films taken early in the injection period be used for physiologic information.3 Another study demonstrated no consistent change in EDV or EF.4 For studies in man, a method has not been available for determining ventricular volumes from control beats immediately before the start of injection for comparison with volumes during and immediately following injection. Recently, we reported a method of determining spatial distances between metallic markers placed on the epicardium at the time of cardiac surgery and for calibrating these marker distances with respect to volume so that volumes and changes in volume could be derived subsequently from these measurements.' The purpose of the study reported here was to evaluate the immediate effects of injection of contrast medium on EDV, ESV, SV, and EF by comparing the volumes and ejection fractions immediately before injection with those during ventricular opacification. MethodsPatients who had had epicardial radiopaque markers placed at the time of cardiac surgery were selected for study. End-diastolic volumes (EDV) prior to injection ranged from 93-263 ml and did not change significantly with injection. End-systolic volumes (ESV) showed a mean decrease of 7.3 ml by beat 7 following injection; this was of borderline significance. Similarly, there was no significant change of SV or EF until beat 7 when there were small but significant increases of 6.4 ml and 0.04, respectively. The injection of moderate amounts of contrast in man does not cause significant changes in LV volume or EF through the sixth postinjection beat.The markers consisted of four or more silver vascular clips which were attached to the epicardium at the apex and on the anterior, posterior, and free wall of the left ventricle approximately two-thirds of the distance from the apex to t...
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