Exercise intravenous digital subtraction angiography

Attempts to use exercise ventriculography have been made, not only to give diagnostic and perhaps even prognostic information in patients with coronary artery disease, but also in patients with valvular heart disease both before and after surgical intervention. Clearly an accurate method of assessing ventricular function under conditions of stress in various cardiac diseases would provide important information that would help in patient management. Exercise ventriculography using gated blood pool equilibrium technetium studies are widely used, but are limited by spatial resolution and by the foreshortening affects of visualizing the left ventricular chamber in the left anterior oblique view. First pass radionuclide studies have the added advantage of being able to visualize the ventricular chamber in the anterior or even the right anterior oblique view, but are even more limited by their spatial resolution problems. Several investigations have shown that digital subtraction angiography produces left ventricular images with a spatial resolution almost identical to that of conventional contrast ventriculography, but without the inherent problems of cardiac arrhythmias, which often limit the assessment of left ventricular function. Because of its ability to accurately delineate wall motion abnormalities, the technique may provide an adequate assessment of global and regional left ventricular function after exercise. Digital subtraction angiography may identify ischemic wall motion abnormalities produced by exercise in patients who already had significant permanent left ventricular damage from myocardial infarction