Left ventriculography is an expensive and often unnecessary test that is routinely overused, according to a new study in the American Heart Journal from Stanford University. It's also invasive, adding unnecessary risks and costs to the cardiac workup.
Ventriculography, developed 50 years ago to measure ejection fraction, is commonly performed as an add-on procedure during invasive CT angiography, at a cost of $300, the researchers wrote in a statement accompanying the study's release (AHJ, March 30, 2012).
Several less-invasive and often superior methods of measuring ejection fraction are available, including echocardiograms and nuclear cardiac imaging, rendering the use of left ventriculography questionable in many cases, wrote Dr. Ronald Witteles and colleagues from Stanford University Medical Center in Stanford, CA.
Witteles and colleagues performed a retrospective analysis of insurance claims data from the Aetna health care benefits database, including all adults who underwent coronary angiography in 2007. The primary outcome was use of left ventriculography during coronary angiography.
Of the 96,235 patients who underwent invasive coronary angiography, ventriculography was performed in 78,705 (81.8%), the group reported. The greatest use was in young patients, patients with a diagnosis of coronary artery disease, and patients in the Southern U.S. Among patients who had undergone another test to measure ejection fraction without an additional intervening diagnosis, myocardial infarction or shock (n = 37,149), use of ventriculography was even higher at 32,798 patients (88%). New clinical guidelines should be considered to reduce the overuse of this invasive test, Witteles et al concluded.
The biggest drawback is the invasive nature of the exam, when the catheter goes across the valve into the heart, Witteles said. There's always a risk of dislodging a blood clot and causing a stroke, and the procedure increases the risk of arrhythmias, in addition to increasing costs, he added.
