Use and Overuse of Left Ventriculography
What is the frequency with which left ventriculography is performed during coronary angiography in patients with and without a recent alternative assessment of left ventricular function?
The investigators 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 the concomitant use of left ventriculography during coronary angiography. These analyses were conducted for subgroups based on gender, diagnosis of renal failure, and location of the United States. Pearson χ2 analysis was used to evaluate categorical variables, and t tests were used to evaluate differences in continuous variables.
Of 96,235 patients who underwent coronary angiography, left ventriculography was performed in 78,705 (81.8%). Use of left ventriculography was high in all subgroups, with greatest use in younger patients, those with a diagnosis of coronary disease, and those in the Southern United States. In the population who had undergone a very recent ejection fraction assessment by another modality (within 30 days) and who had had no intervening diagnosis of new heart failure, myocardial infarction, hypotension, or shock (37,149 patients), left ventriculography was performed in 32,798 patients (88%)—a rate higher than in the overall cohort.
The authors concluded that left ventriculography was performed in most coronary angiography cases and often when an alternative imaging modality had been recently completed.
This study reports that left ventriculography was performed as a routine ‘add-on’ with most of the cardiac catheterizations and that the frequency of its use was actually increased when no new information was likely to be obtained. The findings raise concerns that there is substantial overuse of left ventriculography, with implications for cost of care and patient morbidity. Despite some limitations of the study, it appears reasonable to question appropriateness of routine left ventriculography in patients undergoing cardiac catheterization.
Keywords: Fluoroscopy, Myocardial Infarction, Ventricular Function, Left, Shock, Cardiac Catheterization, Hypotension, Coronary Disease, Angioplasty, Balloon, Coronary, Heart Diseases, Renal Insufficiency, Coronary Angiography, Cardiovascular Diseases, Stroke Volume, United States
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