Cardiac catheterization facilitates the assessment of left ventricular function in coronary artery disease (CAD). Digital left ventriculography offers the potential for an on-line quantitative determination of left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV). These are routinely evaluated by the area- length method (ALM), which is considered as a standard. Densitometry (DENS) is an alternative method but may lead to calculated underestimations. The purpose of this study was to investigate the accuracy of corrected DENS for LVEDV and LVESV in comparison with ALM in single-plane 30° right anterior oblique (RAO) projection. The computer densitometric correction equation was adapted from the linear regression analysis (y=0.86x+2.73) in cardiac models and applied to the analysis of digital left ventriculograms in patients suffering from CAD. The study of cardiac models yielded highly significant correlations ( r≥ 0.9; P≤ 0.001) between true volumes and both DENS and ALM. DENS and ALM correlated highly signif icantly ( r≥ 0.9; P ≤ 0.001) with a low standard error of estimate (SEE) of ±9.5 mL. The comparison of DENS and ALM in 44 patients' digital ventriculograms exhibited highly significant (r=0.74; P ≤ 0.001) correlations for noncorrected and corrected LVEDV. Systematic underestimation by DENS of LVEDV disappeared after correction and SEE decreased from ±23.7 to ±19.2 mL. DENS and ALM correlated highly significantly for LVESV (r=0.78; P ≤ 0.001; SEE ± 15.6 mL ± 13.5 mL, respectively) after correction. Following correction, mean values for DENS increased from 116 ±32 to 132 ±37 mL (LVEDV) and 50 ±22 to 55 ±25 mL (LVESV). For ALM, mean values decreased from 159 ±35 to 127 ±28 mL (LVEDV) and 55 ±25 to 46 ±21 mL (LVESV). This study shows that LVEDV and LVESV can be reliably analyzed on-line by corrected computer densitometry. Method-related errors of both DENS and ALM are present and account for minor volume deviations.

The angiocardiographic evaluation of left ventricular end‐diastolic (LVEDV) and end‐systolic (LVESV) volumes and ejection fraction (EF) is routinely performed by the area‐length method (ALM) but may lead to erroneous results. Digital imaging in real time allows densitometric procedures of determining left ventricular (LV) performance to be applied alternatively. In this study, we present densitometric algorithms for the analysis of LVEDV, LVESV, and EF from digital image data, establish accuracy and reproducibility, and determine value and limitations in comparison with ALM in single‐plane 30°right anterior oblique (RAO) projection. A linear relationship between iodine depth and measured densities is mainly burdened with scatter radiation and beam hardening which reduce primary radiation and suppress iodine depth. However, facilities such as deconvolution and correction algorithms are capable of reducing these sources of error. In the present study, computer‐analyzed contrast images of iodine‐filled wedges and spheres showed a near‐linear relationship between iodine depth between 50‐100 mg/cm2 and measured densities. Contrast images of heart casts and LV an‐gio‐grams of 54 patients were obtained with a digital image acquisition and processing system, and evaluated by two in dependent observers. The phantom study resulted in significantly (p≤0.01) better densitometric standard errors of estimate for volumes [3.3 ml densitometry (DENS) vs. 8.9 ml (ALM)] and simulated EF [4.3% (DENS) vs. 7.8% (ALM)] than ALM. The standard error of estimate for the comparison between both methods was 8.4 ml for volumes and 7.5% for EF. Densitometric volumes tended to underestimate volumes calculated by ALM. The angiographic study of patients demonstrated significant correlations between both methods (LVEDV r = 0.78, LVESV r = 0.83, total volumes: r = 0.89;EF r = 0.88). The standard errors of estimate can be ascribed to systematic, method‐related errors of both DENS and ALM (LVEDV ± 28.9 ml, LVESV ± 23.4 ml, total volumes (EDV and ES V) ± 27.1 ml; EF ± 8.1 %). The intra‐ and interobserv‐er variability, respectively, exhibited significantly smaller (p ≤0.01 and p ≤0.05, respectively) standard errors of estimate for densitometric EF [4.6% (DENS) vs. 8.5% (ALM) and 7.1% (DENS) vs. 10.3% (ALM), respectively]. Inclined but not significant differences were found for LVEDV and LVESV. In conclusion, the data presented indicate that the calculation of LV volumes and EF in digital left ventriculography may be performed accurately by densitometric calculation in single‐plane 30°RAO projection. Minor underestima‐tions in densitometric volume determination may be anticipated in the evaluation of LV geometry.

In digital angiocardiography left ventricular volumes are routinely calculated by the area-length-method (ALM) which is considered to be a standard and with which other techniques are compared. Densitometric analysis (DENS) is an alternative method and can be performed on-line but may lead to erroneous results. A novel technique of densitometric calculation of left ventricular enddiastolic and endsystolic volume (LVEDV resp. LVESV) is presented. Digital images were analyzed by measuring densities of iodine signals and transforming these into calculated volumes by applying appropriate computer algorithms. The evaluation of volumes in cardiac models demonstrated significant correlations between true volumes and both DENS and ALM. An algorithmic approach to volume correction in patient evaluation of left ventricular volumes was drawn from the linear regression analysis of DENS and true volumes in the cardiac models. LVEDV and LVESV calculated by DENS correlated significantly with volumes determined by ALM in patients (r=0.78 resp. r=0.83) but showed a systematic underestimation for volumes > or =45 ml without densitometric correction. Following correction for DENS, an improvement in calculation was observed for volumes < or =200 ml without systematic deviations. In conclusion, our study demonstrates that corrected densitometric volumetry offers the potential for a reliable on-line analysis of enddiastolic and endsystolic volumes. Modest, but no systematic deviations for densitometric analysis may be anticipated in myogene dilatation with volumes larger than 200 ml. However, when comparing both DENS and ALM, method-related errors of both techniques are present and account for volume deviations.

The angiographic assessment of left ventricular volume (LV) and ejection fraction (EF) by means of the area-length method (ALM) is based upon geometric assumptions, which might lead to erroneous results. With the development of digital subtraction angiocardiography in real-time, densitometric procedures of calculating left ventricular parameters can be used on-line. This study examines both reliability and accuracy of a densitometric technique for evaluating LV and EF in comparison to the single-plane ALM. Contrast images of heart casts and left ventricular angiograms of 54 patients suffering from different cardiac diseases were obtained by the image acquisition and processing system Polytron 1000 VR (Siemens AG, Erlangen, FRG). Digital images of both heart casts and patients were evaluated densitometrically and geometrically by two independent observers. In the phantom study the densitometric method exhibited a significantly (p < 0.01) better agreement with the true values than the ALM. The evaluation of left ventricular angiograms in patients comparing densitometry with the ALM demonstrated a relatively high residual deviation (enddiastolic volume Syx = +/- 27 ml, endsystolic volume Syx = +/- 19.4 ml). This is mainly due to systematic, method-related errors of densitometry and the morphometric technique. The intra- and interobserver variability in calculating EF showed a significantly (p < 0.05) smaller residual deviation for densitometry than for ALM; no significant differences were found for the calculation of LV. In conclusion, we demonstrated that the presented densitometric technique offers an objective and simple means of determining LV and EF with comparable reliability and validity to the area-length method.