title: Use and overuse of left ventriculography.
abstract: BACKGROUND
  Left ventriculography provided the first imaging of left ventricular function and was historically performed as part of coronary angiography despite a small but significant risk of complications. Because modern noninvasive imaging techniques are more accurate and carry smaller risks, the routine use of left ventriculography is of questionable utility. We sought to analyze the frequency that left ventriculography was performed during coronary angiography in patients with and without a recent alternative assessment of left ventricular function.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Left ventriculography was performed in most coronary angiography cases and often when an alternative imaging modality had been recently completed. New clinical practice guidelines should be considered to decrease the overuse of this invasive test.
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305-5406, USA. witteles@stanford.edu
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Witteles
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Knowles
authors.forename: Marco
authors.initials: M
authors.lastname: Perez
authors.forename: William M
authors.initials: WM
authors.lastname: Morris
authors.forename: Claire M
authors.initials: CM
authors.lastname: Spettell
authors.forename: Troyen A
authors.initials: TA
authors.lastname: Brennan
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left