PROSPECTIVE ASSESSMENT OF THE VALUE OF A CHEST RADIOGRAPH IN THE PERFORMANCE OF DIAGNOSTIC CARDIAC-CATHETERIZATION IN ADULTS

Objective-To assess the value of a chest radiograph in the performance of diagnostic cardiac catheterisation in adults. Patients and methods -340 consecutive diagnostic cardiac catheter procedures in adults at o ne institution. It is normal practice for primary operators to report the results of catheterisation using a graphical user interface databa se system. Data entry screens were modified to present a study questio nnaire to assess the use made of the chest radiograph in the performan ce of the catheter procedure. Setting-Tertiary referral cardiac centre . Results-The chest radiograph was judged of value in only 12/340 proc edures (4%). The radiograph influenced catheter selection in six proce dures, the volume of injected radiographic contrast medium in five, an d showed an abnormality important to the planning or conduct of the pr ocedure in six procedures. A dual benefit was reported in five procedu res. Utility of the radiograph was related to the pre-catheter diagnos is. It proved of value in only 2/283 (0.7%) procedures with a working diagnosis of ischaemic heart disease, influencing only catheter select ion. Its utility was greater in congenital heart disease, contributing in 3/4 (75%) procedures, dilated cardiomyopathy in 2/6 (33%) procedur es, and valvar heart disease in 4/35 (11.5%) procedures. Conclusions-I n the performance of diagnostic cardiac catheterisation in adults acce ss to a recent chest radiograph contributes little to the conduct of i nvestigations performed for suspected ischaemic heart disease, but may be of greater value in congenital disease, valve abnormalities, and d ilated cardiomyopathy.