The aim was to study color-coded Doppler ventriculography in patients with good and poor left ventricular function. Patients in group 1 (n = 10) had angina pectoris or inferior infarction and slightly impaired left ventricular function (median calculated ejection fraction 0.54). Patients in group 2 (n =10) had considerably reduced pump function on the basis of anterior infarction or diffuse myocardial disease (median ejection fraction 0.30). Doppler ventriculography showed a red-coded area in the inferolateral compartment in diastole and a blue-coded area in the anteroseptal compartment in systole. At the time of maximum size of these main-flow areas, smaller reverse-flow areas were seen in the opposite compartments. Blinded analysis demonstrated a higher reverse-flow/main-flow area ratio in group 2 [0.53 (0.21-0.85)] than in group 1 [0.30 (0.10-0.41); p < 0.05]. Continuous blood flow from the inflow to the outflow compartment was observed at the apex throughout the heart cycle in 7 of the 10 group 2 patients, but not in any of the patients in group 1(p < 0.05). Apical thrombi were seen only in the setting of continuously circulating blood flow and appeared in 3 of the 7 patients. Aneurysms contained separate flow compartments. A statistically significant correlation between the two-dimensional echocardiographie image quality and the maximum colorcoded area fraction of the ventricle was found. It is, therefore, concluded that Doppler ventriculography did not improve the overall delineation of the cavity. However, color Doppler imaging revealed a continuously swirling paddle wheel flow in the left ventricle in 70% of patients with poor pump function. In patients with slightly reduced left ventricular function, the Doppler ventriculographic flow pattern resembled the abrupt bidirectional blood flow observed in the normal heart. This flow pattern may be compared with the flow pattern in a piston engine. The value of color Doppler ventriculography, e.g., in the prediction of thromboembolism, should be established in a larger prospective study.

Keywords:
Echocardiography, Color Doppler imaging, Ventriculography, Left ventricular function, Thromboembolism
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1993
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