Very well said.  This is a most unfortunate paper and should not have been published.  I felt deeply offended by the author's allegation that we cardiologists are doing this as "an add on procedure" "unnecessarily" essentially to pad our wallets.  I feel I was well trained at the University of Michigan and left ventriculography was always done, except when there contraindications or it was crossing the aortic valve was too difficult (severe aortic stenosis).  The assessment of wall motion is used to correlate the angiographic findings.  Even if there has been a recent echocardiogram: 1. wall motion could have changed for a variety of reasons; 2. echocardiography does not "see" the apex of the heart and has known technical issues.  The authors incorrectly suggest that there is a unique danger to preforming ventriculography which is incorrect.  Air embolism is extremely rare and can happen at any time during a coronary angiogram, care must be taken throughout the entire procedure.  When modern imaging chains, the total amount of contrast used can limited to 10 to 20 mL which is not a large amount.

I am very, very surprised to see this type of publication coming from Stanford University.  I wonder what the faculty there thinks of this paper.  Perhaps some of them will be willing to post their comments in this forum.