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Combined left and right ventricular volume determination by radionuclide angiocardiography using double bolus and
K H Stokholm1, M Stubgaard, J Møgelvang
1Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, University of Copenhagen, Denmark.
Insights
Radionuclide angiocardiography accurately measures cardiac output and ventricular volumes in patients with ischemic heart disease. This nuclear medicine technique shows good agreement with indicator dilution for stroke volume and cardiac output assessments.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Ischemic heart disease (IHD) affects cardiac function, necessitating accurate assessment of ventricular volumes and cardiac output.
- Traditional methods for measuring cardiac output have limitations, driving the need for advanced imaging techniques.
Purpose of the Study:
- To evaluate the accuracy of radionuclide angiocardiography (RNA) in determining left and right ventricular volumes and cardiac output in IHD patients.
- To compare RNA measurements with simultaneously obtained indicator dilution (ID) measurements.
Main Methods:
- Eighteen IHD patients underwent RNA using a double bolus and equilibrium technique.
- RNA involved first-pass right ventricle study, left ventricle bolus and equilibrium studies, and red blood cell distribution volume determination.
- Cardiac output was simultaneously measured using indicator dilution for comparison.
Main Results:
- Radionuclide angiocardiography demonstrated acceptable agreement with indicator dilution for stroke volume (r=0.74) and cardiac output.
- Mean stroke volume by RNA was 83 ± 20 ml vs. 84 ± 20 ml by ID; mean cardiac output was 5.24 ± 1.37 L/min vs. 5.28 ± 1.23 L/min by ID.
- Left ventricular ejection fraction (EF) was 0.44 ± 0.14 and right ventricular EF was 0.57 ± 0.10, with low intra-observer variability.
Conclusions:
- Radionuclide angiocardiography is a reliable method for assessing ventricular volumes and cardiac output in patients with ischemic heart disease.
- The technique offers good correlation with indicator dilution, supporting its clinical utility in IHD management.
Abstract:
Eighteen patients with ischaemic heart disease were studied. Left and right ventricular volumes including cardiac output (forward flow) were determined by radionuclide angiocardiography using a double bolus and equilibrium technique. As reference, cardiac output was simultaneously measured by indicator dilution. The radionuclide technique comprised four steps: (1) a first-pass study of right ventricle; (2) a bolus study of left ventricle; (3) an equilibrium study of left ventricle; (4) determination of the distribution volume of red blood cells. Absolute volumes of left ventricle were determined from steps 2 + 3 + 4. Absolute volumes of right ventricle were calculated from stroke volume and right ventricular ejection fraction (EF) which in turn was determined from step 1 by creating composite systolic and composite diastolic images. There was an acceptable agreement between stroke volume determinations by radionuclide angiocardiography and indicator dilution (r = 0.74; P less than 0.001). Stroke volume determination by radionuclide was 83 +/- 20 ml (mean +/- SD) and by indicator dilution 84 +/- 20 ml with a difference of -1 +/- 15 ml (NS). Cardiac output determination by radionuclide was 5.24 +/- 1.37 l min-1 and by indicator dilution 5.28 +/- 1.23 l min-1 with a difference of -0.04 +/- 0.95 l min-1 (NS). Left ventricular EF was 0.44 +/- 0.14 and right ventricular EF 0.57 +/- 0.10. The intra-observer coefficient of variation for duplicate calculations of the radionuclide determinations was 5.5% for stroke volume, 2.5% for left ventricular EF and 4.8% for right ventricular EF.