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European Heart Journal 1984 5(4):317-325;
Copyright © 1984 by the European Society of Cardiology.
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© 1984 The European Society of Cardiology

Volumetric evaluation of aortic regurgitation by combined first-pass/equilibrium radionuclide ventriculography

H. KLEPZIG, JR*,, R. STANDKE{dagger}, T. NICKELSEN*, B. KUNKEL*, F.D. MAUL{dagger}, G. HÖR{dagger} and M. KALTENBACH*

*Department of Internal Medicine (Division of Cardiology) Frankfurt am Main, F.R.G.
{dagger}Department of Radiology (Division of General Nuclear Medicine), University Hospital Frankfurt am Main, F.R.G.

Received 14 December 1982; revised 9 November 1983; .

Address for correspondence: Dr Harald Klepzig, Division of Cardiology, University Hospital, Theodor Stern Kai 7, D-6000 Frankfurt, F.R.C.

Abstract

In 16 men with normal valvular function (group I) and 23 men and one woman with isolated aortic regurgitation (group 2) effective stroke volume was determined by first pass radionuclide ventriculography. Total left ventricular stroke volume was derived from equilibrium radionuclide ventriculography using a geometric approach for the end diastolic volume multiplied by the ejection fraction. The difference between the two stroke volumes as a fraction of total left ventricular stroke volume was taken as radionuclide regurgitant fraction. Radionuclide Iv/rv stroke count ratio was calculated as the ratio of end–diastolic–end–systolic count–rate differences from the left and right ventricles. All patients underwent left heart catheterization. A ngiographic regurgitant fraction was evaluated by the method of Sandier and Dodge in 16 patients of group 2. In the others, aortic regurgitation was quantified in 5 grades of severity. Group I was classified correctly by both radionuclide regurgitant fraction and Iv/rv stroke count ratio (specificity 100%). In group 2 the radionuclide regurgitant fraction was elevated in all (from +20% to +88%, sensitivity 100%), radio nuclide Iv/rv stroke count ratio in 19 of 24 cases (from 0/6 to 5/6, sensitivity 79%). The angiographic regurgitant fraction correlated well with the radionuclide regurgitant fraction (r=0–78), whereas a/o significant correlation was found between the angiographic stroke volume ratio (i.e. left ventricular stroke volume/ cardiac output per beat) and radionuclide stroke count ratio (r= 0/10) due to the high rate of false negative results of the latter method.

In conclusion, in patients, with moderate to severe isolated aortic regurgitation, using combined first pass/equilibrium radionuclide regurgitant fraction allows a reliable noninvasive evaluation of aortic regurgitation which is superior to the evaluation of the radionuclide Iv/rv stroke count ratio.

Key Words: Aortic regurgitation • stroke volume • regurgitant fraction • ejection fraction • cardiac catheterization • radionuclide ventriculography • transluminal coronary angioplasty


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