Measurement of Shunt Amount Using Radionuclide Angiocardiography: Accuracy According to Level of Shunt and Associated Lesion

Kim, Yang Min

Abstract

PURPOSE: Determination of pulmonary to systemic blood flow ratio (QP/QS) is important for the management of patients with left-to-right shunt. This study was performed to assess the agreement of Qp/Qs ratio using the radionuclide method and oxymetry, to investigate the factors influencing the agreement, and to know how interchangeable the results of each technique.
MATERIALS AND METHODS
We compared the Qp/Qs measured by single-pass radionuclide angiocardiography and oxymetry during catheterization in 207 patients who underwent both studies. In radionuclide method, Qp/Qs was calculated from the pulmonary time-activity curves using a gamma variate fit. The correlation and Bland-Altman analysis were performed according to the levels of shunt and associated lesions.
RESULTS
The mean Qp/Qs was 1.83+/10.50 by radionuclide, and 1.74+/10.51 by oxymetry. The overall correlation coefficient was 0.86(p<0.001), and Bland-Altman range of agreement encompassing 4SD was 1.05. For atrial septal defect, ventricular septal defect, patent ductus arteriosus, tricuspid and mitral insufficiency, the correlation coefficient was 0.78, 0.90, 0.84, 0.63 and 0.44, and Bland-Altman range was 1.52, 0.74, 0.96, 1.57, and 1.50, respectively.
CONCLUSION
There is good agreement but wide variance between the Qp/Qs ratios by radionuclide method and oxymetry. Associated atrioventricular valvar insufficiency decreases the correlation coefficient and widens the variance. Wide overall variance suggests that Qp/Qs measurements by two techniques should not be used interchangeably.