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Pulmonary Capillary Wedge Pressure, as Inferred from Lung Areas in Gated Blood-Pool Scintigrams: Concise Communication

Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

Correspondence: For reprints contact: Robert D. Okada, MD, Cardiac Unit, Massachusetts General Hospital, Boston, MA 02114.

ABSTRACT

To determine whether the apex-to-base distribution of pulmonary blood volume, as obtained from gated cardiac blood-pool scans, could be used as a noninvasive method to estimate mean pulmonary capillary wedge pressure (PCWP), gated blood-pool scans were analyzed in 77 patients who also had PCWP measurements at cardiac catheterization. Ten of these patients had gated cardiac blood-pool scans and PCWP measurements both at rest and during exercise. The apex-to-base distribution of pulmonary blood volume was determined from the end-systolic frame of the left anterior oblique view by placing equal-sized regions of interest over the apex and base of the right lung. The ratio of apex counts over base counts (A/B ratio) was considered abnormal if greater than unity.

The mean A/B ratio was 1.15 ± 0.27 (1 s.d.) for the 32 studies associated with an abnormal mean PCWP (greater than 12 mm Hg). The mean A/B ratio was 0.85 ± 0.23 for the 55 studies associated with a normal mean PCWP (p <0.01 comparing normal group with abnormal). The sensitivity of the A/B ratio for a mean PCWP >12 mm Hg was 81% (26/32). The specificity of the A/B ratio for a mean PCWP 12 mm Hg was 89% (49/55).

Thus, noninvasive determination of the pulmonary apex-to-base ratio from gated cardiac blood-pool scans appears to differentiate subjects with normal and abnormal mean pulmonary capillary wedge pressures.