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Evaluation of Valvular Regurgitation by Factor Analysis of First-Pass Angiography

Divisions of Nuclear Medicine and cardiology, Harbor-UCLA Medical Center, Torrance, UCLA School of Medicine, Los Angeles, California

Correspondence: For reprints contact: I. Mena, MD, Director, Division of Nuclear Medicine, Harbor-UCLA Medical Center, 1000 W. Carson St., Torrance, CA, 90509.

ABSTRACT

We have evaluated left ventricular regurgitation by means of factor analysis of ^99mTc first-pass radionuclide angiography (FPRNA) and time-activity curve deconvolution. The FPRNA regurgitant fraction (RF) was computed in 26 individuals: 13 patients (eight mitral, three aortic, and two mitral-aortic) and 13 controls. The reference method was contrast ventriculography (CV) performed within 1 hr after FPRNA. In 19 patients, CV was preceded by the determination of cardiac output, using indocyanine green dye (n= 16) or thermodilution technique (n = 3), to determine a catheterization regurgitant fraction (CATH-RF). Lung and left ventricular (LV) time-activity curves were gathered by factor analysis and the FPRNA regurgitant fraction assessed by a lagged normal deconvolution of these curves. In valvular regurgitation, the LV deconvolved curve demonstrates the appearance of a long transit time component that is amenable to quantification. The presence of regurgitation was determined by contrast ventriculography. With a 10% RF as an acceptable upper limit of normal for nonregurgitant patients, FPRNA yielded one false-negative and no false-positive studies (n = 26), while CATH-RF yielded two false-negative and four false-positive determinations (n = 19). The following are results of quantitative determination of RF (mean ± s.d.): FPRNA 0.39 ± 0.19 (n = 13 Valvular), 0.01 ± 0.03 (n = 13 Controls); CATH 0.34 ± 0.24 (n = 11 Valvular), 0.13 ± 0.12 (n= eight controls). FPRNA was able to differentiate (p < 0.001) between control patients (CV grading 0) and mild/moderate regurgitation (CV grading 1+ or 2+) and severe regurgitation (3+ or 4+) (p < 0.025).

FOOTNOTES

^* Present address: CHU Trousseau - Div. Nuclear Medicine, 37044 Tours, France.