[Quantification of left-to-right shunt in atrial septal defect using oximetry, isotopes, and Doppler echocardiography. Is there a method of reference?]

Rev Esp Cardiol. 1998:51 Suppl 1:2-9.
[Article in Spanish]

Abstract

Introduction: Determination of pulmonary to systemic blood flow ratio (QP/QS) is considered to be important for the management of patients with atrial septal defect. The QP/QS provides information on shunt severity and is usually determined by three methods: oximetry, first-pass radionuclide angiocardiography and Doppler echocardiography. The aim of the present study was to assess the accuracy and concordance level of these three methods in QP/QS quantification in atrial septal defects.

Patients and methods: Sixty-four adult atrial septal defects patients in whom QP/QS was determined by these three methods with a 6 month interval were studied. Nuclear and echocardiographic post-surgical studies were repeated in 36 patients.

Results: QP/QS values determined by the three techniques had a low correlation between them: oximetry (r = 0.52; SEE = 0.74); radionuclide angiocardiography (r = 0.40; SEE = 0.79) and Doppler echocardiography (r = 0.72; SEE = 0.57). Radionuclide angiocardiography underestimated QP/QS > 3 (-0.61 +/- 1.21; p < 0.01). Only in 33% of studies there concordance (differences < 0.5) among the three methods and in 58% between two methods. Right ventricular dilatation and tricuspid regurgitation influenced radionuclide accuracy. Nevertheless, the correlation between this technique and echocardiography was satisfactory when the 36 post-surgical were included (r = 0.75); both techniques agreed in the diagnosis of the two cases with residual post-surgical shunt.

Conclusions: Inter-method disparity in QP/QS quantification is high and no method can be used as a gold standard; clinical decisions therefore based on QP/QS quantification by one technique alone are ill-advised.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Coronary Circulation
  • Echocardiography, Doppler
  • Female
  • Heart Septal Defects, Atrial / diagnosis
  • Heart Septal Defects, Atrial / diagnostic imaging
  • Heart Septal Defects, Atrial / physiopathology*
  • Hemodynamics
  • Humans
  • Male
  • Middle Aged
  • Oximetry
  • Prospective Studies
  • Pulmonary Circulation
  • Ventriculography, First-Pass