Effects of Rest and Exercise on Cardiac Blood Volume Determinations^[*]

Summary

Aim: The purpose of this study was to investigate the changes in blood activity during rest, exercise and recovery, and to assess its influence on left ventricular (LV) volume determination using the count-based method requiring blood sampling. Methods: Forty-four patients underwent rest-stress radionuclide ventriculography; Tc-99m-human serum albumin was used in 13 patients (Group I), red blood cells was labeled using Tc-99m in 17 patients (Group II) in vivo, and in 14 patients (Group III) by modified in vivo/in vitro method. LV volumes were determined by a count-based method using corrected count rate in blood samples obtained during rest, peak exercise and after recovery. Results: In group I at stress, the blood activity decreased by 12.6 ± 5.4%, p <0.05, as compared to the rest level, and increased by 25.1 ± 6.4%, p <0.001, and 12.8 ± 4.5%, p <0.05, above the resting level in group II and III, respectively. This had profound effects on LV volume determinations if only one rest blood aliquot was used: during exercise, the LV volumes significantly decreased by 22.1 ± 9.6%, p <0.05, in group I, whereas in groups II and III it was significantly overestimated by 32.1 ± 10.3%, p <0.001, and 10.7 ± 6.4%, p <0.05, respectively. The changes in blood activity between stress and recovery were not significantly different for any of the groups. Conclusion: The use of only a single blood sample as volume aliquot at rest in rest-stress studies leads to erroneous estimation of cardiac volumes due to significant changes in blood radioactivity during exercise and recovery.

Zusammenfassung

Ziel: Erfassung von Veränderungen der Blutradioaktivität in Ruhe, unter Belastung und in der Erholung sowie Abschätzung des Einflusses auf die Bestimmung des linksventrikulären Blutvolumens bei Berechnung mittels Blutprobenmessungen. Methode: Die Radionuklidventrikulo-graphie wurde bei 44 Patienten in Belastung und Ruhe durchgeführt. Bei 13 Patienten wurde ^99mTc-Humanserumalbumin (Gruppe 1) benützt, bei 17 Patienten die Erythrozytenmarkierung in vivo (Gruppe 2) und bei 14 Patienten eine modifizierte ln-vivo-/in-vitro-Markierung (Gruppe 3). Die linksventrikulären Volumina wurden aus dem Vergleich mit Radioaktivitätskonzentrationen in Blutproben errechnet, entnommen während Ruhe, maximaler Belastung und nach Erholung. Ergebnisse: Die Blutradioaktivitätskonzentration nahm, im Vergleich zur Ruhe, in Gruppe 1 (Belastung) um 12,6 ± 5,4% (p <0,05) ab, erhöhte sich jedoch um 25,1 ± 6,4% (p <0,001) bzw. um 12,8 ± 4,5% (p <0,05) über den Ruhewert in Gruppe 2 und 3. Dies führte zu Veränderungen der linksventrikulären Blutvolumina dann, wenn ausschließlich die Radioaktivitätskonzentration in Ruhe als Referenz verwendet wurde: sie wurden um 22,1 ± 0,6% in Gruppe 1 unterschätzt, in den Gruppen 2 und 3 mit 32,1 ± 10,3% bzw. mit 10,7 ± 6,4% überschätzt. Zwischen Belastung und Erholung gab es keine signifikanten Unterschiede. Schlußfolgerung: Die Verwendung nur der Ruhe-Radioaktivitätskonzentration als Volumenaliquot führt zu einer Verfälschung der berechneten kardialen Blutvolumina, weil sich die Konzentration im Blut bei Belastung und in der Erholung signifikant verändert.

Key words

Rest/exercise radionuclide angiocardiography - Technetium-99m - left ventricular volume

Schlüsselwörter

Ruhe-/Belastungs-Radionuklid-Angiokardiographie - Technetium-99m - linksventrikuläres Volumen

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