Pulmonary oligemia in aortic valve disease.
OBJECTIVE
To determine whether the severity of the radiographic appearance of oligemia correlates with the severity of cardiac dysfunction.


METHODS
Nine readers graded a set of 25 chest radiographs (15 cases of aortic valve disease [AVD], 10 control cases without AVD) for blood volume and ventricular size. Blood volume was graded on a scale of -3 (severe hyperemia) to 0 (normovolemia) to +3 (severe oligemia). Ventricular size was graded on a scale of 0 (normal) to 3 (massively enlarged). The oligemia and ventricular size grades were added to yield the radiographic severity index. Pulmonary capillary wedge pressure, pulmonary arterial pressure, stroke volume, and cardiac output were measured at the time of catheterization.


RESULTS
The five more experienced readers achieved good nonchance agreement (kappa = 0.48; P < .001). They were unanimous in scoring 12 cases as oligemic; variations occurred only in severity assessments. Oligemia was due to emphysema in one case and to AVD in 11. In oligemic cases, radiographic severity correlated significantly with wedge pressure (r = 0.93, P < .001) and pulmonary arterial pressure (r = 0.93, P < .002).


CONCLUSIONS
Many cases of AVD show oligemia. The severity of oligemia correlates well with hemodynamic abnormality. Oligemia may be caused by atrial-pulmonary-vascular reflex vasoconstriction, low right ventricular output, and possibly high levels of atrial natriuretic factor.
Bruno
M A
MA
Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232-2675, USA.
Milne
E N
EN
Stanford
W
W
Smith
C W
CW
D000328:Adult; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001810:Blood Volume; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006439:Hemodynamics; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011652:Pulmonary Circulation; D011859:Radiography