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. 2000 May;76(895):289–291. doi: 10.1136/pmj.76.895.289

Unreliability of cardiothoracic ratio as a marker of left ventricular impairment: comparison with radionuclide ventriculography and echocardiography

A Clark 1, A Coats 1
PMCID: PMC1741581  PMID: 10775282

Abstract

BACKGROUND—The size of the heart assessed by cardiothoracic ratio on chest radiography is often used as a screening test for the presence of heart failure and for assessing its severity.
METHODS—We compared cardiothoracic ratio (CTR), left ventricular ejection fraction (LVEF) from radionuclide ventriculography, and left ventricular dimensions from echocardiography in a population of 91 patients (aged 60.4 (SD 9.6) years) with a diagnosis of chronic heart failure.
RESULTS—There was a weak relation between CTR and LVEF (R=0.33) and fractional shortening from echocardiography (R=0.22). LVEF and fractional shortening correlated more closely (R=0.55). No measure of left ventricular function correlated with exercise capacity as measured by peak oxygen consumption. For the group of patients with a normal fractional shortening (n=17), the left ventricle was dilated in all but two (mean end diastolic dimension 5.9 (0.7) cm). The two with normal dimensions had a low ejection fraction. For the 12 patients with a CTR in the normal range, the left ventricular end diastolic dimension was only slightly smaller than for the rest (6.2 (0.9) v 6.9 (1.2); p=0.045).
CONCLUSIONS—Chest radiography is not a reliable indicator of the degree of left ventricular dysfunction. Echocardiography and radionuclide ventriculography are more appropriate investigations for assessing cardiac function.


Keywords: chronic heart failure; chest radiography; radionuclide ventriculography; echocardiography

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Selected References

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  1. Alam M., Rosenhamer G., Höglund C. Comparability of echocardiography and chest X-ray following myocardial infarction. J Intern Med. 1989 Sep;226(3):171–175. doi: 10.1111/j.1365-2796.1989.tb01375.x. [DOI] [PubMed] [Google Scholar]
  2. Albin G., Rahko P. S. Comparison of echocardiographic quantitation of left ventricular ejection fraction to radionuclide angiography in patients with regional wall motion abnormalities. Am J Cardiol. 1990 Apr 15;65(15):1031–1032. doi: 10.1016/0002-9149(90)91009-u. [DOI] [PubMed] [Google Scholar]
  3. Carlson K. J., Lee D. C., Goroll A. H., Leahy M., Johnson R. A. An analysis of physicians' reasons for prescribing long-term digitalis therapy in outpatients. J Chronic Dis. 1985;38(9):733–739. doi: 10.1016/0021-9681(85)90115-8. [DOI] [PubMed] [Google Scholar]
  4. Chakko S., Woska D., Martinez H., de Marchena E., Futterman L., Kessler K. M., Myerberg R. J. Clinical, radiographic, and hemodynamic correlations in chronic congestive heart failure: conflicting results may lead to inappropriate care. Am J Med. 1991 Mar;90(3):353–359. doi: 10.1016/0002-9343(91)80016-f. [DOI] [PubMed] [Google Scholar]
  5. Choy A. M., Darbar D., Lang C. C., Pringle T. H., McNeill G. P., Kennedy N. S., Struthers A. D. Detection of left ventricular dysfunction after acute myocardial infarction: comparison of clinical, echocardiographic, and neurohormonal methods. Br Heart J. 1994 Jul;72(1):16–22. doi: 10.1136/hrt.72.1.16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Francis C. M., Caruana L., Kearney P., Love M., Sutherland G. R., Starkey I. R., Shaw T. R., McMurray J. J. Open access echocardiography in management of heart failure in the community. BMJ. 1995 Mar 11;310(6980):634–636. doi: 10.1136/bmj.310.6980.634. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Harlan W. R., oberman A., Grimm R., Rosati R. A. Chronic congestive heart failure in coronary artery disease: clinical criteria. Ann Intern Med. 1977 Feb;86(2):133–138. doi: 10.7326/0003-4819-86-2-133. [DOI] [PubMed] [Google Scholar]
  8. Himelman R. B., Cassidy M. M., Landzberg J. S., Schiller N. B. Reproducibility of quantitative two-dimensional echocardiography. Am Heart J. 1988 Feb;115(2):425–431. doi: 10.1016/0002-8703(88)90491-7. [DOI] [PubMed] [Google Scholar]
  9. Jensen-Urstad K., Bouvier F., Höjer J., Ruiz H., Hulting J., Samad B., Thorstrand C., Jensen-Urstad M. Comparison of different echocardiographic methods with radionuclide imaging for measuring left ventricular ejection fraction during acute myocardial infarction treated by thrombolytic therapy. Am J Cardiol. 1998 Mar 1;81(5):538–544. doi: 10.1016/s0002-9149(97)00964-8. [DOI] [PubMed] [Google Scholar]
  10. Madsen E. B., Gilpin E., Slutsky R. A., Ahnve S., Henning H., Ross J., Jr Usefulness of the chest x-ray for predicting abnormal left ventricular function after acute myocardial infarction. Am Heart J. 1984 Dec;108(6):1431–1436. doi: 10.1016/0002-8703(84)90688-4. [DOI] [PubMed] [Google Scholar]
  11. Marantz P. R., Tobin J. N., Wassertheil-Smoller S., Steingart R. M., Wexler J. P., Budner N., Lense L., Wachspress J. The relationship between left ventricular systolic function and congestive heart failure diagnosed by clinical criteria. Circulation. 1988 Mar;77(3):607–612. doi: 10.1161/01.cir.77.3.607. [DOI] [PubMed] [Google Scholar]
  12. McKee P. A., Castelli W. P., McNamara P. M., Kannel W. B. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971 Dec 23;285(26):1441–1446. doi: 10.1056/NEJM197112232852601. [DOI] [PubMed] [Google Scholar]
  13. Parameshwar J., Keegan J., Sparrow J., Sutton G. C., Poole-Wilson P. A. Predictors of prognosis in severe chronic heart failure. Am Heart J. 1992 Feb;123(2):421–426. doi: 10.1016/0002-8703(92)90656-g. [DOI] [PubMed] [Google Scholar]
  14. Stevenson L. W., Perloff J. K. The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. JAMA. 1989 Feb 10;261(6):884–888. [PubMed] [Google Scholar]
  15. Wackers F. J., Berger H. J., Johnstone D. E., Goldman L., Reduto L. A., Langou R. A., Gottschalk A., Zaret B. L. Multiple gated cardiac blood pool imaging for left ventricular ejection fraction: validation of the technique and assessment of variability. Am J Cardiol. 1979 Jun;43(6):1159–1166. doi: 10.1016/0002-9149(79)90148-6. [DOI] [PubMed] [Google Scholar]

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