Association between cardiothoracic ratio, left ventricular size and systolic function in patients undergoing computed tomography coronary angiography

Zhu,Yinsu; Xu,Hai; Zhu,Xiaomei; Wei,Yongyue; Yang,Guanyu; Xu,Yi; Tang,Lijun

doi:10.3892/etm.2014.2016

Association between cardiothoracic ratio, left ventricular size and systolic function in patients undergoing computed tomography coronary angiography

Authors:
- Yinsu Zhu
- Hai Xu
- Xiaomei Zhu
- Yongyue Wei
- Guanyu Yang
- Yi Xu
- Lijun Tang
View Affiliations

Affiliations: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China, Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China, Laboratory of Image Science and Technology, School of Computer Science and Engineering, Southeast University, Nanjing, Jiangsu 210096, P.R. China
Published online on: October 13, 2014 https://doi.org/10.3892/etm.2014.2016
Pages: 1757-1763

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study aimed to investigate the association between cardiothoracic ratio (CTR) and left ventricular (LV) systolic function parameters in patients with or without preserved LV ejection fraction (LVEF). A total of 203 subjects suspected with coronary artery disease underwent chest radiography and dual source computed tomography coronary angiography (DSCT‑CA). The LV systolic function parameters: LV end‑diastolic volume index (LVEDVI), LV end‑systolic volume index (LVESVI), and LVEF were measured from the DSCT‑CA. The association between CTR and LV systolic function parameters was analyzed according to LVEF value (<55%, depressed LVEF group; versus ≥55%, preserved LVEF group) and CTR value (<0.5, normal range CTR group; versus ≥0.5, larger CTR group). The LVEDVI and LVESVI were higher in the depressed LVEF group compared with the preserved LVEF group (108.56±57.15 vs. 67.52±14.56 ml/m2, P<0.001; and 64.07±37.81 vs. 20.23±7.23 ml/m2, P<0.001, respectively) and lower in the normal range CTR group compared with the larger CTR group (67.10±15.00 vs. 77.30±34.32 ml/m2, P=0.009 and 21.94±8.96 vs. 28.97±26.54 ml/m2, P=0.017, respectively). Significant correlations were found between CTR and LVEDVI, and LVESVI and LVEF in the depressed LVEF group (r=0.66, P<0.001; r=0.65, P<0.001; and r=‑0.46, P=0.018, respectively). However, there was no significant association detected between CTR and LV systolic function parameters in the other subgroups. The LVEDVI and LVESVI showed an inverse correlation with the LVEF in each group. Although the CTR was not a reliable indicator of LV size and systolic function in patients with preserved LVEF, it was correlated with LV size and LVEF in patients with depressed LVEF.

View Figures

View References

1	No authors listed. Guidelines for the evaluation and management of heart failure. Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Evaluation and Management of Heart Failure). Circulation. 92:2764–2784. 1995. View Article : Google Scholar
2	Goldsmith SR and Dick C: Differentiating systolic from diastolic heart failure: pathophysiologic and therapeutic considerations. Am J Med. 95:645–655. 1993. View Article : Google Scholar : PubMed/NCBI
3	Cohn JN and Rector TS: Prognosis of congestive heart failure and predictors of mortality. Am J Cardiol. 62:25A–30A. 1988. View Article : Google Scholar : PubMed/NCBI
4	Keogh AM, Baron DW and Hickie JB: Prognostic guides in patients with idiopathic or ischemic dilated cardiomyopathy assessed for cardiac transplantation. Am J Cardiol. 65:903–908. 1990. View Article : Google Scholar : PubMed/NCBI
5	Cintron G, Johnson G, Francis G, Cobb F and Cohn JN: Prognostic significance of serial changes in left ventricular ejection fraction in patients with congestive heart failure. The V-HeFT VA Cooperative Studies Group. Circulation. 87:VI17–VI23. 1993.PubMed/NCBI
6	Cohn JN, Archibald DG, Francis GS, et al: Veterans Administration. Cooperative Study on Vasodilator Therapy of Heart Failure: influence of prerandomization variables on the reduction of mortality by treatment with hydralazine and isosorbide dinitrate. Circulation. 75:IV49–IV54. 1987.
7	Kearney MT, Fox KA, Lee AJ, et al: Predicting sudden death in patients with mild to moderate chronic heart failure. Heart. 90:1137–1143. 2004. View Article : Google Scholar : PubMed/NCBI
8	Lee TH, Hamilton MA, Stevenson LW, et al: Impact of left ventricular cavity size on survival in advanced heart failure. Am J Cardiol. 72:672–676. 1993. View Article : Google Scholar : PubMed/NCBI
9	White HD, Norris RM, Brown MA, Brandt PW, Whitlock RM and Wild CJ: Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation. 76:44–51. 1987.PubMed/NCBI
10	Woo P, Mao S, Wang S and Detrano RC: Left ventricular size determined by electron beam computed tomography predicts significant coronary artery disease and events. Am J Cardiol. 79:1236–1238. 1997. View Article : Google Scholar : PubMed/NCBI
11	Laczkovics A, Grabenwöger F, Teufelsbauer H, Dock W, Wollenek G and Wolner E: Noninvasive assessment of acute rejection after orthotopic heart transplantation: value of changes in cardiac volume and cardiothoracic ratio. J Cardiovasc Surg (Torino). 29:582–586. 1988.
12	Hammermeister KE, Chikos PM, Fisher L and Dodge HT: Relationship of cardiothoracic ratio and plain film heart volume to late survival. Circulation. 59:89–95. 1979.PubMed/NCBI
13	Cohn JN, Johnson GR, Shabetai R, et al: Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure. The V-HeFT VA Cooperative Studies Group. Circulation. 87(6 Suppl): VI5–VI16. 1993.
14	Bertolet BD, Freund G, Martin CA, Perchalski DL, Williams CM and Pepine CJ: Unrecognized left ventricular dysfunction in an apparently healthy alcohol abuse population. Drug Alcohol Depend. 28:113–119. 1991. View Article : Google Scholar : PubMed/NCBI
15	Ernst ER, Shub C, Bailey KR, Brown LR and Redfield MM: Radiographic measurements of cardiac size as predictors of outcome in patients with dilated cardiomyopathy. J Card Fail. 7:13–20. 2001. View Article : Google Scholar : PubMed/NCBI
16	Giamouzis G, Sui X, Love TE, Butler J, Young JB and Ahmed A: A propensity-matched study of the association of cardiothoracic ratio with morbidity and mortality in chronic heart failure. Am J Cardiol. 101:343–347. 2008. View Article : Google Scholar : PubMed/NCBI
17	Dimopoulos K, Giannakoulas G, Bendayan I, et al: Cardiothoracic ratio from postero-anterior chest radiographs: a simple, reproducible and independent marker of disease severity and outcome in adults with congenital heart disease. Int J Cardiol. 166:453–457. 2013. View Article : Google Scholar
18	Chikos PM, Figley MM and Fisher L: Correlation between chest film and angiographic assessment of left ventricular size. AJR Am J Roentgenol. 128:367–373. 1977. View Article : Google Scholar : PubMed/NCBI
19	Clark AL and Coats AJ: Unreliability of cardiothoracic ratio as a marker of left ventricular impairment: comparison with radionuclide ventriculography and echocardiography. Postgrad Med J. 76:289–291. 2000. View Article : Google Scholar : PubMed/NCBI
20	Schlett CL, Kwait DC, Mahabadi AA, et al: Simple area-based measurement for multidetector computed tomography to predict left ventricular size. Eur Radiol. 20:1590–1596. 2010. View Article : Google Scholar : PubMed/NCBI
21	Hemingway H, Shipley M, Christie D and Marmot M: Cardiothoracic ratio and relative heart volume as predictors of coronary heart disease mortality. The Whitehall study 25 year follow-up. Eur Heart J. 19:859–869. 1998.PubMed/NCBI
22	Wiese TH, Rogalla P, Taupitz M, et al: Assessment of left ventricular volumes and function: intraindividual comparison of multi-slice spiral CT and electron beam CT in an animal model. Acta Radiol. 45:819–827. 2004.PubMed/NCBI
23	Rose CP and Stolberg HO: The limited utility of the plain chest film in the assessment of left ventricular structure and function. Invest Radiol. 17:139–144. 1982. View Article : Google Scholar : PubMed/NCBI
24	Owan TE, Hodge DO, Herges RM, et al: Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 355:251–259. 2006. View Article : Google Scholar : PubMed/NCBI
25	Maeder MT and Kaye DM: Heart failure with normal left ventricular ejection fraction. J Am Coll Cardiol. 53:905–918. 2009. View Article : Google Scholar : PubMed/NCBI
26	Jaffe CC and Weltin G: Echocardiography of the right side of the heart. Cardiol Clin. 10:41–57. 1992.PubMed/NCBI
27	Parmley WW: Pathophysiology and current therapy of congestive heart failure. J Am Coll Cardiol. 13:771–785. 1989. View Article : Google Scholar : PubMed/NCBI
28	Fleischmann KE, Goldman L, Robiolio PA, et al: Echocardiographic correlates of survival in patients with chest pain. J Am Coll Cardiol. 23:1390–1396. 1994. View Article : Google Scholar : PubMed/NCBI
29	Galderisi M, Lauer MS and Levy D: Echocardiographic determinants of clinical outcome in subjects with coronary artery disease (the Framingham Heart Study). Am J Cardiol. 70:971–976. 1992. View Article : Google Scholar : PubMed/NCBI