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Cardiothoracic ratio within the "normal" range independently predicts mortality in patients undergoing coronary

M Justin S Zaman1, Julie Sanders, Angela M Crook

  • 1Department of Epidemiology and Public Health, University College London, London, UK. j.zaman@ucl.ac.uk

Heart (British Cardiac Society)
|December 14, 2006
PubMed

Insights

A higher cardiothoracic ratio (CTR) within the normal range, specifically between 0.42 and 0.49, predicts increased mortality and coronary events in patients undergoing coronary angiography. This challenges the traditional threshold for abnormal CTR.

Area of Science:

  • Cardiology
  • Radiology
  • Prognostic Biomarkers

Background:

  • The cardiothoracic ratio (CTR), a measurement from chest radiography, is conventionally considered abnormal if greater than or equal to 0.5.
  • Its prognostic value within the normal range for patients undergoing coronary angiography is not well-established.

Purpose of the Study:

  • To investigate whether CTR, within the conventionally normal range, predicts prognosis in patients undergoing coronary angiography.
  • To evaluate the association between CTR and all-cause mortality and coronary events.

Main Methods:

  • A cohort study followed 1005 consecutive patients undergoing coronary angiography.
  • Cardiothoracic ratio was measured from chest radiography, excluding patients with CTR >= 0.5.
  • Outcomes included all-cause mortality and coronary events, with a median follow-up of 7 years.

Main Results:

  • Patients with a CTR between 0.42 and 0.49 had significantly higher all-cause mortality compared to those with a CTR below 0.42 (18.9% vs 27.8%, p<0.001).
  • This increased risk persisted after adjusting for confounders (adjusted HR 1.45).
  • A linear relationship was observed between increasing CTR (below 0.5) and the risk of coronary events (p=0.024).

Conclusions:

  • A CTR between 0.42 and 0.49 is associated with higher mortality in patients undergoing coronary angiography.
  • There is a continuous increase in risk with higher CTR values below the conventional threshold.
  • These findings suggest that the conventional cut-off of >= 0.5 for abnormal CTR may need re-evaluation.
Abstract

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