Clinical implications of chest x-ray parameters in evaluating patients with cardiac dyspnea

To evaluate the relationship between aortic arch calcification and clinical and radiographical parameters on chest radiography.

We retrospectively evaluated 242 consecutive patients that were admitted to our intensive care unit for dyspnea. Chest radiography was performed for all patients with the posteroanterior view. Cardiothoracic ratio (CTR), mediastinal ratio (MR), aortic width (AW) parameters and the grade of aortic calcification were recorded. Patients with grade 1, 2 or 3 were defined as the calcification-positive (+) group and patients having no calcification (grade 0) were defined as the calcification-negative (-) group. Statistical analyses were performed on both groups.

The study population consisted of 124 (51.2%) female and 118 (48.8%) male patients. The mean age was 67 ± 12 (range: 25-101) years. There was no significant relationship between aortic arch calcification and gender, presence of hypertension, diabetes mellitus, lipid levels, AW and MR, but age was correlated positively with aortic arch calcification with high statistical significance (p<0.0001). In patients with coronary artery disease (CAD), the prevalence of aortic arch calcification tended to be higher but was not statistically significant (p=0.07). The grade of calcification was not found to be correlated with gender, comorbidity, lipid levels, MR or CTR. However, as the grade of calcification increased, the mean age of patients in consecutive calcification grade groups tended to increase significantly. CTR, MR and AW increased with age. However, on regression analysis, only age was found to be an independent factor for aortic knob calcification (β=0.397, t=6.375, p<0.0001).

Simple, useful radiographical parameters such as AW, CTR, MR and calcification grade can help to predict the etiology of dyspnea and cardiovascular disease.