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Relationship between enlarged cardiac silhouette on chest X-ray and left ventricular size on transthoracic

Soohyun A Chang1, Jeffrey Yim2, Darwin F Yeung2

  • 1Division of Cardiology, University of British Columbia, 2775 Laurel Street, Vancouver, V5Z 1M9, Canada. s.chang@alumni.ubc.ca.

The International Journal of Cardiovascular Imaging
|December 30, 2021
PubMed

Insights

The cardiothoracic ratio on chest X-ray does not accurately predict left ventricular enlargement. Echocardiography measurements showed no significant correlation, indicating the ratio is unreliable for diagnosing this condition.

Area of Science:

  • Cardiology
  • Radiology
  • Diagnostic Imaging

Background:

  • The cardiothoracic ratio (CTR) on chest X-ray is traditionally associated with cardiomegaly.
  • Its diagnostic accuracy for detecting left ventricular (LV) enlargement remains poorly defined.
  • Accurate assessment of LV size is crucial for cardiovascular health management.

Purpose of the Study:

  • To evaluate the predictive accuracy of the CTR for LV enlargement.
  • To compare CTR with indexed linear measurements of the LV obtained via transthoracic echocardiography (TTE).

Main Methods:

  • Retrospective analysis of 173 patients who underwent both chest X-ray and TTE within 90 days.
  • LV end-diastolic dimension (LVEDD) and indexed LVEDDI were measured using TTE.
  • CTR was calculated from posteroanterior chest X-rays.

Main Results:

  • No significant correlation was found between CTR and LVEDD (r=0.011, p=0.879) or LVEDDI (r=0.122, p=0.111).
  • The CTR's ability to predict LV enlargement (LVEDDI > 30 mm/m²) was not statistically significant.
  • Mean CTR was 0.56 ± 0.09; mean LVEDDI was 27 ± 4.5 mm/m².

Conclusions:

  • The cardiothoracic ratio on chest X-ray is not a reliable predictor of left ventricular enlargement.
  • TTE provides more accurate indexed linear measurements for assessing LV size.
  • Relying on CTR alone for diagnosing LV enlargement may lead to misdiagnosis.

Keywords:
CardiomegalyCardiothoracic ratioChest X-rayEchocardiography

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