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Radiological Cardiothoracic Ratio as a Potential Marker of Left Ventricular Hypertrophy Assessed by Echocardiography
Krystian Truszkiewicz1, Piotr Macek2, Małgorzata Poręba3
1Center for Diagnostic Imaging, University Clinical Hospital in Wroclaw, Wroclaw, Poland.
Insights
The cardiothoracic ratio (CTR) on chest X-rays can help detect left ventricular hypertrophy (LVH). A CTR cutoff of 0.49 shows high accuracy in identifying LVH, serving as a useful screening tool.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Left ventricular hypertrophy (LVH) is a significant cardiovascular risk factor.
- Echocardiography is the gold standard for assessing LVH, but it is not always accessible.
- Radiological assessment using the cardiothoracic ratio (CTR) is a widely available imaging technique.
Purpose of the Study:
- To evaluate the utility of the cardiothoracic ratio (CTR) as a non-invasive marker for left ventricular hypertrophy (LVH).
- To compare CTR measurements with echocardiographic findings in a cohort of patients.
- To determine optimal CTR cut-off values for predicting different types of left ventricular geometry.
Main Methods:
- Retrospective analysis of 96 patients undergoing both chest radiography (PA projection) and echocardiography.
- Measurement of cardiothoracic ratio (CTR) from chest radiographs, with CTR > 0.50 indicating heart silhouette enlargement.
- Assessment of left ventricular geometry by echocardiography: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH).
Main Results:
- Patients with enlarged heart silhouettes (CTR > 0.50) showed significantly higher prevalence of LVH compared to those without.
- A CTR threshold of > 0.49 demonstrated high sensitivity (93.3%) and specificity (82.7%) for detecting LVH, yielding an overall accuracy of 84.4%.
- CTR > 0.49 accurately predicted CH (80.2% accuracy), while CTR > 0.52 was better for EH (71.9% accuracy), though CR prediction was less accurate.
Conclusions:
- The cardiothoracic ratio (CTR) is a moderately effective radiological marker for left ventricular hypertrophy (LVH) when compared to echocardiographic criteria.
- Establishing population-specific cut-off points for CTR is crucial for optimizing its diagnostic performance.
- CTR can serve as a valuable, accessible screening tool for LVH, particularly in resource-limited settings.
Abstract:
The aim of the study was to verify the usefulness of the radiological cardiothoracic ratio as a potential marker of left ventricular hypertrophy assessed by echocardiography. The study included 96 patients (mean age: 49.52 ± 9.64 years). Chest radiograph in the PA projection and echocardiography were performed. In CR the measurement of the cardiothoracic ratio (CTR) was performed. Assuming CTR > 0.50, heart silhouette enlargement was diagnosed. In echocardiography, four types of left ventricular geometry were assessed: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). It was shown that patients with an enlarged heart silhouette were characterized by a significantly more frequent occurrence of left ventricular hypertrophy (LVH) on echocardiography than patients with a nonenlarged heart silhouette. In the subgroup of patients with LVH compared to the subgroup of patients with normal left ventricular geometry, CTR values are statistically significantly higher, and heart silhouette enlargement is significantly more frequent. The criterion "CTR > 0.49" estimates LVH with a sensitivity of 93.3% and specificity of 82.7%, which translates into a high accuracy of 84.4%. By analyzing the prediction of left ventricular geometry types, high accuracy of CH prediction was obtained using the "CTR > 0.49" criterion of 80.2% (with a high sensitivity of 84.0% and a satisfactory specificity of 60.0%) and a high accuracy of EH prediction using the "CTR > 0.52" criterion of 71.9% (with high sensitivity 80.5% and low specificity 36.8%), as well as low CR prediction accuracy of only 57.3% (with low sensitivity 36.7%, even if high specificity 78.7%). In summary, the radiological cardiothoracic ratio may be a moderate marker of left ventricular hypertrophy assessed according to standard echocardiographic criteria, provided that its cut-off point is standardized in each population of subjects.
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