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[Heart size and left ventricular function in coronary artery disease. II. Heart volume, coronary morphology and
Insights
Radiologically determined heart size can predict left ventricular function in coronary artery disease patients. Enlarged hearts correlate with myocardial infarction, while normal sizes are seen without it, aiding in assessing cardiac health.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Assessing left ventricular function is crucial in coronary artery disease (CAD).
- Radiological heart size is a simple measurement, but its predictive value for cardiac function needs clarification.
Purpose of the Study:
- To investigate the relationship between radiologically determined cardiac volume and coronary angiogram findings.
- To evaluate the association between cardiac size and left ventricular function parameters derived from laevocardiography in CAD patients.
Main Methods:
- Correlative analysis of cardiac volume (radiology) with coronary angiogram data.
- Laevocardiography to determine endsystolic volume, enddiastolic volume, and ejection fraction.
- Statistical analysis to assess the relationship between cardiac size and volumetric parameters, and to determine predictive values (sensitivity, specificity).
Main Results:
- No direct relationship was found between cardiac size and coronary angiogram findings.
- Enlarged hearts were observed in patients with ECG-evidence of myocardial infarction, while normal sizes were found in those without.
- A significant correlation (r=0.73, 0.55, 0.69) exists between cardiac volume and endsystolic, enddiastolic volumes, and ejection fraction.
- Using the upper boundary of 1-SD for heart size yielded 81% specificity and 74% sensitivity for predicting pathological ejection fraction.
- Using the upper boundary of 2-SD improved specificity to 92% but reduced sensitivity to 58%.
Conclusions:
- Radiologically determined heart size is a simple, practical method for assessing and monitoring left ventricular function in patients with coronary artery disease.
- Heart size can serve as an indicator of myocardial infarction and predict abnormal ejection fraction, particularly when using specific cut-off values.
Abstract:
We have investigated the possible relationship between the radiogically determined cardiac volume and the coronary angiogram and laevocardiogram. There was no relationship between cardiac size and coronary angiogram. Independently from the number of coronary vessels involved, we found normal sized hearts in patients without ECG-evidence of myocardial infarction, and enlarged hearts in patients with ECG-evidence of myocardial infarction. There was a significant, though loose relationship between the cardiac volume and the endsystolic and enddiastolic volumes (r=0.73 and 0.55 respectively) and the ejection fraction (r=0.69) as determined by laevocardiography. The critical value of the cardiac size, about which one encounters an increased number of abnormal volume parameters, was the upper boundary of 1-SD. Using this value we found a specifity of 81% and a sensitivity of 74% for the heart volume as a predictor of a pathological ejection fraction. On the other hand, using the upper boundary of 2-SD as a critical value, there was a sensitivity of only 58%, but a specificity of 92%. Only 11% of the patients with a cardiac size in the lower range of normal or below had an ejection fraction below 50%. Therefore the radiologically determined heart size is a simple, in daily practive acceptable method to assess and follow up left ventricular function in coronary patients.