Diagnostic accuracy of cardiothoracic ratio on admission chest radiography to detect left or right ventricular systolic dysfunction: a retrospective study

Chana, Harmeet; Martin, Claire; Cakebread, Holly E; Adjei, Felicia D; Gajendragadkar, Parag R

doi:10.1177/0141076815588314

Cited by 14 publications

(9 citation statements)

References 31 publications

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“…The researchers highlighted the problem of a lack of correlation between a “big heart” and its dysfunction. This is probably due to the development of diagnostics and the implementation of prior treatment; therefore, a large heart cannot be equated to a heart with the presence of dysfunction [ 19 ]. It is important to know whether the CTR may normalize or decrease with the introduction of treatment and whether the CTR may be a prognostic factor in this situation.…”

Section: Ctr and Heart Functionmentioning

confidence: 99%

Radiological Cardiothoracic Ratio in Evidence-Based Medicine

Truszkiewicz¹,

Poręba

Gać

2021

JCM

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The cardiothoracic ratio (CTR), expressing the relationship between the size of the heart and the transverse dimension of the chest measured on a chest PA radiograph, is a commonly used parameter in the assessment of cardiomegaly with a cut-off value of 0.5. A value of >0.5 should be interpreted as enlargement of the heart. The following review describes the current state of available knowledge in terms of contentious issues, limitations and useful aspects regarding the CTR. The review was carried out on the basis of an analysis of scientific articles available in the PubMed database, searched for using the following keywords: “CTR”, “cardiothoracic ratio”, “cardiopulmonary ratio”, “cardiopulmonary index”, and “heart-lung ratio”. According to the accumulated knowledge, the CTR can still be used as an important parameter that can be easily determined in establishing enlargement of the heart. However, an increased CTR does not directly relate to heart function. In the era following the development of diagnostic methods such as computed tomography, magnetic resonance imaging, and ultrasonography, CTR modifications based on these methods are used with varying clinical usefulness. It is important to consider the definition of the CTR and remember to base measurements on PA radiographs, as attempts to mark it in other projections face many limitations.

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Section: Ctr and Heart Functionmentioning

confidence: 99%

Radiological Cardiothoracic Ratio in Evidence-Based Medicine

Truszkiewicz¹,

Poręba

Gać

2021

JCM

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“…On the contrary, CTR in patients with NSTEMI showed lower sensitivity (40%) but higher specificity (91%) in detecting cardiomegaly compared to echocardiography, however in this study, cardiomegaly was described as an enlargement of the right or left ventricle [18]. Furthermore, Chana et al found CTR to have a limited value in detecting left and/or right ventricular dysfunction (0.7 AUC, 73.9% sensitivity and 47.4% specificity) [19].…”

Section: Discussionmentioning

confidence: 54%

Limitations of cardiothoracic ratio derived from chest radiographs to predict real heart size: comparison with magnetic resonance imaging

et al. 2021

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Background Cardiothoracic ratio (CTR) in chest radiographs is still widely used to estimate cardiac size despite the advent of newer imaging techniques. We hypothesise that a universal CTR cut-off value of 50% is a poor indicator of cardiac enlargement. Our aim was to compare CTR with volumetric and functional parameters derived from cardiac magnetic resonance imaging (MRI). Methods 309 patients with a chest radiograph and cardiac MRI acquired within a month were reviewed to assess how CTR correlates with multiple cardiac MRI variables: bi-ventricular EDV (absolute and indexed to body surface area), EF, indexed total heart volume and bi-atrial areas. In addition, we have also determined CTR accuracy by creating multiple ROC curves with the described variables. Results All cardiac MRI variables correlate weakly but statistically significantly with CTR. This weak correlation is explained by a substantial overlap of cardiac MRI parameters in patients with normal and increased CTR. For all variables, CTR was only mildly to moderately better than a chance to discriminate cardiac enlargement (AUC 0.6–0.7). Large CTR values (> 55%) are specific but not sensitive, while low CTR values (< 45%) are sensitive but not specific. Values in between are not sensitive nor specific. Conclusions CTR correlates weakly with true chamber size assessed by gold standard cardiac MRI and has a weak discriminatory power. Thus, clinical decisions based on intermediate CTRs (45–55%) should be avoided. Large CTRs (> 55%) are likely indicative of true heart chamber enlargement. Low CTRs (< 45%) are likely indicative of normal heart size.

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“…Felkai et al (2014) claimed that the presence of pleural residual leakage and cardiomegaly were associated with increased VHS values in the primate Cercopithecus neglectus, which was later confirmed by echocardiographic examination. In humans, a cardiothoracic ratio of >0.5 on a postero-anterior radiograph showed a good predictor of left ventricular dysfunction (Chana et al 2015). Studies have aimed to standardize CTR values in nonhuman primates (Schillaci et al 2009) and wild rodents (Moura et al 2015), but are still scarce in several wild species, with no reports for species proposed in this research.…”

Section: Introductionmentioning

confidence: 93%

Assessment of the vertebral heart scale and cardiothoracic ratio to standardize the heart size of collared peccaries (Tayassu tajacu Linnaeus, 1758) restrained with ketamine and midazolam

et al. 2018

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Wild species, especially those threatened with extinction, are increasingly being investigated to obtain information that can be useful for their preservation. The objective of the present study was to standardize the vertebral heart scale (VHS) and cardiothoracic ratio (CTR) of the collared peccary (Tayassu tajacu Linnaeus, 1758) sedated with ketamine and midazolam. Fourteen clinically healthy collared peccaries were examined in the two-year age group weighing 15-22kg. The animals were submitted to digital radiography of the thorax in lateral and dorsal ventral projections to calculate the VHS and CTR. The VHS mean values for males and females was 8.88±0.51v for right recumbency and 8.84±0.39v for left decubitus, and there were no significant between-gender differences regarding recumbency (p>0.05). The CTR showed mean values of 0.50±0.05 (males) and 0.45±0.04 (females), but the gender-differences were not significant (p>0.05). A positive correlation was shown between VHS and CTR (r=0.98, right decubitus; r=0.96, left decubitus). Establishing reference values for heart measurements in collared peccaries using digital radiography of the thorax permitted standardization of the VHS and CTR values for this wild species. In the studied wild animal model, the VHS and CTR heart assessment indexes were shown to be essential diagnostic tools for investigations of alterations in the size of the cardiac silhouette.

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Diagnostic accuracy of cardiothoracic ratio on admission chest radiography to detect left or right ventricular systolic dysfunction: a retrospective study

Cited by 14 publications

References 31 publications

Radiological Cardiothoracic Ratio in Evidence-Based Medicine

Radiological Cardiothoracic Ratio in Evidence-Based Medicine

Limitations of cardiothoracic ratio derived from chest radiographs to predict real heart size: comparison with magnetic resonance imaging

Assessment of the vertebral heart scale and cardiothoracic ratio to standardize the heart size of collared peccaries (Tayassu tajacu Linnaeus, 1758) restrained with ketamine and midazolam

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