Cardiothoracic Ratio as a Predictor of Cardiovascular Events in a Cohort of Hemodialysis Patients

Abstract

Aim: The cardiothoracic ratio (CTR) on a chest X-ray is an indicator of cardiac enlargement, although its predictive power for cardiovascular disease (CVD) events in chronic kidney disease is unknown. We examined it in a cohort of hemodialysis patients, as compared with an N-terminal fragment of probrain natriuretic peptide (NT-proBNP).Method: This was an observational study with cross-sectional and longitudinal analyses including 517 maintenance hemodialysis patients and 122 healthy control subjects. The main predictors were CTR and serum NT-proBNP, and the main outcome was CVD events in 5 years.Results: At baseline, the hemodialysis patients had higher median (interquartile range) levels of CTR [0.487 (0.457–0.520)] than the control group [0.458 (0.432–0.497)]. In the hemodialysis group, CTR was positively correlated with NT-proBNP (Spearman's r = 0.44, P < 0.001). During follow-up, 190 CVD events occurred. CTR was significantly associated with the risk of CVD [HR 2.12 (95% CI, 1.38–3.25) for the fourth quartile as compared with the second quartile of CTR] in a multivariate Cox model. In the same model, NT-proBNP (fourth versus first quartile) showed a HR of 3.27 (2.02–5.31). When CTR and NT-proBNP were simultaneously included as predictors, only NT-proBNP remained a significant predictor of CVD events, all-cause mortality and composite of CVD plus all-cause mortality.Conclusions: We showed that CTR was a significant and independent predictor of CVD in hemodialysis patients. CTR can be used for CVD risk stratification in hemodialysis patients when NT-proBNP is not available.

Follow-up of isolated congenital complete atrioventricular block with longitudinal measurements of serum NT-proBNP and cardiothoracic ratio

“…Unlike NT -proBNP, CTR is not influenced by renal function 1) . CTR increases with cardiac hypertrophy, but it can also be influenced by other factors such as extracellular volume and pulmonary diseases such as pulmonary hypertension 11,12) . At the aforementioned four periods, the transition of this patient's CTR showed a temporary increase and decrease.…”

“…To our knowledge, there are no reports on the natural course of ICCAVB accompanied by serial changes of plasma NT -proBNP. We present a female preterm infant with ICCAVB in whom changes of plasma NT -proBNP were measured serially along with the cardiothoracic ratio (CTR) soon after birth 11,12) . This is the first report on combined use of CTR and NT -proBNP in the followup of ICCAVB.…”

Altered Serum n-6 Polyunsaturated Fatty Acid Profile and Risks of Mortality and Cardiovascular Events in a Cohort of Hemodialysis Patients

“…As described elsewhere, 12,28,29 we defined CVD events in the DREAM cohort as the composite of the events related to ischemic heart disease, ischemic stroke, hemorrhagic stroke, peripheral artery disease, congestive heart failure, and cardiac valve disease. Ischemic heart disease events included myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting.…”

“…The selection of participants of the DREAM cohort from the total dialysis patients of Inoue Hospital was previously shown. 12,28,29 Among the 518 total participants of the cohort, we excluded 1 patient because of missing PUFA measurement. The remaining 517 participants were included in this study.…”

Evaluating Cardiomegaly by Radiological Cardiothoracic Ratio as Compared to Conventional Echocardiography

“…They showed that the cardiac diameter, but not the CTR, was significantly correlated with the left ventricular size, the well-known predictor of cardiovascular morbidity and mortality. However, there are several studies that emphasize the utility of CTR in different entities [27][28][29][30][31]. Even CTR values that are within normal limits were found to have clinical implication.…”