The cardiothoracic ratio—an inaccurate and outdated measurement: new data from CT

Screaton, Nick

doi:10.1007/s00330-010-1721-y

Cited by 20 publications

(8 citation statements)

References 3 publications

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“…The standard PA CXR (taken by analog calibrated Toshiba system with this criteria: Beam limiting device, model TF-6TL-6, input 1-phase 50/60Hz AC12V, max input power 100VA, max tube voltage 150KV, filtration 1.2 mm) was taken on deep inspiration which was interpreted only by one radiologist and CTR was recorded as shown in Figure 1, which is less than 50 % in normal condition (6, 11, 17). …”

Section: Methodsmentioning

confidence: 99%

“…Enlarged heart size is an independent predictor of death, and an increased CTR in CXR, irrespective of its etiology, is associated with poor prognosis in middle-aged patients. This issue is indicative of great importance and necessity of early diagnosis, especially in older patients (6-11). …”

Section: Introductionmentioning

confidence: 99%

“…Above all, more than 75% of physicians in Iran are general practitioners and less than 25% are specialists (of course only a few of them are cardiologist). Furthermore, availability of medical instruments could play a significant role, especially at first line of diagnosis (11). Having considered the aforementioned issues, we designed this study to compare radiological findings of CXR with echocardiography in determination of the heart size and show the value of standard PA CXR as a cost-effective and applicable approach in diagnosis of the heart size.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Radiological Findings of Chest X-Ray With Echocardiography in Determination of the Heart Size

Monfared¹,

Farajollah²,

Sabour³

et al. 2015

Iran Red Crescent Med J

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Background:Heart size is an important and effective parameter in chest X-ray (CXR) interpretation. Studies indicate that, especially in middle-aged men, increased cardiothoracic ratio (CTR) is associated with ischemic heart disease (IHD) and increased rate of morbidity and mortality. The CXR is the most common imaging examination of the heart.Objectives:A good quality posterior-anterior (PA) chest radiograph is an important indicator of the cardiac size. Nowadays, CXR has given its place to more advanced approaches such as two-dimensional echocardiography. However, CXR is still more accessible and feasible for most of the physicians. This study was designed to compare the findings of CXR and echocardiography in determination of the heart size.Patients and Methods:This cross-sectional study was carried out from 2006 to 2007. A total of 197 patients entered the study. The cases had been undergone PA CXR and 2-D echocardiography maximum within two days.Results:Of participants, 24.9% had cardiomegaly according to the findings of CXR and 50.8% based on echocardiography. There was a statistically significant difference between the mean size of Right Ventricular End Diastolic Diameter in the patients with cardiothoracic ratio < 50% and ≥ 50% (P = 0.002) as well as Left Ventricular End Diastolic Diameter (P = 0.023). Also, a statistically significant difference was seen between echocardiography and CXR findings with regard to determination of the heart size (P = 0.003). Nonetheless, it is noteworthy that sensitivity and specificity of CXR findings in the diagnosis of cardiomegaly were 34%, and 84.5%, respectively.Conclusions:CTR is the most common method of describing the heart size. Increased CTR in CXR is associated with poor prognosis, which is suggestive of importance and necessity of early diagnosis. Although CXR may not have the same diagnostic accuracy as echocardiography, its easy accessibility and high specificity in diagnosis of cardiomegaly is very helpful, which can play an important and a cost-benefit role, particularly in screening the enlarged heart size. Moreover, according to the statistics released by Medical Council of Iran, most of Iranian physicians are general practitioners and a few of them are cardiologist.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Radiological Findings of Chest X-Ray With Echocardiography in Determination of the Heart Size

Monfared¹,

Farajollah²,

Sabour³

et al. 2015

Iran Red Crescent Med J

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show abstract

“…Although we have not studied animals with the presence of cardiopathies, the proximity between these values suggests that, potentially, the peccary may present cut-off points close to those reported in humans for the determination of cardiac pathological alterations. Screaton (2010) demonstrated that the CTR was intimately related to the volume of the left ventricle. Rubens (1996) described CTR values of over 0.5 in humans as pathological.…”

Section: Discussionmentioning

confidence: 98%

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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“…Pulmonary hypertension as defined as estimated right ventricular systolic pressure > 40 mmHg by echocardiographic evaluation using simplified Bernoulli equation ( 12 13 ). The cardiothoracic ratio (CTR) was measured in the initial chest radiograph and cardiomegaly was defined as CTR > 0.55 ( 14 15 ).…”

Section: Methodsmentioning

confidence: 99%

Natural Course of Adult Ebstein Anomaly When Treated according to Current Recommendation

et al. 2016

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The objectives of this study were to assess the clinical outcomes of adults with Ebstein Anomaly (EA) according to their treatment modalities. All adult EA patients diagnosed between October 1994 and October 2014 were retrospectively evaluated by medical record review. Total 60 patients were categorized into 3 groups according to their treatment strategy, i.e. non-operative treatment (Group I, n = 23), immediate operative treatment (Group II, n = 27), and delayed operative treatment (Group III, n = 10). A composite of major adverse cardiac and cerebrovascular events (MACCE) and factors associated with MACCE were assessed in each treatment group. MACCE occurred in 13.0% patients in Group I, 55.6% patients in Group II and 50% in Group III (P = 0.006). Event free survivals at 5 years were 90% in Group I, 52.7% in Group II, 50.0% in Group III (P = 0.036). Post-operatively, most patients showed improvement on clinical symptoms. However, event free survival rate was lower in patients with operation compared to those with non-operative treatment (58.7% vs. 90.9%; P = 0.007). Major arrhythmic event occurred more frequently even after surgical ablation (50.0% vs. 20.0%; P = 0.034). Re-operation was more frequent in patients underwent delayed surgery compared to those with immediate surgery (50.0% vs. 18.5%; P = 0.001). Current guideline to decide patient’s treatment strategy appeared to be appropriate in adult patients with EA. However, surgical ablation for arrhythmia was not enough so that concomitant medical treatment should be considered. Therefore, attentive risk stratification and cautious decision of treatment strategy by experienced cardiac surgeon are believed to improve clinical outcome.

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The cardiothoracic ratio—an inaccurate and outdated measurement: new data from CT

Cited by 20 publications

References 3 publications

Comparison of Radiological Findings of Chest X-Ray With Echocardiography in Determination of the Heart Size

Comparison of Radiological Findings of Chest X-Ray With Echocardiography in Determination of the Heart Size

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

Natural Course of Adult Ebstein Anomaly When Treated according to Current Recommendation

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