A L Clark1, A J Coats. 1. Academic Unit, Department of Cardiology, Castle Hill Hospital, Castle Road, Cottingham, Kingston-upon-Hull HU16 5JQ, UK. A.L.Clark@medschool.hull.ac.uk
Abstract
BACKGROUND: The size of the heart assessed by cardiothoracic ratio on chest radiography is often used as a screening test for the presence of heart failure and for assessing its severity. METHODS: We compared cardiothoracic ratio (CTR), left ventricular ejection fraction (LVEF) from radionuclide ventriculography, and left ventricular dimensions from echocardiography in a population of 91 patients (aged 60.4 (SD 9.6) years) with a diagnosis of chronic heart failure. RESULTS: There was a weak relation between CTR and LVEF (R = 0.33) and fractional shortening from echocardiography (R = 0.22). LVEF and fractional shortening correlated more closely (R = 0.55). No measure of left ventricular function correlated with exercise capacity as measured by peak oxygen consumption. For the group of patients with a normal fractional shortening (n = 17), the left ventricle was dilated in all but two (mean end diastolic dimension 5. 9 (0.7) cm). The two with normal dimensions had a low ejection fraction. For the 12 patients with a CTR in the normal range, the left ventricular end diastolic dimension was only slightly smaller than for the rest (6.2 (0.9) v. 6.9 (1.2); p = 0.045). CONCLUSIONS: Chest radiography is not a reliable indicator of the degree of left ventricular dysfunction. Echocardiography and radionuclide ventriculography are more appropriate investigations for assessing cardiac function.
BACKGROUND: The size of the heart assessed by cardiothoracic ratio on chest radiography is often used as a screening test for the presence of heart failure and for assessing its severity. METHODS: We compared cardiothoracic ratio (CTR), left ventricular ejection fraction (LVEF) from radionuclide ventriculography, and left ventricular dimensions from echocardiography in a population of 91 patients (aged 60.4 (SD 9.6) years) with a diagnosis of chronic heart failure. RESULTS: There was a weak relation between CTR and LVEF (R = 0.33) and fractional shortening from echocardiography (R = 0.22). LVEF and fractional shortening correlated more closely (R = 0.55). No measure of left ventricular function correlated with exercise capacity as measured by peak oxygen consumption. For the group of patients with a normal fractional shortening (n = 17), the left ventricle was dilated in all but two (mean end diastolic dimension 5. 9 (0.7) cm). The two with normal dimensions had a low ejection fraction. For the 12 patients with a CTR in the normal range, the left ventricular end diastolic dimension was only slightly smaller than for the rest (6.2 (0.9) v. 6.9 (1.2); p = 0.045). CONCLUSIONS: Chest radiography is not a reliable indicator of the degree of left ventricular dysfunction. Echocardiography and radionuclide ventriculography are more appropriate investigations for assessing cardiac function.
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