The relationship between cardiothoracic ratio and left ventricular ejection fraction in congestive heart failure
The relationship between cardiothoracic ratio and left ventricular ejection fraction in congestive heart failure
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DOI：
10.1001/archinte.158.5.501
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发表时间：
1998-03-09
影响因子：
--
通讯作者：
Fleg, JL
中科院分区：
文献类型：
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作者：
Philbin, EF;Garg, R;Fleg, JL
背景：左心室射血分数（EF）是判断充血性心力衰竭（CHF）患者预后的重要指标。虽然EF可以很容易地测量，但许多临床医生使用x线片心脏大小作为区分收缩期和舒张期功能障碍的线索，即使在缺乏可靠的支持数据的情况下。目的：验证胸片测量的胸廓比（CTR）可用于估计CHF患者左室EF的假设。方法：利用洋地黄研究组试验数据库回答这一问题。使用Danzer方法测定的CTR和局部使用血管造影、放射性核素或二维超声心动图技术测量的定量EF，比较了7476例由缺血性、高血压、特发性和酒精相关原因的左侧获得性心脏病引起的临床CHF（纽约心脏协会功能分级I-IV）患者。结果：该队列的平均（+/- sd） CTR为0.53 +/- 0.07。平均（+/- sd） EF为31.7% +/- 12.2%。CTR与EF呈弱负相关（r = -0.176）。当根据CHF的病因、临床定义的右室功能障碍的存在和EF测量方法对结果进行分层时，也得到了类似的结果。分类分析未能产生一个CTR截断点，以促进EF大于35%或小于35%的个体的有用隔离；大于40%或小于40%；在任何患者组中都大于45%或小于45%结论：虽然CTR和EF之间存在微弱的负相关，但这种关系不能准确测定单个CHF患者的收缩功能。考虑到与CHF相关的发病率和死亡率，以及该综合征的收缩功能的临床意义，建议直接测量EF。
Background: Left ventricular ejection fraction (EF) is a valuable prognostic index in patients with congestive heart failure (CHF). Although EF can be readily measured, many clinicians use roentgenographic heart size as a clue to differentiate systolic from diastolic dysfunction, even in the absence of solid supportive data.Objective: To test the hypothesis that the cardiothoracic ratio (CTR) measured from the chest roentgenogram can be used to estimate left ventricular EF in individuals with CHF.Methods: To answer this question, the database of the Digitalis Investigation Group trial was used. The CTR, determined using the Danzer method, and quantitative EF, measured locally using angiographic, radionuclide, or 2-dimensional echocardiographic techniques, were compared in 7476 patients with clinical CHF (New York Heart Association functional classes I-IV) due to acquired left-sided cardiac disease of ischemic, hypertensive, idiopathic, and alcohol-related causes.Results: Mean (+/-SD) CTR for the cohort was 0.53 +/- .07. Mean (+/-SD) EF was 31.7% +/- 12.2%. A weak, negative correlation between CTR and EF was observed (r = -0.176). Similar findings were obtained when the results were stratified by cause of CHF, presence of clinically defined right ventricular dysfunction, and method of EF measurement. Categorical analysis failed to yield a CTR cutoff point that facilitated useful segregation of individuals with an EF greater than 35% or 35% and below; greater than 40% or 40% and below; and greater than 45% or 45% and below in any patient group.Conclusions: Although a weak, negative correlation exists between CTR and EF, this relationship does not allow for accurate determination of systolic function in individual patients with CHF. Considering the morbidity and mortality associated with CHF, and the clinical implications of systolic function in this syndrome, direct measurement of EF is recommended.