Routine Chest X-ray: Still Valuable for the Assessment of Left Ventricular Size and Function in the Era of Super Machines
Routine Chest X-ray: Still Valuable for the Assessment of Left Ventricular Size and Function in the Era of Super Machines
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DOI：
10.4103/2156-7514.96540
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发表时间：
2012-05-01
影响因子：
0.9
通讯作者：
Rovai, Daniele
中科院分区：
文献类型：
--
作者：
Morales, Maria-Aurora;Prediletto, Renato;Rovai, Daniele
目的：随着技术的进步和昂贵技术的发展，在临床实践中评价左心室(LV)扩张和功能障碍的胸部X光检查的价值逐渐降低。尽管关于这种广泛可用的技术在心脏评估中的作用有争议的数据报道，但众所周知，心胸比率可以预测左心功能不全患者NYHA分级的进展风险、住院时间和预后。本研究旨在通过与不同临床原因的磁共振成像(MRI)比较，评价胸部X线片测量心脏阴影横径[TDH]检测左室扩张和功能不全的可靠性。材料和方法：101例患者均在2天内行数字胸片、左心室容量和MRI测量射血分数(EF)。结果：TDH值与舒张末容量呈正相关(r=0.75，P<；0.0001)。女性以14.5 mm为界值判断LV舒张期容量为150毫升(敏感度：82%，特异度：69%)；男性以15.5 mm为界值判断LV舒张期容量为210毫升(敏感度：84%；特异度：72%)。TdH与LVEF呈负相关(r=-.54，P<；0.0001)。TDH的上述临界值可区分左心室收缩功能不全患者--35%(敏感性和特异性：女性分别为67%和57%；男性分别为76%和59%)。结论：与心脏MRI相比，胸片能准确测量TDH值，仍可被认为是预测LV扩大的可靠技术。技术先进、价格昂贵、可获得性较低的成像技术应该在合理的临床要求的基础上进行。
Objectives: The development of technologically advanced, expensive techniques has progressively reduced the value of chest X-ray in clinical practice for the assessment of left ventricular (LV) dilatation and dysfunction. Although controversial data are reported on the role of this widely available technique in cardiac assessment, it is known that the cardio-thoracic ratio is predictive of risk of progression in the NYHA Class, hospitalization, and outcome in patients with LV dysfunction. This study aimed to evaluate the reliability of the transverse diameter of heart shadow [TDH] by chest X-ray for detecting LV dilatation and dysfunction as compared to Magnetic Resonance Imaging (MRI) performed for different clinical reasons. Materials and Methods: In 101 patients, TDH was measured in digital chest X-ray and LV volumes and ejection fraction (EF) by MRI, both exams performed within 2 days. Results: A direct correlation between TDH and end-diastolic volumes (r = .75, P < 0.0001) was reported. TDH cut-off values of 14.5 mm in females identified LV end-diastolic volumes > 150 mL (sensitivity: 82%, specificity: 69%); in males a cut-off value of 15.5 mm identified LV end-diastolic volumes > 210 mL (sensitivity: 84%; specificity: 72%). A negative relation was found between TDH and LVEF (r = -.54, P < 0.0001). The above cut-off values of TDH discriminated patients with LV systolic dysfunction - LVEF < 35% (sensitivity and specificity: 67% and 57% in females; 76% and 59% in males, respectively). Conclusions: Chest X-ray may still be considered a reliable technique in predicting LV dilatation by the accurate measurement of TDH as compared to cardiac MRI. Technologically advanced, expensive, and less available imaging techniques should be performed on the basis of sound clinical requests.