The relationship between cardiothoracic ratio and left ventricular ejection fraction in congestive heart failure

Edward F. Philbin, Rekha Garg, Kola Danisa, D. Marty Denny, Gilbert Gosselin, Constantine Hassapoyannes, Anne Horney, David E. Johnstone, Roberto M. Lang, K Ramanathan, Robert E. Safford, Radha J. Sarma, Robert Weiss, William O. Williford, Jerome L. Fleg

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)501-506
Number of pages6
JournalArchives of Internal Medicine
Volume158
Issue number5
DOIs
StatePublished - Mar 9 1998
Externally publishedYes

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Stroke Volume
Heart Failure
Right Ventricular Dysfunction
Digitalis
Radioisotopes
Heart Diseases
Thorax
Alcohols
Databases
Morbidity
Mortality

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Philbin, E. F., Garg, R., Danisa, K., Denny, D. M., Gosselin, G., Hassapoyannes, C., ... Fleg, J. L. (1998). The relationship between cardiothoracic ratio and left ventricular ejection fraction in congestive heart failure. Archives of Internal Medicine, 158(5), 501-506. https://doi.org/10.1001/archinte.158.5.501

The relationship between cardiothoracic ratio and left ventricular ejection fraction in congestive heart failure. / Philbin, Edward F.; Garg, Rekha; Danisa, Kola; Denny, D. Marty; Gosselin, Gilbert; Hassapoyannes, Constantine; Horney, Anne; Johnstone, David E.; Lang, Roberto M.; Ramanathan, K; Safford, Robert E.; Sarma, Radha J.; Weiss, Robert; Williford, William O.; Fleg, Jerome L.

In: Archives of Internal Medicine, Vol. 158, No. 5, 09.03.1998, p. 501-506.

Research output: Contribution to journalArticle

Philbin, EF, Garg, R, Danisa, K, Denny, DM, Gosselin, G, Hassapoyannes, C, Horney, A, Johnstone, DE, Lang, RM, Ramanathan, K, Safford, RE, Sarma, RJ, Weiss, R, Williford, WO & Fleg, JL 1998, 'The relationship between cardiothoracic ratio and left ventricular ejection fraction in congestive heart failure', Archives of Internal Medicine, vol. 158, no. 5, pp. 501-506. https://doi.org/10.1001/archinte.158.5.501
Philbin, Edward F. ; Garg, Rekha ; Danisa, Kola ; Denny, D. Marty ; Gosselin, Gilbert ; Hassapoyannes, Constantine ; Horney, Anne ; Johnstone, David E. ; Lang, Roberto M. ; Ramanathan, K ; Safford, Robert E. ; Sarma, Radha J. ; Weiss, Robert ; Williford, William O. ; Fleg, Jerome L. / The relationship between cardiothoracic ratio and left ventricular ejection fraction in congestive heart failure. In: Archives of Internal Medicine. 1998 ; Vol. 158, No. 5. pp. 501-506.
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abstract = "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.",
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AU - Garg, Rekha

AU - Danisa, Kola

AU - Denny, D. Marty

AU - Gosselin, Gilbert

AU - Hassapoyannes, Constantine

AU - Horney, Anne

AU - Johnstone, David E.

AU - Lang, Roberto M.

AU - Ramanathan, K

AU - Safford, Robert E.

AU - Sarma, Radha J.

AU - Weiss, Robert

AU - Williford, William O.

AU - Fleg, Jerome L.

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N2 - 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.

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