Cardiothoracic ratio within the "normal" range independently predicts mortality in patients undergoing coronary angiography
- 1 April 2007
- Vol. 93 (4), 491-494
- https://doi.org/10.1136/hrt.2006.101238
Abstract
Objective: To determine whether cardiothoracic ratio (CTR), within the range conventionally considered normal, predicted prognosis in patients undergoing coronary angiography. Design: Cohort study with a median of 7-years follow-up. Setting: Consecutive patients undergoing coronary angiography at Barts and The London National Health Service (NHS) Trust. Subjects: 1005 patients with CTRs measured by chest radiography, and who subsequently underwent coronary angiography. Of these patients, 7.3% had a CTR ⩾0.5 and were excluded from the analyses. Outcomes: All-cause mortality and coronary event (non-fatal myocardial infarction or coronary death). Adjustments were made for age, left ventricular dysfunction, ACE inhibitor treatment, body mass index, number of diseased coronary vessels and past coronary artery bypass graft. Results: The risk of death was increased among patients with a CTR in the upper part of the normal range. In total, 94 (18.9%) of those with a CTR below the median of 0.42 died compared with 120 (27.8%) of those with a CTR between 0.42 and 0.49 (log rank test p<0.001). After adjusting for potential confounders, this increased risk remained (adjusted HR 1.45, 95% CI 1.03 to 2.05). CTR, at values below 0.5, was linearly related to the risk of coronary event (test for trend p = 0.024). Conclusion: : In patients undergoing coronary angiography, CTR between 0.42 and 0.49 was associated with higher mortality than in patients with smaller hearts. There was evidence of a continuous increase in risk with higher CTR. These findings, along with those in healthy populations, question the conventional textbook cut-off point of ⩾0.5 being an abnormal CTR.Keywords
This publication has 21 references indexed in Scilit:
- The clinical characteristics and investigations planned in patients with stable angina presenting to cardiologists in Europe: from the Euro Heart Survey of Stable AnginaEuropean Heart Journal, 2005
- Magnitude and consequences of error in coronary angiography interpretation (the ACRE study)The American Journal of Cardiology, 2000
- Pathophysiology of myocardial perfusion in hypertension.1991
- Prognostic Implications of Echocardiographically Determined Left Ventricular Mass in the Framingham Heart StudyThe New England Journal of Medicine, 1990
- The spectrum of left ventricular hypertrophy in a general population sample: the Framingham Study.1987
- Prognostic value of angiographic indices of coronary artery disease from the Coronary Artery Surgery Study (CASS).JCI Insight, 1983
- Relationship of cardiothoracic ratio and plain film heart volume to late survival.Circulation, 1979
- Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method.Circulation, 1977
- Letter: Grading of angina pectoris.Circulation, 1976
- Prognostic significance of coronary arteriography.1970