Fukuta Hidekatsu, Ohte Nobuyuki, Brucks Steffen, Carr J Jeffrey, Little William C
Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Am J Cardiol. 2007 Jan 1;99(1):62-7. doi: 10.1016/j.amjcard.2006.07.067. Epub 2006 Nov 3.
We investigated the contribution of a dilated right-sided heart to roentgenographic cardiomegaly in patients with heart failure (HF) and a normal ejection fraction (EF; diastolic HF) and those with HF and a decreased EF (systolic HF). We compared the cardiothoracic ratio (CTR) on upright chest roentgenograms and major- and minor-axis dimensions of the 4 cardiac chambers on echocardiograms in patients with HF and a normal EF (> or =0.50, n = 35) and those with a decreased EF (<0.50, n = 37) and examined the correlation between the CTR and cardiac chamber dimensions. The CTR did not differ between patients with normal and decreased EF values (0.58 +/- 0.07 vs 0.60 +/- 0.06, p = 0.26). Left-side cardiac chamber dimensions were substantially smaller in patients with a normal EF than in those with a decreased EF (left ventricular minor-axis dimension, 4.4 +/- 0.7 vs 5.8 +/- 0.8 cm, p <0.001). In contrast, right-side cardiac chamber dimensions were generally similar between groups. The CTR correlated with major-axis dimensions of the right ventricle and right atrium (p <0.01 for the 2 comparisons), but not with the left-side cardiac chamber dimensions (all p values >0.05). In conclusion, the CTR predominantly reflects right- rather than left-sided heart size in patients with HF. Right-sided heart size is similar between patients with normal and decreased EF values. Thus, despite the substantial difference in left ventricular size and EF, there is substantial overlap in the CTR between patients with diastolic and systolic HFs and the CTR is unable to discriminate between groups.
我们研究了右心扩大对心力衰竭（HF）且射血分数（EF）正常（舒张性HF）以及HF且EF降低（收缩性HF）患者X线心脏扩大的影响。我们比较了HF且EF正常（≥0.50，n = 35）和EF降低（<0.50，n = 37）患者直立位胸部X线片上的心胸比率（CTR）以及超声心动图上4个心腔的长轴和短轴尺寸，并检查了CTR与心腔尺寸之间的相关性。EF正常和降低的患者之间CTR无差异（0.58±0.07对0.60±0.06，p = 0.26）。EF正常的患者左心腔尺寸明显小于EF降低的患者（左心室短轴尺寸，4.4±0.7对5.8±0.8 cm，p<0.001）。相比之下，两组之间右心腔尺寸通常相似。CTR与右心室和右心房的长轴尺寸相关（两次比较p<0.01），但与左心腔尺寸无关（所有p值>0.05）。总之，HF患者的CTR主要反映右心大小而非左心大小。EF正常和降低的患者右心大小相似。因此，尽管左心室大小和EF存在显著差异，但舒张性和收缩性HF患者之间的CTR有很大重叠，且CTR无法区分两组。
