Daines Benjamin, Rao Sanjana, Hosseini Omid, Prieto Sofia, Abdelmalek John, Elmassry Mohamed, Sethi Pooja, Test Victor, Nugent Kenneth
Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
J Community Hosp Intern Med Perspect. 2021 Nov 15;11(6):787-792. doi: 10.1080/20009666.2021.1982488. eCollection 2021.
Chest radiographs can identify important abnormalities in patients undergoing diagnostic evaluation for cardiovascular diseases. Cardiomegaly often reflects cardiac chamber dilation, or cardiac muscle hypertrophy, or both conditions. The clinical implications of cardiomegaly depend on the underlying clinical disorder. Does cardiomegaly have any clinical, laboratory, echocardiographic, and right heart catheterization associations in patients undergoing evaluation for pulmonary hypertension?
Patients referred to a pulmonary vascular disease clinic for possible pulmonary hypertension underwent a comprehensive evaluation that included right heart catheterization. These patients also had chest radiographs, laboratory studies, and echocardiograms. The patients were divided into two groups based on the presence or absence of cardiomegaly.
This study included 102 patients (63.7% female) with a mean age of 62.3 ± 15.0 years. Patients with cardiomegaly (n = 64) had elevated BNP, BUN, and creatinine levels. They had elevated right atrial pressures, right ventricular pressures, and pulmonary artery pressures and reduced cardiac indices and reduced mixed venous oxygen saturations. There were no differences in echocardiographic parameters between the two groups.
This study demonstrates that the presence of cardiomegaly on chest radiographs has important clinical implications, including increased BNP levels and increased right heart pressures, in patients undergoing evaluation for pulmonary hypertension. Consequently, the presence of cardiomegaly supports the need for additional evaluation, including right heart catheterization, and provides useful information for primary care physicians and specialists.
胸部X线片可识别接受心血管疾病诊断评估患者的重要异常情况。心脏扩大通常反映心腔扩张、心肌肥厚或两者皆有。心脏扩大的临床意义取决于潜在的临床疾病。对于接受肺动脉高压评估的患者，心脏扩大是否与临床、实验室、超声心动图及右心导管检查结果存在关联？
转诊至肺血管疾病诊所怀疑患有肺动脉高压的患者接受了包括右心导管检查在内的全面评估。这些患者还进行了胸部X线片、实验室检查及超声心动图检查。根据有无心脏扩大将患者分为两组。
本研究纳入了102例患者（女性占63.7%），平均年龄为62.3±15.0岁。有心脏扩大的患者（n = 64）脑钠肽、血尿素氮和肌酐水平升高。他们的右心房压、右心室压和肺动脉压升高，心脏指数降低，混合静脉血氧饱和度降低。两组间超声心动图参数无差异。
本研究表明，对于接受肺动脉高压评估的患者，胸部X线片上出现心脏扩大具有重要的临床意义，包括脑钠肽水平升高和右心压力升高。因此，心脏扩大提示需要进行包括右心导管检查在内的进一步评估，并为初级保健医生和专科医生提供有用信息。
