Key result
A chest radiograph-derived cardiothoracic ratio cutoff of 50% discriminated patients with a plasma BNP level ≥100 pg/mL with an area under the curve of 0.77, a sensitivity of 76.5%, and a specificity of 64.6%.
Why the study?
The utility of chest X-ray in screening high-risk elderly patients for heart failure with preserved ejection fraction has not been tested.
Does chest radiograph-derived cardiothoracic ratio (CTR) detect elevated plasma BNP levels (≥100 pg/mL) in older adults visiting the emergency department?
Observational (n=300)
No
Does chest radiograph-derived cardiothoracic ratio (CTR) detect elevated plasma BNP levels (≥100 pg/mL) in older adults visiting the emergency department?
Effect estimate: AUC 0.77 (95% CI 0.71-0.82)
A chest radiograph-derived cardiothoracic ratio cutoff of 60% provides high specificity (96.4%) for detecting elevated BNP levels (≥100 pg/mL) in unselected older emergency department patients.
May support chest radiography for heart failure screening; hypothesis-generating and requires prospective validation before adoption.
Chest X-ray is routine for diagnostic imaging in the emergency department. However, its utility in screening high-risk patients for heart failure has not been tested in the elderly population with heart failure who have preserved ejection fraction which barely shows left ventricular dilatation and systolic function as the dominant phenotype of heart failure. We retrospectively investigated the clinical utility of chest radiograph-derived cardiothoracic ratio (CTR) to detect patients with higher plasma B-type natriuretic peptide (BNP) levels in consecutive 108 patients visited the emergency department of our university hospital. CTR showed a significant positive correlation with log BNP ( r = 0.59, P 0.0001). Although CTR showed a significant correlation with left atrial diameter (r = 0.45, P ‹0.0001), it showed weak correlations with left ventricular end-diastolic diameter ( r = 0.21, P = 0.0285). We found that CTR discriminates patients with a plasma BNP level equal to or more than 100 pg/mL with an area under the curveof0.773(P‹0.0001).ACTRcutoff value of 60% showed a sensitivity of 35.1%, specificity of 96.4%, positive likelihood ratio of 9. 75, and negative-likelihood ratio of 0. 67. In conclusion, chest radiograph-derived cardio- thoracic ratio is a simple and powerful tool to screen high-risk patients for heart failure in the era of an aging society.
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Ohara et al. (2023) conducted an observational in Heart failure screening in emergency department patients (n=300). Chest radiograph-derived cardiothoracic ratio (CTR) vs. Unexposed/reference group (different CTR cutoffs) was evaluated on Detection of plasma BNP level ≥ 100 pg/mL (AUC 0.77, 95% CI 0.71-0.82). A chest radiograph-derived cardiothoracic ratio cutoff of 50% discriminated patients with a plasma BNP level ≥100 pg/mL with an area under the curve of 0.77, a sensitivity of 76.5%, and a specificity of 64.6%.
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