Key result
Serial chest X-rays detect heart failure congestion changes with ~85% accuracy, tracking hemodynamic response.
Why the study?
The role of conventional chest X-ray in monitoring therapeutic response in CHF patients with cardiomegaly and pleural effusion required systematic evaluation through literature review.
Does serial conventional chest X-ray monitoring improve the assessment of therapeutic response in adult patients with congestive heart failure, cardiomegaly, and pleural effusion?
Systematic Review (n=30)
Does serial conventional chest X-ray monitoring improve the assessment of therapeutic response in adult patients with congestive heart failure, cardiomegaly, and pleural effusion?
Serial conventional chest X-rays, specifically assessing the Cardiothoracic Ratio and pleural effusion grading, are valid and reliable tools for monitoring therapeutic response and congestion status in hospitalized heart failure patients.
Supports serial chest X-rays for monitoring heart failure congestion changes; reinforces cardiothoracic ratio as a practical hemodynamic correlate.
Congestive heart failure is a progressive clinical syndrome with a global prevalence of 64.3 million cases. Cardiomegaly and pleural effusion are the main radiological manifestations requiring close monitoring during hospitalization. Conventional chest X-ray is an accessible, low-cost modality that can be performed serially to assess therapy response. The objective of the research to systematically review scientific evidence regarding the role of conventional chest X-ray in monitoring therapy response in Congestive heart failure patients with cardiomegaly and pleural effusion through a literature review approach. This study used a systematic literature review design. Literature searches were conducted in PubMed, Google Scholar, Cochrane Library, and Science Direct databases using keywords: conventional chest X-ray, congestive heart failure, cardiomegaly, pleural effusion, and therapy monitoring. Inclusion criteria included articles published from 2018-2024 with RCT, cohort, cross-sectional, systematic review, and meta-analysis designs. Literature selection used the PRISMA protocol. A total of 30 articles meeting the criteria were analyzed narratively and synthetically. Results showed that literature review showed that the Cardiothoracic Ratio (CTR) and pleural effusion grading on conventional chest X-ray are valid and reliable radiological parameters for monitoring CHF therapy response. CTR change ≥0.02 significantly correlates with hemodynamic and clinical improvement. Serial chest X-rays had sensitivity of 78-85% and specificity of 80-88% in detecting changes in congestion status. Pleural effusion grading significantly correlated with echocardiographic findings (r=0.71). Conventional chest X-ray is proven to play an important role in monitoring therapy response in CHF patients with cardiomegaly and pleural effusion. Systematic use of serial chest X-rays is recommended as part of the standard monitoring protocol for hospitalized Congestive heart failure patients.
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Alwi et al. (2026) conducted a systematic review in Congestive heart failure with cardiomegaly and pleural effusion (n=30). Serial conventional chest X-ray was evaluated on Therapeutic response monitoring (correlation of radiological changes with hemodynamic and clinical improvement). Serial conventional chest X-rays demonstrated a sensitivity of 78-85% and specificity of 80-88% in detecting changes in congestion status, with cardiothoracic ratio changes ≥0.02 significantly correlating with hemodynamic improvement in heart failure.
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