A Quantitative Evaluation of Heart Size Measurements from Chest Roentgenograms

In order to assess the accuracy of radiographic parameters of left heart enlargement, quantitative biplane angiographic data was compared to chest X-ray data in 254 adults with various heart diseases. Cardiac silhouette volume measured from PA and lateral chest roentgenograms compared most favorably to the sum of the left ventricular mass, end-diastolic volume, and left atrial maximal volume (r = 0.78, P < 0.01; 79% accuracy). The cardiothoracic ratio gave 70% accuracy (r = 0.64, P < 0.01). Subgrouping of patients according to specific left ventricular hemodynamic alterations did not improve correlations. The roentgenographic relationship of the left ventricle and inferior vena cava correlated poorly with left ventricular size. Of 99 patients with increased left atrial maximal volumes, 81 had visible posterior displacement of the barium-outlined esophagus by the left atrium.