J Rheum Dis.  2015 Feb;22(1):19-24. 10.4078/jrd.2015.22.1.19.

Correlation of Cardiothoracic Ratio and Right Ventricular Systolic Pressure in Systemic Sclerosis

• Lee SY
• Yim SW
• Park JY
• Chung WT
• Lee SW

• KMID: 2222922
• DOI: http://doi.org/10.4078/jrd.2015.22.1.19

Abstract

OBJECTIVE
This study was designed to assess sequential association between right ventricular systolic pressure and cardiothoracic (C/T) ratio of chest radiography in systemic sclerosis (SSc) patients and inferred pulmonary arterial hypertension by increased C/T ratio and right ventricular systolic pressure.
METHODS
Twenty-eight consecutive patients with confirmed SSc (22 females, 6 males; mean age 51.1+/-2.1 years), with a mean time of 91.0+/-6.7 months from SSc diagnosis, were prospectively included in the study. C/T ratio was obtained by chest radiography with an interval of two years. The first C/T ratio was taken at diagnosis and second C/T ratio was taken at the time of enrollment. The enrolled subjects were agree to undergo echocardiography and measurement of brain natriuretic peptide.
RESULTS
In 24 SSc patients with normal right ventricular systolic pressure, 10 SSc patients had increased C/T ratio, the other four SSc patients with increased right ventricular systolic pressure by echocardiography, had increased C/T ratio all together. In four SSc patients with increased right ventricular systolic pressure, one patient had resting dyspnea, taken cardiac catheterization and confirmed as pulmonary hypertension and the other three patients had no clinical symptoms. The increased right ventricular systolic pressure is related to the increase of C/T ratio (>0.55) in chest radiography (p<0.05) and increased brain natriuretic peptide in blood (p<0.05).
CONCLUSION
The increase of C/T ratio (>0.55) in chest radiography was associated with increased right ventricular systolic pressure measured by echocardiography and inferred a role in early detection of asymptomatic pulmonary arterial hypertension in SSc patients.

Keyword

Pulmonary hypertension; Systemic sclerosis

MeSH Terms

Blood Pressure*
Cardiac Catheterization
Cardiac Catheters
Diagnosis
Dyspnea
Echocardiography
Female
Humans
Hypertension
Hypertension, Pulmonary
Male
Natriuretic Peptide, Brain
Prospective Studies
Radiography
Scleroderma, Systemic*
Thorax
Natriuretic Peptide, Brain

Figure

• 

  Figure 1. The correlation of right ventricular systolic pressure and cardiothoracic ratio difference. Scatter plots of cardiothoracic ratio showed slightly positive correlations with right ventricular systolic pressure (Spearman correlation co-efficient=0.2, p-value＜0.05, relative risk: 4.0 [95% confidence interval: 2.0∼7.9]).

• 

  Figure 2. The correlation of brain natriuretic peptide and cardiothoracic ratio difference. Scatter plots of cardiothoracic ratio showed positive correlations with brain natriuretic peptide (spearman correlation coefficient=0.2, p-value＜0.05, relative risk: 1.1 [95% confidence interval: 0.0∼1.3]).

• 

  Figure 3. The correlation of right ventricular systolic pressure and brain natriuretic peptide. Scatter plots of brain natriuretic peptide showed slightly positive correlations with right ventricular systolic pressure (spearman correlation co-efficient=0.7, p-value＜0.05, relative risk: 1.1 [95% confidence interval: 0.0∼1.3]).

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