Radiographic evaluation of cardiothoracic ratio, pulmonary congestion and vascular pedicle widths in patients with dilated cardiomyopathy: Correlation with hemodynamic findings

Multiparametric evaluation of the chest X-ray was performed in a series of patients with dilated cardiomyopathy in order to assess if and to what extent radiographic variables correlate to hemodynamic findings. Cardiothoracic ratio, pulmonary vascular congestion and vascular pedicle width were measured in the upright chest X-ray of 33 patients with dilated cardiomyopathy (24 males, 9 females, mean age 52.6 years) obtained within 48 hours of cardiac catheterization. By means of linear and non-linear correlation, we found that: the radiographic parameters are not related to each other; the cardiothoracic ratio correlates to mitral regurgitation, vascular resistance and cardiac index, but not to left ventricular volumes; the degree of pulmonary vascular congestion correlates with wedge pressure and is a specific predictor of a wedge pressure greater than 18 mmHg; vascular pedicle width correlates with right atrial pressure and tricuspid regurgitation; a cardiothoracic ratio ≥0.56, vascular pedicle width ≥6 and a moderate-to-severe pulmonary vascular congestion identify patients with advanced disease and severe hemodynamic compromise. In conclusion, the concomitant evaluation of cardiothoracic ratio, pulmonary vascular congestion, and vascular pedicle width provides complementary information about the hemodynamic status of patients with dilated cardiomyopathy.