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Harry Hemingway - One of the best experts on this subject based on the ideXlab platform.
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Cardiothoracic Ratio within the normal range independently predicts mortality in patients undergoing coronary angiography
Heart, 2007Co-Authors: Justin M Zaman, Martin J Shipley, Julie Sanders, Angela M Crook, Gene Feder, Adam Timmis, Harry HemingwayAbstract:OBJECTIVE: To determine whether Cardiothoracic Ratio (CTR), within the range conventionally considered normal, predicted prognosis in patients undergoing coronary angiography. DESIGN: Cohort study with a median of 7-years follow-up. SETTING: Consecutive patients undergoing coronary angiography at Barts and The London National Health Service (NHS) Trust. SUBJECTS: 1005 patients with CTRs measured by chest radiography, and who subsequently underwent coronary angiography. Of these patients, 7.3% had a CTR > or =0.5 and were excluded from the analyses. OUTCOMES: All-cause mortality and coronary event (non-fatal myocardial infarction or coronary death). Adjustments were made for age, left ventricular dysfunction, ACE inhibitor treatment, body mass index, number of diseased coronary vessels and past coronary artery bypass graft. RESULTS: The risk of death was increased among patients with a CTR in the upper part of the normal range. In total, 94 (18.9%) of those with a CTR below the median of 0.42 died compared with 120 (27.8%) of those with a CTR between 0.42 and 0.49 (log rank test p or =0.5 being an abnormal CTR.
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Cardiothoracic Ratio within the "normal'' range independently predicts mortality in patients undergoing coronary angiography
HEART, 2007Co-Authors: Harry HemingwayAbstract:Objective: To determine whether Cardiothoracic Ratio (CTR), within the range conventionally considered normal, predicted prognosis in patients undergoing coronary angiography.Design: Cohort study with a median of 7-years follow-up.Setting: Consecutive patients undergoing coronary angiography at Barts and The London National Health Service (NHS) Trust.Subjects: 1005 patients with CTRs measured by chest radiography, and who subsequently underwent coronary angiography. Of these patients, 7.3% had a CTR >= 0.5 and were excluded from the analyses.Outcomes: All-cause mortality and coronary event (non-fatal myocardial infarction or coronary death). Adjustments were made for age, left ventricular dysfunction, ACE inhibitor treatment, body mass index, number of diseased coronary vessels and past coronary artery bypass graft.Results: The risk of death was increased among patients with a CTR in the upper part of the normal range. In total, 94 (18.9%) of those with a CTR below the median of 0.42 died compared with 120 (27.8%) of those with a CTR between 0.42 and 0.49 (log rank test p < 0.001). After adjusting for potential confounders, this increased risk remained (adjusted HR 1.45, 95% CI 1.03 to 2.05). CTR, at values below 0.5, was linearly related to the risk of coronary event (test for trend p = 0.024).Conclusion : In patients undergoing coronary angiography, CTR between 0.42 and 0.49 was associated with higher mortality than in patients with smaller hearts. There was evidence of a continuous increase in risk with higher CTR. These findings, along with those in healthy populations, question the conventional textbook cutoff point of >= 0.5 being an abnormal CTR.
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Cardiothoracic Ratio and relative heart volume as predictors of coronary heart disease mortality the whitehall study 25 year follow up
European Heart Journal, 1998Co-Authors: Harry Hemingway, Martin J Shipley, D Christie, Michael MarmotAbstract:Aim To examine the association of radiographic measures of heart size with mortality from coronary heart disease. Methods and Results One thousand, one hundred and ninety-one male civil servants aged 40‐69 years were followed-up for mortality over 25 years in relation to Cardiothoracic Ratio and relative heart volume. A high Cardiothoracic Ratio and relative heart volume predicted coronary (n=196 deaths) and all-cause mortality, but not respiratory or malignant mortality. After adjustment for age, systolic and diastolic blood pressure, the highest (§0·47) compared to the lowest quintile of the Cardiothoracic Ratio (<0·40) was associated with a rate Ratio of 1·84 (95% CI 1·14‐2·97) for the eVect on coronary heart disease mortality. Further adjustment for heart rate, smoking, cholesterol, angina and ECG ischaemia had little eVect, reducing the rate Ratio to 1·65 (95% CI 1·01‐2·70). Similar rate Ratios were observed for relative heart volume. Conclusions Cardiothoracic Ratio within the range considered ‘normal’ in clinical practice predicted coronary heart disease mortality independent of established coronary heart disease risk factors. The relative heart volume, which uses measurements from the lateral as well as the posteroanterior chest X-ray, did not predict coronary heart disease any better than the Cardiothoracic Ratio. The extent to which left ventricular mass and systolic dysfunction— pathophysiological correlates of the Cardiothoracic Ratio and relative heart volume — are independent risk factors for coronary heart disease should be further investigated. (Eur Heart J 1998; 19: 859‐869)
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Cardiothoracic Ratio and relative heart volume as predictors of coronary heart disease mortality The Whitehall study 25 year follow-up
European Heart Journal, 1998Co-Authors: Harry Hemingway, Martin J Shipley, D Christie, Michael MarmotAbstract:Aim To examine the association of radiographic measures of heart size with mortality from coronary heart disease. Methods and Results One thousand, one hundred and ninety-one male civil servants aged 40‐69 years were followed-up for mortality over 25 years in relation to Cardiothoracic Ratio and relative heart volume. A high Cardiothoracic Ratio and relative heart volume predicted coronary (n=196 deaths) and all-cause mortality, but not respiratory or malignant mortality. After adjustment for age, systolic and diastolic blood pressure, the highest (§0·47) compared to the lowest quintile of the Cardiothoracic Ratio (
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is Cardiothoracic Ratio in healthy middle aged men an independent predictor of coronary heart disease mortality whitehall study 25 year follow up
BMJ, 1998Co-Authors: Harry Hemingway, Martin J Shipley, D Christie, Michael MarmotAbstract:Aetiological studies of myocardial ischaemia have tended to concentrate on factors which influence atherothrombotic processes in the coronary arteries rather than myocardial pathophysiology.1 The commonest clinical measure of heart size—Cardiothoracic Ratio—was included in the original Whitehall study of healthy middle aged civil servants. Cardiothoracic Ratio is associated with left ventricular mass2 and left ventricular systolic function; since left ventricular mass determined by echocardiography has been shown to predict coronary heart disease in elderly people,1 we hypothesised that increased Cardiothoracic Ratio would independently predict mortality from coronary heart disease. Unlike previous studies3 we did not include mortality from stroke since it may be related to heart size through different pathophysiological mechanisms. View this table: Adjusted hazard Ratios (95% confidence intervals) for the effect of Cardiothoracic Ratio on all cause and coronary heart disease mortality We studied the 1203 male British …
Du Feng - One of the best experts on this subject based on the ideXlab platform.
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the Cardiothoracic Ratio a neglected preoperative risk stratified method for patients with rheumatic heart disease undergoing valve replacement surgery
European Journal of Cardio-Thoracic Surgery, 2019Co-Authors: Lei Jiang, Wei-guo Chen, Qing-shan Geng, Gang Du, Pengcheng He, Du FengAbstract:OBJECTIVES: It is common for patients with rheumatic heart disease to have an enlarged heart. We investigated the prognostic value of Cardiothoracic Ratio (CTR) in patients with rheumatic heart disease undergoing valve replacement surgery. METHODS: A total of 1772 patients were divided into 4 groups based on the quartiles of preoperative CTR: 0.6, which was significantly higher in males without a CTR. A similar result was observed in females (1.9 vs 5.1%, P = 0.004). Multivariable regression showed that a CTR >0.6 was an independent predictor of in-hospital (odds Ratio 2.36, P = 0.005) and 1-year mortality (hazard Ratio 2.06, P = 0.006). Kaplan-Meier curves, for the cumulative rate of 1-year mortality among groups, indicated that the risk of death was increased if the CTR >0.6 (log-rank 16.36, P < 0.001). CONCLUSIONS: CTR, as a simple and reproducible indicator, was identified as a prognostic factor for predicting poor outcomes in patients with rheumatic heart disease undergoing valve replacement surgery.
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The Cardiothoracic Ratio: a neglected preoperative risk-stratified method for patients with rheumatic heart disease undergoing valve replacement surgery
European Journal of Cardio-Thoracic Surgery, 2018Co-Authors: Lei Jiang, Wei-guo Chen, Qing-shan Geng, Gang Du, Pengcheng He, Du FengAbstract:OBJECTIVES: It is common for patients with rheumatic heart disease to have an enlarged heart. We investigated the prognostic value of Cardiothoracic Ratio (CTR) in patients with rheumatic heart disease undergoing valve replacement surgery. METHODS: A total of 1772 patients were divided into 4 groups based on the quartiles of preoperative CTR: 0.6, which was significantly higher in males without a CTR. A similar result was observed in females (1.9 vs 5.1%, P = 0.004). Multivariable regression showed that a CTR >0.6 was an independent predictor of in-hospital (odds Ratio 2.36, P = 0.005) and 1-year mortality (hazard Ratio 2.06, P = 0.006). Kaplan-Meier curves, for the cumulative rate of 1-year mortality among groups, indicated that the risk of death was increased if the CTR >0.6 (log-rank 16.36, P
Martin J Shipley - One of the best experts on this subject based on the ideXlab platform.
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Cardiothoracic Ratio within the normal range independently predicts mortality in patients undergoing coronary angiography
Heart, 2007Co-Authors: Justin M Zaman, Martin J Shipley, Julie Sanders, Angela M Crook, Gene Feder, Adam Timmis, Harry HemingwayAbstract:OBJECTIVE: To determine whether Cardiothoracic Ratio (CTR), within the range conventionally considered normal, predicted prognosis in patients undergoing coronary angiography. DESIGN: Cohort study with a median of 7-years follow-up. SETTING: Consecutive patients undergoing coronary angiography at Barts and The London National Health Service (NHS) Trust. SUBJECTS: 1005 patients with CTRs measured by chest radiography, and who subsequently underwent coronary angiography. Of these patients, 7.3% had a CTR > or =0.5 and were excluded from the analyses. OUTCOMES: All-cause mortality and coronary event (non-fatal myocardial infarction or coronary death). Adjustments were made for age, left ventricular dysfunction, ACE inhibitor treatment, body mass index, number of diseased coronary vessels and past coronary artery bypass graft. RESULTS: The risk of death was increased among patients with a CTR in the upper part of the normal range. In total, 94 (18.9%) of those with a CTR below the median of 0.42 died compared with 120 (27.8%) of those with a CTR between 0.42 and 0.49 (log rank test p or =0.5 being an abnormal CTR.
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Cardiothoracic Ratio and relative heart volume as predictors of coronary heart disease mortality the whitehall study 25 year follow up
European Heart Journal, 1998Co-Authors: Harry Hemingway, Martin J Shipley, D Christie, Michael MarmotAbstract:Aim To examine the association of radiographic measures of heart size with mortality from coronary heart disease. Methods and Results One thousand, one hundred and ninety-one male civil servants aged 40‐69 years were followed-up for mortality over 25 years in relation to Cardiothoracic Ratio and relative heart volume. A high Cardiothoracic Ratio and relative heart volume predicted coronary (n=196 deaths) and all-cause mortality, but not respiratory or malignant mortality. After adjustment for age, systolic and diastolic blood pressure, the highest (§0·47) compared to the lowest quintile of the Cardiothoracic Ratio (<0·40) was associated with a rate Ratio of 1·84 (95% CI 1·14‐2·97) for the eVect on coronary heart disease mortality. Further adjustment for heart rate, smoking, cholesterol, angina and ECG ischaemia had little eVect, reducing the rate Ratio to 1·65 (95% CI 1·01‐2·70). Similar rate Ratios were observed for relative heart volume. Conclusions Cardiothoracic Ratio within the range considered ‘normal’ in clinical practice predicted coronary heart disease mortality independent of established coronary heart disease risk factors. The relative heart volume, which uses measurements from the lateral as well as the posteroanterior chest X-ray, did not predict coronary heart disease any better than the Cardiothoracic Ratio. The extent to which left ventricular mass and systolic dysfunction— pathophysiological correlates of the Cardiothoracic Ratio and relative heart volume — are independent risk factors for coronary heart disease should be further investigated. (Eur Heart J 1998; 19: 859‐869)
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Cardiothoracic Ratio and relative heart volume as predictors of coronary heart disease mortality The Whitehall study 25 year follow-up
European Heart Journal, 1998Co-Authors: Harry Hemingway, Martin J Shipley, D Christie, Michael MarmotAbstract:Aim To examine the association of radiographic measures of heart size with mortality from coronary heart disease. Methods and Results One thousand, one hundred and ninety-one male civil servants aged 40‐69 years were followed-up for mortality over 25 years in relation to Cardiothoracic Ratio and relative heart volume. A high Cardiothoracic Ratio and relative heart volume predicted coronary (n=196 deaths) and all-cause mortality, but not respiratory or malignant mortality. After adjustment for age, systolic and diastolic blood pressure, the highest (§0·47) compared to the lowest quintile of the Cardiothoracic Ratio (
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is Cardiothoracic Ratio in healthy middle aged men an independent predictor of coronary heart disease mortality whitehall study 25 year follow up
BMJ, 1998Co-Authors: Harry Hemingway, Martin J Shipley, D Christie, Michael MarmotAbstract:Aetiological studies of myocardial ischaemia have tended to concentrate on factors which influence atherothrombotic processes in the coronary arteries rather than myocardial pathophysiology.1 The commonest clinical measure of heart size—Cardiothoracic Ratio—was included in the original Whitehall study of healthy middle aged civil servants. Cardiothoracic Ratio is associated with left ventricular mass2 and left ventricular systolic function; since left ventricular mass determined by echocardiography has been shown to predict coronary heart disease in elderly people,1 we hypothesised that increased Cardiothoracic Ratio would independently predict mortality from coronary heart disease. Unlike previous studies3 we did not include mortality from stroke since it may be related to heart size through different pathophysiological mechanisms. View this table: Adjusted hazard Ratios (95% confidence intervals) for the effect of Cardiothoracic Ratio on all cause and coronary heart disease mortality We studied the 1203 male British …
Lei Jiang - One of the best experts on this subject based on the ideXlab platform.
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the Cardiothoracic Ratio a neglected preoperative risk stratified method for patients with rheumatic heart disease undergoing valve replacement surgery
European Journal of Cardio-Thoracic Surgery, 2019Co-Authors: Lei Jiang, Wei-guo Chen, Qing-shan Geng, Gang Du, Pengcheng He, Du FengAbstract:OBJECTIVES: It is common for patients with rheumatic heart disease to have an enlarged heart. We investigated the prognostic value of Cardiothoracic Ratio (CTR) in patients with rheumatic heart disease undergoing valve replacement surgery. METHODS: A total of 1772 patients were divided into 4 groups based on the quartiles of preoperative CTR: 0.6, which was significantly higher in males without a CTR. A similar result was observed in females (1.9 vs 5.1%, P = 0.004). Multivariable regression showed that a CTR >0.6 was an independent predictor of in-hospital (odds Ratio 2.36, P = 0.005) and 1-year mortality (hazard Ratio 2.06, P = 0.006). Kaplan-Meier curves, for the cumulative rate of 1-year mortality among groups, indicated that the risk of death was increased if the CTR >0.6 (log-rank 16.36, P < 0.001). CONCLUSIONS: CTR, as a simple and reproducible indicator, was identified as a prognostic factor for predicting poor outcomes in patients with rheumatic heart disease undergoing valve replacement surgery.
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The Cardiothoracic Ratio: a neglected preoperative risk-stratified method for patients with rheumatic heart disease undergoing valve replacement surgery
European Journal of Cardio-Thoracic Surgery, 2018Co-Authors: Lei Jiang, Wei-guo Chen, Qing-shan Geng, Gang Du, Pengcheng He, Du FengAbstract:OBJECTIVES: It is common for patients with rheumatic heart disease to have an enlarged heart. We investigated the prognostic value of Cardiothoracic Ratio (CTR) in patients with rheumatic heart disease undergoing valve replacement surgery. METHODS: A total of 1772 patients were divided into 4 groups based on the quartiles of preoperative CTR: 0.6, which was significantly higher in males without a CTR. A similar result was observed in females (1.9 vs 5.1%, P = 0.004). Multivariable regression showed that a CTR >0.6 was an independent predictor of in-hospital (odds Ratio 2.36, P = 0.005) and 1-year mortality (hazard Ratio 2.06, P = 0.006). Kaplan-Meier curves, for the cumulative rate of 1-year mortality among groups, indicated that the risk of death was increased if the CTR >0.6 (log-rank 16.36, P
Michael Marmot - One of the best experts on this subject based on the ideXlab platform.
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Cardiothoracic Ratio and relative heart volume as predictors of coronary heart disease mortality the whitehall study 25 year follow up
European Heart Journal, 1998Co-Authors: Harry Hemingway, Martin J Shipley, D Christie, Michael MarmotAbstract:Aim To examine the association of radiographic measures of heart size with mortality from coronary heart disease. Methods and Results One thousand, one hundred and ninety-one male civil servants aged 40‐69 years were followed-up for mortality over 25 years in relation to Cardiothoracic Ratio and relative heart volume. A high Cardiothoracic Ratio and relative heart volume predicted coronary (n=196 deaths) and all-cause mortality, but not respiratory or malignant mortality. After adjustment for age, systolic and diastolic blood pressure, the highest (§0·47) compared to the lowest quintile of the Cardiothoracic Ratio (<0·40) was associated with a rate Ratio of 1·84 (95% CI 1·14‐2·97) for the eVect on coronary heart disease mortality. Further adjustment for heart rate, smoking, cholesterol, angina and ECG ischaemia had little eVect, reducing the rate Ratio to 1·65 (95% CI 1·01‐2·70). Similar rate Ratios were observed for relative heart volume. Conclusions Cardiothoracic Ratio within the range considered ‘normal’ in clinical practice predicted coronary heart disease mortality independent of established coronary heart disease risk factors. The relative heart volume, which uses measurements from the lateral as well as the posteroanterior chest X-ray, did not predict coronary heart disease any better than the Cardiothoracic Ratio. The extent to which left ventricular mass and systolic dysfunction— pathophysiological correlates of the Cardiothoracic Ratio and relative heart volume — are independent risk factors for coronary heart disease should be further investigated. (Eur Heart J 1998; 19: 859‐869)
-
Cardiothoracic Ratio and relative heart volume as predictors of coronary heart disease mortality The Whitehall study 25 year follow-up
European Heart Journal, 1998Co-Authors: Harry Hemingway, Martin J Shipley, D Christie, Michael MarmotAbstract:Aim To examine the association of radiographic measures of heart size with mortality from coronary heart disease. Methods and Results One thousand, one hundred and ninety-one male civil servants aged 40‐69 years were followed-up for mortality over 25 years in relation to Cardiothoracic Ratio and relative heart volume. A high Cardiothoracic Ratio and relative heart volume predicted coronary (n=196 deaths) and all-cause mortality, but not respiratory or malignant mortality. After adjustment for age, systolic and diastolic blood pressure, the highest (§0·47) compared to the lowest quintile of the Cardiothoracic Ratio (
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is Cardiothoracic Ratio in healthy middle aged men an independent predictor of coronary heart disease mortality whitehall study 25 year follow up
BMJ, 1998Co-Authors: Harry Hemingway, Martin J Shipley, D Christie, Michael MarmotAbstract:Aetiological studies of myocardial ischaemia have tended to concentrate on factors which influence atherothrombotic processes in the coronary arteries rather than myocardial pathophysiology.1 The commonest clinical measure of heart size—Cardiothoracic Ratio—was included in the original Whitehall study of healthy middle aged civil servants. Cardiothoracic Ratio is associated with left ventricular mass2 and left ventricular systolic function; since left ventricular mass determined by echocardiography has been shown to predict coronary heart disease in elderly people,1 we hypothesised that increased Cardiothoracic Ratio would independently predict mortality from coronary heart disease. Unlike previous studies3 we did not include mortality from stroke since it may be related to heart size through different pathophysiological mechanisms. View this table: Adjusted hazard Ratios (95% confidence intervals) for the effect of Cardiothoracic Ratio on all cause and coronary heart disease mortality We studied the 1203 male British …