Is cardiothoracic point-of-care ultrasonography the future of heart failure diagnosis?

摘要

More than 5 of every 1000 people in Canada will receive a new diagnosis of heart failure this year. Many more will have respiratory symptoms that will prompt the ordering of chest radiography. In a related research article, Torres and colleagues challenged an established rule-of-thumb of chest radiography, namely that a cardiac silhouette wider than half of the chest diameter represents cardiomegaly, which is suggestive of underlying heart failure. They compared cardiothoracic ratio measurements on chest radiographs with the gold standard of assessing cardiac enlargement with magnetic resonance imaging (MRI),3 and showed that the positive and negative likelihood ratios (LR) of the cardiothoracic ratio are unhelpful in either confirming or refuting cardiomegaly at any cutpoint. The absolute size of the cardiac silhouette was more useful, with a maximum heart diameter greater than 19 cm for men and greater than 13 cm for women associated with clinically useful LRs for predicting cardiac enlargement.