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Cardiothoracic Ratio as a Predictor of Cardiovascular Events in a Cohort of Hemodialysis Patients

View Article: PubMed Central - PubMed

ABSTRACT

Aim:: The cardiothoracic ratio (CTR) on a chest X-ray is an indicator of cardiac enlargement, although its predictive power for cardiovascular disease (CVD) events in chronic kidney disease is unknown. We examined it in a cohort of hemodialysis patients, as compared with an N-terminal fragment of probrain natriuretic peptide (NT-proBNP).

Method:: This was an observational study with cross-sectional and longitudinal analyses including 517 maintenance hemodialysis patients and 122 healthy control subjects. The main predictors were CTR and serum NT-proBNP, and the main outcome was CVD events in 5 years.

Results:: At baseline, the hemodialysis patients had higher median (interquartile range) levels of CTR [0.487 (0.457–0.520)] than the control group [0.458 (0.432–0.497)]. In the hemodialysis group, CTR was positively correlated with NT-proBNP (Spearman's r = 0.44, P < 0.001). During follow-up, 190 CVD events occurred. CTR was significantly associated with the risk of CVD [HR 2.12 (95% CI, 1.38–3.25) for the fourth quartile as compared with the second quartile of CTR] in a multivariate Cox model. In the same model, NT-proBNP (fourth versus first quartile) showed a HR of 3.27 (2.02–5.31). When CTR and NT-proBNP were simultaneously included as predictors, only NT-proBNP remained a significant predictor of CVD events, all-cause mortality and composite of CVD plus all-cause mortality.

Conclusions:: We showed that CTR was a significant and independent predictor of CVD in hemodialysis patients. CTR can be used for CVD risk stratification in hemodialysis patients when NT-proBNP is not available.

No MeSH data available.


Related in: MedlinePlus

Additional analyses with other endpointsThe figure shows the hazard ratios (diamonds) and 95% confidence intervals (vertical bars) for CTR and NT-proBNP in the association with three endpoints, namely, CVD events (top panels), all-cause mortality (middle panels), and composite of the two (bottom panels). Risks of these endpoints were predicted by CTR alone (left panels), by NT-proBNP alone (middle panels), and by both CTR and NT-proBNP (right panels), using Cox model adjusted for age, sex, dialysis duration, diabetic nephropathy, pre-existing CVD, and HD shift.Abbreviations: CTR, cardiothoracic ratio; NT-proBNP, N-terminal fragment of probrain natriuretic peptide; CVD, cardiovascular disease; HD, hemodialysis; Q, quartile.*P < 0.05, **P < 0.01, ***P < 0.001.
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Figure 2: Additional analyses with other endpointsThe figure shows the hazard ratios (diamonds) and 95% confidence intervals (vertical bars) for CTR and NT-proBNP in the association with three endpoints, namely, CVD events (top panels), all-cause mortality (middle panels), and composite of the two (bottom panels). Risks of these endpoints were predicted by CTR alone (left panels), by NT-proBNP alone (middle panels), and by both CTR and NT-proBNP (right panels), using Cox model adjusted for age, sex, dialysis duration, diabetic nephropathy, pre-existing CVD, and HD shift.Abbreviations: CTR, cardiothoracic ratio; NT-proBNP, N-terminal fragment of probrain natriuretic peptide; CVD, cardiovascular disease; HD, hemodialysis; Q, quartile.*P < 0.05, **P < 0.01, ***P < 0.001.

Mentions: To examine whether CTR and NT-proBNP independently predict CVD, we put both CTR and NT-proBNP simultaneously into the Cox model (Fig. 2). In such analysis, CTR was not a significant predictor of CVD independent of NT-proBNP, whereas NT-proBNP remained a significant predictor of CVD independent of CTR and the case-mix variables.


Cardiothoracic Ratio as a Predictor of Cardiovascular Events in a Cohort of Hemodialysis Patients
Additional analyses with other endpointsThe figure shows the hazard ratios (diamonds) and 95% confidence intervals (vertical bars) for CTR and NT-proBNP in the association with three endpoints, namely, CVD events (top panels), all-cause mortality (middle panels), and composite of the two (bottom panels). Risks of these endpoints were predicted by CTR alone (left panels), by NT-proBNP alone (middle panels), and by both CTR and NT-proBNP (right panels), using Cox model adjusted for age, sex, dialysis duration, diabetic nephropathy, pre-existing CVD, and HD shift.Abbreviations: CTR, cardiothoracic ratio; NT-proBNP, N-terminal fragment of probrain natriuretic peptide; CVD, cardiovascular disease; HD, hemodialysis; Q, quartile.*P < 0.05, **P < 0.01, ***P < 0.001.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5392479&req=5

Figure 2: Additional analyses with other endpointsThe figure shows the hazard ratios (diamonds) and 95% confidence intervals (vertical bars) for CTR and NT-proBNP in the association with three endpoints, namely, CVD events (top panels), all-cause mortality (middle panels), and composite of the two (bottom panels). Risks of these endpoints were predicted by CTR alone (left panels), by NT-proBNP alone (middle panels), and by both CTR and NT-proBNP (right panels), using Cox model adjusted for age, sex, dialysis duration, diabetic nephropathy, pre-existing CVD, and HD shift.Abbreviations: CTR, cardiothoracic ratio; NT-proBNP, N-terminal fragment of probrain natriuretic peptide; CVD, cardiovascular disease; HD, hemodialysis; Q, quartile.*P < 0.05, **P < 0.01, ***P < 0.001.
Mentions: To examine whether CTR and NT-proBNP independently predict CVD, we put both CTR and NT-proBNP simultaneously into the Cox model (Fig. 2). In such analysis, CTR was not a significant predictor of CVD independent of NT-proBNP, whereas NT-proBNP remained a significant predictor of CVD independent of CTR and the case-mix variables.

View Article: PubMed Central - PubMed

ABSTRACT

Aim:: The cardiothoracic ratio (CTR) on a chest X-ray is an indicator of cardiac enlargement, although its predictive power for cardiovascular disease (CVD) events in chronic kidney disease is unknown. We examined it in a cohort of hemodialysis patients, as compared with an N-terminal fragment of probrain natriuretic peptide (NT-proBNP).

Method:: This was an observational study with cross-sectional and longitudinal analyses including 517 maintenance hemodialysis patients and 122 healthy control subjects. The main predictors were CTR and serum NT-proBNP, and the main outcome was CVD events in 5 years.

Results:: At baseline, the hemodialysis patients had higher median (interquartile range) levels of CTR [0.487 (0.457&ndash;0.520)] than the control group [0.458 (0.432&ndash;0.497)]. In the hemodialysis group, CTR was positively correlated with NT-proBNP (Spearman's r = 0.44, P &lt; 0.001). During follow-up, 190 CVD events occurred. CTR was significantly associated with the risk of CVD [HR 2.12 (95% CI, 1.38&ndash;3.25) for the fourth quartile as compared with the second quartile of CTR] in a multivariate Cox model. In the same model, NT-proBNP (fourth versus first quartile) showed a HR of 3.27 (2.02&ndash;5.31). When CTR and NT-proBNP were simultaneously included as predictors, only NT-proBNP remained a significant predictor of CVD events, all-cause mortality and composite of CVD plus all-cause mortality.

Conclusions:: We showed that CTR was a significant and independent predictor of CVD in hemodialysis patients. CTR can be used for CVD risk stratification in hemodialysis patients when NT-proBNP is not available.

No MeSH data available.


Related in: MedlinePlus