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

• Published in: Journal of Atherosclerosis and Thrombosis Vol. 24; no. 4; pp. 412 - 421
• Main Authors: Okute, Yujiro, Shoji, Tetsuo, Hayashi, Tomoshige, Kuwamura, Yukinobu, Sonoda, Mika, Mori, Katsuhito, Shioi, Atsushi, Tsujimoto, Yoshihiro, Tabata, Tsutomu, Emoto, Masanori, Inaba, Masaaki
• Format: Journal Article
• Language: English; Japanese
• Published: Japan Japan Atherosclerosis Society 01.01.2017
• Subjects: Aged; Biomarkers - blood; Cardiothoracic ratio (CTR); Cardiovascular Diseases - blood; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - etiology; Cardiovascular event; Case-Control Studies; Cohort; Cross-Sectional Studies; Female; Hemodialysis; Humans; Longitudinal Studies; Male; Middle Aged; Natriuretic Peptide, Brain - blood; NT-proBNP; Original; Peptide Fragments - blood; Predictive Value of Tests; Prospective Studies; Radiography, Thoracic - methods; Renal Dialysis - adverse effects; Risk Factors
• ISSN: 1340-3478; 1880-3873
• DOI: 10.5551/jat.36426

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.