Diagnostic Utility of Chest Radiography in Predicting Long-Standing Systemic Arterial Hypertension

Abstract

Purpose: To investigate the association between aortic arch width on frontal chest radiography and systemic hypertension.

Methods: A total of 200 consecutive patients were included. Relationships between aortic arch width measurement on chest radiography and blood pressure measurement were investigated using Student’s t -tests and Fisher’s exact tests.

Results: Twenty-five patients were normotensive (< 130/90 mmHg), and 175 were hypertensive. Using cut-off values, 136 patients had an aortic arch width ≥ 3.5 cm, and 65 had an aortic arch width ≥ 4 cm. We found a significant relationship between aortic arch width and hypertension (p < 0.001) as well between aortic arch width cut-off values of 3.5 cm and 4 cm and hypertension (p < 0.001 and p < 0.005, respectively). An aortic arch width ≥ 3.5 cm was associated with a positive likelihood ratio (LR) of 2.3, negative LR of 0.39, sensitivity of 73, specificity of 68, positive predictive value of 94, negative predictive value of 26.6, pretest odds of 7, posttest odds of 16, and posttest probability of 94%. An aortic arch width ≥ 4 cm was associated with a positive LR of 4.50, negative LR of 0.70, sensitivity of 36, specificity of 92, positive predictive value of 97, negative predictive value of 17, pretest odds of 7, posttest odds of 31.5, and posttest probability of 97%.

Conclusions: Aortic arch width measurement on chest radiography can be used to predict the presence of long-standing systemic arterial hypertension.

Key Words

Aortic arch width - Chest radiography - Hypertension

• References

• 1 Torpy JM, Lynm C, Glass RM. Hypertension. JAMA 2010; 303: 2098 . DOI: 10.1001/jama.303.20.2098
• 2 Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G. , et al. Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105-1187 . DOI: 10.1097/HJH.0b013e3281fc975a
• 3 Rayner BL, Goodman H, Opie LH. The chest radiograph. A useful investigation in the evaluation of hypertensive patients. Am J Hypertens 2004; 17: 507-510 . DOI: 10.1016/j.amjhyper.2004.02.012
• 4 Kannel WB, Cobb J. Left ventricular hypertrophy and mortality – results from the Framingham Study. Cardiology 1992; 81: 291-298 . DOI: 10.1159/000175819
• 5 Korkmaz L, Erkan H, Korkmaz AA, Acar Z, Ağaç MT, Bektaş H. , et al. Relationship of aortic knob width with cardio-ankle vascular stiffness index and its value in diagnosis of subclinical atherosclerosis in hypertensive patients: a study on diagnostic accuracy. Anadolu Kardiyol Derg 2012; 12: 102-106 . DOI: 10.5152/akd.2012.034
• 6 Takaki A, Ogawa H, Wakeyama T, Iwami T, Kimura M, Hadano Y. , et al. Cardio-ankle vascular index is a new noninvasive parameter of arterial stiffness. Circ J 2007; 71: 1710-1714 . DOI: 10.1253/circj.71.1710
• 7 Felson B. A review of over 30,000 normal chest roentgenograms. . In: Chest Roentgenology. Philadelphia: WB Saunders; 1973. p. 494-495
• 8 Ray A, Mandal D, Kundu P, Manna S, Mandal S. Aortic knob diameter in chest X-ray and its relation with age, heart diameter and transverse diameter of thorax in a population of Bankura District of West Bengal, India: a cross sectional study. J Evol Med Dent Sci 2014; 3: 8595-8600 . DOI: 10.14260/jemds/2014/3092
• 9 Higaki T, Kurisu S, Watanabe N, Ikenaga H, Shimonaga T, Iwasaki T. , et al. Usefulness of aortic knob width on chest radiography to predict central hemodynamics in patients with known or suspected coronary artery disease. Clin Exp Hypertens 2015; 37: 440-444 . DOI: 10.3109/10641963.2015.1057834
• 10 Simon G, Gamsu G. Cardiopulmonary dimensions: stability over a long period. AJR Am J Roentgenol 1977; 128: 239-241 . DOI: 10.2214/ajr.128.2.239