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Cardio-Thoracic Ratio Is Stable, Reproducible and Has Potential as a Screening Tool for HIV-1 Related Cardiac Disorders in Resource Poor Settings
BACKGROUND: Cardiovascular disorders are common in HIV-1 infected persons in Africa and presentation is often insidious. Development of screening algorithms for cardiovascular disorders appropriate to a resource-constrained setting could facilitate timely referral. Cardiothoracic ratio (CTR) on ches...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050014/ https://www.ncbi.nlm.nih.gov/pubmed/27701421 http://dx.doi.org/10.1371/journal.pone.0163490 |
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author | Esmail, Hanif Oni, Tolu Thienemann, Friedrich Omar-Davies, Nashreen Wilkinson, Robert J. Ntsekhe, Mpiko |
author_facet | Esmail, Hanif Oni, Tolu Thienemann, Friedrich Omar-Davies, Nashreen Wilkinson, Robert J. Ntsekhe, Mpiko |
author_sort | Esmail, Hanif |
collection | PubMed |
description | BACKGROUND: Cardiovascular disorders are common in HIV-1 infected persons in Africa and presentation is often insidious. Development of screening algorithms for cardiovascular disorders appropriate to a resource-constrained setting could facilitate timely referral. Cardiothoracic ratio (CTR) on chest radiograph (CXR) has been suggested as a potential screening tool but little is known about its reproducibility and stability. Our primary aim was to evaluate the stability and the inter-observer variability of CTR in HIV-1 infected outpatients. We further evaluated the prevalence of cardiomegaly (CTR≥0.5) and its relationship with other risk factors in this population. METHODOLOGY: HIV-1 infected participants were identified during screening for a tuberculosis vaccine trial in Khayelitsha, South Africa between August 2011 and April 2012. Participants had a digital posterior-anterior CXR performed as well as history, examination and baseline observations. CXRs were viewed using OsiriX software and CTR calculated using digital callipers. RESULTS: 450 HIV-1-infected adults were evaluated, median age 34 years (IQR 30–40) with a CD4 count 566/mm(3) (IQR 443–724), 70% on antiretroviral therapy (ART). The prevalence of cardiomegaly was 12.7% (95% C.I. 9.6%-15.8%). CTR was calculated by a 2(nd) reader for 113 participants, measurements were highly correlated r = 0.95 (95% C.I. 0.93–0.97) and agreement of cardiomegaly substantial κ = 0.78 (95% C.I 0.61–0.95). CXR were repeated in 51 participants at 4–12 weeks, CTR measurements between the 2 time points were highly correlated r = 0.77 (95% C.I 0.68–0.88) and agreement of cardiomegaly excellent κ = 0.92 (95% C.I. 0.77–1). Participants with cardiomegaly had a higher median BMI (31.3; IQR 27.4–37.4) versus 26.9; IQR 23.2–32.4); p<0.0001) and median systolic blood pressure (130; IQR 121–141 versus 125; IQR 117–135; p = 0.01). CONCLUSION: CTR is a robust measurement, stable over time with substantial inter-observer agreement. A prospective study evaluating utility of CXR to identify cardiovascular disorder in this population is warranted. |
format | Online Article Text |
id | pubmed-5050014 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-50500142016-10-27 Cardio-Thoracic Ratio Is Stable, Reproducible and Has Potential as a Screening Tool for HIV-1 Related Cardiac Disorders in Resource Poor Settings Esmail, Hanif Oni, Tolu Thienemann, Friedrich Omar-Davies, Nashreen Wilkinson, Robert J. Ntsekhe, Mpiko PLoS One Research Article BACKGROUND: Cardiovascular disorders are common in HIV-1 infected persons in Africa and presentation is often insidious. Development of screening algorithms for cardiovascular disorders appropriate to a resource-constrained setting could facilitate timely referral. Cardiothoracic ratio (CTR) on chest radiograph (CXR) has been suggested as a potential screening tool but little is known about its reproducibility and stability. Our primary aim was to evaluate the stability and the inter-observer variability of CTR in HIV-1 infected outpatients. We further evaluated the prevalence of cardiomegaly (CTR≥0.5) and its relationship with other risk factors in this population. METHODOLOGY: HIV-1 infected participants were identified during screening for a tuberculosis vaccine trial in Khayelitsha, South Africa between August 2011 and April 2012. Participants had a digital posterior-anterior CXR performed as well as history, examination and baseline observations. CXRs were viewed using OsiriX software and CTR calculated using digital callipers. RESULTS: 450 HIV-1-infected adults were evaluated, median age 34 years (IQR 30–40) with a CD4 count 566/mm(3) (IQR 443–724), 70% on antiretroviral therapy (ART). The prevalence of cardiomegaly was 12.7% (95% C.I. 9.6%-15.8%). CTR was calculated by a 2(nd) reader for 113 participants, measurements were highly correlated r = 0.95 (95% C.I. 0.93–0.97) and agreement of cardiomegaly substantial κ = 0.78 (95% C.I 0.61–0.95). CXR were repeated in 51 participants at 4–12 weeks, CTR measurements between the 2 time points were highly correlated r = 0.77 (95% C.I 0.68–0.88) and agreement of cardiomegaly excellent κ = 0.92 (95% C.I. 0.77–1). Participants with cardiomegaly had a higher median BMI (31.3; IQR 27.4–37.4) versus 26.9; IQR 23.2–32.4); p<0.0001) and median systolic blood pressure (130; IQR 121–141 versus 125; IQR 117–135; p = 0.01). CONCLUSION: CTR is a robust measurement, stable over time with substantial inter-observer agreement. A prospective study evaluating utility of CXR to identify cardiovascular disorder in this population is warranted. Public Library of Science 2016-10-04 /pmc/articles/PMC5050014/ /pubmed/27701421 http://dx.doi.org/10.1371/journal.pone.0163490 Text en © 2016 Esmail et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Esmail, Hanif Oni, Tolu Thienemann, Friedrich Omar-Davies, Nashreen Wilkinson, Robert J. Ntsekhe, Mpiko Cardio-Thoracic Ratio Is Stable, Reproducible and Has Potential as a Screening Tool for HIV-1 Related Cardiac Disorders in Resource Poor Settings |
title | Cardio-Thoracic Ratio Is Stable, Reproducible and Has Potential as a Screening Tool for HIV-1 Related Cardiac Disorders in Resource Poor Settings |
title_full | Cardio-Thoracic Ratio Is Stable, Reproducible and Has Potential as a Screening Tool for HIV-1 Related Cardiac Disorders in Resource Poor Settings |
title_fullStr | Cardio-Thoracic Ratio Is Stable, Reproducible and Has Potential as a Screening Tool for HIV-1 Related Cardiac Disorders in Resource Poor Settings |
title_full_unstemmed | Cardio-Thoracic Ratio Is Stable, Reproducible and Has Potential as a Screening Tool for HIV-1 Related Cardiac Disorders in Resource Poor Settings |
title_short | Cardio-Thoracic Ratio Is Stable, Reproducible and Has Potential as a Screening Tool for HIV-1 Related Cardiac Disorders in Resource Poor Settings |
title_sort | cardio-thoracic ratio is stable, reproducible and has potential as a screening tool for hiv-1 related cardiac disorders in resource poor settings |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050014/ https://www.ncbi.nlm.nih.gov/pubmed/27701421 http://dx.doi.org/10.1371/journal.pone.0163490 |
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