Cardiothoracic ratio as a predictor of cardiovascular events in a cohort of hemodialysis patients

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 ntprobnp 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 ntprobnp is not available. © 2017 japan atherosclerosis society.