Abstract
Background
The classic Hoffman and Rigler (H&R) sign, originally described in 1965, suggests
that left ventricular (LV) dilatation is present if the left ventricle extends more
than 18 mm posterior to the inferior vena cava at a level 2 cm above their crossing
on a lateral chest radiograph. This sign is still widely used by radiologists but
has not been well evaluated against modern methods of noninvasive assessment. This
study investigated the sensitivity and specificity of the H&R sign in a modern population.
Methods
A sample of 145 patients with LV dilatation based on current echocardiographic criteria
was matched for age and sex with 145 patients without LV dilatation. Patients were
required to have undergone a lateral chest radiograph in the 3 months before or after
undergoing echocardiography; the H&R sign and the cardiothoracic index were assessed
on the radiograph independently by 2 blinded physicians.
Results
Using the threshold value of 18 mm, sensitivity, specificity, and positive and negative
likelihood ratios of the H&R sign were 54.9%, 59.2%, 1.34, and 0.76, respectively
(area under the curve [AUC], 0.58). In comparison, the cardiothoracic index provided
better prediction of LV dilatation (sensitivity, 87.9%; specificity, 47.5%; AUC, 0.72).
Conclusions
The H&R sign is a poor marker of LV enlargement when compared with echocardiography
and should not be used as a radiologic index of LV enlargement.
Résumé
Introduction
Le modèle classique d’Hoffman et Rigler (H & R), publié à l'origine en 1965, suggère
qu’une dilatation ventriculaire gauche est présente si le ventricule gauche (VG) dépasse
postérieurement de plus de 18 mm la veine cave inférieure à un niveau de 2 cm au-dessus
de leur intersection sur une radiographie thoracique latérale. Ce modèle est encore
largement utilisé par les radiologues mais n'a pas été bien confronté aux méthodes
modernes d'évaluation non invasive. Cette étude a examiné la sensibilité et la spécificité
du modèle H & R dans une population contemporaine.
Méthodes
Un échantillon de 145 patients avec une dilatation du VG sur la base de critères échocardiographiques
actuels a été apparié pour l'âge et le sexe avec 145 patients sans dilatation du VG.
Les patients devaient avoir subi une radiographie thoracique latérale dans les trois
mois avant ou après avoir subi une échocardiographie; le modèle H & R et l'index cardiothoracique
ont été évalués sur la radiographie indépendamment, en aveugle, par deux médecins.
Résultats
L’utilisation de la valeur seuil de 18 mm, la sensibilité, la spécificité et les rapports
de vraisemblance positifs et négatifs du modèle H & R étaient de 54,9 %, 59,2 %, 1,34
et 0,76, respectivement (aire sous la courbe, 0,58). En comparaison, l'index cardiothoracique
fourni une meilleure prédiction de la dilatation du VG (sensibilité, 87,9 %; spécificité,
47,5 %; aire sous la courbe, 0,72).
Conclusions
Le modèle H & R est un marqueur faible de l'élargissement du VG en comparaison à une
échocardiographie et ne devrait pas être utilisé comme un indice radiologique de l'élargissement
du VG.
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References
- Emergency Department Summary Tables.(Available at:) (Accessed January 6, 2015)
- Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE).Am Heart J. 2005; 149: 209-216
- Diagnosis of heart failure in older adults: predictive value of dyspnea at rest.Arch Gerontol Geriatr. 2004; 38: 297-307
- The value of Bayes theorem in the interpretation of subjective diagnostic findings: what can we learn from agreement studies?.Med Decis Making. 2007; 27: 735-743
- Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study.N Engl J Med. 1990; 322: 1561-1566
- Does this dyspneic patient in the emergency department have congestive heart failure?.JAMA. 2005; 294: 1944-1956
- Evaluation of left ventricular enlargement in the lateral projection of the chest.Radiology. 1965; 85: 93-100
- Evaluation of left ventricular enlargement in the lateral position of the chest using the Hoffman and Rigler sign.Cardiovasc J South Afr. 2003; 14: 134-137
- Validity of Hoffman and Rigler sign in the evaluation of left ventricular enlargement.Phil Heart Center J. 2008; 14: 39-41
- Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28 (e14): 1-39
- Recommendations for chamber quantification.Eur J Echocardiogr. 2006; 7: 79-108
Article info
Publication history
Published online: June 24, 2015
Accepted:
June 13,
2015
Received:
April 6,
2015
Footnotes
See page 383 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
