Left Ventricular Dilatation Assessed on the Lateral Chest Radiograph: The Classic Hoffman and Rigler Sign Falls Short in a Modern-Day Population.
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.
Faculty of Medicine, Université de Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada; McGill University Health Center (MUHC), Montréal, Québec, Canada.
Marco
M
Spaziano
Faculty of Medicine, Université de Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
Guillaume
G
Marquis-Gravel
Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
Isabelle
I
Ramsay
Faculty of Medicine, Université de Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
Giovanni
G
Romanelli
Faculty of Medicine, Université de Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
Émilie
É
Marchand
Faculty of Medicine, Université de Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada; Centre de Recherche du CHUM, Montréal, Québec, Canada. Electronic address: francois.tournoux@umontreal.ca.
François
F
Tournoux
D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D015994:Incidence; D008297:Male; D011159:Population Surveillance; D011792:Quebec / Q000453:epidemiology; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*