Evaluating the radiographic assessment of pulmonary venous hypertension in chronic heart disease

This study evaluated how accurately the chest film could be used to determine pulmonary capillary wedge pressure (PCW) in patients with chronic heart disease. Six experienced readers interpreted the erect posteroanterior chest radiographs of 50 patients whose measured PCWs ranged from 6 to 38 mm Hg. Direct numeric estimates of PCW from the films were closely related to measured levels of PCW (r = 0.675). This linear correlation increased to 0.81 when individual-reader variations were reduced by taking a "consensus" (mean) of the six readers' estimates for each case. A combination of the judged degree of pulmonary blood flow redistribution (PFR) and three particular signs of pulmonary venous hypertension (PVH), basal and perihilar vascular blurring and alveolar edema, adequately summarized the radiographic information about PCW. These combined judgments of PFR/PVH identified films from patients with higher and lower PCW levels as accurately as readers' numeric estimates of PCW. Other radiographic signs (enlargement of the heart and central pulmonary vessels and the presence of Kerley lines or pleural effusion) were also positively related to increases in PCW, but added little to the information provided by the PFR/PVH criteria.