THE ROLE OF CHEST X-RAYS AND ECHO IN DIAGNOSING HEART FAILURE: A SIDE-BY-SIDE COMPARISON
Keywords:
Accuracy of chest radiographs in the emergency diagnosis of heart failure. (Studler et al., 2018). Comparison of a basic lung scanning protocol against formally reported chest x‐ray in the diagnosis of pulmonary oedema. (Baker et al., 2013).Abstract
The distinction between chest X-ray and echocardiography in diagnosing heart failure is outlined, with advantages and disadvantages highlighted for both tests. An innovative chest X-ray assessment, along with echocardiography, was previously provided, yet standard chest X-ray still plays a crucial role in diagnosing heart failure, complementing echocardiography (Baker et al., 2013). Hence, both chest X-ray and echocardiography should remain accessible when clinically indicated.
Still, there is a need to assess the benefit of a joint interpretation approach, where both ECHOs and chest X-rays are interpreted at the same time. In such cases, the combined interpretation is likely to benefit as both tests are images of the thorax (Studler et al., 2018). To the best knowledge, no similar studies exist currently on a cardiology side.
One of the study's limitations lies in the difference in time intervals from image acquisition to report generation between chest X-ray and echocardiography. Chest X-rays were interpreted before echocardiography, resulting in ultra-early interpretations. However, the image quality of echocardiograms is compared to reports as they are considered in their intrinsic quality. This difference cannot be eliminated due to the eccentric order of case referrals in the database.
Another limitation regards the generalizability of the study findings. The dataset may exhibit some bias towards negative pre-test probability cases, particularly in chest X-ray interpretation. Though case shuffling and blinding were conducted to minimize biases, it might not be excluded completely if interpretive performance is known in advance. Additionally, there is a moderate learning curve for viewers interpreting acute ECHO and chest X-ray images.
Recalling the original question of whether chest X-ray is still a viable substitute for echocardiography, the answer leans favorably towards chest X-ray because it is a more accessible cardiac test, displaying overall good diagnostic power and being more lengthy. However, there are merits on an interpretative basis for echocardiography being the first-choice test. Given the current clinical demands on cardiology resources, this question is more academic, but future work may investigate the option of a joint interpretation, which represents a new avenue in this area.
