Objectives: Cardiomegaly has important medical and forensic implications. Left ventricular circumferential area (LVCA) has been proposed as a simple and effective measure of heart weight. We determined if LVCA reflects actual heart weight, as measured at autopsy.Methods: Two blinded radiologist independently and retrospectively measured the LVCA, in postmortem computed tomography scans of 50 decedents (34 male, 16 female, mean age 53 years). Actual heart weight was obtained from the written autopsy record. Calculated heart weight was derived using a linear regression equation describing the relationship between mean measured heart weight and actual heart weight. Results: The mean actual heart weight was 416.6g (median 395.0g, range 250.0-770.0g, SD 97.9). The mean measured LVCA was 3756.3mm2 (range 2133.5-7083.0mm2, SD 794.2). There was a significant and strong positive correlation between the mean measured LVCA and actual heart weight (p<0.0001, correlation coefficient 0.707). There was no significant inter-observer variability. There was no significant difference between calculated heart weight and autopsy heart weight. Conclusions: LVCA and calculated heart weight reflect actual heart weight, as measured at autopsy. These results suggest that heart weight estimation can be performed on non-contrast postmortem CT, using a linear regression equation based on the LVCA. Â© 2013 Elsevier Ltd.