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Gelé RR, Burnotte P, Valcke A, Walker TG, Kennedy CR, Merveille AC, Gommeren K. Retrospective evaluation of a right heart parameter score in the assessment of precapillary pulmonary hypertension in dogs (2017-2021): 135 cases. J Vet Emerg Crit Care (San Antonio) 2024; 34:277-284. [PMID: 38809226 DOI: 10.1111/vec.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/06/2023] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To determine if emergency and critical care residents can identify moderate to severe precapillary pulmonary hypertension on cardiologist-obtained cineloops using a pulmonary hypertension score (PHS) and report the interobserver variability of the PHS. DESIGN Multicenter, retrospective, case-control study from 2017 to 2021. SETTING Private referral center and veterinary teaching hospital. ANIMALS One hundred and thirty-five client-owned dogs that underwent diagnostic echocardiography. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Medical records of dogs with stage B1 myxomatous mitral valve disease (MMVD) and dogs diagnosed with precapillary pulmonary hypertension (PCPH) via echocardiograms were reviewed. Dogs were categorized by a cardiologist into 5 groups (normal, B1 MMVD, mild, moderate, and severe PCPH) based on Doppler pulmonary pressure gradients and right heart morphology. Cineloops from each case were subjectively evaluated by emergency and critical care residents for the presence of right atrial and ventricular enlargement, right ventricular hypertrophy, interventricular septal flattening, and pulmonary artery and trunk enlargement to form a composite pulmonary hypertension score out of 8 (PHS8). When available, signs of peritoneal effusion and distention of the caudal vena cava were subjectively assessed to generate a pulmonary hypertension score out of 10 (PHS10). There was excellent discrimination of moderate to severe PCPH versus grouped absent to mild PCPH using PHS8 (area under the receiver operator curve [AUC] [95% confidence interval, CI] = 0.90 [0.84-0.95], P < 0.0001) and PHS10 (AUC [95% CI] = 0.89 [0.81-0.97], P < 0.0001). PHS8 ≥3 was 64% sensitive and 98% specific for moderate to severe PCPH (positive likelihood ratio [LR+] 32, negative likelihood ration [LR-] 0.37). PHS10 ≥ 3.3 was 64% sensitive and 92% specific for moderate to severe PCPH (LR+ 8, LR- 0.39). Interobserver agreement was good to excellent (intraclass correlation coefficient [ICC] = 0.74 [95% CI: 0.66-0.80], n = 135). CONCLUSIONS Residents identified moderate to severe PCPH in dogs using PHS on cineloops previously obtained by a cardiologist. The interrater agreement was good to excellent with limited training. Prospective studies to determine if residents can obtain diagnostic images for PHS are warranted.
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Affiliation(s)
- Rebecca R Gelé
- Emergency and Critical Care, BluePearl Veterinary Specialists, Sandy Springs, Georgia, USA
| | | | - Annelies Valcke
- Emergency and Critical Care, University of Liège, Liège, Belgium
| | - Thomas G Walker
- Emergency and Critical Care, BluePearl Veterinary Specialists, Sandy Springs, Georgia, USA
| | | | | | - Kris Gommeren
- Emergency and Critical Care, University of Liège, Liège, Belgium
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2
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Lachance L, Conversy B, Wiggen K, Pavard C, Reinero C, Masseau I. No evidence of pulmonary hypertension revealed in an echographic evaluation of right-sided hemodynamics in hyperthyroid cats. J Feline Med Surg 2022; 24:e558-e567. [PMID: 36350661 PMCID: PMC9742920 DOI: 10.1177/1098612x221127102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Hyperthyroidism is a common endocrinopathy affecting middle-aged to elderly cats, with multisystemic repercussions. Hyperthyroid humans show decreased lung compliance and increased cardiac output with subsequent left heart failure leading to pulmonary capillary congestion. Prognosis worsens with the development of increased pulmonary vascular pressures (ie, pulmonary hypertension [PH]) in hyperthyroid humans. The effect of excess thyroid hormone concentration on pulmonary arterial hemodynamics is unknown in cats. Assessing pulmonary vascular pressures in veterinary medicine relies heavily on echocardiographic measurements performed at the level of the heart and pulmonary trunk. This study investigated right-sided cardiac and pulmonary arterial hemodynamics in hyperthyroid cats using echocardiography. METHODS Echocardiographic examinations of hyperthyroid cats identified through a bi-institutional database search were reviewed for the determination of systolic pulmonary arterial pressure (PAP) and 20 other metrics. Values were compared with those of a healthy cat group using non-parametric statistical analyses. RESULTS Systolic PAP could not be determined in 23/26 hyperthyroid and 13/14 healthy cats owing to unmeasurable tricuspid regurgitation flow velocity. Hyperthyroid cats were roughly twice as old (P <0.001) and had 2-4-fold higher respiratory rates (P <0.001) than healthy cats. Hyperthyroid cats showed an increase in acceleration time-to-ejection time ratio of pulmonary flow (1.4-fold, P = 0.001), pulmonary artery velocity time integral (1.2-1.6-fold, P = 0.001), maximal pulmonary velocity (1.3-1.7-fold, P = 0.002), stroke volume (1.5-fold, P = 0.001) and cardiac output (1.6-fold, P <0.001) vs healthy cats. None of the other echocardiographic metrics reached statistical significance. CONCLUSIONS AND RELEVANCE Systolic PAP estimation proved unsuitable as a sole measurement for the assessment of PH in hyperthyroid cats owing to the frequent inability to interrogate tricuspid regurgitant flow velocity. Hyperthyroid cats have altered echocardiographic measures of pulmonary hemodynamics dissimilar to those reported in hyperthyroid humans. Differential effects of thyrotoxic cardiomyopathy on ventricular systolic function may underlie species differences.
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Affiliation(s)
- Laury Lachance
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, University of Montréal, Saint-Hyacinthe,
Canada
| | - Bérénice Conversy
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, University of Montréal, Saint-Hyacinthe,
Canada
| | - Kelly Wiggen
- Department of Veterinary Medicine and
Surgery, University of Missouri Veterinary Health Center, College of Veterinary
Medicine, University of Missouri, Columbia, MO, USA
| | - Christophe Pavard
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, University of Montréal, Saint-Hyacinthe,
Canada
| | - Carol Reinero
- Department of Veterinary Medicine and
Surgery, University of Missouri Veterinary Health Center, College of Veterinary
Medicine, University of Missouri, Columbia, MO, USA
| | - Isabelle Masseau
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, University of Montréal, Saint-Hyacinthe,
Canada,Isabelle Masseau DVM, PhD, Dipl ACVR,
Department of Clinical Sciences, Faculty of Veterinary Medicine, University of
Montréal, 3200 Sicotte, Saint-Hyacinthe, QC J2S 2M2, Canada
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3
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Suzuki R, Yuchi Y, Kanno H, Saito T, Teshima T, Matsumoto H, Koyama H. Pulmonary Vascular Resistance Estimated by Echocardiography in Dogs With Myxomatous Mitral Valve Disease and Pulmonary Hypertension Probability. Front Vet Sci 2021; 8:771726. [PMID: 34765671 PMCID: PMC8576378 DOI: 10.3389/fvets.2021.771726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022] Open
Abstract
Post-capillary pulmonary hypertension (PH) is a life-threatening complication in dogs with myxomatous mitral valve disease (MMVD). An increase in pulmonary vascular resistance (PVR) is associated with post-capillary PH progression. In humans, PVR estimated by echocardiography (PVRecho) enables the non-invasive assessment of PVR in patients with PH. This study aimed to evaluate the clinical utility of PVRecho in dogs with MMVD, PH probability, and right-sided congestive heart failure (R-CHF). Dogs with MMVD and detectable tricuspid valve regurgitation were included in the study. Dogs were classified into three PH probability groups (low/intermediate/high) and according to the presence or absence of R-CHF. All dogs underwent echocardiographic measurements for right ventricular (RV) morphology and function. PVRecho was calculated by two methods using tricuspid valve regurgitation velocity and velocity–time integral of the pulmonary artery flow (PVRecho and PVRecho2). RV size indicators were significantly higher with a higher probability of PH. RV strain and velocity–time integral of the pulmonary artery flow in the high probability group were significantly lower than those in the other groups. Tricuspid valve regurgitation velocity, PVRecho, and PVRecho2 were significantly higher with an increase in PH probability. Logistic regression analysis revealed a significant association between the presence of R-CHF and increased PVRecho2 and end-diastolic RV internal dimension normalized by body weight. PVRecho and PVRecho2 showed significant differences among the PH probability groups. These non-invasive variables may be useful for the diagnosis and stratification of PH and the determination of the presence of R-CHF in dogs with MMVD.
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Affiliation(s)
- Ryohei Suzuki
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Medicine, School of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Yunosuke Yuchi
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Medicine, School of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Haruka Kanno
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Medicine, School of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Takahiro Saito
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Medicine, School of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Takahiro Teshima
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Medicine, School of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Hirotaka Matsumoto
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Medicine, School of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Hidekazu Koyama
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Medicine, School of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Japan
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4
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ECHOCARDIOGRAPHIC VARIABLES IN THE AFRICAN PAINTED DOG ( LYCAON PICTUS). J Zoo Wildl Med 2021; 51:668-671. [PMID: 33480543 DOI: 10.1638/2020-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to screen for cardiac disease and report normal echocardiographic variables from a managed population of the African painted dog (Lycaon pictus; APD). The study included six male adult APDs under managed care with no evidence of significant structural cardiac disease. Echocardiography was performed with APD maintained under anesthesia with a combination of midazolam, butorphanol, and inhaled isoflurane. All animals underwent a full physical examination and two-dimensional (2D), M-mode, and Doppler echocardiography using standard views. Left ventricular volumes were calculated using the Simpson's method of discs. Medians with ranges were reported for the echocardiographic variables. No valvular structural abnormalities were noted. Trace mitral regurgitation was documented in five of six APD, trace tricuspid regurgitation in three of six, and mild pulmonic regurgitation in all APD. No aortic regurgitation was noted. Standard M-mode measurements fell within the normal ranges for allometrically scaled M-mode cardiac measurements for normal adult domestic dogs (Canis familiaris). Two-dimensional measurements were comparable with that of domestic dogs with similar body weight. The study demonstrates a similarity in cardiac size and function compared with normal adult domestic dogs and provides baseline echocardiographic variables for investigation of cardiac health in other populations of APDs in the future.
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5
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Menciotti G, Abbott JA, Aherne M, Lahmers SM, Borgarelli M. Accuracy of echocardiographically estimated pulmonary artery pressure in dogs with myxomatous mitral valve disease. J Vet Cardiol 2021; 35:90-100. [PMID: 33895627 DOI: 10.1016/j.jvc.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Echocardiographically identified pulmonary hypertension is an independent predictor of poor outcome in dogs affected by myxomatous valvular degeneration (MMVD). Systolic pulmonary arterial pressure is routinely estimated based on its relationship with the Doppler-determined velocity of tricuspid regurgitation as defined by the simplified Bernoulli equation (sPAP_D). Experimental studies suggest that the method is imperfect, but its accuracy in dogs with MMVD is not known. ANIMALS Twenty dogs affected by MMVD that had cardiac remodeling and measurable tricuspid regurgitation. METHODS A flow-directed thermodilution monitoring catheter was percutaneously placed in the right external jugular vein and advanced to the main pulmonary artery. Pulmonary arterial systolic pressure was recorded (systolic pulmonary arterial pressure obtained by right heart catheterization [sPAP_C]). A second operator contemporaneously acquired tricuspid regurgitant velocity spectra to calculate sPAP_D. Each operator was blinded to the result of the other techniques. RESULTS Technical difficulties prevented the analysis of catheterization data in two dogs. Eighteen measurement pairs were therefore used for comparison of sPAP_C and sPAP_D through correlation and Bland-Altman analysis. A statistically significant bias between sPAP_C and sPAP_D (mean difference = 0.5 mmHg; confidence interval = -6.5 mmHg, +7.5 mmHg) was not detected. The interval of agreement between the techniques was wide (-27.3 mmHg, +28.2 mmHg). A significant linear association between the two techniques was not identified (r = 0.11, p=0.17). CONCLUSION Echocardiographically estimated pulmonary artery pressure poorly agrees with sPAP_C measurement in dogs affected by MMVD and cardiac remodeling with or without previously diagnosed congestive heart failure. In these dogs, sPAP_D could under- or over-estimate sPAP_C by more than 20 mmHg, and therefore caution should be used when interpreting sPAP_D.
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Affiliation(s)
- G Menciotti
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, 24061, USA.
| | - J A Abbott
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, 24061, USA
| | - M Aherne
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, 24061, USA
| | - S M Lahmers
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, 24061, USA
| | - M Borgarelli
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, 24061, USA
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6
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Visser LC, Wood JE, Johnson LR. Survival characteristics and prognostic importance of echocardiographic measurements of right heart size and function in dogs with pulmonary hypertension. J Vet Intern Med 2020; 34:1379-1388. [PMID: 32501601 PMCID: PMC7379050 DOI: 10.1111/jvim.15826] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The clinical relevance of echocardiographic measurements of right heart size and function in dogs with pulmonary hypertension (PH) is unknown. OBJECTIVE To determine if echocardiographic measurements of right heart size and right ventricular (RV) function are associated with survival times in dogs with PH. ANIMALS Eighty-two client-owned dogs. METHODS Retrospective study where data from medical records and baseline echocardiographic examinations were collected and measured in a standardized manner. Owners or primary veterinarians were contacted for outcome data. RESULTS Enlargement of the right atrium (88%), RV (69%), and pulmonary artery (72%) was common. One-third of the cases had reduced RV function quantified by two-dimensional echocardiography-derived tricuspid annular plane systolic excursion (TAPSE). Decreased TAPSE was significantly (P = .008) more common in dogs with PH not secondary to left heart disease (LHD; 43%) compared to dogs with PH secondary to LHD (14%) but median survival times (182, 95% confidence interval [CI] = 39-309 versus 298, 95% CI = 85-314 days, respectively) were not significantly different (P = .78). Right atrial area (hazard ratio [HR] = 2.72, 95% CI = 1.58-4.70), TAPSE < 3.23 mm/kg0.284 (HR = 2.19, 95% CI = 1.28-3.74), and right heart failure (HR = 2.05, 95% CI = 1.18-3.57) were independently associated with shorter survival time (P ≤ .04). CONCLUSIONS AND CLINICAL IMPORTANCE Right atrial area, RV function (TAPSE < 3.23 mm/kg0.284 ), and right heart failure offer clinically relevant prognostic information in dogs with PH. Results support the quantitative assessment of right heart size and function in dogs with PH.
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Affiliation(s)
- Lance C Visser
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - James E Wood
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Lynelle R Johnson
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
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7
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Reinero C, Visser LC, Kellihan HB, Masseau I, Rozanski E, Clercx C, Williams K, Abbott J, Borgarelli M, Scansen BA. ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs. J Vet Intern Med 2020; 34:549-573. [PMID: 32065428 PMCID: PMC7097566 DOI: 10.1111/jvim.15725] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/30/2020] [Indexed: 01/01/2023] Open
Abstract
Pulmonary hypertension (PH), defined by increased pressure within the pulmonary vasculature, is a hemodynamic and pathophysiologic state present in a wide variety of cardiovascular, respiratory, and systemic diseases. The purpose of this consensus statement is to provide a multidisciplinary approach to guidelines for the diagnosis, classification, treatment, and monitoring of PH in dogs. Comprehensive evaluation including consideration of signalment, clinical signs, echocardiographic parameters, and results of other diagnostic tests supports the diagnosis of PH and allows identification of associated underlying conditions. Dogs with PH can be classified into the following 6 groups: group 1, pulmonary arterial hypertension; group 2, left heart disease; group 3, respiratory disease/hypoxia; group 4, pulmonary emboli/pulmonary thrombi/pulmonary thromboemboli; group 5, parasitic disease (Dirofilaria and Angiostrongylus); and group 6, disorders that are multifactorial or with unclear mechanisms. The approach to treatment of PH focuses on strategies to decrease the risk of progression, complications, or both, recommendations to target underlying diseases or factors contributing to PH, and PH‐specific treatments. Dogs with PH should be monitored for improvement, static condition, or progression, and any identified underlying disorder should be addressed and monitored simultaneously.
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Affiliation(s)
- Carol Reinero
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri
| | - Lance C Visser
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Heidi B Kellihan
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin
| | - Isabelle Masseau
- Department of Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, Medford, Massachusetts
| | - Cécile Clercx
- Department of Clinical Sciences of Companion Animals and Equine, University of Liège, Liège, Belgium
| | - Kurt Williams
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Jonathan Abbott
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Michele Borgarelli
- Department of Small Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Brian A Scansen
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
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8
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Scansen BA, Drees R. Joint virtual issue on recent advances in veterinary cardiac imaging. J Vet Intern Med 2020; 34:546-548. [PMID: 31943370 PMCID: PMC7096632 DOI: 10.1111/jvim.15669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Brian A Scansen
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Randi Drees
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, United Kingdom
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Scansen BA, Drees R. Joint virtual issue on recent advances in veterinary cardiac imaging. Vet Radiol Ultrasound 2020; 61:127-129. [PMID: 31943510 DOI: 10.1111/vru.12841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Brian A Scansen
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Randi Drees
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
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10
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Visser LC, Nishimura S, Oldach MS, Bélanger C, Gunther-Harrington CT, Stern JA, Hsue W. Echocardiographic assessment of right heart size and function in dogs with pulmonary valve stenosis. J Vet Cardiol 2019; 26:19-28. [PMID: 31794914 DOI: 10.1016/j.jvc.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION/OBJECTIVES We sought to determine the prevalence and clinical significance of right heart remodeling and right ventricular (RV) dysfunction in dogs with pulmonary valve stenosis (PS). We also sought to evaluate repeatability of several measurements of severity of PS, right heart size, and RV function in dogs with PS. ANIMALS, MATERIALS AND METHODS Several indices of right atrial (RA) size and RV size and function were prospectively evaluated in 48 dogs with PS. Regression analysis was used to determine if indices of right heart size and function were independently associated with maximum transpulmonary pressure gradient (max PG) and adverse clinical findings (exercise intolerance, syncope, or right heart failure). Eight dogs underwent a second echocardiogram performed by the same operator to assess repeatability of the echocardiographic indices, which was quantified by coefficient of variation (CV) and repeatability coefficient. RESULTS Increased RA size (81%), increased RV wall thickness (83%), and decreased tricuspid annular plane systolic excursion (TAPSE [81%]) were common. Right atrial size, end-diastolic RV area, and RV wall thickness were independently associated with max PG. Decreased TAPSE was independently associated with adverse clinical findings. All indices except RA area (18.6%) and RV systolic velocity (20.7%) had CVs <15%. Repeatability coefficients are available to help distinguish a true change versus measurement variability during serially obtained exams. CONCLUSIONS Right heart remodeling and RV dysfunction are common in dogs with PS and are associated with echocardiographic and clinical severity. Results support the quantitative assessment of right heart size and function in dogs with PS.
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Affiliation(s)
- L C Visser
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Ave, Davis, CA, 95616, USA.
| | - S Nishimura
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Ave, Davis, CA, 95616, USA
| | - M S Oldach
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Ave, Davis, CA, 95616, USA
| | - C Bélanger
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Ave, Davis, CA, 95616, USA
| | - C T Gunther-Harrington
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Ave, Davis, CA, 95616, USA
| | - J A Stern
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Ave, Davis, CA, 95616, USA
| | - W Hsue
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Ave, Davis, CA, 95616, USA
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To A, Hostnik ET, Rhinehart JD, Scansen BA. Electrocardiography-gated cardiac CT angiography can differentiate brachycephalic dogs with and without pulmonary valve stenosis and findings differ from transthoracic echocardiography. Vet Radiol Ultrasound 2018; 60:145-158. [PMID: 30475441 DOI: 10.1111/vru.12701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 09/10/2018] [Accepted: 09/17/2018] [Indexed: 12/17/2022] Open
Abstract
Pulmonary valve stenosis (PS) is one of the most commonly diagnosed congenital heart defects in dogs. Currently, transthoracic echocardiography (TTE) is the standard modality used to evaluate PS. Image acquisition by TTE can be challenging in some brachycephalic breeds of dogs. The use of echocardiographic-gated CT angiography (ECG-gated CTA) in veterinary medicine is limited. This retrospective method comparison study investigated right and left ventricular outflow diameters by sedated ECG-gated CTA and unsedated TTE in 14 brachycephalic dogs with PS and 12 brachycephalic dogs without PS. Measurements of ventricular outflow structures were made in early systole and end diastole for both modalities and then compared for significance between systolic and diastolic phases, as well as between the two modalities. Ratios of the pulmonary trunk diameter to the aorta at different locations (aortic valve, aortic annulus, and ascending aorta) and in different planes (transverse, sagittal) were compared between dogs with PS and without PS, as well as within dogs, by both TTE and ECG-gated CTA. Transthoracic echocardiography and ECG-gated CTA both detected significantly greater pulmonary trunk to aorta ratios in dogs with PS at all aortic locations (P < 0.05). Pulmonary valve to aortic valve ratios were significantly smaller in dogs with PS (P < 0.05). Pulmonary trunk to aorta and pulmonary valve to aorta ratios were achieved with good anatomic detail using ECG-gated CTA. Ratios of the pulmonary trunk and pulmonary valve relative to the aorta may be useful to evaluate for PS using a modality that is underutilized for cardiac assessment.
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Affiliation(s)
- Ada To
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Eric T Hostnik
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Jaylyn D Rhinehart
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Brian A Scansen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio.,Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado
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12
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Nishimura S, Visser LC, Bélanger C, Oldach MS, Gunther-Harrington CT, Stern JA. Echocardiographic evaluation of velocity ratio, velocity time integral ratio, and pulmonary valve area in dogs with pulmonary valve stenosis. J Vet Intern Med 2018; 32:1570-1578. [PMID: 30079482 PMCID: PMC6189360 DOI: 10.1111/jvim.15244] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/20/2018] [Accepted: 05/22/2018] [Indexed: 12/29/2022] Open
Abstract
Background Velocity ratio, velocity time integral (VTI) ratio, and pulmonary valve area indexed to body surface area (iPVA) are methods of assessment of pulmonary valve stenosis (PS) severity that are less dependent on blood flow. Studies evaluating these methods are limited. Objectives To determine the effects of butorphanol, atenolol, and balloon valvuloplasty (BV) on velocity ratio, VTI ratio, iPVA, mean PG, and max PG. Animals Twenty‐seven dogs with PS (max PG >50 mm Hg). Methods Prospective study. All dogs underwent an echocardiogram at baseline, 5‐minutes after administration of butorphanol (0.2‐0.25 mg/kg IV), and 2‐to‐4 weeks after atenolol (1‐1.5 mg/kg q12h). Twenty‐one of these were evaluated 24‐hours after BV. Results There were no significant differences (P > .05) amongst any of the methods of assessment of PS severity after butorphanol. After atenolol, mean (SD) of mean (57.0 [21.0] mm Hg) and max PG (93.1 [33.8] mm Hg) were significantly decreased (P ≤ .047) compared with baseline (65.2 [26.2] mm Hg and 108 [44.4] mm Hg, respectively). After atenolol, there were no significant (P ≥ .12) differences in velocity ratio (0.29 [0.09]), VTI ratio (0.18 [0.05]), or iPVA (0.43 [0.16] cm2/m2) compared with baseline (0.30 [0.09], 0.19 [0.09], 0.44 [0.17] cm2/m2, respectively). Conclusions and Clinical Importance Atenolol might reduce mean and max PG but does not alter less flow‐dependent methods of assessment of PS severity (velocity ratio, VTI ratio, and iPVA) in dogs with PS. Results support an integrative approach to assessment of PS severity that includes less flow‐dependent methods, particularly in states of altered flow or right ventricular function.
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Affiliation(s)
- Satoko Nishimura
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Lance C Visser
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Catherine Bélanger
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Maureen S Oldach
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Catherine T Gunther-Harrington
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Joshua A Stern
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California
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Chapel EH, Scansen BA, Schober KE, Bonagura JD. Echocardiographic Estimates of Right Ventricular Systolic Function in Dogs with Myxomatous Mitral Valve Disease. J Vet Intern Med 2017; 32:64-71. [PMID: 29224256 PMCID: PMC5787149 DOI: 10.1111/jvim.14884] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/01/2017] [Accepted: 10/19/2017] [Indexed: 01/01/2023] Open
Abstract
Background Right ventricular (RV) dysfunction independently predicts outcomes in human myxomatous mitral valve disease (MMVD). There is limited information regarding RV systolic function in dogs with MMVD. Hypothesis Right ventricular systolic function differs among stages of disease, decreasing in decompensated MMVD. Animals Thirty‐sixclient‐owned dogs with MMVD not receiving oral cardiovascular medications. Methods Prospective clinical study. Dogs were categorized according to disease severity as ACVIM Stage B1, B2, or C. Seven echocardiographic indices of RV systolic function were measured. Groups were compared by 1‐way ANOVA and Tukey's HSD test. Frequencies of cases with cardiac remodeling falling outside previously established reference intervals were compared using Fisher's exact test. Intra‐ and interobserver measurement variability was calculated for each RV function index. Results The indices TAPSE (P = 0.029), RV StL (P = 0.012), and RV StRL (P = 0.041) were significantly different between groups. A greater proportion of B2 dogs (7 of 12) had TAPSE values above reference intervals compared with B1 (2 of 12) or C (2 of 12) dogs (P = 0.027). Measurement variability of TAPSE, RV S', and RV StG was clinically acceptable. Conclusions and Clinical Importance Right ventricular systolic function differs between stages of MMVD, increasing in stage B2, and declining in stage C. The prognostic importance of RV function indices, particularly TAPSE, might be worth evaluating in dogs with MMVD.
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Affiliation(s)
- E H Chapel
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - B A Scansen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - K E Schober
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - J D Bonagura
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
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