1
|
Bruining-Staal K, Tiemessen I, Vernooij JCM, Beijerink N. Effect of body condition score on the interobserver variability of vertebral heart scale assessment in dogs. Vet Radiol Ultrasound 2024. [PMID: 39054653 DOI: 10.1111/vru.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 06/28/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
The vertebral heart scale (VHS) is widely known and used as an objective standard for the evaluation of cardiomegaly on thoracic radiographs. It, therefore, plays an important role in assessing the severity of canine heart disease. The body condition score (BCS) is a nine-scale body condition scoring system used to objectively document the body condition in dogs. Obese animals have widened precardiac and postcardiac mediastinum, fat deposits between the sternum and lungs or heart, as well as increased pericardial fat. These conditions could complicate cardiac silhouette evaluation and could, therefore, result in higher interobserver variability in the assessment of VHS. The purpose of this study was to investigate whether overweight dogs (BCS 6/9, 7/9, 8/9, and 9/9) have more variability in the interobserver VHS measurement compared with dogs with a normal BCS (BCS 4/9 and 5/9). The dogs were admitted to a private referral center for different medical reasons. The VHS was measured by three trained observers in right lateral radiographs of 18 overweight dogs and 33 dogs with a normal BCS. Bland-Altmann plots were constructed, and limits of agreement were calculated to show the variability of VHS measurements. No statistically significant differences in VHS variability were found between BCS categories, observers, sex, or age categories. In conclusion, BCS does not affect the reliability of VHS assessment among trained veterinarians.
Collapse
Affiliation(s)
| | - Ilse Tiemessen
- AniCura Dierenziekenhuis Drechtstreek, Dordrecht, The Netherlands
| | - Johannes C M Vernooij
- Department Population Heath Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Niek Beijerink
- AniCura Dierenziekenhuis Drechtstreek, Dordrecht, The Netherlands
- Veterinaire Specialisten, Vught, The Netherlands
| |
Collapse
|
2
|
Puccinelli C, Vezzosi T, Grosso G, Tognetti R, Auriemma E, Domenech O, Citi S. The vertebral right heart index: A new radiographic method to assess right heart enlargement in dogs. Vet Radiol Ultrasound 2024. [PMID: 39031718 DOI: 10.1111/vru.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/10/2024] [Accepted: 06/04/2024] [Indexed: 07/22/2024] Open
Abstract
In veterinary medicine, the radiographic assessment of right heart enlargement (RHE) is essentially subjective. The aim of this study was to evaluate the vertebral right heart index (VRHi) as a new quantitative radiographic method to detect RHE in dogs. This was a multicenter, retrospective, observational study, including dogs with RHE and control dogs. All dogs had to have a thoracic radiographic study and a complete echocardiography on the same day. Right heart enlargement was defined as the presence of right atrial enlargement, right ventricular enlargement, and/or hypertrophy based on echocardiography. For the radiographic study, all the radiographic views available for each case were considered for measurement: right lateral (RL), left lateral (LL), ventrodorsal (VD), and dorsoventral (DV). The VRHi was measured using LL, RL, VD, and DV views. A total of 204 dogs were included: 91 dogs with RHE and 113 control dogs. The VRHi (RL), the VRHi (LL), and the VRHi (VD) were significantly greater in dogs with RHE compared with controls (P < .0001). The best diagnostic accuracy was observed for VRHi (LL) (area under the curve [AUC] 0.86, P < .0001; cutoff ≥ 3.5 vertebrae, sensitivity [Se] 71%, specificity [Sp] 89%), followed by VRHi (RL) (AUC 0.85, P < .0001; cutoff ≥ 3.5 vertebrae, Se 68%, Sp 86%) and VRHi (VD) (AUC 0.80, P = .0004; cutoff ≥ 3.0 vertebrae, Se 57%, Sp 95%). In conclusion, the lateral VRHi in LL and RL and the VD VRHi could represent useful radiological tools for the detection of RHE in dogs.
Collapse
Affiliation(s)
| | - Tommaso Vezzosi
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Giovanni Grosso
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Rosalba Tognetti
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | | | | | - Simonetta Citi
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| |
Collapse
|
3
|
Chanmongkolpanit K, Riengvirodkij N, Channgam P, Kaenchan P, Buayam W, Janhirun Y, Phonarknguen R, Tansakul M, Sakcamduang W. How accurate are NT-proBNP, ANP, and cTnI levels in diagnosing dogs with myxomatous mitral valve disease? Open Vet J 2024; 14:1426-1441. [PMID: 39055758 PMCID: PMC11268905 DOI: 10.5455/ovj.2024.v14.i6.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/21/2024] [Indexed: 07/27/2024] Open
Abstract
Background Myxomatous mitral valve disease (MMVD) is prevalent in dogs. Specialized diagnostics (radiography and echocardiography) may be unavailable in some veterinary settings. Cardiac biomarkers offer potential alternatives. Aim This study evaluated the diagnostic value of N-terminal fragments of pro-brain natriuretic peptides (NT-proBNPs), atrial natriuretic peptides (ANPs), and cardiac troponin I (cTnI) levels in dogs with MMVD. Methods 69 dogs with MMVD (asymptomatic and symptomatic) and 19 healthy controls were assessed. Biomarker levels were measured using commercial kit rapid tests. Results Our results showed that the median NT-proBNP level in the symptomatic group was higher than those in the asymptomatic (p < 0.001) and control (p < 0.001) groups. Moreover, the median NT-proBNP level in the asymptomatic group was higher than that in the control group (p < 0.001). The cTnI level in the control group was lower than those in the asymptomatic (p = 0.039) and symptomatic (p = 0.001) groups. No statistically significant difference in the cTnI level was noted between the asymptomatic and symptomatic groups. The best cutoff value of the NT-proBNP level to differentiate the normal controls from dogs with MMVD with or without congestive heart failure was > 505.65 pmol/l [sensitivity, 76.8%; specificity, 89.5%; and area under the curve (AUC), 0.862]. The suggested cutoff value of the NT-proBNP level to differentiate symptomatic MMVD from asymptomatic MMVD was >787.65 pmol/l (sensitivity, 78.38%; specificity, 72.55%; and AUC, 0.792). Conclusion NT-proBNP and cTnI may serve as point-of-care tests for dyspneic dogs, aiding MMVD assessment where specialized diagnostics are limited.
Collapse
Affiliation(s)
- Kittara Chanmongkolpanit
- Prasu Arthorn Veterinary Teaching Hospital, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | - Nattapon Riengvirodkij
- Prasu Arthorn Veterinary Teaching Hospital, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | - Phuttipan Channgam
- Department of Clinical Sciences and Public Health, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | - Pemika Kaenchan
- Pasu-Palan Livestock and Wildlife Hospital, Mahidol university, Kanchanaburi, Thailand
| | - Wasana Buayam
- Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | - Yada Janhirun
- Department of Clinical Sciences and Public Health, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | - Rassameepen Phonarknguen
- The Monitoring and Surveillance Center for Zoonotic Diseases in Wildlife and Exotic Animals, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | - Mookmanee Tansakul
- Department of Clinical Sciences and Public Health, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | - Walasinee Sakcamduang
- Department of Clinical Sciences and Public Health, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| |
Collapse
|
4
|
Zhou Q, Cui X, Zhou H, Guo S, Wu Z, Li L, Zhang J, Feng W, Guo Y, Ma X, Chen Y, Qiu C, Xu M, Deng G. Differentially expressed platelet activation-related genes in dogs with stage B2 myxomatous mitral valve disease. BMC Vet Res 2023; 19:271. [PMID: 38087280 PMCID: PMC10717932 DOI: 10.1186/s12917-023-03789-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Peripheral blood carries a reservoir of mRNAs that regulate cardiac structure and function potential. Although it is well recognized that the typical symptoms of Myxomatous Mitral Valve Disease (MMVD) stage B2 are long-standing hemodynamic disorder and cardiac structure remodeling caused by mitral regurgitation, the transcriptomic alterations in blood from such dogs are not understood. RESULTS In the present study, comparative high-throughput transcriptomic profiling of blood was performed from normal control (NC) and naturally-occurring MMVD stage B2 (MMVD) dogs. Using Weighted Gene Co-expression Network Analyses (WGCNA), Gene Ontology (GO), and Kyoto Encyclopedia of Gene and Genomes (KEGG), we identified that the turquoise module was the most highly correlated with echocardiographic features and found 64 differentially expressed genes (DEGs) that were significantly enriched in platelet activation related pathways. Therefore, from the turquoise module, we selected five DEGs (MDM2, ROCK1, RIPK1, SNAP23, and ARHGAP35) that, according to real-time qPCR, exhibited significant enrichment in platelet activation related pathways for validation. The results showed that the blood transcriptional abundance of MDM2, ROCK1, RIPK1, and SNAP23 differed significantly (P < 0.01) between NC and MMVD dogs. On the other hand, Correlation Analysis revealed that MDM2, ROCK1, RIPK1, and SNAP23 genes negatively regulated the heart structure parameters, and followed the same trend as observed in WGCNA. CONCLUSION We screened four platelet activation related genes, MDM2, ROCK1, RIPK1, and SNAP23, which may be considered as the candidate biomarkers for the diagnosis of MMVD stage B2. These findings provided new insights into MMVD pathogenesis.
Collapse
Affiliation(s)
- Qingqing Zhou
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Xiang Cui
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Han Zhou
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Shuai Guo
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Zhimin Wu
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Liyang Li
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Jinxin Zhang
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Wen Feng
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Yingfang Guo
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Xiaofei Ma
- Department of Clinical Animal Medicine, College of Veterinary Medicine, Gansu Agricultural University, Lanzhou, 730070, China
| | - Yu Chen
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Changwei Qiu
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Ming Xu
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China.
| | - Ganzhen Deng
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China.
| |
Collapse
|
5
|
Marbella Fernández D, Montoya-Alonso JA. Radiographic Left Atrial Size Measurement of Dogs in Different Mitral Valve Disease Stages with Four Different Methods. Animals (Basel) 2023; 13:3835. [PMID: 38136872 PMCID: PMC10741156 DOI: 10.3390/ani13243835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
The left atrial size increases (LAS) in patients with mitral valve disease (MVD) as the disease progresses. The vertebral left atrial size (VLAS), the modified-vertebral left atrial size (M-VLAS), and the radiographic left atrial dimension (RLAD) are methods reported to assess LAS on dogs' radiographs. All these methods transform the LAS into vertebral units. The thoracic inlet (TI) has been used as a reliable reference point to measure the cardiac silhouette of dogs with MVD in different stages. The objective of this study was to assess the clinical utility of measuring a dog LAS on right thoracic X-rays using the TI as a reference and determine whether it could differentiate dogs in different MVD stages. LAS was divided by the TI to obtain the thoracic inlet left atrial score (TILAS). This was a retrospective observational study including 135 apparently healthy dogs performed to assess their LAS with four different methods: VLAS, M-VLAS, RLAD, and TILAS. Thirty-six dogs from the general population were selected and compared to 100 dogs in different MVD stages. The TILAS was significantly different between the control dogs and MVD dogs, increasing with the disease stage: control dogs 0.51 ± 0.08, B1 0.57 ± 0.14, B2 0.75 ± 0.13, and C 0.84 ± 0.18. VLAS, M-VLAS, and RLAD also increased as the disease progressed, as shown in previous studies. The TILAS accuracy to distinguish MVD dogs with cardiac enlargement was comparable to VLAS, M-VLAS, and RLAD (AUC 0.91 vs. 0.93, 0.90, and 0.94 respectively). A TILAS > 0.8 can identify dogs with cardiac enlargement secondary to MVD.
Collapse
Affiliation(s)
- David Marbella Fernández
- Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, 35413 Las Palmas de Gran Canaria, Spain
- CEU Small Animal Hospital, 46115 Valencia, Spain
| | - Jose Alberto Montoya-Alonso
- Internal Medicine, Faculty of Veterinary Medicine, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35413 Las Palmas de Gran Canaria, Spain;
| |
Collapse
|
6
|
van Staveren MDB, Muis E, Szatmári V. Self-Reported Utilization of International Guidelines for Staging Dogs with Myxomatous Mitral Valve Degeneration: A Survey among Veterinary Practitioners. Vet Sci 2023; 10:687. [PMID: 38133238 PMCID: PMC10747438 DOI: 10.3390/vetsci10120687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND ACVIM developed and published guidelines for staging myxomatous mitral valve degeneration in dogs in 2009. An updated version was published in 2019. The present study aimed to investigate whether these guidelines are actually used by the intended public more than a decade after their first publication. METHODS An online survey was distributed among Dutch and Belgian veterinarians through online channels and mailing lists. RESULTS Of the 524 responses, only 363 complete surveys were analyzed. The ACVIM guidelines are used by 60% of the respondents. Veterinarians find it more difficult to differentiate stage B1 from B2 in asymptomatic dogs compared to diagnosing stage C. Three-quarters of the respondents would recommend echocardiography for an incidentally detected new murmur with an intensity of 3 out of 6 in an adult dog. Two-thirds of the respondents find coughing a convincing finding for stage C disease. Close to half of the respondents associate a horizontal, dull percussion line with pulmonary edema. For confirming cardiogenic pulmonary edema, 98% of the respondents used thoracic radiographs. CONCLUSIONS Veterinary practitioners might not have the expected training and equipment to be able to apply the guidelines in their practices, especially in the differentiation of stage B1 from stage B2.
Collapse
Affiliation(s)
| | | | - Viktor Szatmári
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (M.D.B.v.S.); (E.M.)
| |
Collapse
|
7
|
Ross ES, Visser LC, Sbardellati N, Potter BM, Ohlendorf A, Scansen BA. Utility of vertebral left atrial size and vertebral heart size to aid detection of congestive heart failure in dogs with respiratory signs. J Vet Intern Med 2023; 37:2021-2029. [PMID: 37882250 PMCID: PMC10658574 DOI: 10.1111/jvim.16918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Differentiating cardiogenic vs noncardiogenic causes of respiratory signs can be challenging when echocardiography is unavailable. Radiographic vertebral left atrial size (VLAS) and vertebral heart size (VHS) have been shown to predict echocardiographic left heart size, with VLAS specifically estimating left atrial size. HYPOTHESIS/OBJECTIVES Compare the diagnostic accuracy of VLAS and VHS to predict left-sided congestive heart failure (CHF) in dogs presenting with respiratory signs. ANIMALS One-hundred fourteen dogs with respiratory signs and radiographic pulmonary abnormalities. METHODS Retrospective cross-sectional study. Dogs had to have an echocardiogram and thoracic radiographs obtained within 24 hours. Diagnosis of CHF was confirmed based on the presence of respiratory signs, cardiac disease, LA enlargement, and cardiogenic pulmonary edema. RESULTS Fifty-seven dogs had CHF and 57 did not have CHF. Compared to VHS (area under the curve [AUC] 0.85; 95% confidence interval [CI], 0.77-0.91), VLAS was a significantly (P = .03) more accurate predictor of CHF (AUC, 0.92; 95% CI, 0.85-0.96). Optimal cutoff for VLAS was >2.3 vertebrae (sensitivity, 93.0%; specificity, 82.5%). Murmur grade (P = .02) and VLAS (P < .0001) were independently associated with CHF and VHS was not. Increased VHS (54%) was significantly (P = .01) more common than increased VLAS (24%) in dogs without CHF. Results were similar in a subsample of older and smaller dogs. CONCLUSIONS AND CLINICAL IMPORTANCE When echocardiography is unavailable, VLAS and murmur grade have clinically utility to aid in differentiating cardiogenic from noncardiogenic respiratory signs. These findings might be especially useful to help rule out CHF in dogs with increased VHS that present with respiratory signs.
Collapse
Affiliation(s)
- Evan S. Ross
- Department of Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Colorado State UniversityFort CollinsColoradoUSA
| | - Lance C. Visser
- Department of Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Colorado State UniversityFort CollinsColoradoUSA
| | - Nicholas Sbardellati
- Department of Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Colorado State UniversityFort CollinsColoradoUSA
| | - Brianna M. Potter
- Department of Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Colorado State UniversityFort CollinsColoradoUSA
| | - Alex Ohlendorf
- Department of Environmental and Radiological Health SciencesCollege of Veterinary Medicine and Biomedical Sciences, Colorado State UniversityFort CollinsColoradoUSA
| | - Brian A. Scansen
- Department of Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Colorado State UniversityFort CollinsColoradoUSA
| |
Collapse
|
8
|
Marbella Fernández D, García V, Santana AJ, Montoya-Alonso JA. The Thoracic Inlet Length as a Reference Point to Radiographically Assess Cardiac Enlargement in Dogs with Myxomatous Mitral Valve Disease. Animals (Basel) 2023; 13:2666. [PMID: 37627458 PMCID: PMC10451611 DOI: 10.3390/ani13162666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
The diagnostic value of the vertebral heart size (VHS) in dogs with mitral valve degeneration (MVD) is compromised when middle thoracic vertebral anomalies are present. The objective of this study was to assess the use of the thoracic inlet heart score (TIHS) to identify left heart enlargement (LHE) secondary to MVD. The cardiac silhouette of 50 clinically healthy dogs and 106 MVD dogs in different stages was assessed on a right lateral chest radiograph. The TIHS and VHS value were calculated for each patient and compared. The TIHS was significantly different between the control dogs and the dogs with MMVD, increasing with disease stage, control 2.91 ± 0.23, Stage B1 2.98 ± 0.36, B2 3.25 ± 0.34, and C 3.53 ± 0.36, p < 0.05. A THIS ≥3.3 showed 69% sensitivity and 81% specificity to identify LHE. The TIHS showed moderate correlation with the VHS, LA/Ao, and LVIDDN 0.59, 0.42, and 0.62, respectively. The intraobserver and interobserver agreement were almost perfect, 0.96, and substantial, 0.73. The TIHS method can be used to identify LHE secondary to MMVD on dogs' thoracic radiographs.
Collapse
Affiliation(s)
- David Marbella Fernández
- Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, 35413 Las Palmas de Gran Canaria, Spain
- CEU Small Animal Hospital, 46115 Valencia, Spain
| | | | | | - José Alberto Montoya-Alonso
- Internal Medicine, Faculty of Veterinary Medicine, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35413 Las Palmas de Gran Canaria, Spain;
| |
Collapse
|
9
|
Szatmári V, Hofman ZMM, van Bijsterveldt NJ, Tellegen AR, Vilaplana Grosso FR. A Novel Standardized Method for Aiding to Determine Left Atrial Enlargement on Lateral Thoracic Radiographs in Dogs. Animals (Basel) 2023; 13:2178. [PMID: 37443976 DOI: 10.3390/ani13132178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Left atrial enlargement indicates severe cardiac disease. Although the gold standard for determining left atrial size is echocardiography, many veterinary practices lack the necessary equipment and expertise. Therefore, thoracic radiography is often used to differentiate cardiogenic pulmonary edema from primary respiratory diseases and to facilitate distinguishing dogs with stage B1 and B2 mitral valve degeneration. METHODS The goal was to test a new standardized method for identifying radiographic left atrial enlargement. On a lateral radiograph, a straight line was drawn from the dorsal border of the tracheal bifurcation to the crossing point of the dorsal border of the caudal vena cava and the most cranial crus of the diaphragm. If a part of the left atrium extended this line dorsally, it was considered enlarged. Echocardiographic left atrial to aortic ratio (LA:Ao) was used as a reference. Thirty-nine observers with various levels of experience evaluated 90 radiographs, first subjectively, then applying the new method. RESULTS The new method moderately correlated with LA:Ao (r = 0.56-0.66) in all groups. The diagnostic accuracy (72-74%) of the subjective assessment and the new method showed no difference. CONCLUSIONS Though the new method was not superior to subjective assessment, it may facilitate learning and subjective interpretation.
Collapse
Affiliation(s)
- Viktor Szatmári
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - Zelie M M Hofman
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - Nynke J van Bijsterveldt
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - Anna R Tellegen
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - Federico R Vilaplana Grosso
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| |
Collapse
|
10
|
The Thoracic Inlet Heart Size, a New Approach to Radiographic Cardiac Measurement. Animals (Basel) 2023; 13:ani13030389. [PMID: 36766278 PMCID: PMC9913153 DOI: 10.3390/ani13030389] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/06/2023] [Accepted: 01/22/2023] [Indexed: 01/25/2023] Open
Abstract
In 1995, the Vertebral Heart Size (VHS) method for measuring the cardiac silhouette on thoracic radiographs was published, becoming a quantifiable and objective reference way of assessing the heart size. Since then, many studies have showed that VHS is influenced by breed variations, vertebral malformations, reference points selection, and short and long axes dimensions conversion into vertebral units. The Thoracic Inlet Heart Size (TIHS) normalizes heart size to body size using the thoracic inlet length. The lengths of the long and short axes of the heart of 144 clinically normal dogs were measured on right lateral thoracic radiographs. The sum of both measures was indexed to the thoracic inlet length. For comparison, dogs of the most represented breeds in our hospital were selected to measure their heart size using the TIHS protocol. The mean TIHS value for the population studied was 2.86 ± 0.27, and 90% of dogs had a TIHS value of less than 3.25. There was no difference in TIHS between male and female, and between small and large dogs (p-value < 0.01). There was no difference in the TIHS value between Yorkshire Terrier, Chihuahua, and Labrador retriever breeds, and between each of those three breeds and the general population. The TIHS is a simple, straightforward and accurate way to measure heart size.
Collapse
|
11
|
Methods of Radiographic Measurements of Heart and Left Atrial Size in Dogs with and without Myxomatous Mitral Valve Disease: Intra- and Interobserver Agreement and Practicability of Different Methods. Animals (Basel) 2022; 12:ani12192531. [PMID: 36230272 PMCID: PMC9559670 DOI: 10.3390/ani12192531] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
Dogs suffering from Myxomatous Mitral Valve Disease (MMVD) show a potential heart enlargement, especially in the left atrium, detectable by radiography. Due to digital radiography, different radiographic measurements estimate cardiac size quite uncomplicatedly. The Vertebral Heart Size (VHS), Radiographic Left Atrial Dimension (RLAD), Left Atrial Width (LAWidth), and the Vertebral Left Atrial Size (VLAS) used anatomical landmarks for measuring cardiac size in relation to the vertebral column. This study aimed to compare VHS, RLAD, LAWidth, and VLAS measured in conventional and inverted radiographs by veterinarians with different levels of experience in healthy dogs and dogs with MMVD. The reliability and user-friendliness of these measurements were evaluated, and the staging was compared to the echocardiography staging. A total of 50 unaffected dogs and 150 dogs with MMVD in stages B1, B2, and C were assessed. Three veterinarians with different levels of experience examined 200 conventional radiographs and their corresponding inverted radiographs blinded to the echocardiographic and clinical examination results. Analyses were performed to compare the measurements’ grading and determine anatomical landmarks with measurement difficulties. Additionally, inter- and intraobserver agreement was assessed using intraclass correlation coefficient, and the agreement between radiographic and echocardiographic staging was compared using the kappa coefficient. The VHS, LAWidth, and VLAS were easier to define than the RLAD. The interobserver agreement was almost perfect for VHS (0.962) and good for the other radiographic measurements (RLAD: 0.778, LAWidth: 0.772, VLAS: 0.858). The VHS assigned the most dogs to the correct stage. However, VHS, RLAD, LAWidth, and VLAS presented an almost perfect intraobserver agreement. The dorsal left atrial margin of the RLAD was the most difficult measurement point to identify. The VHS is the most reproducible radiographic method for measuring the canine heart size and shows the highest agreement with echocardiography. An observer-related influence could be detected for RLAD, LAWidth, and VLAS.
Collapse
|
12
|
Comparison of different radiographic scores with associated echocardiographic measurements and prediction of heart enlargement in dogs with and without myxomatous mitral valve disease. J Vet Cardiol 2022; 44:1-12. [PMID: 36174296 DOI: 10.1016/j.jvc.2022.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Staging of myxomatous mitral valve disease (MMVD) requires an echocardiographic examination along with thoracic radiographs. The aims of this study were to calculate mean values for radiographic scores vertebral heart size (VHS), left atrial width (LAWidth), radiographic left atrial dimension (RLAD), and vertebral left atrial size (VLAS) in conventional and grayscale inverted images in healthy dogs and dogs with different stages of MMVD, and to find cutoff values for a stage assignment. ANIMALS One hundred fifty dogs in different stages of MMVD and 50 unaffected dogs were evaluated. METHODS Radiographic scores, echocardiographic left atrium-to-aorta ratio and normalized left ventricular internal dimension at end-diastole, and results of a clinical examination were obtained. Analyses were performed to evaluate the correlation between radiographic scores and echocardiographic values, to determine cutoff values for a radiographic stage assignment, and to compare measurements in conventional and inverted radiographs. RESULTS After excluding breed-specific higher VHS, the means of VHS, LAWidth, RLAD, and VLAS were similar in the control group and stage B1. All radiographic scores increased in stages B2 and C. The cutoff values identifying heart enlargement, and therefore differentiating stages B1 and B2, were 11.0 for VHS, 1.8 for LAWidth, 2.0 for RLAD, and 2.3 for VLAS. Besides RLAD, scores were similar in conventional and inverted radiographs. CONCLUSION Cutoff values for the different radiographic scores for stage assignment were calculated. Radiographic cardiac scores using either conventional or inverted grayscale could be a tool to differentiate between different stages of MMVD when echocardiography is unavailable.
Collapse
|
13
|
Wiegel PS, Mach R, Nolte I, Freise F, Levicar C, Merhof K, Bach JP. Breed-specific values for vertebral heart score (VHS), vertebral left atrial size (VLAS), and radiographic left atrial dimension (RLAD) in pugs without cardiac disease, and their relationship to Brachycephalic Obstructive Airway Syndrome (BOAS). PLoS One 2022; 17:e0274085. [PMID: 36054125 PMCID: PMC9439199 DOI: 10.1371/journal.pone.0274085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/22/2022] [Indexed: 12/03/2022] Open
Abstract
This prospective study aims to establish reference ranges for vertebral heart score (VHS), vertebral left atrial size (VLAS), and radiographic left atrial dimension (RLAD) in pugs. The impact of clinical severity of Brachycephalic Obstructive Airway Syndrome (BOAS), gender, body condition score, and body weight on VHS, VLAS, and RLAD were investigated. Intra- and interobserver correlation was determined. Correlation of radiographic scores to echocardiographic left atrial dimension was inspected. Additionally, for VLAS and RLAD, correlation to VHS was examined. Additionally, an assessment of thoracic and vertebral malformations was performed. Forty-seven privately owned pugs underwent physical examination, echocardiography, and thoracic radiography to determine cardiac health. Thirty-two pugs were eligible for establishing reference ranges for VHS in right lateral radiographs, which was 11.25 ± 0.62 (95% range, 10.1–12.8). Reference ranges for VHS in left lateral, and for VLAS and RLAD in right lateral radiograph were determined in 30 pugs. The VHS in left lateral radiograph was 11.01 ± 0.70 (95% range, 9.4–12.6), VLAS was 1.96 ± 0.38 (95% range, 1.1–2.8), and RLAD was 1.59 ± 0.34 (95% range, 0.7–2.4). Clinical severity of BOAS did not show any impact on radiographic measurements. For VLAS, a significant correlation to VHS was detected by all observers. No other variables had a consistent influence on the radiographic scores given by all observers. Interobserver agreement was almost perfect for VHS (0.89 on right lateral and 0.91 on left lateral image), moderate for VLAS (0.49), and fair for RLAD (0.22). More than one third of the entire study population (18 of 47 pugs) showed at least one thoracic cavity or spine abnormality, often leading to considerable changes in vertebral body shape and size.
Collapse
Affiliation(s)
- Pia Saskia Wiegel
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Rebekka Mach
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Ingo Nolte
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
- * E-mail:
| | - Fritjof Freise
- Institute for Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Charanthorn Levicar
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Kristina Merhof
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Jan-Peter Bach
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| |
Collapse
|
14
|
Hertzer J, Gordon S, Wesselowski S. Effects of recording device, body position, electrode placement, and sedation on electrocardiogram intervals in dogs. Vet J 2022; 288:105885. [PMID: 36028186 DOI: 10.1016/j.tvjl.2022.105885] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 10/15/2022]
Abstract
Selected electrocardiograph (ECG) intervals may be useful when incorporated into prediction models for cardiac risk assessment in dogs. Standard recommendations for ECG acquisition may not be adhered to in practice. Study objectives were to compare duration of P, PR, QRS, QT, and R wave peak time intervals in: (1) lead II ECGs vs. single lead precordial ECGs in conscious dogs; (2) lead II ECGs with electrodes placed in proximal limb (PL) vs. distal limb (DL) positions with dogs in right lateral (RL) recumbency, left lateral (LL) recumbency and standing positions; (3) single lead precordial ECGs from dogs in RL, LL and standing positions; and (4) before and after sedation with butorphanol in lead II ECGs obtained in RL recumbency. All intervals could be measured in all dogs (conscious and sedated) from a RL lead II ECG with both PL and DL electrode positioning. This was reduced to 98% for lead II ECGs with dogs in LL and standing positions. Intervals that were not different regardless of recording device, dog position, electrode limb position or sedation included P, QRS and P+QRS, suggesting that these intervals have the greatest clinical utility across a variety of recording conditions. The main impact of positioning in healthy dogs was the lack of ability to consistently measure all intervals in standing dogs, particularly P wave duration. Further investigation is needed to determine if this is applicable to dogs with cardiac disease.
Collapse
Affiliation(s)
- J Hertzer
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474 USA.
| | - S Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474 USA
| | - S Wesselowski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474 USA
| |
Collapse
|
15
|
Gordon SG, Saunders AB, Wesselowski SR. Asymptomatic Canine Degenerative Valve Disease. Vet Clin North Am Small Anim Pract 2022; 52:819-840. [DOI: 10.1016/j.cvsm.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Boissady E, De La Comble A, Zhu X, Abbott J, Adrien-Maxence H. Comparison of a Deep Learning Algorithm vs. Humans for Vertebral Heart Scale Measurements in Cats and Dogs Shows a High Degree of Agreement Among Readers. Front Vet Sci 2021; 8:764570. [PMID: 34957280 PMCID: PMC8695672 DOI: 10.3389/fvets.2021.764570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Heart disease is a leading cause of death among cats and dogs. Vertebral heart scale (VHS) is one tool to quantify radiographic cardiac enlargement and to predict the occurrence of congestive heart failure. The aim of this study was to evaluate the performance of artificial intelligence (AI) performing VHS measurements when compared with two board-certified specialists. Ground truth consisted of the average of constituent VHS measurements performed by board-certified specialists. Thirty canine and 30 feline thoracic lateral radiographs were evaluated by each operator, using two different methods for determination of the cardiac short axis on dogs' radiographs: the original approach published by Buchanan and the modified approach proposed by the EPIC trial authors, and only Buchanan's method for cats' radiographs. Overall, the VHS calculated by the AI, radiologist, and cardiologist had a high degree of agreement in both canine and feline patients (intraclass correlation coefficient (ICC) = 0.998). In canine patients, when comparing methods used to calculate VHS by specialists, there was also a high degree of agreement (ICC = 0.999). When evaluating specifically the results of the AI VHS vs. the two specialists' readings, the agreement was excellent for both canine (ICC = 0.998) and feline radiographs (ICC = 0.998). Performance of AI trained to locate VHS reference points agreed with manual calculation by specialists in both cats and dogs. Such a computer-aided technique might be an important asset for veterinarians in general practice to limit interobserver variability and obtain more comparable VHS reading over time.
Collapse
Affiliation(s)
| | | | - Xiajuan Zhu
- Office of Information Technology, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Jonathan Abbott
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Hespel Adrien-Maxence
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, Knoxville, TN, United States
| |
Collapse
|
17
|
Vertebral Heart Scale for the Brittany Spaniel: Breed-Specific Range and Its Correlation with Heart Disease Assessed by Clinical and Echocardiographic Findings. Vet Sci 2021; 8:vetsci8120300. [PMID: 34941827 PMCID: PMC8708192 DOI: 10.3390/vetsci8120300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022] Open
Abstract
The vertebral heart scale (VHS) was proposed by Buchanan and Bucheler as an objective method for estimating heart size in dogs. However, several studies have reported significant variation between breeds. The purpose of this retrospective study was to evaluate the VHS and to suggest a useful upper limit for normal heart size in Brittany Spaniels. The VHS was measured using a right lateral view in twenty-eight normal dogs and fifteen dogs with myxomatous mitral valve disease. The mean ± SD (standard deviation) VHS was 10.6 ± 0.2 vertebrae (v) in the normal dogs, which differs significantly from the mean VHS of 9.7 ± 0.5 v in Buchanan’s original study with dogs of various breeds. The VHS in the dogs with myxomatous mitral valve disease was 11.9 ± 1.1 v. With a threshold value of 11.1 vertebrae, the sensitivity, specificity, positive and negative predictive values for diagnosing a cardiomegaly are 90%, 72%, 53% and 96%, respectively.
Collapse
|
18
|
Baisan RA, Vulpe V. Vertebral heart size and vertebral left atrial size reference ranges in healthy Maltese dogs. Vet Radiol Ultrasound 2021; 63:18-22. [PMID: 34585453 DOI: 10.1111/vru.13027] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022] Open
Abstract
The most common cardiac measurements on thoracic radiography in veterinary medicine are vertebral heart size (VHS) and vertebral left atrial size (VLAS). Previously published studies have demonstrated evidence that reference ranges for these measures vary among different dog breeds, however reference ranges for Maltese breed dogs are currently lacking. We hypothesized that VHS and VLAS in healthy Maltese dogs would not be influenced by sex, age, or bodyweight. This retrospective, reference interval study aimed to describe reference intervals for VHS and VLAS in a sample of clinically healthy Maltese dogs and assess the intra- and interobserver variabilities for VLAS and VHS measurements. A total of 81 clinically healthy Maltese dogs were included, with healthy status being based on a complete cardiologic examination. Thoracic radiography in right lateral recumbency was performed for all dogs. The intra- and interobserver variability assessments of VHS and VLAS were based on measurements independently performed by three observers. The mean VHS was 9.53 ± 0.46 vertebrae (v). The median and interquartile range (IQR) for VLAS was 2 v (IQR, 1.8-2.1v). A statistically significant moderate positive correlation was observed between VHS and VLAS (P < .01, r = 0.416). Both VHS and VLAS showed an almost perfect intraobserver agreement. Interobserver agreement was almost perfect for VHS and substantial for VLAS. Findings supported previous studies recommending the use of breed-specific reference values for VHS and VLAS, and provided background data for future radiographic evaluations of Maltese dogs with clinical signs of cardiac disease.
Collapse
Affiliation(s)
- Radu Andrei Baisan
- Department of Clinics, Faculty of Veterinary Medicine, University of Applied Life Sciences and Environment "Ion Ionescu de la Brad", Iași, Romania
| | - Vasile Vulpe
- Department of Clinics, Faculty of Veterinary Medicine, University of Applied Life Sciences and Environment "Ion Ionescu de la Brad", Iași, Romania
| |
Collapse
|
19
|
Lam C, Gavaghan BJ, Meyers FE. Radiographic quantification of left atrial size in dogs with myxomatous mitral valve disease. J Vet Intern Med 2021; 35:747-754. [PMID: 33634912 PMCID: PMC7995357 DOI: 10.1111/jvim.16073] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background In the absence of echocardiography, identification of cardiomegaly via thoracic radiography is a necessary criterion for classification of disease severity in dogs with myxomatous mitral valve disease (MMVD). Objective Modified‐vertebral left atrial size (M‐VLAS) facilitates objective radiographic assessment of the left atrium (LA) in 2 dimensions and identifies LA enlargement more accurately than existing methods. Animals Sixty‐four dogs with various stages of MMVD and 6 control healthy dogs. Methods Retrospective case–control study. Medical records were searched for dogs with varying severity of MMVD. Modified‐vertebral left atrial size, vertebral left atrial size (VLAS), vertebral heart size (VHS), and radiographic left atrial dimension (RLAD) were measured from thoracic radiographs and compared with echocardiographically derived measurements. Results Positive correlation to LA/Ao was identified for M‐VLAS (r = 0.77, P < .001), VLAS (r = 0.76, P < .001), RLAD (r = 0.75, P < .001), and VHS (r = 0.67, P < .001). Receiver operating characteristic analyzes provided an area under the curve of 0.97 (95% CI, 0.94‐1.00) for M‐VLAS, which was superior to VHS (0.90, 95% CI, 0.94‐1.00, P = .03) in identifying dogs with LA/Ao ≥1.6. A cut‐off value of ≥3.4 vertebrae using M‐VLAS provided 92.7% sensitivity and 93.1% specificity in predicting LA enlargement. Conclusions and clinical importance M‐VLAS, which is superior to VHS, offers an accurate and repeatable way to radiographically identify LA enlargement in dogs with MMVD.
Collapse
Affiliation(s)
- Christopher Lam
- Cardiology Service, Veterinary Specialist Services, Brisbane, Queensland, Australia
| | - Brad J Gavaghan
- Cardiology Service, Veterinary Specialist Services, Brisbane, Queensland, Australia
| | - Fiona E Meyers
- Cardiology Service, Veterinary Specialist Services, Brisbane, Queensland, Australia
| |
Collapse
|
20
|
Duler L, Visser LC, Jackson KN, Phillips KL, Pollard RE, Wanamaker MW. Evaluation of radiographic predictors of left heart enlargement in dogs with known or suspected cardiovascular disease. Vet Radiol Ultrasound 2021; 62:271-281. [PMID: 33439529 DOI: 10.1111/vru.12949] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 11/27/2022] Open
Abstract
Radiographic assessment of heart size is important for clinical management of dogs with cardiovascular disease (CVDz). We sought to compare the ability of vertebral heart size (VHS), vertebral left atrial size (VLAS), and radiologists' assessment of left atrial size (RadLAE) to predict echocardiographic left atrial size (EchoLAE), an important marker of left heart disease severity. We also compared the ability of VHS and VLAS to predict echocardiographic criteria for ACVIM stage B2 (EchoB2) in dogs with myxomatous mitral valve disease (MMVD). This prospective observational study enrolled 183 dogs with known or suspected CVDz that had an echocardiographic examination and thoracic radiographs obtained within 24 h. Compared to increased VHS, VLAS >2.3 was a more accurate predictor of EchoLAE (P = .002). VLAS >2.3 and RadLAE (both P <.0001) were independently associated with EchoLAE but VHS was not (P = .45). Optimal cutoffs for VLAS and VHS to predict EchoLAE were >2.3 vertebrae (sensitivity [Sn] = 90.3%, specificity [Sp] = 73.6%) and >11.1 vertebrae (Sn = 75.8%, Sp = 76.0%), respectively. Diagnostic accuracy of VLAS (AUC 0.84, 95% CI 0.73-0.92) and VHS (AUC 0.78, 95% CI 0.66-0.88) to predict EchoB2 in dogs with subclinical MMVD (n = 64) were not significantly different (P = .17). Results demonstrate that VLAS and RadLAE were superior indicators of EchoLAE compared to VHS in dogs with known or suspected CVDz. Both VLAS and VHS are useful predictors of EchoB2 in dogs with subclinical MMVD. When echocardiography is unavailable, VLAS represents a useful radiographic measurement to aid clinical management of dogs with known or suspected CVDz.
Collapse
Affiliation(s)
- Laetitia Duler
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Lance C Visser
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Kristina N Jackson
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Kathryn L Phillips
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Rachel E Pollard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Mason W Wanamaker
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, California, USA
| |
Collapse
|
21
|
Poad MH, Manzi TJ, Oyama MA, Gelzer AR. Utility of radiographic measurements to predict echocardiographic left heart enlargement in dogs with preclinical myxomatous mitral valve disease. J Vet Intern Med 2020; 34:1728-1733. [PMID: 32686167 PMCID: PMC7517506 DOI: 10.1111/jvim.15854] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Evaluation of left heart size helps determine disease severity in dogs with myxomatous mitral valve disease (MMVD). HYPOTHESIS/OBJECTIVES Determine the ability of radiographic vertebral heart size (VHS) and vertebral left atrial size (VLAS) to predict LHEECHO in dogs with preclinical MMVD. ANIMALS Seventy client-owned dogs with MMVD and no historical or present clinical or radiographic evidence of congestive heart failure (CHF). METHODS Retrospective cross-sectional study of dogs with same-day echocardiography and thoracic radiography. Receiver-operating characteristic (ROC) curves were used to assess the ability of VHS, VLAS, and VHS + VLAS to discern dogs with and without LHEECHO , and clinically relevant cutpoints for these radiographic measurements were selected. RESULTS The ability of VHS and VHS + VLAS to predict LHEECHO was moderate (area under the curve [AUC]VHS = 0.851; 95% CI, 0.762-0.941; AUCVHS + VLAS = 0.865; 0.783-0.947), and performance of VLAS and VHS + VLAS was not different from that of VHS alone. A VHS cutpoint of >10.8 had sensitivity = 91.1% (76.3%-98.1%) and specificity = 69.4% (51.9%-83.7%) for predicting LHEECHO . A cutpoint of >11.7 had sensitivity = 32.4% (17.4%-50.5%) and specificity = 97.2% (85.5%-99.9%) for predicting LHEECHO . Thirty (43%) of the 70 dogs had a VHS value of 10.9 to 11.7. CONCLUSIONS AND CLINICAL IMPORTANCE Vertebral heart size >11.7 identified dogs with LHEECHO and VHS ≤ 10.8 excluded dogs with LHEECHO . A large percentage of dogs had VHS values intermediate to these cutpoints.
Collapse
Affiliation(s)
- Megan H. Poad
- University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Mark A. Oyama
- University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | |
Collapse
|