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Pradelli D, Quintavalla C, Crosta MC, Mazzoni L, Oliveira P, Scotti L, Brambilla P, Bussadori C. The influence of emotional stress on Doppler-derived aortic peak velocity in boxer dogs. J Vet Intern Med 2014; 28:1724-30. [PMID: 25312007 PMCID: PMC4895642 DOI: 10.1111/jvim.12434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 06/23/2014] [Accepted: 07/14/2014] [Indexed: 11/29/2022] Open
Abstract
Background Subaortic stenosis (SAS) is a common congenital heart disease in Boxers. Doppler‐derived aortic peak velocity (AoPV) is a diagnostic criterion for the disease. Objectives To investigate the influence of emotional stress during echocardiographic examination on AoPV in normal and SAS‐affected Boxers. To evaluate the effects of aortic root diameters on AoPV in normal Boxers. Dogs Two hundred and fifteen normal and 19 SAS‐affected Boxers. Methods The AoPV was recorded at the beginning of echocardiographic examination (T0), and when the emotional stress of the dog was assumed to decrease based on behavioral parameters and heart rate (T1). AoPV0–AoPV1 was calculated. In normal dogs, stroke volume index was calculated at T0 and T1. Aortic root diameters were measured and their relationship with AoPV and AoPV0–AoPV1 was evaluated. Results In normal dogs, AoPV was higher at T0 (median, 1.95 m/s; range, 1.60–2.50 m/s) than at T1 (median, 1.76 m/s; range, 1.40–2.20 m/s; P < .0001; reduction 9.2%). The stroke volume index at T0 also was greater than at T1 (P < .0001). Weak negative correlations were detected between aortic root size and aortic velocities. In SAS‐affected dogs, AoPV0 was higher than AoPV1 (P < .0001; reduction 7.3%). Conclusion and Clinical Importance Aortic peak velocity was affected by emotional stress during echocardiographic examination both in SAS‐affected and normal Boxers. In normal Boxers, aortic root size weakly affected AoPVs, but did not affect AoPV0–AoPV1. Stroke volume seems to play a major role in stress‐related AoPV increases in normal Boxers. Emotional stress should be taken into account when screening for SAS in the Boxer breed.
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Affiliation(s)
- D Pradelli
- Clinica Veterinaria "Gran Sasso", Milan, Italy
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Menegazzo L, Bussadori C, Chiavegato D, Quintavalla C, Bonfatti V, Guglielmini C, Sturaro E, Gallo L, Carnier P. The relevance of echocardiography heart measures for breeding against the risk of subaortic and pulmonic stenosis in Boxer dogs1. J Anim Sci 2012; 90:419-28. [DOI: 10.2527/jas.2011-4018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L. Menegazzo
- Department of Animal Science, University of Padova, viale dell'Università 16, 35020 Legnaro (PD), Italy
| | - C. Bussadori
- Istituto di Medicina Cardiovascolare, Ospedale Maggiore IRCCS, University of Milan, Italy
| | - D. Chiavegato
- La Clinica Veterinaria, Via Callegari 48, 35010 Padova, Italy
| | - C. Quintavalla
- Department of Animal Health, Parma University, Via del Taglio, 8, 43100 Parma, Italy
| | - V. Bonfatti
- Department of Animal Science, University of Padova, viale dell'Università 16, 35020 Legnaro (PD), Italy
| | - C. Guglielmini
- Department of Veterinary Clinical Sciences, University of Padova, viale dell'Università 16, 35020 Legnaro (PD), Italy
| | - E. Sturaro
- Department of Animal Science, University of Padova, viale dell'Università 16, 35020 Legnaro (PD), Italy
| | - L. Gallo
- Department of Animal Science, University of Padova, viale dell'Università 16, 35020 Legnaro (PD), Italy
| | - P. Carnier
- Department of Animal Science, University of Padova, viale dell'Università 16, 35020 Legnaro (PD), Italy
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Höglund K, Häggström J, Bussadori C, Kvart C. A prospective study of systolic ejection murmurs and left ventricular outflow tract in boxers. J Small Anim Pract 2010; 52:11-7. [PMID: 21143232 DOI: 10.1111/j.1748-5827.2010.01009.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the prevalence and progression of murmurs and the development of the left ventricular outflow tract (LVOT) and flow velocities in the great arteries in boxer puppies through adolescence until three years of age. METHODS Nineteen boxer puppies with or without a low-intensity murmur, but without evidence of congenital heart disease, were studied prospectively. Examinations were carried out at 7 weeks, 3, 4, 6, 9, 12 and 36 months of age by cardiac auscultation and Doppler echocardiography. RESULTS Presence and intensity of heart murmurs varied in the same dog and between dogs, but flow velocities did not change. Estimated effective orifice diameter (EOD) and indexed EOD was significantly narrower than measured subvalvular and valvular diameters. CLINICAL SIGNIFICANCE The variability in presence and intensity of low-intensity ejection murmurs is high during growth in boxers.
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Affiliation(s)
- K Höglund
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden
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4
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Quintavalla C, Guazzetti S, Mavropoulou A, Bussadori C. Aorto-septal angle in Boxer dogs with subaortic stenosis: an echocardiographic study. Vet J 2009; 185:332-7. [PMID: 19665399 DOI: 10.1016/j.tvjl.2009.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 05/28/2009] [Accepted: 06/27/2009] [Indexed: 10/20/2022]
Abstract
The present study was designed to determine the aorto-septal angle (AoSA) in Boxer dogs with or without subaortic stenosis (SAS) by using two-dimensional echocardiography. Forty-five Boxer dogs were prospectively included in the study. The AoSA was steeper in the group with SAS than in healthy Boxers with a mean difference of 10 degrees . According to the proposed regression model, the AoSA is associated with SAS in Boxers, particularly because it becomes steeper as SAS severity increases. Several studies in humans demonstrate that small changes in the AoSA produce important changes in septal shear stress, which in turn causes proliferation of the endocardial cells resulting in subaortic obstruction. A definite conclusion about the role of the AoSA on the formation and/or progression of subvalvular lesions in Boxers cannot be drawn from the data analysed due to the transversal nature of the observations.
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Affiliation(s)
- Cecilia Quintavalla
- Dept. Animal Health, Parma University, Via del Taglio, 8, 43100 Parma, Italy.
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5
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Bussadori C, Pradelli D, Borgarelli M, Chiavegato D, D’Agnolo G, Menegazzo L, Migliorini F, Santilli R, Zani A, Quintavalla C. Congenital heart disease in boxer dogs: Results of 6years of breed screening. Vet J 2009; 181:187-92. [DOI: 10.1016/j.tvjl.2008.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 01/31/2008] [Accepted: 02/12/2008] [Indexed: 10/22/2022]
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6
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Jenni S, Gardelle O, Zini E, Glaus TM. Use of auscultation and Doppler echocardiography in Boxer puppies to predict development of subaortic or pulmonary stenosis. J Vet Intern Med 2009; 23:81-6. [PMID: 19175725 DOI: 10.1111/j.1939-1676.2008.0213.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Boxers are predisposed to subaortic and pulmonic stenosis (SAS, PS). Screening of puppies may be useful in estimating the risk of their developing a defect that potentially compromises life expectancy or exercise tolerance. HYPOTHESIS Presence of SAS or PS in adult Boxers can be predicted by auscultation and Doppler echocardiography at 9-10 weeks of age. ANIMALS Eighty-five Boxer puppies examined at 9-10 weeks of age and at 12 months of age. METHODS Prospective, longitudinal observational study. Auscultation by stethoscope and continuous wave-Doppler echocardiography for peak velocities (V(max)) in the aorta (Ao) and pulmonary artery (PA). RESULTS Intensity of heart murmurs in puppies correlated with V(max)Ao and V(max)PA in adults. V(max)Ao and V(max)PA in puppies correlated with V(max)Ao and V(max)PA in adults, respectively. From puppy to adult, V(max)Ao increased and V(max)PA remained unchanged. The negative predictive value for absent or only a soft (< or =II/VI) murmur in puppies being associated with V(max)Ao and PA < or = 2.4 m/s as an adult was 90% and < or =3.5 m/s 100%. The negative predictive value of a V(max)< or = 2.4 m/s as a puppy still being < or =2.4 m/s as an adult was 94% for Ao and 96% for PA, and of a V(max)< or = 3.5 m/s, 99% for Ao and 100% for PA. CONCLUSIONS AND CLINICAL IMPORTANCE Even though V(max)Ao increases during growth in Boxer puppies, indicating relative narrowing of the aorta, puppies with V(max)Ao < or = 2.4 m/s do not usually progress to clinically have relevant SAS at 12 months of age.
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Affiliation(s)
- S Jenni
- Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Cunningham SM, Rush JE, Freeman LM, Brown DJ, Smith CE. Echocardiographic ratio indices in overtly healthy Boxer dogs screened for heart disease. J Vet Intern Med 2008; 22:924-30. [PMID: 18537876 DOI: 10.1111/j.1939-1676.2008.0121.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Boxer dogs are routinely screened by echocardiography to exclude congenital and acquired heart disease. Individuals of a given breed may span a large range of body sizes, potentially invalidating linear regression of M-mode measurements against body weight. Echocardiographic ratio indices (ERIs) provide a novel method of characterizing echocardiographic differences between Boxers and other dog breeds. HYPOTHESIS ERIs obtained from overtly healthy Boxer dogs presented for cardiac screening will be different from ERIs established for normal non-Boxer dogs, and those differences will be unrelated to aortic velocity or systolic blood pressure. ANIMALS Eighty-one Boxers with no outward clinical signs of heart disease were studied. METHODS All dogs were examined by 2-dimensional, M-mode, and Doppler echocardiography. M-mode measurements were used to perform ERI calculations, and the indices in Boxers were compared between Boxers with varying severity of arrhythmia and those of normal non-Boxer dogs. RESULTS Differences in weight-based ERIs, which reflect increased thickness of the left ventricular free wall (LVW) and interventricular septum (IVS) and smaller aortic size, were found in overtly healthy Boxer dogs compared with normal non-Boxer dogs. ERIs of left atrial and LV cavity size in overtly healthy Boxers were not significantly different from those of non-Boxer dogs. CONCLUSIONS AND CLINICAL IMPORTANCE Boxer dogs may have an increased relative thickness of the LVW and IVS that is independent of aortic size, aortic velocity, or arterial blood pressure, and this morphology should be taken into consideration when screening Boxers by echocardiography.
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Affiliation(s)
- S M Cunningham
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
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8
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Ahlstrom Ast C, Höglund K, Hult P, Häggström J, Kvart C, Ask P. Assessing aortic stenosis using sample entropy of the phonocardiographic signal in dogs. IEEE Trans Biomed Eng 2008; 55:2107-9. [PMID: 18632375 DOI: 10.1109/tbme.2008.923767] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In aortic valve stenosis (AS), heart murmurs arise as an effect of turbulent blood flow distal to the obstructed valves. With increasing AS severity, the flow becomes more unstable, and the ensuing murmur becomes more complex. We hypothesize that these hemodynamic flow changes can be quantified based on the complexity of the phonocardiographic (PCG) signal. In this study, sample entropy (SampEn) was investigated as a measure of complexity using a dog model. Twenty-seven boxer dogs with various degrees of AS were examined with Doppler echocardiography, and the peak aortic flow velocity ( V(max)) was used as a reference of AS severity. SampEn correlated to V(max) with R = 0.70 using logarithmic regression. In a separate analysis, significant differences were found between physiologic murmurs and murmurs caused by AS ( p << 0.05), and the area under a receiver operating characteristic curve was calculated to 0.96. Comparison with previously presented PCG measures for AS assessment showed improved performance when using SampEn, especially for differentiation between physiological murmurs and murmurs caused by mild AS. Studies in patients will be needed to properly assess the technique in humans.
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Affiliation(s)
- C Ahlstrom Ast
- Department of Biomedical Engineering, Linköping University, SE-581 83 Linköping, Sweden.
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9
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Contrast echocardiography in Boxer dogs with and without aortic stenosis. J Vet Cardiol 2007; 9:15-24. [DOI: 10.1016/j.jvc.2006.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 01/14/2006] [Accepted: 02/18/2006] [Indexed: 11/18/2022]
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10
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Linde A, Koch J. Screening for aortic stenosis in the Boxer: Auscultatory, ECG, blood pressure and Doppler echocardiographic findings. J Vet Cardiol 2006; 8:79-86. [PMID: 19083341 DOI: 10.1016/j.jvc.2006.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Revised: 01/19/2006] [Accepted: 02/27/2006] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study was conducted to estimate the incidence of aortic stenosis (AS) in a group of Boxers evaluated by auscultation, ECG, blood pressure measurement and Doppler-echocardiography. BACKGROUND The Boxer is a breed at significantly increased risk of AS. The prevalence of murmurs and Doppler-echocardiographic findings consistent with AS in this breed is reportedly high. ANIMALS, MATERIALS AND METHODS Eighty-nine Boxers were evaluated by auscultation, and final murmur grade recorded after stress testing. Doppler echocardiography was performed in fifty-five adult Boxers. Electrocardiograms (ECG, n=53), non-invasive blood pressure measurement (n=32), and Holter monitoring (n=24) were performed in selected dogs. Degree of AS was based on the aortic peak flow velocity (Ao PFV). Final Ao PFV was recorded as the highest value obtained after stress testing. AS was defined as an Ao PFV>2m/s on continuous wave Doppler, using the subcostal window. Pressure gradients (Deltap) were calculated using the modified Bernoulli equation (Deltap=4V(2)). Mild AS was defined as Deltap=16-40mmHg, moderate AS Deltap=40-75mmHg, and severe AS Deltap>75mmHg. RESULTS 62% of adult Boxers evaluated by echocardiography had an Ao PFV>2m/s suggestive of AS. Systolic basilar ejection murmurs were diagnosed in 73%. Murmur intensity showed a statistically significant correlation with Ao PFV (p<0.05). ECG abnormalities were only detected in dogs with severe AS. CONCLUSION The study reports on systolic murmurs and Doppler-echocardiographic findings consistent with AS, as well as ECG and blood pressure measurements in a sample of pure-breed Boxers.
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Affiliation(s)
- Annika Linde
- Department of Anatomy and Physiology, Kansas State University, 140 Justin Hall, Manhattan, KS 66506-1407, USA
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11
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Chetboul V, Trollé JM, Nicolle A, Carlos Sampedrano C, Gouni V, Laforge H, Benalloul T, Tissier R, Pouchelon JL. Congenital Heart Diseases in the Boxer Dog: A Retrospective Study of 105 Cases (1998â2005). ACTA ACUST UNITED AC 2006; 53:346-51. [PMID: 16922831 DOI: 10.1111/j.1439-0442.2006.00865.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Subaortic stenosis (SAS) is one of the most common congenital heart diseases (CHD) in dogs with Boxers being predominantly affected. However, the increasing availability of modern diagnostic imaging systems now allows a better assessment of cardiac morphology and function, thereby facilitating early detection of CHD in awake animals. In this context, the case records of Boxer dogs diagnosed with CHD using echocardiography combined with Doppler mode, were retrospectively reviewed (1998-2005). One hundred and five Boxers exhibiting either a single CHD (53/105, 50.5%) or association of several CHD (52/105, 49.5%) were included. The most common CHD was atrial septal defect (ASD) observed in 56.2% of these animals (59/105), followed by mitral dysplasia (58/105, 55.2%), and SAS (49/105, 46.7%). SAS was associated with one or two CHD in 29.5% of cases (31/105). Most of the dogs with a low intensity left heart base systolic murmur had an isolated ASD whereas most of the dogs with a similar but high intensity murmur had SAS, either isolated or associated with a concurrent CHD. The incidence of ASD and mitral dysplasia in Boxer dogs is higher than previously assumed, and ASD is a common cause of left heart base systolic murmur in this breed of dog. This confirms that the detection of such a murmur should not be used as the unique criterion for diagnostic confirmation of SAS.
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Affiliation(s)
- V Chetboul
- Cardiology Unit of Alfort, National Veterinary School of Alfort, 7 avenue du General de Gaulle, 94704 Maisons-Alfort cedex, France.
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12
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Koplitz S, Meurs K, Bonagura J. Echocardiographic Assessment of the Left Ventricular Outflow Tract in the Boxer. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb01804.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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13
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Quintavalla C, Pradelli D, Domenech O, Bussadori C. TRANSESOPHAGEAL ECHOCARDIOGRAPHY OF THE LEFT VENTRICULAR OUTFLOW TRACT, AORTIC VALVE AND ASCENDING AORTA IN BOXER DOGS WITH HEART MURMURS. Vet Radiol Ultrasound 2006; 47:307-12. [PMID: 16700184 DOI: 10.1111/j.1740-8261.2006.00145.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The study was aimed at evaluating the anatomy of the left ventricular outflow tract, aortic valve, and ascending aorta by means of multiplane transesophageal echocardiography in Boxer dogs with left basilar heart murmurs and at comparing two-dimensional (2D) transthoracic to transesophageal echocardiography for the diagnosis of subaortic stenosis in this breed. Twenty-eight Boxers were included in the study and allocated to four groups according to physical and routine transthoracic 2D and Doppler echocardiography findings: group A--dogs with low grade (I-II/VI) heart murmurs without overt evidence of aortic stenosis (14 dogs); group B--dogs with type 1 subaortic stenosis (seven dogs); group C--dogs with type 2 subaortic stenosis (five dogs); group D--dogs with type 3 subaortic stenosis (two dogs). Anatomic lesions were not discovered by transesophageal echocardiography in dogs belonging to group A. Transesophageal imaging confirmed the type of subaortic stenosis, as graded by transthoracic echocardiography, in diseased animals (groups BCD). Morphologic information obtained by transesophageal echocardiography in Boxer dogs was similar to that obtained by transthoracic echocardiography.
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Höglund K, French A, Dukes-McEwan J, Häggström J, Smith P, Corcoran B, Kvart C. Low intensity heart murmurs in boxer dogs: inter-observer variation and effects of stress testing. J Small Anim Pract 2004; 45:178-85. [PMID: 15116885 DOI: 10.1111/j.1748-5827.2004.tb00221.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Inter-observer variation in the detection and grading of low intensity heart murmurs in boxer dogs was investigated. Six veterinarians with different levels of experience examined 27 boxers by cardiac auscultation. The dogs were auscultated before and after exercise, and the results were compared with phonocardiographic and echocardiographic examinations performed at rest and during two different stress tests. A subvalvular aortic ridge was identified in six dogs on two-dimensional echocardiography. Using dogs with low intensity murmurs or dogs free of heart murmurs, inter-observer agreement was positively correlated to the level of experience at rest (weighted kappa [kappa] 0.14 to 0.75), while the agreement was poor after exercise (weighted kappa 0.01 to 0.36). The presence of a subvalvular aortic ridge was associated with higher aortic flow velocities (P<0.002) and higher auscultatory murmur grading (P<0.001). There was an increase in murmur duration during one kind of stress test (P<0.001) and in aortic flow velocity during the other (P=0.001).
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Affiliation(s)
- K Höglund
- Department of Anatomy and Physiology, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, PO Box 7045, 750 07 Uppsala, Sweden
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Koplitz SL, Meurs KM, Spier AW, Bonagura JD, Fuentes VL, Wright NA. Aortic ejection velocity in healthy Boxers with soft cardiac murmurs and Boxers without cardiac murmurs: 201 cases (1997-2001). J Am Vet Med Assoc 2003; 222:770-4. [PMID: 12675300 DOI: 10.2460/javma.2003.222.770] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine aortic ejection velocity in healthy adult Boxers with soft ejection murmurs without overt structural evidence of left ventricular outflow tract obstruction and in healthy Boxers without cardiac murmurs. DESIGN Retrospective study. ANIMALS 201 Boxers. PROCEDURE Dogs were examined independently by 2 individuals for evidence of a cardiac murmur, and a murmur grade was assigned. Maximal instantaneous (peak) aortic ejection velocity was measured by means of continuous-wave Doppler echocardiography from a subcostal location. Forty-eight dogs were reexamined approximately 1 year later. RESULTS A soft (grade 1, 2, or 3) left-basilar ejection murmur was detected in 113 (56%) dogs. Overall median aortic ejection velocity was 1.91 m/s (range, 1.31 to 4.02 m/s). Dogs with murmurs had significantly higher aortic ejection velocities than did those without murmurs (median, 2.11 and 1.72 m/s, respectively). Auscultation of a murmur was 87% sensitive and 66% specific for the identification of aortic ejection velocity > 2.0 m/s. An ejection murmur and aortic ejection velocity > 2.0 m/s were identified in 73 (36%) dogs. For most dogs, observed changes in murmur grade and aortic ejection velocity during a follow-up examination 1 year later were not clinically important. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that ejection murmurs were common among healthy adult Boxers and that Boxers with murmurs were likely to have high (> 2.0 m/s) aortic ejection velocities. The cause of the murmurs in these dogs is unknown.
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Affiliation(s)
- Shianne L Koplitz
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43201, USA
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