Accuracy of Doppler echocardiographic estimates of pulmonary artery pressures in a canine model of pulmonary hypertension (original) (raw)
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Prognostic value of right pulmonary artery distensibility in dogs with pulmonary hypertension
Journal of Veterinary Science, 2019
The right pulmonary artery distensibility (RPAD) index has been used in dogs with pulmonary hypertension (PH) caused by heartworm infection, myxomatous mitral valve disease, or patent ductus arteriosus. We hypothesized that this index correlates with the tricuspid regurgitation pressure gradient (TRPG) assessed by echocardiography and could predict survival in dogs with PH secondary to various causes. To assess this hypothesis, the medical records of 200 client-owned dogs at a referral institution were retrospectively reviewed. The RPAD index and the ratios of acceleration time to peak pulmonary artery flow (AT) and to the ejection time of pulmonary artery flow (ET) were recorded for each dog. The owners were contacted for follow-up assessments. The findings indicated that the RPAD index was correlated with the TRPG (R 2 = 0. 362, p < 0.001). The survival time was significantly shorter in dogs with an RPAD index ≤ 21% that were followed up for 3 months and in dogs with an RPAD index ≤ 24% that were followed up for 1 year. Thus, the RPAD index was correlated with the TRPG and could predict the clinical outcome in dogs with PH caused by various diseases. This index could be used to evaluate the severity of PH in dogs without tricuspid regurgitation.
Pesquisa Veterinária Brasileira
ABSTRACT: Pulmonary hypertension (PH) in dogs is a syndrome that can occur secondary to several causes, including left heart disease (postcapillary) and chronic respiratory disease (precapillary). This study evaluates morphological and functional consequences in the right ventricle (RV) of dogs with pre- and postcapillary PH through echocardiography, and also considers the severity of PH (mild, moderate or severe). Echocardiography was performed on 66 dogs of various breeds and weights (age >3 years old) which were assigned to three groups: postcapillary PH, which included mitral valve disease/endocardiosis, precapillary PH, which included chronic respiratory diseases (bronchitis, collapse of the trachea and primary lung cancer or metastasis), and finally, a healthy group of controls. The parameters for RV morphology were RV1, RV2, and RV3 for systole and diastole. The following measurements were used to assess RV systolic function: tricuspid annular plane systolic excursion (TAP...
Echocardiographic Evaluation of the Right Atrial Area Index in Dogs with Pulmonary Hypertension
Journal of Veterinary Internal Medicine, 2018
BACKGROUND: Right atrial area (RAA) is a prognostic factor in human patients with pulmonary arterial hypertension (PAH). Reference intervals for RAA have been described in healthy dogs. OBJECTIVES: To evaluate RAA indexed to the body surface area in dogs with PAH as an indicator of right atrial size, PAH severity and right-sided congestive heart failure (R-CHF). ANIMALS: A total of 119 client-owned dogs, 48 dogs with PAH and 71 control dogs. METHODS: Prospective observational study. Pulmonary arterial hypertension was classified according to the tricuspid regurgitation pressure gradient (TRPG) as mild (36-50 mmHg), moderate (51-75 mmHg), or severe (>75 mmHg). The RAA index was calculated as the RAA divided by body surface area. RESULTS: The RAA index was higher in dogs with moderate PAH (13.3 cm /m ; range, 3.4-24.7 cm /m) and severe PAH (12.1 cm /m ; range, 5.4-21.8 cm /m) than in those with mild PAH (6.7 cm /m ; range, 4.8-10.7 cm /m) or in controls (7.3 cm /m ; range, 4.2-10.2 cm /m ; P < 0.001). The RAA index was higher (P < 0.0001) in dogs with R-CHF (17.5 cm /m ; range, 12.7-24.7 cm /m) compared to those without R-CHF (7.6 cm /m ; range, 4.4-19.4 cm /m). The most accurate cutoff value of the RAA index to identify R-CHF was >12.3 cm /m (sensitivity, 100%; specificity, 89.5%). In dogs with PAH, severity of tricuspid regurgitation (TR) was the only independent predictor of RAA index based on multivariate analysis (P < 0.02). CONCLUSIONS AND CLINICAL IMPORTANCE: The RAA index can be used to evaluate right atrial size in dogs and may be more effective than TRPG in predicting R-CHF in dogs with PAH. The severity of TR is the main determinant of the RAA index in dogs with PAH.
The International Journal of Cardiovascular Imaging, 2010
Pulmonary arterial hypertension (PAH) is a life-threatening condition characterized by progressive elevation in pulmonary artery pressure (PAP) and total pulmonary vascular resistance (TPVR). Recent advances in imaging techniques have allowed the development of new echocardiographic parameters to evaluate disease progression. However, there are no reports comparing the diagnostic performance of these non-invasive parameters to each other and to invasive measurements. Therefore, we investigated the diagnostic yield of echocardiographically derived TPVR and Doppler parameters of PAP in screening and measuring the severity of PAH in a rat model. Serial echocardiographic and invasive measurements were performed at baseline, 21 and 35 days after monocrotaline-induction of PAH. The most challenging echocardiographic derived TPVR measurement had good correlation with the invasive measurement (r = 0.92, P \ 0.001) but also more simple and novel parameters of TPVR were found to be useful although the non-invasive TPVR measurement was feasible in only 29% of the studies due to lack of sufficient tricuspid valve regurgitation. However, echocardiographic measures of PAP, pulmonary artery flow acceleration time (PAAT) and deceleration (PAD), were measurable in all animals, and correlated with invasive PAP (r = -0.74 and r = 0.75, P \ 0.001 for both). Right ventricular thickness and area correlated with invasive PAP (r = 0.59 and r = 0.64, P \ 0.001 for both). Observer variability of the invasive and non-invasive parameters was low except in tissue-Doppler derived isovolumetric relaxation time. These non-invasive parameters may be used to replace invasive measurements in detecting successful disease induction and to complement invasive data in the evaluation of PAH severity in a rat model.
Evaluation of a novel echocardiographic view for the assessment of the pulmonary artery in dogs
Journal of Veterinary Cardiology, 2016
Objectives: 1) To describe a novel echocardiographic view (left cranial oblique) for the assessment of the pulmonary artery in dogs 2) To compare this novel view with other standard views. Animals: Prospective inclusion of 48 echocardiograms performed on client-owned dogs. Methods: Two standard views and the novel view were compared for quality of 2D images and spectral Doppler traces and also for pulmonary annulus diameter and spectral Doppler velocities. Association between view, heart rate and body weight and quality, annulus diameter, pulsed-wave and continuous-wave velocities were analyzed using regression analysis. Agreement between views was assessed by BlandeAltman analysis. Pulsed-wave and continuous-wave velocities were compared using the sign test for medians. Results: Forty-eight studies were undertaken of which thirty-nine were analyzed. The quality of 2D images was associated with view and heart rate. No significant difference was found in quality of spectral Doppler traces between views. Annulus diameter showed significant association with view, heart rate and weight. This measured about 0.26 cm less on one particular view. Spectral Doppler velocities
Pre-and postcapillary pulmonary hypertension in dogs: Circulating biomarkers
Background: Pulmonary hypertension (PH) in dogs is a syndrome that could be primary or secondary due to pulmonary disease, pulmonary thromboembolism, heartworm disease, and heart failure. Due to the inability of right heart catheterization in veterinary patients, there is a lack of differential criteria between PH forms. In some acute cases, it is impossible to provide a full EchoCG or catheterization study. In this situation, circulating markers may be useful to discover the possible mechanism of PH form and provide specific therapy. Aim: Following all previous data in human and veterinary studies, we assumed that plasm concentration of serotonin, endothelin-1 (ET-1), and vascular endothelial growth factor D (VEGF-D) would show a predominance in affected part of pulmonary circulation. Methods: We studied 59 small-breed dogs of different sexes and ages. Groups were formed according to a primary pathology: healthy dogs (n = 8); dogs with myxomatous mitral valve disease (MMVD) and postcapillary PH (PostPH, n = 23); dogs with MMVD and precapillary PH (PrePH, n = 28). Animals in the study were diagnosed with the primary disease by standard echocardiographic methods and algorithms. Blood samples were collected at the moment of presentation and frozen in a −80°C fridge. For biochemistry analysis, we used species-specific ELISA kits, provided by Cloud-Clone Corp. (USA). The tests were provided by the means of Almazov National Medical Research Center, IEM laboratory. Results: Dogs with EchoCG-proved PostPH had a higher concentration of VEGF-D in comparison to control and PrePH (р <0.001, for both). There was no difference between the control and PrePH groups (р >0.05). ET-1 was higher in PrePH in comparison to PostPH and control dogs (р <0.001, for both). In addition, there was no difference between the control and PostPH groups (р >0.05). Serotonin concertation did not have a difference between controls and PostPH. However, it was higher in PrePH than in control (р <0.033) and PostPH group (р <0.006). Receiver operating curve analysis showed that plasma concentrations of ET-1 (0.99) and VEGF-D (0.92) had high effectiveness in the differentiation of PostPH and PrePH. Conclusion: This study showed a correlation between circulating biomarkers (serotonin, ET-1, and VEGF-D). We found a connection between ET-1 and right-sided heart failure as well as VEGF-D and left heart failure in the PH context.
Pulmonary Hypertension in the Dog
Acta Veterinaria, 2016
Canine pulmonary hypertension is a clinical condition that needs to be adequately investigated and recognised because of the lack of specific clinical signs, the potential for rapid and irreversible deterioration of pulmonary vascular function and the development of right-sided heart failure. In recent years, many studies have been published on pulmonary hypertension, improving the understanding of its pathophysiology, the accuracy of diagnostic tests and the management of affected patients. This article provides updated information on pulmonary hypertension and serves as a resource for veterinarians regarding the interpretation of diagnostic tests and the clinical management of affected dogs.
The Veterinary Journal, 2013
Canine pulmonary arterial hypertension (PAH) remains under-recognized and under-treated despite being prevalent. This retrospective study investigated whether selected historical and physical examination findings were associated with the diagnosis of canine PAH, defined as tricuspid regurgitation (TR) with a confirmed systolic pressure gradient P35 mmHg. Two hundred and one client-owned dogs (PAH group, n = 96; control group, n = 105) were studied. Dogs in the control group had TR with a confirmed systolic gradient <35 mmHg. All dogs underwent a complete physical examination and a complete echocardiographic assessment. A loud systolic right-apical murmur (RAM) was significantly associated with TR P 35 mmHg. The proportion of dogs with PAH significantly increased as the RAM grade increased, with odds ratios of 4.4-37.6 for Grades 3/6-5/6 (P = 0.004 to <0.001), respectively. A stronger right-than-left apical-murmur had a positive predictive value (PPV) of 83% and was 96% specific for TR P 35 mmHg, and when combined with syncope, it had a PPV of 92% and was 92% specific. A Grade P4/6 RAM had a PPV of 85% and was 93% specific. Syncope with a Grade P4/6 RAM had a PPV of 94% and was 92% specific. Ascites combined with a Grade P4 or P5/6 RAM had a PPV of 100% and was 100% specific for TR P 35 mmHg. For each of these three murmur categories (Grades P4/6, P5/6, and a louder-right-than-left murmur), when detected with no concurrent ascites or syncope, the positive likelihood ratio varied from 4.6 to 6.4. A loud systolic RAM in dogs with degenerative valve disease is highly suggestive of concurrent PAH.