Left atrial size and contractile function in healthy dogs and dogs with chronic mitral valve disease (original) (raw)
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Journal of Veterinary Internal Medicine
Background: Assessment of left atrial (LA) size is important in medical decision making and prognostication in dogs with myxomatous mitral valve disease (MMVD). Real-time 3-dimensional (RT3DE) and 2-dimensional echocardiographic (2DE) methods may be used to assess LA size. Objectives: To compare measured LA volumes obtained by RT3DE with those calculated by biplane Simpson's modified method of discs (SMOD) and the area-length method (ALM) using the same RT3DE acquisition with the same timing. Animals: One hundred twenty-one privately owned dogs with naturally occurring MMVD. Methods: Prospective observational study comparing LA volumes indexed to body weight using RT3DE and 2DE-based biplane SMOD and ALM. Agreement between methods was evaluated using Bland-Altman plots and linear regression analyses. Results: Estimations of LA volume using SMOD or ALM did not show good agreement with RT3DE-derived measurements. Absolute differences between methods increased with increasing LA volume, but SMOD underestimated whereas ALM overestimated calculated volumes compared to RT3DE-derived measurements. The difference in LA volume between RT3DE and the biplane methods showed a systematic underestimation of 7% for SMOD and a systematic overestimation of 24% for ALM. Comparison of LA volumes obtained by SMOD and ALM did not show good agreement. The ALM yielded 30% larger LA volumes compared to SMOD. Conclusion and Clinical Importance: In comparison with RT3DE, SMOD systematically underestimated whereas ALM systematically overestimated LA volumes in dogs with MMVD. Because the systematic difference between RT3DE and SMOD was only 7%, SMOD might be considered the method of choice. K E Y W O R D S area-length method, canine, mitral regurgitation, Simpson's modified method of discs 1 | INTRODUCTION Left atrial (LA) size has been shown to be 1 of the strongest predictors of outcome in dogs with myxomatous mitral valve disease (MMVD). 1,2 Estimation of LA size is also important in decision making regarding medication in dogs with preclinical MMVD. 3 Mitral regurgitation (MR) causes increased LA preload which, in turn, causes LA dilatation. 4
Journal of veterinary internal medicine, 2018
The prognostic relevance of left atrial (LA) morphological and functional variables, including those derived from speckle tracking echocardiography (STE), has been little investigated in veterinary medicine. To assess the prognostic value of several echocardiographic variables, with a focus on LA morphological and functional variables in dogs with myxomatous mitral valve disease (MMVD). One-hundred and fifteen dogs of different breeds with MMVD. Prospective cohort study. Conventional morphologic and echo-Doppler variables, LA areas and volumes, and STE-based LA strain analysis were performed in all dogs. A survival analysis was performed to test for the best echocardiographic predictors of cardiac-related death. Most of the tested variables, including all LA STE-derived variables were univariate predictors of cardiac death in Cox proportional hazard analysis. Because of strong correlation between many variables, only left atrium to aorta ratio (LA/Ao > 1.7), mitral valve E wave v...
Journal of Veterinary Internal Medicine, 2017
Background: The assessment of left atrial (LA) function by 2-dimensional speckle tracking echocardiography (STE) holds important clinical implications in human medicine. Few similar data are available in dogs. Objectives: To assess LA function by STE in dogs with and without myxomatous mitral valve disease (MMVD), analyzing LA areas, systolic function, and strain. Animals: One hundred and fifty dogs were divided according to the American College of Veterinary Internal Medicine classification of heart failure: 23 dogs in class A, 52 in class B1, 36 in class B2, and 39 in class C + D. Methods: Prospective observational study. Conventional morphologic and Doppler variables, LA areas, and STE-based LA strain analysis were performed in all dogs and results were compared among groups. Correlation analysis was carried out between LA STE variables and other echocardiographic variables. Results: Variability study showed good reproducibility for all the tested variables (coefficient of variation <16%). Left atrial areas, fractional area change, peak atrial longitudinal strain (PALS), peak atrial contraction strain, and contraction strain index (CSI) differed significantly between groups B2 and C + D and all the other groups (overall P < .001), whereas only PALS differed between groups B1 and A (P = .01). Left atrial areas increased with progression of the disease, whereas LA functional parameters decreased. Only CSI increased nonsignificantly from group A to group B1 and then progressively decreased. Thirty-one significant correlations (P < .001, r > .3) were found between conventional left heart echocardiographic variables and LA areas and strain variables. Conclusions and Clinical Importance: Left atrial STE analysis provides useful information on atrial function in the dog, highlighting a progressive decline in atrial function with worsening of MMVD.
PARAmETERS IN DOGS wITH mITRAL VALVE DISEASE
2011
For several years, the 'One Health' concept has sought to address health from a more global point of view, because of the close links between human and animal health and the environment. Ceva Santé Animale is committed to this collaborative approach, applied here to cardiology, one of its sectors of expertise. The first joint cardiology symposium organized by Ceva Santé Animale two years ago in Bordeaux was a big success among experts in both human and veterinary cardiology. The scientists particularly appreciated the chance to pool their results and study similarities and differences between the human and canine contexts. The second joint human and veterinary cardiology symposium is a logical follow-up of the First one, and took place over the weekend of 1st and 2nd October 2011. Over one hundred world experts in human and veterinary cardiology were welcomed to Bordeaux. The specialists spent all day cardiology were welcomed to Bordeaux. The specialists spent all day cardiology Saturday discussing the latest research. Each theme was addressed in turn from the human and veterinary medicine viewpoints, and the rich discussions brought up plenty of ideas on both sides. This report contains the proceedings of each presentation and a summary of the discussions that came out during each session. We hope you will enjoy reading it.
Journal of Veterinary Internal Medicine, 2013
Background: Real-time 3-dimensional (RT3D) echocardiography provides a novel technique for assessing left atrial ejection fraction (LAEF) in dogs. Hypothesis: Left atrial ejection fraction is associated with severity of myxomatous mitral valve disease (MMVD). Animals: Privately owned dogs; 101 with MMVD and 52 healthy control dogs. Methods: Prospective observational study using RT3D echocardiographic estimations of LA volumes at atrial end-diastole and atrial end-systole to calculate LAEF in comparison with conventional 2-dimensional echocardiographic variables. Results: Left atrial ejection fraction decreased with increasing LA to aortic ratio (LA/Ao), percentage increase in left ventricular (LV) internal dimension, corrected for body weight (BW), in diastole (LVIDd inc%) and systole (LVIDs inc%), and age for MMVD dogs, and with BW for control dogs. The final models in the multiple regression analyses included LVIDd inc% and age for MMVD dogs, and BW alone for control dogs. LAEF varied widely in both MMVD dogs and control dogs. Conclusion and clinical importance: The wide variation of LAEF and the fact that LAEF does not appear to be an independent marker of disease severity suggest that the clinical importance of determining LAEF in dogs with MMVD might be limited.
Journal of Veterinary Internal Medicine, 2020
Background Atrial fibrillation (AF) occurs in dogs with myxomatous mitral valve disease (MMVD) as a consequence of left atrial (LA) dilatation, and it affects survival and quality of life. Objectives To evaluate the usefulness of echocardiography in predicting the first occurrence of AF in dogs with MMVD. Animals Forty-four client-owned dogs with MMVD, 22 dogs that developed AF, and 22 dogs that maintained sinus rhythm. Methods Retrospective observational study. Medical databases were reviewed for dogs that developed AF during the year after diagnosis of MMVD (AF group). The last echocardiographic examination obtained while still in sinus rhythm was used to derive selected variables. For each dog with AF, a control dog matched for body weight, class of heart failure, and LA dimension was selected. Echocardiographic results including LA volumes and LA speckle tracking echocardiography (STE)-derived variables were measured. Results Among the tested echocardiographic variables, only LA diameter (P = .03) and left ventricular internal diameter in diastole (P = .03) differed significantly between groups, whereas body weight-indexed variables of cardiac dimension as well as LA volumes and volume-derived functional variables were not different. Among the STE-derived variables, peak atrial longitudinal strain (PALS) results differed significantly between the AF group (23.8% ± 8.6%) and the control group (30.5% ± 9.6%; P = .03). A value of PALS 28% predicted AF occurrence with sensitivity and specificity of 0.80 and 0.65, respectively. Conclusions and Clinical Importance Absolute cardiac diameters and LA STE (in particular, PALS) are useful echocardiographic predictors for the development of AF in dogs with MMVD.
Journal of Veterinary Internal Medicine, 2015
Background: Early recognition of left-sided congestive heart failure (CHF) in dogs with degenerative mitral valve disease (DMVD) is important because it influences medical therapy, timing of follow-up, and outcome. Hypothesis: Pulmonary vein diameter-to-pulmonary artery diameter ratio (PV/PA) measured by echocardiography can predict CHF. Animals: Ninety-eight client-owned dogs, 37 controls, and 61 dogs with DMVD. Methods: Prospective clinical cohort study. History, physical examination and Doppler-echocardiography were performed. Dogs were classified as International Small Animal Cardiac Health Council class I, II or III. Congestive heart failure was identified in a subset of 56 dogs based on radiographic findings. The PV/PA was measured in bidimensional (2D) and M-mode by 2 investigators blinded to the radiologists' conclusions. Results: Interobserver coefficients of variation for PV/PA acquisition and measurement were <10%. The PV/PA in control dogs was approximately 1 and increased with class of heart failure. The presence of CHF could be best predicted by measuring PV/PA in 2D echocardiography (cut-off, 1.7; area under the curve, 0.98; CI, 0.97-0.98; P < .001) with a sensitivity of 96% and a specificity of 91%. Conclusion and clinical importance: The PV/PA is a simple and reproducible echocardiographic variable that increases with class of heart failure and may help discriminate dogs in CHF from asymptomatic dogs with DMVD. Additional studies are required to determine whether PV/PA might provide additional information in the integrated interpretation of Dopplerechocardiographic indices of left ventricular filling pressures and could be used for rapid assessment of CHF in dogs in a critical care setting.
Journal of Veterinary Cardiology
Objectives: To identify the predictive value on time to onset of heart failure (HF) or cardiac death of clinical, radiographic, and echocardiographic variables, as well as cardiac biomarkers N-terminal pro brain natriuretic peptide (NT-proBNP) and cardiac troponin I in dogs with preclinical myxomatous mitral valve disease (MMVD). Animals: One hundred sixty-eight dogs with preclinical MMVD and left atrium to aortic root ratio !1.6 (LA:Ao) and normalized left ventricular end-diastolic diameter !1.7 were included. Methods: Prospective, randomized, multicenter, single-blinded, placebo-controlled study. Clinical, radiographic, echocardiographic variables and plasma cardiac biomarkers concentrations were compared at different time points. Using receiving operating curves analysis, best cutoff for selected variables was identified and the risk to develop the study endpoint at six-month intervals was calculated. Results: Left atrial to aortic root ratio >2.1 (hazard ratio [HR] 3.2, 95% confidence interval [95% CI] 1.9e5.6), normalized left ventricular end-diastolic diameter > 1.9 (HR: 6.3; 95% CI: 3.3e11.8), early transmitral peak velocity (E peak) > 1 m/sec (HR: 3.9; 95% CI: 2.3e6.7), and NT-proBNP > 1500 rmol/L (HR: 5.7; 95% CI: 3.3e9.5) were associated with increased risk of HF or cardiac death. The best fit model to predict the risk to reach the endpoint was represented by the plasma NT-proBNP concentrations adjusted for LA:Ao and E peak. Conclusions: Logistic and survival models including echocardiographic variables and NT-proBNP can be used to identify dogs with preclinical MMVD at higher risk to develop HF or cardiac death.