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Del Nero B, Potter BM, Visser LC, Scansen BA, Orton EC. Quantitative methods for evaluation of mitral regurgitation severity in canine degenerative mitral valve disease. J Vet Cardiol 2025; 58:38-46. [PMID: 39914360 DOI: 10.1016/j.jvc.2025.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 01/02/2025] [Accepted: 01/06/2025] [Indexed: 03/24/2025]
Abstract
INTRODUCTION/OBJECTIVES Quantitative assessment of mitral regurgitation (MR) severity has become increasingly important as procedural therapies for MR reduction become available. This study aimed to obtain quantitative measures of MR severity across stages of degenerative mitral valve disease (DMVD) and evaluate agreement between two echocardiographic methods. ANIMALS, MATERIALS AND METHODS Fifty-one client-owned dogs were included across three DMVD stages (American College of Veterinary Internal Medicine B1, B2, and C). Regurgitant volume (RVol) and regurgitant fraction (RF) were measured on echocardiograms prospectively acquired by a single cardiologist using volumetric (using Simpson's method of discs) and proximal isovelocity surface area (PISA) methods. Results were compared across stages. Agreement between methods over the range of MR severity was determined by Bland-Altman analyses. Intra-observer and inter-observer measurement variability assessments were performed via intraclass correlation coefficients (ICCs). RESULTS Median differences (25th percentile, 75th percentile) for volumetric and PISA-derived RVol and RF were as follows, respectively: B1: 0.19 mL/kg (-0.02 mL/kg, 0.25 mL/kg), 13.6% (-2.17%, 20.6%); B2: 1.49 mL/kg (1.09 mL/kg, 2.12 mL/kg), 55.6% (45.0%, 70.5%); C: 2.72 mL/kg (1.76 mL/kg, 3.13 mL/kg), 67.2% (61.8%, 78.5%); B1: 0.39 mL/kg (0.22 mL/kg, 0.69 mL/kg), 34.3% (19.0%, 56.1%); B2: 1.67 mL/kg (1.33 mL/kg, 2.15 mL/kg), 58.8% (49.8%, 73.9%); C: 3.1 mL/kg (1.91 mL/kg, 3.57 mL/kg), 75.2% (66.4%, 92.0%). All were different (P<0.0001) across stages. There was no proportional bias for RVol or RF (P=0.79, P=54). Intra-observer and inter-observer variability assessments showed ICC greater than 0.75 except PISA RF. CONCLUSIONS Measures of MR severity correlate with disease stage, although their accuracy remains unknown. Volumetric and PISA methods are not interchangeable.
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Affiliation(s)
- B Del Nero
- Department of Clinical Sciences, Colorado State University, Campus Delivery 1678, Fort Collins, CO 80523-1678, USA
| | - B M Potter
- Department of Clinical Sciences, Colorado State University, Campus Delivery 1678, Fort Collins, CO 80523-1678, USA.
| | - L C Visser
- Department of Clinical Sciences, Colorado State University, Campus Delivery 1678, Fort Collins, CO 80523-1678, USA
| | - B A Scansen
- Department of Clinical Sciences, Colorado State University, Campus Delivery 1678, Fort Collins, CO 80523-1678, USA
| | - E C Orton
- Department of Clinical Sciences, Colorado State University, Campus Delivery 1678, Fort Collins, CO 80523-1678, USA
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Davis KE, Visser LC, Boon JA, Ross ES, Sankisov JN, Laws AC. Echocardiographic estimates of stroke volume in healthy dogs: comparability, reference intervals, and reproducibility. J Vet Cardiol 2025; 57:27-38. [PMID: 39612601 DOI: 10.1016/j.jvc.2024.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 10/25/2024] [Accepted: 10/30/2024] [Indexed: 12/01/2024]
Abstract
INTRODUCTION This study aimed to compare estimates of stroke volume (SV) from different anatomic sites and to generate reference intervals for indices such as shunt volume (ShuntVol) or regurgitant volume (RegVol) in a large sample of healthy dogs. ANIMALS, MATERIALS AND METHODS Ninety healthy dogs underwent an echocardiogram, where SV was assessed at the level of the pulmonary valve (SVPV), aortic valve (SVAV), mitral valve (SVMV), and left ventricle using the difference in end-diastolic volume and end-systolic volume from a right parasternal long-axis four-chamber view (SVLV_RPLx) and left apical four-chamber view (SVLV_Ap4Ch). Eight dogs underwent repeated echocardiograms by the same operator on three different days and by three different operators on the same day. Bland-Altman plots and 95% reference intervals were generated. Reproducibility was described using coefficients of variation and reproducibility coefficients. RESULTS Mean differences (95% limits of agreement) for ShuntVol (SVPV-SVAV), RegVolLV_RPLx (SVLV_RPLx-SVAV), RegVolLV_Ap4Ch (SVLV_Ap4Ch-SVAV), and RegVolMV (SVMV-SVAV) were as follows: -0.14 (-0.72, 0.44), -0.05 (-0.59, 0.48), -0.16 (-0.71, 0.39), and 0.12 (-0.76, 1.00) mL/kg, respectively. All but RegVolLV_RPLx showed significant (P<0.01) fixed bias. Reference intervals for ShuntVol, RegVolLV_RPLx, RegVolLV_Ap4Ch, and RegVolMV were as follows: -0.85-0.64, -0.65-0.58, -0.77-0.52, and -0.91-1.06 mL/kg, respectively. Intra-operator and interoperator coefficients of variation were lowest for SVAV and highest for SVMV and SVLV_AP4Ch. CONCLUSIONS Echocardiographic estimates of SV are not interchangeable and can exhibit wide limits of agreement. Reference intervals help provide a frame of reference to assess disease severity in dogs with a shunting lesion (ShuntVol) and mitral regurgitation (RegVol).
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Affiliation(s)
- K E Davis
- James L. Voss Veterinary Teaching Hospital, College of Veterinary Medicine & Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - L C Visser
- Department of Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Colorado State University, Campus Delivery 1678 Fort Colins, CO 80523, USA.
| | - J A Boon
- Department of Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Colorado State University, Campus Delivery 1678 Fort Colins, CO 80523, USA
| | - E S Ross
- James L. Voss Veterinary Teaching Hospital, College of Veterinary Medicine & Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - J N Sankisov
- Department of Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Colorado State University, Campus Delivery 1678 Fort Colins, CO 80523, USA
| | - A C Laws
- James L. Voss Veterinary Teaching Hospital, College of Veterinary Medicine & Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
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Hsue W, Pelzek CE, Siess S, Terhaar BA, Mintz SB, Pariaut R. Effect of additional dimensions and views in the echocardiographic determination of 3-dimensional left ventricular volume in myxomatous mitral valve disease in dogs. J Vet Intern Med 2025; 39:e17300. [PMID: 39797766 PMCID: PMC11760142 DOI: 10.1111/jvim.17300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 12/18/2024] [Indexed: 01/13/2025] Open
Abstract
BACKGROUND Left ventricular (LV) volumes can be calculated from various linear, monoplane, and multiplane echocardiographic methods, and the same method can be applied to different imaging views. However, these methods and their variations have not been comprehensively evaluated against real-time 3-dimensional echocardiography (RT3D). HYPOTHESIS/OBJECTIVES To identify the LV volumetric approaches that produce the least bias and the best agreement with RT3D, and to assess interoperator reproducibility between an experienced and an inexperienced operator. ANIMALS Fifty-nine client-owned dogs with myxomatous mitral valve disease (38 Stage B1, 13 Stage B2, 8 Stages C/D) received echocardiograms, with a subset of 28 dogs (14 Stage B1, 10 Stage B2, 4 Stages C/D) imaged by 2 operators. METHODS Prospective method comparison study. Body weight-indexed end-diastolic and end-systolic LV volumes using linear methods in long- and short-axis views (Teichholz, cube, modified cube), monoplane methods in right parasternal and left apical views (area-length and Simpson's method of discs), biplane Simpson's method of discs, and real-time triplane (RT3P) were compared against RT3D. RESULTS The RT3P method exhibited no bias and demonstrated the highest agreement with RT3D. The linear methods showed significant bias and lower agreements for end-diastolic volumes, end-systolic volumes, or both. Volumes derived from different imaging views using the same method showed poor agreement. Both RT3P and RT3D methods demonstrated poor interoperator reproducibility. CONCLUSIONS AND CLINICAL IMPORTANCE Incorporating additional dimensions improves bias and agreement in LV volume quantification, but comprehensive clinical experience with RT3P and RT3D is needed to improve consistency across all operators.
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Affiliation(s)
- Weihow Hsue
- Department of Clinical SciencesCollege of Veterinary Medicine, Cornell UniversityIthacaNew YorkUSA
| | - Cortney E. Pelzek
- Department of Clinical SciencesCollege of Veterinary Medicine, Cornell UniversityIthacaNew YorkUSA
| | - Samantha Siess
- Department of Clinical SciencesCollege of Veterinary Medicine, Cornell UniversityIthacaNew YorkUSA
| | - Benjamin A. Terhaar
- Department of Clinical SciencesCollege of Veterinary Medicine, Cornell UniversityIthacaNew YorkUSA
| | - Shana B. Mintz
- Department of Clinical SciencesCollege of Veterinary Medicine, Cornell UniversityIthacaNew YorkUSA
| | - Romain Pariaut
- Department of Clinical SciencesCollege of Veterinary Medicine, Cornell UniversityIthacaNew YorkUSA
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Kamata S, Morita T, Yamasaki M. Detection of early renal perfusion changes by contrast-enhanced ultrasonography in dogs with preclinical myxomatous mitral valve disease. Vet Radiol Ultrasound 2025; 66:e13459. [PMID: 39531152 PMCID: PMC11617612 DOI: 10.1111/vru.13459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/24/2024] [Accepted: 10/15/2024] [Indexed: 11/16/2024] Open
Abstract
Since the prognosis of myxomatous mitral valve disease (MMVD) varies, its characterization is clinically relevant, and renal impairment has been identified as one of its associated factors. Intrarenal Doppler ultrasonography (IRD), an intrarenal hemodynamic assessment method, is useful for predicting cardiac- and renal-related death but cannot detect early changes in dogs with preclinical MMVD. Contrast-enhanced ultrasonography (CEUS), another intrarenal hemodynamic assessment method, may identify earlier changes; however, renal perfusion evaluations using CEUS have not yet been performed on dogs with MMVD. We hypothesized that CEUS detects changes earlier than IRD in dogs with preclinical MMVD. This prospective, cross-sectional study examined renal perfusion in dogs without cardiac disease and preclinical MMVD dogs of different American College of Veterinary Internal Medicine stages using CEUS and compared it with IRD indices. Twenty-three dogs with MMVD (ten stage B1 and thirteen stage B2) and 12 control dogs without cardiac disease were included. The rise times of the renal cortex and medulla were measured from a time-intensity curve. The rise time of the cortex was longer in dogs with stage B2 MMVD than in control dogs, while that of the medulla was shortened in the right ventricular dysfunction group in stage B2. No changes were observed in IRD indices (the resistance index and venous impedance index). In conclusion, CEUS detected changes in renal perfusion in dogs with preclinical MMVD even when IRD indices remained unchanged, suggesting the utility of CEUS in evaluations of renal perfusion in MMVD dogs.
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Affiliation(s)
- Saho Kamata
- Laboratory of Veterinary Small Animal Internal MedicineCooperative Department of Veterinary MedicineFaculty of Agriculture, Iwate UniversityMoriokaJapan
| | - Tomoya Morita
- Laboratory of Veterinary Small Animal Internal MedicineCooperative Department of Veterinary MedicineFaculty of Agriculture, Iwate UniversityMoriokaJapan
| | - Masahiro Yamasaki
- Laboratory of Veterinary Small Animal Internal MedicineCooperative Department of Veterinary MedicineFaculty of Agriculture, Iwate UniversityMoriokaJapan
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Loughran KA, Kraus MS, Achilles EJ, Huh T, Larouche‐Lebel É, Massey LK, Gelzer AR, Oyama MA. Observed and expected reliability of echocardiographic volumetric methods and critical change values for quantification of mitral regurgitant fraction in dogs. J Vet Intern Med 2024; 38:3016-3024. [PMID: 39328176 PMCID: PMC11586563 DOI: 10.1111/jvim.17205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 09/12/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND Reliability of echocardiographic calculations for stroke volume and mitral regurgitant fraction (RFMR) are affected by observer variability and lack of a gold standard. Variability is used to calculate critical change values (CCVs) that are thresholds representing real change in a measure not associated with observer variability. HYPOTHESIS Observed intra- and interobserver accuracy and variability in healthy dogs help model CCV for RFMR. ANIMALS Reliability cohort of 34 healthy dogs; allometric scaling cohort of 99 dogs with heart disease and 25 healthy dogs. METHODS Accuracy, variability, and CCV of 2 observers using geometric and flow-based echocardiography were prospectively compared against a standard of RFMR = 0% and extrapolated across a range of expected RFMR values in the reliability cohort partly derived from cardiac dimensions predicted by the allometric cohort. RESULTS Accuracy of methods to determine RFMR in descending order was 4-chamber bullet (Bullet4CH), mitral inflow, cube formula, and Simpson's method of disks. Intraobserver variability was relatively high. The CCV for RFMR ranged from 28% to 88% and was inversely related to RFMR when extrapolated for use in affected dogs. For both observers, the Bullet4CH method had the lowest intraobserver CCV (Operator 1:28%, Operator 2:41%). Interobserver strength of agreement was low with intraclass correlation coefficients ranging from 0.210 to 0.413. CONCLUSIONS AND CLINICAL IMPORTANCE Echocardiographic volumetric methods used to calculate stroke volume and RFMR have low accuracy and high variability in healthy dogs. Extrapolation of observed CCV to a range of expected RFMR suggests observers and methods are not interchangeable and variability might hinder routine clinical usage. Individual observers should be aware of their own variability and CCV.
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Affiliation(s)
- Kerry A. Loughran
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Marc S. Kraus
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Erin J. Achilles
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Terry Huh
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Present address:
Angell Animal Medical CenterBostonMassachusettsUSA
| | - Éva Larouche‐Lebel
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Present address:
Centre Vétérinaire DaubignyQuebec CityQuebecCanada
| | - Laura K. Massey
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Anna R. Gelzer
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Mark A. Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Koch J, Engeland IV, Willesen JL, Schrøder AS, Gleerup CH, Bach MBT. Quantification of Mitral Valve Regurgitation in Cavalier King Charles Spaniels and Chihuahuas Using Radius of Proximal Isovelocity Surface Area. Animals (Basel) 2024; 14:2805. [PMID: 39409756 PMCID: PMC11482544 DOI: 10.3390/ani14192805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 09/20/2024] [Accepted: 09/26/2024] [Indexed: 10/19/2024] Open
Abstract
Mitral regurgitation (MR) resulting from myxomatous mitral valve disease (MMVD) is a prevalent condition in dogs, particularly smaller breeds like Cavalier King Charles Spaniels (CKCSs) and Chihuahuas (CHHs). An accurate assessment of MR severity is essential for effective treatment and disease monitoring, yet a standardized method has yet to be established. In this retrospective study, we evaluated 124 client-owned dogs diagnosed with MMVD, including 64 CKCSs and 60 CHHs. Dogs were categorized into three stages: asymptomatic (B1), remodeled (B2), and congestive heart failure (CHF, C). The MR severity was quantified using the proximal isovelocity surface area (PISA) method, specifically focusing on the PISA radius (PISA-r). The PISA-r measurements exhibited significant increases across disease stages and demonstrated strong correlations with echocardiographic parameters (ranging from 0.83 to 0.94), including the left atrial size and left ventricular internal diameter. The receiver operating characteristic (ROC) curve analysis revealed the high sensitivity and specificity of PISA-r in classifying disease stages, establishing optimal cut-off values. The method displayed excellent repeatability (interobserver variability: 0.95) and reproducibility (intraobserver variability: 0.97). In conclusion, the PISA method, specifically PISA-r, was reliable for assessing MR severity in dogs with MMVD. By simplifying the diagnosis and management of MR, this research can potentially improve the life and management of MMVD-affected dogs.
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Affiliation(s)
- Jørgen Koch
- Department of Clinical Veterinary Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, DK-1870 Frederiksberg, Denmark; (J.L.W.); (A.S.S.); (C.H.G.); (M.B.T.B.)
| | - Inge V. Engeland
- Anicura Dyreklinikken Telemark, Brennavn. 8, 3810 Gvarv, Norway;
| | - Jakob L. Willesen
- Department of Clinical Veterinary Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, DK-1870 Frederiksberg, Denmark; (J.L.W.); (A.S.S.); (C.H.G.); (M.B.T.B.)
| | - Anders S. Schrøder
- Department of Clinical Veterinary Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, DK-1870 Frederiksberg, Denmark; (J.L.W.); (A.S.S.); (C.H.G.); (M.B.T.B.)
| | - Caroline H. Gleerup
- Department of Clinical Veterinary Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, DK-1870 Frederiksberg, Denmark; (J.L.W.); (A.S.S.); (C.H.G.); (M.B.T.B.)
| | - Maiken B. T. Bach
- Department of Clinical Veterinary Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, DK-1870 Frederiksberg, Denmark; (J.L.W.); (A.S.S.); (C.H.G.); (M.B.T.B.)
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Kim Y, Kim J, Kim S, Youn H, Choi J, Seo K. Machine learning-based risk prediction model for canine myxomatous mitral valve disease using electronic health record data. Front Vet Sci 2023; 10:1189157. [PMID: 37720471 PMCID: PMC10500836 DOI: 10.3389/fvets.2023.1189157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Myxomatous mitral valve disease (MMVD) is the most common cause of heart failure in dogs, and assessing the risk of heart failure in dogs with MMVD is often challenging. Machine learning applied to electronic health records (EHRs) is an effective tool for predicting prognosis in the medical field. This study aimed to develop machine learning-based heart failure risk prediction models for dogs with MMVD using a dataset of EHRs. Methods A total of 143 dogs with MMVD between May 2018 and May 2022. Complete medical records were reviewed for all patients. Demographic data, radiographic measurements, echocardiographic values, and laboratory results were obtained from the clinical database. Four machine-learning algorithms (random forest, K-nearest neighbors, naïve Bayes, support vector machine) were used to develop risk prediction models. Model performance was represented by plotting the receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC). The best-performing model was chosen for the feature-ranking process. Results The random forest model showed superior performance to the other models (AUC = 0.88), while the performance of the K-nearest neighbors model showed the lowest performance (AUC = 0.69). The top three models showed excellent performance (AUC ≥ 0.8). According to the random forest algorithm's feature ranking, echocardiographic and radiographic variables had the highest predictive values for heart failure, followed by packed cell volume (PCV) and respiratory rates. Among the electrolyte variables, chloride had the highest predictive value for heart failure. Discussion These machine-learning models will enable clinicians to support decision-making in estimating the prognosis of patients with MMVD.
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Affiliation(s)
- Yunji Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul, Republic of Korea
| | - Jaejin Kim
- School of Biological Sciences, Seoul National University, Seoul, Republic of Korea
| | - Sehoon Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul, Republic of Korea
| | - Hwayoung Youn
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul, Republic of Korea
| | - Jihye Choi
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Kyoungwon Seo
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul, Republic of Korea
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Grosso G, Vezzosi T, Domenech O, Tognetti R. Prognostic relevance of left cardiac enlargement in dogs with preclinical myxomatous mitral valve disease. J Vet Cardiol 2023; 45:50-58. [PMID: 36702085 DOI: 10.1016/j.jvc.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/15/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION According to the most recent consensus guidelines on canine myxomatous mitral valve disease (MMVD), dogs with only left atrial enlargement (LAE) or left ventricular enlargement are classified as stage B1. The concomitant presence of LAE and left ventricular enlargement is needed to be classified as stage B2. The primary aim of the study was to evaluate the prognosis in stage B1 and stage B2 according to the revised definition. The secondary aim was to assess the prognostic relevance of LAE in stage B1. ANIMALS A total of 440 dogs with MMVD, 276 in stage B1 and 164 in stage B2. MATERIALS AND METHODS Retrospective and observational study. The left atrium-to-aorta ratio and the left ventricular end-diastolic diameter normalized were used to define cardiac dimensions. The long-term outcome was assessed by telephone interviews with owners and referring vets. Both cardiac-related and all-cause mortality were evaluated. RESULTS Stage B1 dogs had a longer median survival time than stage B2, considering both cardiac-related death (2344 vs. 1341 days; P<0.001) and all-cause mortality (1832 vs. 855 days; P<0.001). Age, left atrium-to-aorta ratio, and the left ventricular end-diastolic diameter normalized were independent predictors of cardiac-related death and all-cause mortality. Among stage B1, dogs with LAE lived shorter than those without LAE (1183 vs. 1882 days; P=0.005) considering all-cause mortality. DISCUSSION AND CONCLUSIONS Stage B1 dogs lived longer than stage B2 dogs. Among stage B1, LAE had prognostic relevance considering all-cause mortality. This finding could add useful prognostic information in the management of preclinical MMVD.
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Affiliation(s)
- G Grosso
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122 San Piero a Grado, Pisa, Italy
| | - T Vezzosi
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122 San Piero a Grado, Pisa, Italy.
| | - O Domenech
- Department of Cardiology, Anicura Istituto Veterinario Novara, Strada Provinciale 9, 28060 Granozzo con Monticello, Novara, Italy
| | - R Tognetti
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122 San Piero a Grado, Pisa, Italy
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Ellis-Reis RE, Visser LC, Hsue W, Sharpe AN, Kaplan JL. Echocardiographic evaluation of regurgitant fraction in dogs with subclinical myxomatous mitral valve disease: Method comparison, effects of pimobendan, and reproducibility. J Vet Cardiol 2023; 45:27-40. [PMID: 36630740 DOI: 10.1016/j.jvc.2022.12.002] [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: 02/10/2022] [Revised: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION/OBJECTIVES To evaluate regurgitant fraction (RF) using Simpson's method of discs to estimate total stroke volume (RFSMOD_TSV) and using Motion-mode to estimate total stroke volume (RFM-modeTSV) in dogs with subclinical myxomatous mitral valve disease (MMVD). We also sought to evaluate the effects of pimobendan on RF, and to determine the reproducibility of RFSMOD_TSV and RFM-modeTSV. ANIMALS, MATERIALS, AND METHODS Echocardiography was performed on 57 dogs with MMVD (30 stage B1 and 27 stage B2). Ten dogs received pimobendan for 7-10 days and had a second echocardiogram. Nine dogs underwent six repeated echocardiographic examinations by two operators on three nonconsecutive days within one week for reproducibility analysis. RESULTS Both RFSMOD_TSV and RFM-modeTSV exhibited a curvilinear relationship with left atrium-to-aortic root ratio. Both RFSMOD_TSV and RFM-modeTSV varied considerably within stage B1 (minimum-maximum: -9.1%-58.2% and -35.7%-66.2%, respectively) and B2 (13.6%-76.2% and 20.1%-85.7%, respectively). Method comparison showed RFSMOD_TSV and RFM-modeTSV were not interchangeable with proportional bias. Pimobendan significantly reduced RFSMOD_TSV (-32.0% ± 23.3%) and RFM-modeTSV (-19.2% ± 10.9%) within the same dog and relative to controls. Good inter-day and between-operator reproducibility was observed for RFSMOD_TSV and RFM-modeTSV based on intraclass correlation coefficients 0.86-0.90 and 0.83-0.90, respectively. Reproducibility coefficients were 19.6%-24.1% and 24.1%-27.0%, respectively. CONCLUSIONS Use of RF using the total stroke volume method to aid the assessment of dogs with subclinical MMVD might be of clinical value. However, further study is warranted. Based on response to pimobendan and reproducibility analysis, RF SMOD_TSV might be a more reliable technique to quantify RF.
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Affiliation(s)
- R E Ellis-Reis
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - L C Visser
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Ave, Davis, CA 95616, USA.
| | - W Hsue
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - A N Sharpe
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - J L Kaplan
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
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10
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Tidholm A, Häggström J. Prognostic value of selected one-, two- and three-dimensional and Doppler echocardiographic methods to assess severity in dogs with myxomatous mitral valve disease. J Vet Cardiol 2021; 39:89-101. [PMID: 35008002 DOI: 10.1016/j.jvc.2021.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/18/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although challenging, predicting outcomes in dogs with myxomatous mitral valve disease (MMVD) is of importance to owners and veterinarians. Our aim was to compare the prognostic value of selected one-, two-, and three-dimensional and Doppler echocardiographic methods to predict cardiac-related and all-cause mortality in MMVD dogs. We hypothesize that three-dimensional methods would better predict prognosis than one- and two-dimensional methods. ANIMALS One-hundred thirty-eight privately-owned dogs with MMVD. MATERIALS AND METHODS Cox proportional Hazard analyses and Kaplan-Meier curves were used to investigate the predictive value of 14 variables; left atrial (LA) volume indexed to body weight (BW) measured by real-time three-dimensional echocardiography (RT3DE) and calculated using Simpson's modified method of discs (SMOD) and the area-length method; LA diameter in short-axis and long-axis to aortic in short-axis ratio, effective regurgitant orifice area indexed to body surface area measured in RT3DE en face view and calculated using four-chamber (4Ch) and two-chamber views alone or in combination; percentage increase in left ventricular end-diastolic and systolic internal diameters; fractional shortening; E wave velocity; regurgitant jet area/LA area. RESULTS All 14 variables were significantly predictive of cardiac-related mortality, and 11 were predictive of all-cause mortality. The prognosis was best predicted by LA volume/BW estimated by SMOD or RT3DE, consistently showing the highest predictive value in all analyses. CONCLUSIONS Left atrial volume calculated by SMOD showed a similar predictive value compared to RT3DE. Performing SMOD from apical 4Ch images should be considered an alternative to RT3DE for echocardiographic examinations where prognostication of disease outcome is sought.
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Affiliation(s)
- A Tidholm
- Anicura Albano Animal Hospital, Rinkebyvägen 21, Danderyd, Sweden; Department of Clinical Sciences Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala, Sweden.
| | - J Häggström
- Department of Clinical Sciences Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala, Sweden
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11
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Reimann MJ, Fredholm M, Cremer SE, Christiansen LB, Meurs KM, Møller JE, Häggström J, Lykkesfeldt J, Olsen LH. Polymorphisms in the serotonin transporter gene and circulating concentrations of neurotransmitters in Cavalier King Charles Spaniels with myxomatous mitral valve disease. J Vet Intern Med 2021; 35:2596-2606. [PMID: 34599615 PMCID: PMC8692205 DOI: 10.1111/jvim.16277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background The neurotransmitter serotonin (5‐HT) affects valvular degeneration and dogs with myxomatous mitral valve disease (MMVD) exhibit alterations in 5‐HT signaling. In Maltese dogs, 3 single nucleotide polymorphisms (SNPs) in the 5‐HT transporter (SERT) gene are suggested to associate with MMVD. Hypothesis/Objectives Determine the association of SERT polymorphisms on MMVD severity and serum 5‐HT concentration in Cavalier King Charles Spaniels (CKCS). Additionally, investigate the association between selected clinical and hematologic variables and serum 5‐HT and assess the correlation between HPLC and ELISA measurements of serum 5‐HT. Animals Seventy‐one CKCS (42 females and 29 males; 7.8 [4.7;9.9] years (median [Q1;Q3])) in different MMVD stages. Methods This prospective study used TaqMan genotyping assays to assess SERT gene polymorphisms. Neurotransmitter concentrations were assessed by HPLC and ELISA. Results TaqMan analyses identified none of the selected SERT polymorphisms in any of the CKCS examined. Serum 5‐HT was associated with platelet count (P < .001) but not MMVD severity, age or medical therapy and did not correlate with serum concentration of the 5‐HT metabolite, 5‐hydroxyindoleacetic acid. The ELISA serum 5‐HT correlated with HPLC measurements (ρ = .87; P < .0001) but was lower (mean difference = −22 ng/mL; P = .02) independent of serum 5‐HT concentration (P = .2). Conclusions and Clinical Importance Selected SERT SNPs associated with MMVD in Maltese dogs were not found in CKCS and only platelet count influenced serum 5‐HT concentration. These SNPs are unlikely to be associated with MMVD pathophysiology or serum 5‐HT concentration in CKCS. HPLC and ELISA serum 5‐HT demonstrated good correlation but ELISA systematically underestimated 5‐HT.
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Affiliation(s)
- Maria J Reimann
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Merete Fredholm
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Signe E Cremer
- Department of Veterinary Clinical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | | | - Kathryn M Meurs
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Jacob E Møller
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jens Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Jens Lykkesfeldt
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Lisbeth H Olsen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
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12
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Influence of Morphometry on Echocardiographic Measurements in Cavalier King Charles Spaniels: An Inverse Probability Weighting Analysis. Vet Sci 2021; 8:vetsci8100205. [PMID: 34679035 PMCID: PMC8538534 DOI: 10.3390/vetsci8100205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 01/18/2023] Open
Abstract
The development and progression of myxomatous mitral valve disease (MMVD) in Cavalier King Charles Spaniels (CKCS) are difficult to predict. Thus, the identification of dogs with a morphotype associated with more severe mitral disease at a young age is desirable. The aims of this study were to: (1) describe the physical, morphometric, and echocardiographic features of class B1 MMVD-affected Cavalier King Charles Spaniels (CKCS) according to the American College of Veterinary Internal Medicine (ACVIM) guidelines; (2) evaluate the influence of morphometric physical measurements on murmur intensity, mitral valve prolapse (MVP), regurgitant jet size, and indexed mitral valve and annulus measurements. Fifty-two MMVD-affected CKCS were included in the ACVIM class B1. This is a prospective clinical cross-sectional study. Morphometric measurements, which included the body, thorax, and head sizes of each dog, were investigated to establish the association with heart murmur intensity, valvular and annular echocardiographic measurements, MVP, and regurgitant jet size, using inverse probability weighting (IPW) analyses to adjust for confounding. The IPW analyses showed that when the head length and nose length decreased, dogs had a more severe regurgitant jet size. Furthermore, subjects with a more pronounced head stop angle had thicker anterior mitral valve leaflets. A brachycephalic morphotype, as seen in dogs similar to the King Charles Spaniel breed in terms of cephalic morphology, is associated with a more severe regurgitant jet size and with valvular characteristics that are related to the most severe forms of MMVD.
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13
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Pascon J, Jung G, Valandro M, Oliveira M. Prevalence, risk factors and survival in dogs with myxomatous valve degeneration. ARQ BRAS MED VET ZOO 2021. [DOI: 10.1590/1678-4162-12236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The objective of this study was to describe the prevalence, survival time, and risk factors of myxomatous mitral valve disease (MMVD) in dogs by a retrospective observational cohort study design of a Brazilian veterinary center, admitted from 2012 to 2018 (2.585 days). Considering the 105 dog files confirmed as MMVD, the prevalence of the disease was higher in small-breed dogs with ages from 10 to 19 years (30.3%). The survival time of the dogs at B1 stage (1.854 ± 145 days) was higher than the B2 (1.508+209) and C/D (930 ± 209). Higher risks of death (hazard ratio) were detected in the presence of syncope (2.5), pulmonary crackling (2.0), dyspnea (1.9), and higher values of vertebral heart scale (1.7), radiographic left atrium dimension (1.8), the ACVIM staging (1.7), and the duration of QRS complex (1.05). The results achieved demonstrated higher prevalence of MMVD in old small-breed dogs, associated with longer survival time in the B1 stage of the disease, and higher risk of death related to the presence of clinical signs, such as dyspnea, syncope, and pulmonary crackling, beyond some radiographic, echocardiographic, and electrocardiographic variables of heart or atrial enlargement.
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Affiliation(s)
| | - G.C. Jung
- Universidade Federal do Pampa, Brazil
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14
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Abbott-Johnson K, Pierce KV, Roof S, Del Rio CL, Hamlin R. Acute Effects of Pimobendan on Cardiac Function in Dogs With Tachycardia Induced Dilated Cardiomyopathy: A Randomized, Placebo-Controlled, Crossover Study. Front Vet Sci 2021; 8:646437. [PMID: 34277749 PMCID: PMC8281278 DOI: 10.3389/fvets.2021.646437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pimobendan provides a significant survival benefit in dogs with cardiac disease, including degenerative mitral valve disease and dilated cardiomyopathy (DCM). Its positive inotropic effect is well-known, however, it has complex effects and the mechanisms behind the survival benefit are not fully characterized. Secondary hemodynamic effects may decrease mitral regurgitation (MR) in DCM, and the benefits of pimobendan may extend to improved cardiac relaxation and improved atrial function. Hypothesis/Objectives: Our objective was to investigate the acute cardiac effects of pimobendan in dogs with a DCM phenotype. We hypothesized that pimobendan would increase left atrial (LA) contractility, reduce mitral regurgitation, improve diastolic function, and lower circulating NT-ProBNP levels. Animals: Seven purpose-bred Beagles were studied from a research colony with tachycardia induced DCM phenotype. Methods: The effects of pimobendan were studied under a placebo-controlled single-blinded cross-over design. In short, dogs underwent baseline and 3 h post-dose examinations 7 days apart with echocardiography and a blood draw. Dogs were randomized to receive oral placebo or 0.25 mg/kg pimobendan after their baseline exam. Investigators were blinded to treatments until all measurements were compiled. Results: When treated with pimobendan, the dogs had significant increases in systolic function and decreases in MR, compared to when treated with placebo. There were no detectable differences in left atrial measures, including LA size, LA emptying fraction, LA functional index or mitral A wave velocity. Heart rate decreased significantly with pimobendan compared to placebo. There was also a decrease in isovolumetric relaxation time normalized to heart rate. NT-proBNP levels had a high degree of variability. Conclusions: Improved mitral regurgitation severity and improved lusitropic function may contribute to the reported survival benefit for dogs with cardiac disease administered pimobendan. Pimobendan did not overtly improve LA function as assessed by echocardiography, and NT-proBNP was not significantly changed with a single dose of this medication. Further studies are needed to better characterize LA effects with other imaging modalities, to better quantify the total improvement of MR severity, and to assess chronic use of pimobendan on diastolic function in DCM.
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Affiliation(s)
| | - Kursten V Pierce
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
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15
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Vezzosi T, Grosso G, Tognetti R, Meucci V, Patata V, Marchesotti F, Domenech O. The Mitral INsufficiency Echocardiographic score: A severity classification of myxomatous mitral valve disease in dogs. J Vet Intern Med 2021; 35:1238-1244. [PMID: 33951235 PMCID: PMC8163114 DOI: 10.1111/jvim.16131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 11/27/2022] Open
Abstract
Background There is no commonly shared severity score for myxomatous mitral valve disease (MMVD) based on routinely acquired echocardiographic variables. Hypothesis/Objectives To propose an easy‐to‐use echocardiographic classification of severity of MMVD in dogs. Animals Five hundred and sixty dogs with MMVD. Methods This was a retrospective, multicenter, observational study. The proposed Mitral INsufficiency Echocardiographic (MINE) score was based on 4 echocardiographic variables: left atrium‐to‐aorta ratio, left ventricular end‐diastolic diameter normalized for body weight, fractional shortening, and E‐wave transmitral peak velocity. Specific echocardiographic cutoffs were defined based on previous prognostic studies on MMVD, and severity scores were assigned as follows: mild (score: 4‐5), moderate (score: 6‐7), severe (score: 8‐12), late stage (score: 13‐14). Results Median survival time was significantly different (P < .05) between the proposed severity classes: mild (2344 days, 95% confidence interval [CI] 1877‐2810 days), moderate (1882 days, 95% CI 1341‐2434 days), severe (623 days, 95% CI 432‐710 days), and late stage (157 days, 95% CI 53‐257 days). A MINE score >8 was predictive of cardiac death (area under the curve = 0.85; P < .0001; sensitivity 87%, specificity 73%). In the multivariable analysis, all the echocardiographic variables of the MINE score were independent predictors of death because of heart disease (P < .001). Conclusions and Clinical Importance The MINE score is a new easy‐to‐use echocardiographic classification of severity of MMVD, which has been proven to be clinically effective as it is associated with survival. This classification provides prognostic information and could be useful for an objective echocardiographic assessment of MMVD.
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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
| | - Valentina Meucci
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Valentina Patata
- Department of Cardiology, Anicura Istituto Veterinario Novara, Granozzo con Monticello, Italy
| | - Federica Marchesotti
- Department of Cardiology, Anicura Istituto Veterinario Novara, Granozzo con Monticello, Italy
| | - Oriol Domenech
- Department of Cardiology, Anicura Istituto Veterinario Novara, Granozzo con Monticello, Italy
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16
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Levent P, Kocaturk M, Akgun E, Saril A, Cevik O, Baykal AT, Tanaka R, Ceron JJ, Yilmaz Z. Platelet proteome changes in dogs with congestive heart failure. BMC Vet Res 2020; 16:466. [PMID: 33256720 PMCID: PMC7708215 DOI: 10.1186/s12917-020-02692-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Platelets play a central role in the development of cardiovascular diseases and changes in their proteins are involved in the pathophysiology of heart diseases in humans. There is lack of knowledge about the possible role of platelets in congestive heart failure (CHF) in dogs. Thus, this study aimed to investigate the changes in global platelet proteomes in dogs with CHF, to clarify the possible role of platelets in the physiopathology of this disease. Healthy-dogs (n = 10) and dogs with acute CHF due to myxomatous mitral valve disease (MMVD, n = 10) were used. Acute CHF was defined based on the clinical (increased respiratory rate or difficulty breathing) and radiographic findings of pulmonary edema. Dogs Blood samples were collected into tubes with acid-citrate-dextrose, and platelet-pellets were obtained by centrifuge and washing steps. Platelet-proteomes were identified using LC-MS based label-free differential proteome expression analysis method and matched according to protein database for Canis lupus familiaris. RESULTS Totally 104 different proteins were identified in the platelets of the dogs being 4 out of them were significantly up-regulated and 6 down-regulated in acute CHF dogs. Guanine-nucleotide-binding protein, apolipoproteins (A-II and C-III) and clusterin levels increased, but CXC-motif-chemokine-10, cytochrome-C-oxidase-subunit-2, cathepsin-D, serine/threonine-protein-phosphatase-PP1-gamma-catalytic-subunit, creatine-kinase-B-type and myotrophin levels decreased in acute CHF dogs. These proteins are associated with several molecular functions, biological processes, signaling systems and immune-inflammatory responses. CONCLUSION This study describes by first time the changes in the protein composition in platelets of dogs with acute CHF due to MMVD. Our findings provide a resource for increase the knowledge about the proteome of canine platelets and their roles in CHF caused by MMVD and could be a tool for further investigations about the prevention and treatment of this disease.
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Affiliation(s)
- Pinar Levent
- Department of Internal Medicine, Faculty of Veterinary Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Meriç Kocaturk
- Department of Internal Medicine, Faculty of Veterinary Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Emel Akgun
- Department of Medical Biochemistry, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ahmet Saril
- Department of Internal Medicine, Faculty of Veterinary Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Ozge Cevik
- Department of Basic Science, Medical Biochemistry, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - Ahmet Tarik Baykal
- Department of Medical Biochemistry, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ryou Tanaka
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, 183-8509, Japan
| | - Jose Joaquin Ceron
- Interdisciplinary Laboratory of Clinical Pathology, Interlab-UMU, University of Murcia, 30100, Murcia, Spain
| | - Zeki Yilmaz
- Department of Internal Medicine, Faculty of Veterinary Medicine, Bursa Uludag University, 16059, Bursa, Turkey.
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17
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Bourguignon C, Caivano D, Dickson D, Vatne L, Harris J, Rishniw M, Pariaut R. Two-dimensional echocardiographic estimates of left ventricular volumes obtained in different views in dogs provide similar measurements but are not interchangeable. J Vet Cardiol 2020; 33:13-24. [PMID: 33276310 DOI: 10.1016/j.jvc.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Little information exists regarding the interchangeability of left ventricular volume estimates using a monoplane Simpson's Method of Discs on images obtained from the left apical four-chamber and right parasternal long axis four-chamber views. We examined if volume estimates obtained from these views were interchangeable. ANIMALS A total of 224 dogs: 86 healthy, 96 with mitral valve disease, 42 with various cardiac pathologies. MATERIALS AND METHODS Investigators obtained right parasternal long-axis and left apical four-chamber views from each dog and used manufacturer-supplied software to estimate left ventricular volumes in diastole and systole using Simpson's Method of Discs. Estimates based on linear measurements (diameter cubed, 0.67∗diameter cubed, and Teichholz) were also calculated. Reproducibility for each view, and agreement between the estimates obtained with each view, and those calculated from linear dimensions, were examined using Limits of Agreement. Reference intervals for volumes indexed to bodyweight and body surface area were calculated. RESULTS Neither method proved very reproducible. Although no bias was detected, the agreement between volumes indexed to bodyweight and body surface area was insufficient to recommend interchangeability. Estimates based on Teichholz and diameter cubed methods overestimated volumes; however, those based on 0.67∗diameter cubed performed reasonably. CONCLUSIONS Monoplane volume estimates from the left apical and right parasternal long axis four-chamber views are similar but not interchangeable. Clinicians can perform crude estimates of left ventricular volume using the equation 0.67∗diameter cubed.
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Affiliation(s)
- C Bourguignon
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA
| | - D Caivano
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126, Perugia, Italy
| | | | - L Vatne
- AniCura Oslo, Uelandsgate 85, 0462, Oslo, Norway
| | - J Harris
- HeartVets at Vale Referrals, Stinchcombe, Dursley, GL11 6AJ, UK
| | - M Rishniw
- Veterinary Information Network, 777 W Covell Blvd, Davis, CA, 95616, USA.
| | - R Pariaut
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA
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Morgan KRS, Monteith G, Raheb S, Colpitts M, Fonfara S. Echocardiographic parameters for the assessment of congestive heart failure in dogs with myxomatous mitral valve disease and moderate to severe mitral regurgitation. Vet J 2020; 263:105518. [PMID: 32928487 DOI: 10.1016/j.tvjl.2020.105518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
The objective of this study was to evaluate the influence of congestive heart failure (CHF) on echocardiographic variables in dogs with moderate or severe mitral valve regurgitation (MR) secondary to myxomatous mitral valve disease (MMVD). The secondary objective was to investigate the preliminary use of left ventricular early inflow-outflow index (LVEIO) and L-waves as indicators of CHF. Forty-five dogs with moderate or severe MR without (n = 23) or with (n = 22) CHF were retrospectively included. Echocardiographic variables of elevated left ventricular (LV) filling pressures and cardiac function, LVEIO and the presence of L-waves were obtained and statistically compared between the two groups. On general linear model analysis, mitral inflow peak E-wave velocity, E:A ratio, ratio of E to isovolumic relaxation time (IVRT) and LVEIO were increased, while left atrium (LA) fractional shortening was reduced, in dogs with CHF. Peak E-wave velocity, peak A-wave velocity, E:A ratio, LA minimum diameter, LA diameter before the P-wave, LA fractional shortening and LVEIO were found to be predictive of CHF. The absence of L-waves indicated a reduced risk of CHF. Several echocardiographic variables may be useful in identifying elevated LV filling pressures, consistent with CHF, in dogs with moderate and severe MR. Left ventricular early inflow-outflow index and L-waves might be of interest as clinical and prognostic markers in dogs with MMVD and require further investigation.
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Affiliation(s)
- K R S Morgan
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road E., Guelph, ON N1G 2W1 Canada
| | - G Monteith
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road E., Guelph, ON N1G 2W1 Canada
| | - S Raheb
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road E., Guelph, ON N1G 2W1 Canada
| | - M Colpitts
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road E., Guelph, ON N1G 2W1 Canada
| | - S Fonfara
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road E., Guelph, ON N1G 2W1 Canada.
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19
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Loughran KA, Larouche-Lebel É, Huh TP, Kraus MS, Oyama MA. Reproducibility of geometric and flow-based echocardiographic measurements used for quantification of left ventricular total and forward stroke volume in healthy dogs. J Vet Cardiol 2020; 30:100-112. [PMID: 32745962 DOI: 10.1016/j.jvc.2020.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiac structure and function in dogs are commonly assessed using echocardiography. A variety of linear, area, and flow-based measurements can be used to calculate left ventricular (LV) total stroke volume (TSV) and forward stroke volume (FSV), but the reproducibility of many of these measurements has not been fully studied. We hypothesized that survey of echocardiographic variables would identify those with high reproducibility and inform future investigation of different methods to measure LV TSV and FSV. METHODS The reproducibility of 25 geometric and flow-based echocardiographic measurements was prospectively evaluated in 23 healthy dogs by two experienced observers. Reproducibility (i.e., interobserver agreement) was described using intraclass correlation coefficients. The reproducibility of various methods to calculate LV TSV and FSV was explored. RESULTS Reproducibility was generally good to excellent. Variables of LV width, length, and area and aortic and sinotubular junction diameter and velocity time integral were among measures with the highest reproducibility. Measurements of mitral annular diameter and mitral inflow velocity time integral possessed lower reproducibility. Calculation of LV TSV using measurements involved in the cube and bullet formulas demonstrated higher reproducibility than the Simpson's method of disks or mitral inflow methods. Calculation of LV FSV using LV outflow tract and aortic diameters from the right parasternal view generally demonstrated higher reproducibility compared with the left-sided view. CONCLUSIONS The reproducibility of many simple geometric and flow-based echocardiographic measurements is high. Comparison of the reliability of different measurement informs future investigation of echocardiographic methods to determine LV TSV and FSV in dogs.
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Affiliation(s)
- K A Loughran
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St, Philadelphia PA, 19104, USA
| | - É Larouche-Lebel
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St, Philadelphia PA, 19104, USA
| | - T P Huh
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St, Philadelphia PA, 19104, USA
| | - M S Kraus
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St, Philadelphia PA, 19104, USA
| | - M A Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St, Philadelphia PA, 19104, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia PA, 19104, USA.
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20
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Scansen BA, Drees R. Joint virtual issue on recent advances in veterinary cardiac imaging. J Vet Intern Med 2020; 34:546-548. [PMID: 31943370 PMCID: PMC7096632 DOI: 10.1111/jvim.15669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Brian A Scansen
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Randi Drees
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, United Kingdom
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21
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Scansen BA, Drees R. Joint virtual issue on recent advances in veterinary cardiac imaging. Vet Radiol Ultrasound 2020; 61:127-129. [PMID: 31943510 DOI: 10.1111/vru.12841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Brian A Scansen
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Randi Drees
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
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22
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Larouche-Lebel É, Loughran KA, Oyama MA. Echocardiographic indices and severity of mitral regurgitation in dogs with preclinical degenerative mitral valve disease. J Vet Intern Med 2019; 33:489-498. [PMID: 30793808 PMCID: PMC6430891 DOI: 10.1111/jvim.15461] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/06/2019] [Indexed: 12/03/2022] Open
Abstract
Background Describing severity of mitral regurgitation (MR) in dogs with degenerative mitral valve disease (DMVD) is challenging. Hypothesis/Objectives Mitral regurgitant fraction (RF), effective regurgitant orifice area (EROA), and the ratio of mitral regurgitant to aortic flow (QMR:QAo) can be calculated from routine echocardiographic measurements and provide additional information regarding MR severity. Animals Fifty‐seven dogs with preclinical DMVD including 36 without and 21 with cardiomegaly. Methods Prospective observational study. The expected relationships among RF, EROA, and QMR:QAo and 1‐dimensional measurements including left atrium to aortic root diameter ratio (LA:Ao) and normalized left ventricular internal dimension at end‐diastole (LVIDdN) were mathematically derived and calculated using echocardiographic data from the study population. Nonlinear goodness of fit was determined by calculation of the root mean standard error. The correlations between 1‐dimensional and multidimensional indices were analyzed using receiver operating characteristic curves. Results The relationships among RF, EROA, QMR:QAo, and both LA:Ao and LVIDdN were curvilinear, and the multidimensional indices differentiated MR of variable severity. By contrast, 1‐dimensional measurements were insensitive to MR severity until RF equaled or exceeded 50%. Regurgitant fraction ≥50%, EROA to body surface area ≥0.347 and QMR:QAo ≥0.79 were strongly associated with LA:Ao ≥1.6 and LVIDdN ≥1.7. Conclusions and Clinical Importance Regurgitant fraction, EROA, and QMR:QAo quantify MR severity in dogs with preclinical DMVD in a manner that 1‐dimensional measurements do not.
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Affiliation(s)
- Éva Larouche-Lebel
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kerry A Loughran
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark A Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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