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Baisan RA, Vulpe V. Vertebral Heart Score and Vertebral Left Atrial Size as Radiographic Measurements for Cardiac Size in Dogs-A Literature Review. Animals (Basel) 2025; 15:683. [PMID: 40075966 PMCID: PMC11899317 DOI: 10.3390/ani15050683] [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: 01/13/2025] [Revised: 02/08/2025] [Accepted: 02/24/2025] [Indexed: 03/14/2025] Open
Abstract
Radiology plays an important role in veterinary cardiology, along with other methods, such as electrocardiography, echocardiography, and biomarkers, in the diagnosis of cardiac diseases. Particularly, thoracic radiography is often used to assess heart size and for confirmation of left-sided congestive heart failure by the presence of pulmonary edema. Many cardiac diseases in dogs are associated with a heart size increase, especially in more advanced stages, and cardiac size assessment has been of great interest for a long time for both clinicians and researchers. A substantial number of methods for heart size measurement has been described; however, two methods, the vertebral heart score and the vertebral left atrial size are currently widely used in dogs. Therefore, the literature provides an abundant number of research articles for using these measurements in both healthy dogs and dogs with cardiac and extra-cardiac pathologic conditions. This review article aims to cover the current use of two radiographic measurements of the heart in healthy and diseased dogs, based on the available literature.
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Affiliation(s)
- Radu Andrei Baisan
- Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” Iasi University of Life Sciences, 700489 Iasi, Romania
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2
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Baisan RA, Turcu CA, Bilboc LM, Maftei MC, Vulpe V, Ohad DG. Quantification of respiratory sinus arrhythmia in control dogs and in dogs with various severity classes of myxomatous mitral valve disease. J Vet Cardiol 2024; 55:48-56. [PMID: 39232472 DOI: 10.1016/j.jvc.2024.08.001] [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: 04/10/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION Loss of respiratory sinus arrhythmia (RSA) is a negative prognostic factor in dogs with myxomatous mitral valve disease (MMVD). The aim of this study was to calculate the percentage (%) of RSA in healthy dogs and dogs in various MMVD classes. ANIMALS Control and MMVD dogs were prospectively included in the study. MATERIALS AND METHODS Respiratory sinus arrhythmia was calculated from a dual channel electrocardiography and breathing curve recording using the peak-to-trough method, in percent of the average heart rate. RESULTS One hundred and forty-nine dogs were studied, including 24 control and 125 MMVD dogs of different severity classes. An overall %RSA decrease was documented with increasing disease severity up to the Ca class along with a relative %RSA increase in the Cc class. The %RSA magnitude differed between B2 and Ca (P<0.001), and between Ca and Cc (P = 0.001) groups, respectively. The %RSA showed a medium negative correlation with the La:Ao ratio (r2 = -0.568, P<0.001) and with the E-wave velocity (r2 = -0.561, P<0.001). DISCUSSIONS A decrease in %RSA was shown with increased disease severity up to acute congestive heart failure (CHF). Dogs receiving cardiac therapy leading to stabilized CHF might restore their ability to exhibit RSA, often revealing a higher %RSA compared to those in acute CHF. STUDY LIMITATIONS Low number of respiratory cycles for analysis. Therapy effect not evaluated. CONCLUSIONS The findings of this study can serve as the basis for future risk stratification and carry the potential of proving an additional clinical marker for diagnostic and therapeutic decisions making when managing MMVD dogs.
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Affiliation(s)
- R A Baisan
- Clinic Department, Faculty of Veterinary Medicine, Iași University of Life Sciences "Ion Ionescu de la Brad", Mihail Sadoveanu No 8, 700489, Romania.
| | - C A Turcu
- Clinic Department, Faculty of Veterinary Medicine, Iași University of Life Sciences "Ion Ionescu de la Brad", Mihail Sadoveanu No 8, 700489, Romania
| | - L M Bilboc
- Clinic Department, Faculty of Veterinary Medicine, Iași University of Life Sciences "Ion Ionescu de la Brad", Mihail Sadoveanu No 8, 700489, Romania
| | - M C Maftei
- Clinic Department, Faculty of Veterinary Medicine, Iași University of Life Sciences "Ion Ionescu de la Brad", Mihail Sadoveanu No 8, 700489, Romania
| | - V Vulpe
- Clinic Department, Faculty of Veterinary Medicine, Iași University of Life Sciences "Ion Ionescu de la Brad", Mihail Sadoveanu No 8, 700489, Romania
| | - D G Ohad
- Cardiology Service, Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Robert H. Smith Faculty of Agriculture, Food and Environment, Hebrew University of Jerusalem, Israel, P.O. Box 12, Rehovot, 76100, Israel
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Li CC, Chan IP, Chang CC, Hsueh T, Yang CC, Lin SL. Potential prognostic indicators in dogs with advanced heart failure secondary to myxomatous mitral valve disease. Vet Rec 2024; 195:e4393. [PMID: 38959211 DOI: 10.1002/vetr.4393] [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: 07/04/2023] [Revised: 05/12/2024] [Accepted: 05/24/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Advanced heart failure (AHF) secondary to myxomatous mitral valve disease (MMVD) in dogs has unclear predictive variables and survival time. METHODS This retrospective study included 38 dogs with AHF and 38 with stable congestive heart failure (CHF), both due to MMVD. Predictive variables for AHF were analysed, and survival times were calculated using logistic regression and the Kaplan-Meier method. RESULTS Left atrium to aortic root ratio, normalised left ventricular dimension at the end-diastole and end-systole, isovolumic relaxation time (IVRT) and early transmitral inflow velocity to IVRT ratio were associated with AHF progression. The median survival times were significantly longer in the stable group than in the AHF group. After AHF diagnosis, the median survival times for all-cause and cardiogenic mortality were 194 and 354 days, respectively. LIMITATIONS This was a single-centre retrospective observational study. The study population was small, with breed bias (overrepresentation of Maltese dogs). Additionally, the treatment plans depended on clinical experience. CONCLUSIONS AHF in dogs with CHF secondary to MMVD is linked to left heart chamber enlargement and increased left ventricular dimensions, significantly reducing survival time to around six months post-diagnosis. Early recognition and appropriate management may improve outcomes, highlighting the importance of advanced treatment strategies.
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Affiliation(s)
- Chuan-Chuan Li
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - I-Ping Chan
- Veterinary Medical Teaching Hospital, National Chung Hsing University, Taichung, Taiwan
| | - Chao-Chin Chang
- Graduate Institute of Microbiology and Public Health, National Chung Hsing University, Taichung, Taiwan
| | - Tung Hsueh
- Veterinary Medical Teaching Hospital, National Chung Hsing University, Taichung, Taiwan
| | - Chung-Chun Yang
- Veterinary Medical Teaching Hospital, National Chung Hsing University, Taichung, Taiwan
| | - Shiun-Long Lin
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
- Veterinary Medical Teaching Hospital, National Chung Hsing University, Taichung, Taiwan
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Matson H, Llewellyn EA. Retrospective evaluation of the utility of shock index to determine the presence of congestive heart failure in dogs with myxomatous mitral valve disease (2019-2021): 98 cases. J Vet Emerg Crit Care (San Antonio) 2024; 34:231-237. [PMID: 38809224 DOI: 10.1111/vec.13379] [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: 08/28/2022] [Revised: 01/22/2023] [Accepted: 02/07/2023] [Indexed: 05/30/2024]
Abstract
OBJECTIVES To calculate the shock index (SI) in dogs with myxomatous mitral valve disease (MMVD) and to evaluate its use to predict the presence of congestive heart failure (CHF). DESIGN Retrospective study. SETTING Small animal university veterinary teaching hospital. ANIMALS Ninety-eight dogs with MMVD and 20 healthy dogs as part of a control group. INTERVENTIONS Heart rate (HR) and systolic blood pressure (SBP) were recorded, and SI was calculated by dividing HR by SBP for each dog. MEASUREMENTS AND MAIN RESULTS The mean (SD) HR, SBP, and SI were 123/min (32.6), 147 mm Hg (21.5), and 0.86 (0.3), respectively, for dogs with MMVD and 98/min (20.9), 145 mm Hg (18.7), and 0.68 (0.13), respectively, for control dogs. Dogs with MMVD had a significantly higher HR compared with control dogs (P < 0.01), and an elevation in HR was seen as the severity of MMVD increased. Dogs in stage B2 and C/D MMVD had a significantly higher SI value compared with control dogs (P = 0.04 and P < 0.01, respectively). SI was significantly higher in dogs in stage C/D MMVD compared with dogs in stage B2 MMVD (P < 0.01). Ten of 98 (10%) dogs had an arrhythmia. HR, SBP, and SI were not significantly different between dogs with and without arrhythmias (P = 0.13, P = 0.57, and P = 0.07, respectively), but significantly more dogs with CHF had an arrhythmia (P = 0.01). SI (area under the curve [AUC]: 0.98) and HR (AUC: 0.95) were excellent indicators for the presence of CHF. An optimal SI cutoff value ≥1.1 had 92% sensitivity and 95% specificity for predicting the presence of CHF, and an optimal HR cutoff value of ≥157/min had 92% sensitivity and 93% specificity for the prediction of CHF. CONCLUSIONS When there are compatible clinical signs, SI values ≥1.1 may suggest the presence of CHF in dogs with MMVD.
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Affiliation(s)
- Hannah Matson
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK
| | - Efa A Llewellyn
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK
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Baisan RA, Vulpe V. Determination of radiographic vertebral heart score and vertebral left atrial size cutoffs based on echocardiographic left atrial size in dogs with myxomatous mitral valve disease. Vet Radiol Ultrasound 2024; 65:54-61. [PMID: 38148480 DOI: 10.1111/vru.13324] [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: 05/13/2023] [Revised: 11/04/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
Progression of myxomatous mitral valve disease (MMVD) in dogs is a common cause of left atrial enlargement. Recently, a classification of left atrial (LA) size based on echocardiographic measurement has been proposed. This study aims to determine the radiographic LA size by reporting the cutoff values of VHS and VLAS for different groups of echocardiographic-measured LA size in dogs with MMVD. This retrospective analytical cross-sectional study included dogs diagnosed with MMVD grouped based on the echocardiographic LA size into normal (LA/Ao < 1.6), mild (1.6-1.89), moderate (1.9-2.2), and severe enlargement (>2.2) and were compared with ACVIM classification. VHS and VLAS were measured on the right lateral radiograph for each dog and cutoff values were calculated. One hundred and three dogs with MMVD were included in the study. A very strong positive correlation was observed between LA/Ao ratio and VHS (rs , 0.823, P < .01) or VLAS (rs , 0.834, P < .01). For VHS, a cutoff of 10.7 v, 11 v, and 11.5 v were established for echocardiographic LA thresholds of 1.6, 1.9, and 2.2 with a sensitivity of 79%, 92%, and 90% and a specificity of 97%, 90.7%, and 78.1%, respectively. For VLAS, a cutoff of 2.5 v, 2.7 v, and 2.9 v were established for echocardiographic LA cutoffs of 1.6, 1.9, and 2.2 with a sensitivity of 73%, 80%, and 83.3% and a specificity of 94%, 92%, and 86.3%, respectively. The results of this study may facilitate clinical decisions based on radiographic examination in dogs with myxomatous mitral valve disease.
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Affiliation(s)
- Radu Andrei Baisan
- Clinic Department, Faculty of Veterinary Medicine, Iași University of Life Sciences "Ion Ionescu de la Brad", Iași, Romania
| | - Vasile Vulpe
- Clinic Department, Faculty of Veterinary Medicine, Iași University of Life Sciences "Ion Ionescu de la Brad", Iași, Romania
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Solomon J, Bender S, Durgempudi P, Robar C, Cocchiaro M, Turner S, Watson C, Healy J, Spake A, Szlosek D. Diagnostic validation of vertebral heart score machine learning algorithm for canine lateral chest radiographs. J Small Anim Pract 2023; 64:769-775. [PMID: 37622992 DOI: 10.1111/jsap.13666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 04/26/2023] [Accepted: 07/12/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES The vertebral heart score is a measurement used to index heart size relative to thoracic vertebra. Vertebral heart score can be a useful tool for identifying and staging heart disease and providing prognostic information. The purpose of this study is to validate the use of a vertebral heart score algorithm compared to manual vertebral heart scoring by three board-certified veterinary cardiologists. MATERIALS AND METHODS A convolutional neural network centred around semantic segmentation of relevant anatomical features was developed to predict heart size and vertebral bodies. These predictions were used to calculate the vertebral heart score. An external validation study consisting of 1200 canine lateral radiographs was randomly selected to match the underlying distribution of vertebral heart scores. Three American College of Veterinary Internal Medicine board-certified cardiologists were enrolled to manually score 400 images each using the traditional Buchanan method. Post-scoring, the cardiologists evaluated the algorithm for misaligned anatomic landmarks and overall image quality. RESULTS The 95th percentile absolute difference between the cardiologist vertebral heart score and the algorithm vertebral heart score was 1.05 vertebrae (95% confidence interval: 0.97 to 1.20 vertebrae) with a mean bias of -0.09 vertebrae (95% confidence interval: -0.12 to -0.05 vertebrae). In addition, the model was observed to be well calibrated across the predictive range. CLINICAL SIGNIFICANCE We have found the performance of the vertebral heart score algorithm comparable to three board-certified cardiologists. While validation of this vertebral heart score algorithm has shown strong performance compared to veterinarians, further external validation in other clinical settings is warranted before use in those settings.
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Affiliation(s)
- J Solomon
- IDEXX Laboratories, Inc., Westbrook, ME, USA
| | - S Bender
- IDEXX Laboratories, Inc., Westbrook, ME, USA
| | | | - C Robar
- IDEXX Laboratories, Inc., Westbrook, ME, USA
| | - M Cocchiaro
- IDEXX Laboratories, Inc., Westbrook, ME, USA
| | - S Turner
- IDEXX Laboratories, Inc., Westbrook, ME, USA
| | - C Watson
- IDEXX Laboratories, Inc., Westbrook, ME, USA
| | - J Healy
- IDEXX Laboratories, Inc., Westbrook, ME, USA
| | - A Spake
- IDEXX Laboratories, Inc., Westbrook, ME, USA
| | - D Szlosek
- IDEXX Laboratories, Inc., Westbrook, ME, USA
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Koster L, Vogel J, Springer CM, Hecht S. Radiographic lung congestion scores in dogs with acute congestive heart failure caused by myxomatous mitral valve disease. J Vet Intern Med 2023; 37:1983-1991. [PMID: 37694988 PMCID: PMC10658542 DOI: 10.1111/jvim.16850] [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: 08/09/2022] [Accepted: 08/23/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND In humans, lung congestion scores are predictive of recurrence of acute congestive heart failure (CHF) and are superior to cardiac biomarkers in predicting survival. OBJECTIVES The primary aim of this retrospective study was to determine if a modified lung congestion score (LCS) in dogs diagnosed with acute CHF because of myxomatous mitral valve disease was associated with time until recurrence or death. ANIMALS Complete medical records were available for a total of 94 dogs between 2010 and 2019, but only 35 dogs fulfilled the criteria for inclusion. METHODS This retrospective study used descriptive statistics to describe the cumulative and corrected LCS. Correlations were used to examine the association of the corrected LCS and time until recurrence or death, selected echocardiographic variables, and timing of furosemide administration. RESULTS The mean LCS was 8.4 (SD 3.3) and corrected LCS was 0.48 (SD 0.19). The pattern was predominantly symmetric (40% of dogs) and focal (caudal) but more commonly right-sided when asymmetric (40% vs 20%). The median number of days after initial diagnosis of acute CHF to readmission and death was 150 days (range 4-572), and 266 days (range 5-965), respectively. No significant association between the dog's corrected LCS and number of days until readmission (r = .173, P = .42) nor survival (r = .109, P = .56) was found. There was a negative significant correlation (r = -.71, P < .001) between the time interval of furosemide administration and corrected LCS.
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Affiliation(s)
- Liza Koster
- Department of Small Animal Clinical SciencesUniversity of Tennessee College of Veterinary MedicineKnoxvilleTennesseeUSA
| | - Jenna Vogel
- Department of Small Animal Clinical SciencesUniversity of Tennessee College of Veterinary MedicineKnoxvilleTennesseeUSA
| | - Cary M. Springer
- Office of Information TechnologyUniversity of TennesseeKnoxvilleTennesseeUSA
| | - Silke Hecht
- Department of Small Animal Clinical SciencesUniversity of Tennessee College of Veterinary MedicineKnoxvilleTennesseeUSA
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Lee D, Yun T, Koo Y, Chae Y, Ku D, Chang D, Kang BT, Yang MP, Kim H. Change of Vertebral Left Atrial Size in Dogs with Preclinical Myxomatous Mitral Valve Disease prior to the Onset of Congestive Heart Failure. J Vet Cardiol 2022; 42:23-33. [DOI: 10.1016/j.jvc.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/23/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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Baisan RA, Vulpe V. Vertebral heart size and vertebral left atrial size reference ranges in healthy Maltese dogs. Vet Radiol Ultrasound 2021; 63:18-22. [PMID: 34585453 DOI: 10.1111/vru.13027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022] Open
Abstract
The most common cardiac measurements on thoracic radiography in veterinary medicine are vertebral heart size (VHS) and vertebral left atrial size (VLAS). Previously published studies have demonstrated evidence that reference ranges for these measures vary among different dog breeds, however reference ranges for Maltese breed dogs are currently lacking. We hypothesized that VHS and VLAS in healthy Maltese dogs would not be influenced by sex, age, or bodyweight. This retrospective, reference interval study aimed to describe reference intervals for VHS and VLAS in a sample of clinically healthy Maltese dogs and assess the intra- and interobserver variabilities for VLAS and VHS measurements. A total of 81 clinically healthy Maltese dogs were included, with healthy status being based on a complete cardiologic examination. Thoracic radiography in right lateral recumbency was performed for all dogs. The intra- and interobserver variability assessments of VHS and VLAS were based on measurements independently performed by three observers. The mean VHS was 9.53 ± 0.46 vertebrae (v). The median and interquartile range (IQR) for VLAS was 2 v (IQR, 1.8-2.1v). A statistically significant moderate positive correlation was observed between VHS and VLAS (P < .01, r = 0.416). Both VHS and VLAS showed an almost perfect intraobserver agreement. Interobserver agreement was almost perfect for VHS and substantial for VLAS. Findings supported previous studies recommending the use of breed-specific reference values for VHS and VLAS, and provided background data for future radiographic evaluations of Maltese dogs with clinical signs of cardiac disease.
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Affiliation(s)
- Radu Andrei Baisan
- Department of Clinics, Faculty of Veterinary Medicine, University of Applied Life Sciences and Environment "Ion Ionescu de la Brad", Iași, Romania
| | - Vasile Vulpe
- Department of Clinics, Faculty of Veterinary Medicine, University of Applied Life Sciences and Environment "Ion Ionescu de la Brad", Iași, Romania
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Wesselowski S, Gordon SG, Meddaugh N, Saunders AB, Häggström J, Cusack K, Janacek BW, Matthews DJ. Prediction of clinically important acquired cardiac disease without an echocardiogram in large breed dogs using a combination of clinical, radiographic and electrocardiographic variables. J Vet Cardiol 2021; 40:126-141. [PMID: 34483077 DOI: 10.1016/j.jvc.2021.07.003] [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: 01/31/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Large breed (LB) dogs develop dilated cardiomyopathy (DCM) and myxomatous mitral valve disease (MMVD). Echocardiography is required for a definitive diagnosis but is not always available. Our objective was to assess the clinical utility of thoracic radiographs alone and in combination with physical examination and electrocardiography findings for the prediction of clinically important DCM or MMVD in LB dogs. ANIMALS Four hundred fifty-five client-owned dogs ≥20 kg with concurrent thoracic radiographs and echocardiogram. MATERIALS AND METHODS Medical records were reviewed and stored thoracic radiographs and echocardiographic images were measured to classify dogs as normal heart size (NHS), preclinical DCM, clinical DCM, preclinical MMVD (with cardiomegaly), clinical MMVD, or equivocal. Dogs with preclinical MMVD, without cardiomegaly, were classified as NHS. Vertebral heart size (VHS) and vertebral left atrial size (VLAS) were measured. Receiver operating characteristic curves and prediction models were derived. RESULTS Prevalence of MMVD (39.3%) was higher than the prevalence of DCM (24.8%), though most MMVD dogs (67.0%) lacked cardiomegaly and were classified as NHS for analysis. The area under the curve for VHS to discriminate between NHS and clinical DCM/MMVD or preclinical DCM/MMVD was 0.861 and 0.712, respectively, while for VLAS, it was 0.891 and 0.722, respectively. Predictive models incorporating physical examination and electrocardiography findings in addition to VHS/VLAS increased area under the curve to 0.978 (NHS vs. clinical DCM/MMVD) and 0.829 (NHS vs. preclinical DCM/MMVD). CONCLUSIONS Thoracic radiographs were useful for predicting clinically important DCM or MMVD in LB dogs, with improved discriminatory ability when physical examination abnormalities and arrhythmias were accounted for.
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Affiliation(s)
- S Wesselowski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA.
| | - S G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - N Meddaugh
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - A B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - J Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Box 7045, 7507 Uppsala, Sweden
| | - K Cusack
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - B W Janacek
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - D J Matthews
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
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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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12
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Nasciutti PR, Moraes AT, Santos TK, Gonçalves Queiroz KK, Costa APA, Amaral AR, Fernando Gomes Olivindo R, Pontieri CFF, Jeremias JT, Vendramini THA, Brunetto MA, Carvalho RDOA. Protective effects of omega-3 fatty acids in dogs with myxomatous mitral valve disease stages B2 and C. PLoS One 2021; 16:e0254887. [PMID: 34265016 PMCID: PMC8282066 DOI: 10.1371/journal.pone.0254887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/07/2021] [Indexed: 12/02/2022] Open
Abstract
Myxomatous mitral valve disease (MMVD) is characterized by thickening of the valve leaflets and omega-3 (ω-3) supplementation has been associated with modulation of blood pressure (BP) and heart rate, improvement of doppler echocardiographic indices, antiarrhythmic, anti-inflammatory and anti-dislipidemic effects in dogs and humans, although prospective studies of it single use are still absent in the veterinary literature. The objective of this study was to evaluate the influence of ω-3 supplementation in dogs with MMVD. Twenty-nine dogs were followed quarterly for 12 months by clinical evaluation, arterial blood pressure, electrocardiography, doppler echocardiography, thoracic radiography and laboratory tests including inflammatory mediators and cardiac biomarker blood concentrations. The dogs were classified in stages B2 and C, according to the classification proposed by ACVIM 2019. They were randomly assigned to either ω-3 group (ω-3G) or control group (CG). The ingestion of ω-3 reduced the chance of developing arrhythmias by 2.96 times (p = 0.003). The vertebral heart size (VHS) measurements were higher in the control group (p = 0.033). In conclusion, at the dosages used in this study, ω-3 dietary supplementation reduces the volumetric overload, has antiarrhythmic effect and keeps dogs with B2 and C stages of MMVD in milder stages of the disease.
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Affiliation(s)
- Priscilla Regina Nasciutti
- Veterinary Cardiology Service of the Veterinary Hospital of the School of Veterinary Medicine and Animal Science, Federal University of Goias, Goiania, Brazil
| | - Aline Tavares Moraes
- Veterinary Cardiology Service of the Veterinary Hospital of the School of Veterinary Medicine and Animal Science, Federal University of Goias, Goiania, Brazil
| | - Thaiz Krawczyk Santos
- Veterinary Cardiology Service of the Veterinary Hospital of the School of Veterinary Medicine and Animal Science, Federal University of Goias, Goiania, Brazil
| | - Karine Kelly Gonçalves Queiroz
- Veterinary Cardiology Service of the Veterinary Hospital of the School of Veterinary Medicine and Animal Science, Federal University of Goias, Goiania, Brazil
| | - Ana Paula Araújo Costa
- Veterinary Cardiology Service of the Veterinary Hospital of the School of Veterinary Medicine and Animal Science, Federal University of Goias, Goiania, Brazil
| | - Andressa Rodrigues Amaral
- Nutrition and Production Department, Pet Nutrology Research Center, School of Veterinary Medicine and Animal Science, University of Sao Paulo (USP), Pirassununga, Brazil
| | - Rodrigo Fernando Gomes Olivindo
- Nutrition and Production Department, Pet Nutrology Research Center, School of Veterinary Medicine and Animal Science, University of Sao Paulo (USP), Pirassununga, Brazil
| | | | - Juliana Toloi Jeremias
- Nutritional Development Center, Grandfood Indústria e Comércio Ltda (Premier Pet), Dourado, Brazil
| | - Thiago Henrique Annibale Vendramini
- Nutrition and Production Department, Pet Nutrology Research Center, School of Veterinary Medicine and Animal Science, University of Sao Paulo (USP), Pirassununga, Brazil
| | - Marcio Antonio Brunetto
- Nutrition and Production Department, Pet Nutrology Research Center, School of Veterinary Medicine and Animal Science, University of Sao Paulo (USP), Pirassununga, Brazil
| | - Rosângela de Oliveira Alves Carvalho
- Veterinary Cardiology Service of the Veterinary Hospital of the School of Veterinary Medicine and Animal Science, Federal University of Goias, Goiania, Brazil
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13
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Wilshaw J, Rosenthal SL, Wess G, Dickson D, Bevilacqua L, Dutton E, Deinert M, Abrantes R, Schneider I, Oyama MA, Gordon SG, Elliott J, Xia D, Boswood A. Accuracy of history, physical examination, cardiac biomarkers, and biochemical variables in identifying dogs with stage B2 degenerative mitral valve disease. J Vet Intern Med 2021; 35:755-770. [PMID: 33645846 PMCID: PMC7995403 DOI: 10.1111/jvim.16083] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/26/2021] [Accepted: 02/11/2021] [Indexed: 01/26/2023] Open
Abstract
Background Treatment is indicated in dogs with preclinical degenerative mitral valve disease (DMVD) and cardiomegaly (stage B2). This is best diagnosed using echocardiography; however, relying upon this limits access to accurate diagnosis. Objectives To evaluate whether cardiac biomarker concentrations can be used alongside other clinical data to identify stage B2 dogs. Animals Client‐owned dogs (n = 1887) with preclinical DMVD prospectively sampled in Germany, the United Kingdom, and the United States. Methods Dogs that met inclusion criteria and were not receiving pimobendan (n = 1245) were used for model development. Explanatory (multivariable logistic regression) and predictive models were developed using clinical observations, biochemistry, and cardiac biomarker concentrations, with echocardiographically confirmed stage B2 disease as the outcome. Receiver operating characteristic curves assessed the ability to identify stage B2 dogs. Results Age, appetite, serum alanine aminotransferase activity, body condition, serum creatinine concentration, murmur intensity, and plasma N‐terminal propeptide of B‐type natriuretic peptide (NT‐proBNP) concentration were independently associated with the likelihood of being stage B2. The discriminatory ability of this explanatory model (area under curve [AUC], 0.84; 95% confidence interval [CI], 0.82‐0.87) was superior to NT‐proBNP (AUC, 0.77; 95% CI, 0.74‐0.80) or the vertebral heart score alone (AUC, 0.76; 95% CI, 0.69‐0.83). A predictive logistic regression model could identify the probability of being stage B2 (AUC test set, 0.86; 95% CI, 0.81‐0.91). Conclusion and Clinical Importance Our findings indicate accessible measurements could be used to screen dogs with preclinical DMVD. Encouraging at‐risk dogs to seek further evaluation could result in a greater proportion of cases being appropriately managed.
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Affiliation(s)
- Jenny Wilshaw
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK
| | | | - Gerhard Wess
- Clinic of Small Animal Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | | | | | | | | | | | - Mark A Oyama
- Department of Veterinary Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sonya G Gordon
- College of Veterinary Medicine, Texas A&M University, College Station, Texas, USA
| | - Jonathan Elliott
- Department of Comparative Biomedical Science, Royal Veterinary College, University of London, London, UK
| | - Dong Xia
- Research Support Office, Royal Veterinary College, University of London, London, UK
| | - Adrian Boswood
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK
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14
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Murphy SD, Ward JL, Viall AK, Tropf MA, Walton RL, Fowler JL, Ware WA, DeFrancesco TC. Utility of point-of-care lung ultrasound for monitoring cardiogenic pulmonary edema in dogs. J Vet Intern Med 2020; 35:68-77. [PMID: 33270302 PMCID: PMC7848339 DOI: 10.1111/jvim.15990] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 02/02/2023] Open
Abstract
Background Point‐of‐care lung ultrasound (LUS) is an effective tool to diagnose left‐sided congestive heart failure (L‐CHF) in dogs via detection of ultrasound artifacts (B‐lines) caused by increased lung water. Hypothesis/Objectives To determine whether LUS can be used to monitor resolution of cardiogenic pulmonary edema in dogs, and to compare LUS to other indicators of L‐CHF control. Animals Twenty‐five client‐owned dogs hospitalized for treatment of first‐onset L‐CHF. Methods Protocolized LUS, thoracic radiographs (TXR), and plasma N‐terminal pro‐B‐type natriuretic peptide were performed at hospital admission, hospital discharge, and recheck examinations. Lung ultrasound findings were compared between timepoints and to other clinical measures of L‐CHF. Results From time of hospital admission to discharge (mean 19.6 hours), median number of LUS sites strongly positive for B‐lines (>3 B‐lines per site) decreased from 5 (range, 1‐8) to 1 (range, 0‐5; P < .001), and median total B‐line score decreased from 37 (range, 6‐74) to 5 (range, 0‐32; P = .002). Lung ultrasound indices remained improved at first recheck (P < .001). Number of strong positive sites correlated positively with respiratory rate (r = 0.52, P = .008) and TXR edema score (r = 0.51, P = .009) at hospital admission. Patterns of edema resolution differed between LUS and TXR, with cranial quadrants showing more significant reduction in B‐lines compared to TXR edema score (80% vs 29% reduction, respectively; P = .003). Conclusions and Clinical Importance Lung ultrasound could be a useful tool for monitoring resolution of pulmonary edema in dogs with L‐CHF.
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Affiliation(s)
- Shane D Murphy
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Austin K Viall
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Melissa A Tropf
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Rebecca L Walton
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Jennifer L Fowler
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA.,Present address: Jennifer L. Fowler, Idexx Laboratories, 1 Idexx Dr., Westbrook, ME, USA
| | - Wendy A Ware
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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15
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Boswood A, Gordon SG, Häggström J, Vanselow M, Wess G, Stepien RL, Oyama MA, Keene BW, Bonagura J, MacDonald KA, Patteson M, Smith S, Fox PR, Sanderson K, Woolley R, Szatmári V, Menaut P, Church WM, O'Sullivan ML, Jaudon JP, Kresken JG, Rush J, Barrett KA, Rosenthal SL, Saunders AB, Ljungvall I, Deinert M, Bomassi E, Estrada AH, Fernandez Del Palacio MJ, Moise NS, Abbott JA, Fujii Y, Spier A, Luethy MW, Santilli RA, Uechi M, Tidholm A, Schummer C, Watson P. Temporal changes in clinical and radiographic variables in dogs with preclinical myxomatous mitral valve disease: The EPIC study. J Vet Intern Med 2020; 34:1108-1118. [PMID: 32200574 PMCID: PMC7255670 DOI: 10.1111/jvim.15753] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/27/2020] [Indexed: 01/01/2023] Open
Abstract
Background The Evaluation of pimobendan in dogs with cardiomegaly caused by preclinical myxomatous mitral valve disease (EPIC) study monitored dogs with myxomatous mitral valve disease (MMVD) as they developed congestive heart failure (CHF). Objectives To describe the changes in clinical and radiographic variables occurring as dogs with MMVD and cardiomegaly develop CHF, compared to similar dogs that do not develop CHF. Animals One hundred and thirty‐five, and 73 dogs that did or did not develop CHF, respectively. Materials and methods The following variables were evaluated in 2 groups of dogs (dogs that did or did not develop CHF): Heart rate (HR), clinic respiratory rate (RR), home‐measured resting respiratory rate (RRR), rectal temperature (RT), body weight (BW), and vertebral heart sum (VHS). Absolute value and rate of change of each variable were calculated for each day a dog was in study. Daily means were calculated and plotted against time. The onset of CHF or last visit before leaving the study were set as reference time points. Results The most extreme values and rate of change occurred in variables immediately before onset of CHF. Vertebral heart sum increased earliest. Heart rate, RR, and RRR also increased. Rectal temperature and BW decreased. Increases in RR and RRR were most extreme and occurred immediately before CHF. Conclusions and Clinical Importance Dogs with MMVD and cardiomegaly experience increases in HR, RR, RRR, and VHS, and decreases in BW and RT as they develop CHF. The variables with highest absolute change and rate of change were RR and RRR. These findings reinforce the value of RR and RRR as indicators of impending or incipient CHF.
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Affiliation(s)
- Adrian Boswood
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas
| | - Jens Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | | - Gerhard Wess
- Clinic of Small Animal Medicine, University of Munich, Munich, Germany
| | - Rebecca L Stepien
- School of Veterinary Medicine, Medical Sciences, University of Wisconsin Madison, Madison, Wisconsin
| | - Mark A Oyama
- Clinical Studies-Philadelphia, MJR-VHUP-Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bruce W Keene
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina
| | - John Bonagura
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio
| | | | - Mark Patteson
- HeartVets @ Vale Referrals, The Animal Hospital, Stinchcombe, Dursley Glos, UK
| | | | - Philip R Fox
- Department of Cardiology and Caspary Research Institute, Animal Medical Center, New York, New York
| | | | - Richard Woolley
- Cardio Respiratory Pet Referrals, Mordialloc, Melbourne, Victoria, Australia
| | - Viktor Szatmári
- Faculty of Veterinary Medicine, Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands
| | | | | | - M Lynne O'Sullivan
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | | | | | - John Rush
- School of Veterinary Medicine, Clinical Sciences, Tufts University Cummings, North Grafton, Massachusetts
| | | | | | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas
| | - Ingrid Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | | - Eric Bomassi
- Centre Hospitalier Vétérinaire des Cordeliers, Cardiology, Meaux, Paris, France
| | - Amara H Estrada
- University of Florida College of Veterinary Medicine, Small Animal Clinical Sciences, Gainesville, Florida
| | | | - N Sydney Moise
- Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Jonathan A Abbott
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia
| | - Yoko Fujii
- Azabu University, Surgery 1, Kanagawa, Japan
| | - Alan Spier
- Blue Pearl Veterinary Partners, Tampa, Florida
| | - Michael W Luethy
- Chicago Veterinary Emergency and Specialty Center, Chicago, Illinois
| | | | - Masami Uechi
- Japan Animal Specialty Medical Institute Inc., JASMINE Veterinary Cardiovascular Medical Center, Yokohama, Japan
| | | | | | - Philip Watson
- Boehringer Ingelheim, Animal Health, Ingelheim am Rhein, Germany
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