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Matos JI, Caro-Vadillo A, Mohr-Peraza E, García-Rodríguez SN, Montoya-Alonso JA, Carretón E. Comparative Echocardiographic Evaluation of Right Pulmonary Artery Dimensions and Right Pulmonary Artery Distensibility Index in Dogs with Heartworm Disease. Vet Sci 2025; 12:246. [PMID: 40266965 PMCID: PMC11946142 DOI: 10.3390/vetsci12030246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 02/20/2025] [Accepted: 03/03/2025] [Indexed: 04/25/2025] Open
Abstract
Canine cardiopulmonary dirofilariosis or heartworm disease (Dirofilaria immitis), is a globally spread vector-borne disease [...].
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Affiliation(s)
- Jorge Isidoro Matos
- Internal Medicine, Veterinary Medicine and Therapeutic Research Group, Faculty of Veterinary Science, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35017 Las Palmas de Gran Canaria, Spain; (J.I.M.); (E.M.-P.); (J.A.M.-A.); (E.C.)
| | - Alicia Caro-Vadillo
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Complutense University, 28040 Madrid, Spain;
| | - Eva Mohr-Peraza
- Internal Medicine, Veterinary Medicine and Therapeutic Research Group, Faculty of Veterinary Science, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35017 Las Palmas de Gran Canaria, Spain; (J.I.M.); (E.M.-P.); (J.A.M.-A.); (E.C.)
| | - Sara Nieves García-Rodríguez
- Internal Medicine, Veterinary Medicine and Therapeutic Research Group, Faculty of Veterinary Science, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35017 Las Palmas de Gran Canaria, Spain; (J.I.M.); (E.M.-P.); (J.A.M.-A.); (E.C.)
| | - José Alberto Montoya-Alonso
- Internal Medicine, Veterinary Medicine and Therapeutic Research Group, Faculty of Veterinary Science, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35017 Las Palmas de Gran Canaria, Spain; (J.I.M.); (E.M.-P.); (J.A.M.-A.); (E.C.)
| | - Elena Carretón
- Internal Medicine, Veterinary Medicine and Therapeutic Research Group, Faculty of Veterinary Science, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35017 Las Palmas de Gran Canaria, Spain; (J.I.M.); (E.M.-P.); (J.A.M.-A.); (E.C.)
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Basile A, Napoli E, Brianti E, Venco L. Right Pulmonary Artery Distensibility Index in Heartworm Infected Dogs: Are the Different Methods Leading to Same Results? Animals (Basel) 2023; 13:ani13030418. [PMID: 36766307 PMCID: PMC9913324 DOI: 10.3390/ani13030418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
Canine Heartworm Disease (HWD) is mainly a pulmonary vascular disease. The reduction of the Pulmonary Artery Distensibility (PAD) is an early index of pulmonary vascular disease. Echocardiographic evaluation of the Right Pulmonary Artery Distensibility index (RPADi) is calculated as the percentage change in diameter of the right pulmonary artery (RPA) between systole and diastole. Historically, two main methods have been used for RPADi calculation: The Venco method and Visser method; however, different hybrid methods have also been used by other authors. Therefore, it could be difficult for a clinician to decide which method to apply and how to interpret the results based on the reference values reported. The aim of this study was to compare the RPADi obtained by five different techniques (Venco classic, Venco modified, Visser classic, Visser modified 1, and Visser modified 2). The study design was a retrospective, single center, observational study. Forty-seven client-owned dogs were included. The measurements were performed off-line as an average of three consecutive cardiac cycles by a single investigator blinded to the dogs' diagnosis. The RPADi was satisfactorily obtained by all methods in all dogs. Intra-observer measurement variability was clinically acceptable both for systolic and diastolic measurements. Although the Bland-Altman test showed a statistical agreement between the various methods used to calculate the RPADi, these methods cannot be used interchangeably in a clinical setting. Instead, the measurement method and reference values should always be specified.
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Affiliation(s)
- Angelo Basile
- Centro Nefrologico Veterinario, 95123 Catania, Italy
- Correspondence: ; Tel.: +39-338-681-153
| | - Ettore Napoli
- Department of Veterinary Sciences, University of Messina, 98168 Messina, Italy
| | - Emanuele Brianti
- Department of Veterinary Sciences, University of Messina, 98168 Messina, Italy
| | - Luigi Venco
- Ospedale Veterinario Città di Pavia, 27100 Pavia, Italy
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Evaluation of Pulmonary Hypertension in Dogs with Heartworm Disease Using the Computed Tomographic Pulmonary Trunk to Aorta Diameter Ratio. Animals (Basel) 2022; 12:ani12182441. [PMID: 36139301 PMCID: PMC9495137 DOI: 10.3390/ani12182441] [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: 08/15/2022] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022] Open
Abstract
Dirofilaria immitis causes proliferative pulmonary endoarteritis that leads to the appearance of chronic precapillary pulmonary hypertension (PH) in dogs. Pulmonary trunk to aorta ratio (PT:Ao ratio) obtained by computed tomography (CT) was studied and the quantitative measure of the diameters of the pulmonary trunk (PT), the descending thoracic aorta (DAo) and ascending thoracic aorta (AAo) were evaluated for the determination of the presence of moderate to severe PH in 59 dogs. The diagnosis of PH was echocardiographically determined, based on the determination of the right pulmonary artery distensibility (RPAD) index (<29.5%), and compared with other parameters for estimating PH. The results showed a very high concordance: 0.976 (p-value 0.000) between the two CT methods (PT:DAo and PT:AAo) with an excellent intraclass correlation coefficient > 0.95. Moreover, cut-off values of ≥1.111 for PT:DAo, and ≥1.057 for PT:AAo were determined for dogs with an RPAD index < 29.5%, which suggests a cut-off value between healthy dogs and the presence of PH. As has been previously published, The PT:Ao ratios did not determine the presence of mild PH, so the measurements cannot be considered useful for the early diagnosis of PH in dogs with heartworm.
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Yang F, Wang D, Cui S, Zhu Y, Liu L, Ji M, Zou D, Zhao R, Liu Q. Decreased pulmonary artery distensibility as a marker for severity in acute pulmonary embolism patients undergoing ECG-gated CTPA. J Thromb Thrombolysis 2021; 51:748-756. [PMID: 33738769 DOI: 10.1007/s11239-021-02397-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 12/12/2022]
Abstract
To investigate the characteristics of pulmonary artery distensibility (PAD) in patients with acute pulmonary embolism (APE) and to assess whether a relationship exists between PAD and the disease severity. Clinical and radiological data of 30 APE patients who underwent retrospective electrocardiogram (ECG)-gated computed tomography pulmonary angiography (CTPA) with a definite diagnosis of APE were retrospectively reviewed in the present study, including 15 subjects in severe (SPE) group and 15 subjects in non-severe (NSPE) group. PAD and cardiac function parameters were compared between the two groups, their relationships were investigated, and receiver operating characteristic (ROC) curves were used to determine the sensitivity and specificity of the above parameters for the diagnosis of APE severity. The PAD decreased in the following order: NSPE group (6.065 ± 2.114) × 10-3 (%/mmHg), and SPE group (4.334 ± 1.777) × 10-3 (%/mmHg) (P < 0.05). All the cardiac function parameters except RA/LAdiameter showed statistically significant different values between the two groups (P < 0.05). As APE severity increased, the cardiac morphological measurements of RV/LVdiameter, RV/LVarea, RVEDV/LVEDV and RVESV/LVESV increased. There was a weak to moderate negative correlation between PAD and PAmax, PAmin, PA/AAmin, PA/AAmax, RV/LVdiameter, RV/LVarea (r = -0.393 to -0.625), that is, PAD was inversely correlated with cardiac function parameters. There was a moderate negative correlation between PAD and hemoptysis(r = -0.672). The area under the ROC curve (AUC) of PAD was 0.724, the critical value was 4.137 × 10-3 mm/Hg, and the sensitivity and specificity were 60.0% and 93.3%, respectively. PAmin showed the strongest discriminatory power to identify high-risk patients (AUC = 0.827), with the highest sensitivity of 100%, which was also achieved by RA/LAarea. The PAD obtained by retrospective ECG-gated CTPA could be an indicator to be used in the evaluation of the presence and severity of APE.
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Affiliation(s)
- Fei Yang
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China.
| | - Dawei Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Shujun Cui
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - Yuexiang Zhu
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - Lan Liu
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - Mengmeng Ji
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - Dianjun Zou
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - Ru Zhao
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - Qingxiao Liu
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
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Wang D, Yang F, Zhu X, Cui S, Dong S, Zhang Z, Zhang Y. CTPA pulmonary artery distensibility in assessment of severity of acute pulmonary embolism and right ventricular function. Medicine (Baltimore) 2021; 100:e24356. [PMID: 33546070 PMCID: PMC7837935 DOI: 10.1097/md.0000000000024356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/22/2020] [Indexed: 12/03/2022] Open
Abstract
To investigate the characteristics of pulmonary artery distensibility (PAD) in patients with acute pulmonary embolism (APE) and to assess the correlation of PAD with APE severity and right ventricular function. A total of 33 patients who underwent retrospective electrocardiogram (ECG)-gated computed tomography pulmonary angiography (CTPA) with a definite diagnosis of APE were included in the study. According to APE severity, the patients were divided into severe (SPE) and non-severe (NSPE) groups. Data from a control group without APE matching the basic demographics of the APE patients were collected. Pulmonary artery distensibility (PAD) and right ventricular function parameters were compared among the 3 groups, their relationships were investigated, and receiver operating characteristic (ROC) curves were used to determine the sensitivity and specificity of the above parameters for the diagnosis of APE severity. The PAD values of the control, NSPE, and SPE groups were (7.877 ± 2.637) × 10-3 mm/Hg, (6.050 ± 2.011) × 10-3 mm/Hg, (4.321 ± 1.717) × 10-3 mm/Hg, respectively (P < .01). There were statistically significant differences in right ventricular function parameters among the 3 groups (P < .05). The correlation analysis between PAD and right ventricular function parameters showed a weak negative correlation (r = -0.281--0.392). The area under the ROC curve of PAD was 0.743, the critical value was 4.200, and the sensitivity and specificity were 62.5% and 94.1%, respectively. The PAD obtained by retrospective ECG-gated CTPA could accurately evaluate APE severity and right ventricular function. As the severity of APE increases, PAD decreases, which is helpful to identify patients at high risk of APE.
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Affiliation(s)
| | - Fei Yang
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou
| | - Xiaolong Zhu
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou
| | - Shujun Cui
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou
| | - Shanglin Dong
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou
| | | | - Yujiao Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou
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Paradies P, Sasanelli M, Capogna A, Mercadante A, Rubino GTR, Bussadori CM. Is Pulmonary Hypertension a Rare Condition Associated to Angiostrongylosis in Naturally Infected Dogs? Top Companion Anim Med 2021; 43:100513. [PMID: 33484890 DOI: 10.1016/j.tcam.2021.100513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/07/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
Canine angiostrongylosis due to Angiostrongylus vasorum is one of the cardiopulmonary parasitic diseases in dogs and it can manifest with very different clinical pictures, which often make diagnosis very difficult. Based on the nature of the vascular and parenchymal lesions induced by the infection (thrombo-arteritis and fibrosis), it is not surprising that cases of pulmonary arterial hypertension (PAH) associated with angiostrongylosis have been reported in the literature, although it seems to represent a rare condition. The aim of the present work is to describe the clinical and instrumental aspects referred to cases of canine angiostrongylosis before and after treatment then to evaluate even mild conditions of PAH using echocardiography. PAH was not only conventionally investigated based on characteristic cardiac changes that occur secondary to PAH and by estimating pulmonary pressure from spectral Doppler tracings, but also by using a combination of further selected echocardiographic parameters (AT/ET, PA/Ao, Pulmonary flow profile pattern) able also to reveal PAH in the absence of tricuspid or pulmonary regurgitation. Clinical and instrumental aspects of 17 cases of angiostrongylosis, divided into respiratory cases (n = 6), nonrespiratory (n = 5), and asymptomatic (n = 6), are here described. Radiographic alterations were recorded in 90% of patients despite the reason for clinical presentation. A state of mild to severe PAH was diagnosed in 58.8% of cases. Although the return to a normal clinical condition was achieved 2 months after treatment in almost all patients, radiographic and echocardiographic alterations were persistent for longer. The cases presented reinforce the evidence on the complexity of the clinical picture of angiostrongylosis. PAH associated with canine angiostrongylosis could be a more common condition than previously reported in naturally infected dogs. In some cases, echocardiographic findings suggestive of PAH could be the starting point to address the clinical diagnosis toward angiostrongylosis. PAH may be responsible for worsening of the clinical picture of patients; thus, a careful evaluation is suggested before and after anthelmintic treatment in order to optimize the therapeutic management of each case.
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Affiliation(s)
- Paola Paradies
- Clinical Section, Department of Emergency and Organs Transplantation, Campus of Veterinary Medicine, University "Aldo Moro" of Bari, Italy.
| | - Mariateresa Sasanelli
- Clinical Section, Department of Emergency and Organs Transplantation, Campus of Veterinary Medicine, University "Aldo Moro" of Bari, Italy
| | - Antonio Capogna
- Clinical Section, Department of Emergency and Organs Transplantation, Campus of Veterinary Medicine, University "Aldo Moro" of Bari, Italy
| | - Angelica Mercadante
- Clinical Section, Department of Emergency and Organs Transplantation, Campus of Veterinary Medicine, University "Aldo Moro" of Bari, Italy
| | - Giuseppe Tommaso Roberto Rubino
- Clinical Section, Department of Emergency and Organs Transplantation, Campus of Veterinary Medicine, University "Aldo Moro" of Bari, Italy
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Romano AE, Saunders AB, Gordon SG, Wesselowski S. Intracardiac heartworms in dogs: Clinical and echocardiographic characteristics in 72 cases (2010-2019). J Vet Intern Med 2021; 35:88-97. [PMID: 33617036 PMCID: PMC7848357 DOI: 10.1111/jvim.15985] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Heartworms, a cause of pulmonary hypertension (PH) in dogs, can migrate from the pulmonary arteries into the heart resulting in life-threatening caval syndrome (CS). OBJECTIVES To describe clinical and echocardiographic characteristics in dogs with intracardiac heartworms including estimated heartworm burden and frequency of PH and pigmenturia. ANIMALS Seventy-two client-owned dogs with heartworms. METHODS Retrospective study. Data collected from an electronic medical records search for dogs with intracardiac heartworms included clinicopathologic, echocardiographic, and procedural findings. Dogs with heartworms isolated to the pulmonary arteries were excluded. RESULTS Estimated intracardiac heartworm burden was low in 14 of 72 (19%) and high in 58 of 72 (81%) dogs. The majority were small breed (54/72; 75%; 29/72; 40% Chihuahuas) and had a high likelihood of PH (67/72; 93%). Pigmenturia was the second most common clinical finding (31/72; 43%) after lethargy (32/72; 44%). Anemia (37/55; 36%), pigmenturia (30/58; 52%), and bilirubinuria (28/36; 78%) were significantly more common in dogs with a high worm burden (P < .05). Based on the presence of anemia, pigmenturia, and clinical signs, 18 of 72 dogs (25%) were considered to have CS. CONCLUSIONS AND CLINICAL IMPORTANCE Although the majority of dogs with intracardiac heartworms had a high worm burden and high likelihood of PH, only 25% had clinical evidence of CS. Echocardiography is a useful tool to identify intracardiac heartworms, detect likelihood of PH, and could be useful for staging heartworm positive small breed dogs for intracardiac heartworm migration.
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Affiliation(s)
- Abigail E. Romano
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Texas A&M UniversityCollege StationTexasUSA
| | - Ashley B. Saunders
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Texas A&M UniversityCollege StationTexasUSA
| | - Sonya G. Gordon
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Texas A&M UniversityCollege StationTexasUSA
| | - Sonya Wesselowski
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Texas A&M UniversityCollege StationTexasUSA
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Diagnostic Imaging of Cardiovascular Disease in Small Animals. Animals (Basel) 2020; 10:ani10122392. [PMID: 33333726 PMCID: PMC7765131 DOI: 10.3390/ani10122392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/18/2022] Open
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Visser LC, Wood JE, Johnson LR. Survival characteristics and prognostic importance of echocardiographic measurements of right heart size and function in dogs with pulmonary hypertension. J Vet Intern Med 2020; 34:1379-1388. [PMID: 32501601 PMCID: PMC7379050 DOI: 10.1111/jvim.15826] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The clinical relevance of echocardiographic measurements of right heart size and function in dogs with pulmonary hypertension (PH) is unknown. OBJECTIVE To determine if echocardiographic measurements of right heart size and right ventricular (RV) function are associated with survival times in dogs with PH. ANIMALS Eighty-two client-owned dogs. METHODS Retrospective study where data from medical records and baseline echocardiographic examinations were collected and measured in a standardized manner. Owners or primary veterinarians were contacted for outcome data. RESULTS Enlargement of the right atrium (88%), RV (69%), and pulmonary artery (72%) was common. One-third of the cases had reduced RV function quantified by two-dimensional echocardiography-derived tricuspid annular plane systolic excursion (TAPSE). Decreased TAPSE was significantly (P = .008) more common in dogs with PH not secondary to left heart disease (LHD; 43%) compared to dogs with PH secondary to LHD (14%) but median survival times (182, 95% confidence interval [CI] = 39-309 versus 298, 95% CI = 85-314 days, respectively) were not significantly different (P = .78). Right atrial area (hazard ratio [HR] = 2.72, 95% CI = 1.58-4.70), TAPSE < 3.23 mm/kg0.284 (HR = 2.19, 95% CI = 1.28-3.74), and right heart failure (HR = 2.05, 95% CI = 1.18-3.57) were independently associated with shorter survival time (P ≤ .04). CONCLUSIONS AND CLINICAL IMPORTANCE Right atrial area, RV function (TAPSE < 3.23 mm/kg0.284 ), and right heart failure offer clinically relevant prognostic information in dogs with PH. Results support the quantitative assessment of right heart size and function in dogs with PH.
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Affiliation(s)
- Lance C Visser
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - James E Wood
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Lynelle R Johnson
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
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Maerz I. Clinical and diagnostic imaging findings in 37 rescued dogs with heartworm disease in Germany. Vet Parasitol 2020; 283:109156. [PMID: 32526608 DOI: 10.1016/j.vetpar.2020.109156] [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: 01/01/2020] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 01/30/2023]
Abstract
Canine dirofilariasis is currently uncommon in Germany, but its prevalence appears to be increasing due to rehoming of dogs from endemic areas. As part of staging of the disease, this case series describes clinical, radiological and echocardiographic findings in 37 dogs tested positive for Dirofilaria immitis between October 2016 and January 2019. Clinical history revealed 12 (32 %) asymptomatic and 22 (59 %) symptomatic dogs, with most of the dogs showing exercise intolerance, coughing or breathlessness. Thoracic radiographs were performed in 34 dogs and showed parenchymal lesions in 14 (41 %) and bulging of the main pulmonary artery (MPA) in 8 (23,5 %). Enlarged peripheral pulmonary arteries were noted in 22 (65 %) dogs, mainly affecting caudal peripheral pulmonary arteries. In 12 (24 %) of dogs with echocardiographic findings, thoracic radiographs were unremarkable. Echocardiographic examination was performed to assess secondary pulmonary hypertension (PH), identification of worm burden and dilation of pulmonary arteries. RPAD was applied for grading of PH in 34 dogs. Normal values (RPAD > 35 %) were detected in 11 (32 %) dogs, mild PH (RPAD 28-35 %) in 12 (35 %), moderate PH (RPAD 23-27 %) in 5 (15 %), and severe PH (RPAD < 23 %) in 6 (18 %) dogs. Severe systolic PH was confirmed by pressure gradient of tricuspid regurgitation in two dogs. Pressure gradients of pulmonary insufficiency were suggestive of diastolic PH in 5 dogs and correlated with RPAD < 23 %. Right ventricular hypertrophy was observed in 6 dogs with severe PH, flattening of the interventricular septum in 5 dogs. Right ventricular systolic time intervals showed a short acceleration time (<80 ms) and AT/ET of <0.31 in all dogs with severe PH. MPA dilation, defined as the ratio of MPA to aorta (MPA/Ao) exceeding 1.0 was found in 16 (43 %) dogs. Right pulmonary artery (RPA) dilation, defined as the ratio of RPA to aorta (PRA/Ao) exceeding 0.5 was detected in 25 (68 %) dogs. Double, linear parallel objects (DL) suggestive for macrofilaria were found in 28 (76 %) dogs. Of these, 7 (19 %) had a high worm burden occupying RPA and MPA. Six months after the 3rd Melarsomine injection a follow up examination was performed in 21 dogs. Main findings included persistent dilation of RPA in 11 (52 %), as well as RPAD indicative of PH in 11 (52 %) dogs. This case series demonstrates that>70 % of dogs had at least one relevant finding suggestive of PH prior to starting adulticide treatment. Therefore, thoracic radiographs as well as a thorough echocardiographic examination are recommended in all dogs that test positive for D. immitis. Echocardiography should focus on presence and severity of PH, for which RPAD has been proven to be useful. A follow up examination after adulticide treatment should be performed, which provides comparative assessment of presence and severity of PH. Dogs with persistent moderate to severe PH may benefit from long-term monitoring and medical management.
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Affiliation(s)
- Imke Maerz
- Tierklinik Hofheim GbR, Katharina Kemmler Straße 7, 65719, Hofheim am Taunus, Germany.
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