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Deng Z, Liang B, Li T, Liu Q, Wang X, Sun X, Ou Z, Zhao L, Xu C, Liu H, Li J. Development and validation of a risk prediction model for valve regurgitation in Behçet's disease. Clin Rheumatol 2024; 43:1711-1721. [PMID: 38536517 DOI: 10.1007/s10067-024-06897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND In Behçet's disease (BD), mild-to-severe valvular regurgitation (VR) poses a serious complication that contributes significantly to heart failure and eventually death. The accurate prediction of VR is crucial in the early stages of BD subjects for improved prognosis. Accordingly, this study aimed to develop a nomogram that can detect VR early in the course of BD. METHODS One hundred seventy-two patients diagnosed with Behçet's disease (BD) were conducted to assess cardiac valve regurgitation as the primary outcome. The severity of regurgitation was classified as mild, moderate, or severe. The parameters related to the diagnostic criteria were used to develop model 1. The combination of stepAIC, best subset, and random forest approaches was employed to identify the independent predictors of VR and thus establish model 2 and create a nomogram for predicting the probability of VR in BD. Receiver operating characteristics (ROC) and decision curve analysis (DCA) were used to evaluate the model performance. RESULTS Thirty-four patients experienced mild-to-severe VR events. Model 2 was established using five variables, including arterial involvement, sex, age at hospitalization, mean arterial pressure, and skin lesions. In comparison with model 1 (0.635, 95% CI: 0.512-0.757), the ROC of model 2 (0.879, 95% CI: 0.793-0.966) was improved significantly. DCA suggested that model 2 was more feasible and clinically applicable than model 1. CONCLUSION A predictive model and a nomogram for predicting the VR of patients with Behçet's disease were developed. The good performance of this model can help us identify potential high-risk groups for heart failure. Key Points • In this study, the predictors of VR in BD were evaluated, and a risk prediction model was developed for the early prediction of the occurrence of VR in patients with BD. • The VR prediction model included the following indexes: arterial involvement, sex, age at hospitalization, mean arterial pressure, and skin lesions. • The risk model that we developed was better and more optimized than the models built with diagnostic criteria parameters, and visualizing and personalizing the model, a nomogram, provided clinicians with an easy and intuitive tool for practical prediction.
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Affiliation(s)
- Zixian Deng
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China
| | - Benhui Liang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China
| | - Tangzhiming Li
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China
| | - Qiyun Liu
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China
| | - Xiaoyu Wang
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China
| | - Xin Sun
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China
| | - Ziwei Ou
- Department of Cardiology, Xiangya Third Hospital, Central South University, Changsha, China
| | - Lin Zhao
- Department of Cardiology, Xiangya Third Hospital, Central South University, Changsha, China
| | - Cong Xu
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China
| | - Huadong Liu
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China.
| | - Jianghua Li
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China.
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Nagorska A, Zaucker A, Lambert F, Inman A, Toral-Perez S, Gorodkin J, Wan Y, Smutny M, Sampath K. Translational control of furina by an RNA regulon is important for left-right patterning, heart morphogenesis and cardiac valve function. Development 2023; 150:dev201657. [PMID: 38032088 PMCID: PMC10730018 DOI: 10.1242/dev.201657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Heart development is a complex process that requires asymmetric positioning of the heart, cardiac growth and valve morphogenesis. The mechanisms controlling heart morphogenesis and valve formation are not fully understood. The pro-convertase FurinA functions in heart development across vertebrates. How FurinA activity is regulated during heart development is unknown. Through computational analysis of the zebrafish transcriptome, we identified an RNA motif in a variant FurinA transcript harbouring a long 3' untranslated region (3'UTR). The alternative 3'UTR furina isoform is expressed prior to organ positioning. Somatic deletions in the furina 3'UTR lead to embryonic left-right patterning defects. Reporter localisation and RNA-binding assays show that the furina 3'UTR forms complexes with the conserved RNA-binding translational repressor, Ybx1. Conditional ybx1 mutant embryos show premature and increased Furin reporter expression, abnormal cardiac morphogenesis and looping defects. Mutant ybx1 hearts have an expanded atrioventricular canal, abnormal sino-atrial valves and retrograde blood flow from the ventricle to the atrium. This is similar to observations in humans with heart valve regurgitation. Thus, the furina 3'UTR element/Ybx1 regulon is important for translational repression of FurinA and regulation of heart development.
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Affiliation(s)
- Agnieszka Nagorska
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Andreas Zaucker
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Finnlay Lambert
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
- Stem Cell and Regenerative Biology, Genome Institute of Singapore, A*STAR, Singapore 138672
| | - Angus Inman
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Sara Toral-Perez
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Jan Gorodkin
- Center for non-coding RNAs in Technology and Health, Department of Veterinary and Animal Sciences, Faculty for Health and Medical Sciences, University of Copenhagen, Grønnega °rdsvej 3, 1870 Frederiksberg C, Denmark
| | - Yue Wan
- Stem Cell and Regenerative Biology, Genome Institute of Singapore, A*STAR, Singapore 138672
| | - Michael Smutny
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
- Centre for Mechanochemical Cell Biology, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Karuna Sampath
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
- Centre for Mechanochemical Cell Biology, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
- Centre for Early Life, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
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Ertelt A, Stumpff F, Merle R, Kuban S, Bollinger L, Liertz S, Gehlen H. Asymmetric dimethylarginine-A potential cardiac biomarker in horses. J Vet Cardiol 2020; 33:43-51. [PMID: 33360109 DOI: 10.1016/j.jvc.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 11/06/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION/OBJECTIVES Asymmetric dimethylarginine (ADMA) is a cardiac biomarker in humans, symmetric dimethylarginine (SDMA) a renal biomarker in humans, cats, and dogs. The purpose of this prospective study was to investigate if measuring serum ADMA and SDMA concentrations via ELISA allows detection of cardiac disease in horses in a routine laboratory setting. In this context, reference values in horses were established. ANIMALS, MATERIALS, AND METHODS Seventy-eight horses with no known medical history were compared to 23 horses with confirmed structural cardiac disease with/or without arrhythmias. Horses underwent physical examination, electrocardiography, echocardiography and venous blood sampling and were staged based on the severity of cardiac disease from 0 to II. Asymmetric dimethylarginine and SDMA were measured via ELISA and crosschecked using liquid chromatograph triple quadrupole mass spectrometry. Reference intervals with 90th percent confidence intervals were evaluated and standard software was used to test for significant differences in ADMA, SDMA, and the l-arginine/ADMA ratio between groups. RESULTS The reference ranges were 1.7-3.8 μmol/L and 0.3-0.8 μmol/L for ADMA and SDMA, respectively. Serum ADMA was higher in horses with heart disease compared to healthy horses (p < 0.01) and highest in horses with stage II heart disease (p = 0.02). The l-Arginine/ADMA ratio was significantly higher in healthy animals than those with cardiac disease (p = 0.001). CONCLUSIONS Reference values for serum ADMA and SDMA using ELISA methods are presented in horses. This study confirms the association between heart disease and increased serum ADMA concentration as well as a decreased l-Arginine/ADMA ratio in horses.
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Affiliation(s)
- A Ertelt
- Equine Clinic, Internal Medicine, Freie Universitaet Berlin, Oertzenweg 19b, 14193, Berlin, Germany.
| | - F Stumpff
- Institute of Veterinary Physiology, Freie Universitaet Berlin, Oertzenweg 19b, 14163, Berlin, Germany
| | - R Merle
- Institute for Veterinary Epidemiology and Biostatistics, Freie Universitaet Berlin, Koenigsweg 67, 14163, Berlin, Germany
| | - S Kuban
- Equine Clinic, Internal Medicine, Freie Universitaet Berlin, Oertzenweg 19b, 14193, Berlin, Germany
| | - L Bollinger
- Equine Clinic, Internal Medicine, Freie Universitaet Berlin, Oertzenweg 19b, 14193, Berlin, Germany
| | - S Liertz
- Equine Clinic, Internal Medicine, Freie Universitaet Berlin, Oertzenweg 19b, 14193, Berlin, Germany
| | - H Gehlen
- Equine Clinic, Internal Medicine, Freie Universitaet Berlin, Oertzenweg 19b, 14193, Berlin, Germany
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Contractor T, Kheiwa A, Mandapati R, Buch E, M Cooper J, Martens T. Lead extraction and upgrade to a biventricular device with concomitant systemic tricuspid valve replacement in an adult with congenitally corrected transposition: A hybrid approach. HeartRhythm Case Rep 2020; 6:511-515. [PMID: 32817830 PMCID: PMC7424290 DOI: 10.1016/j.hrcr.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Tahmeed Contractor
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Ahmed Kheiwa
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Ravi Mandapati
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Eric Buch
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Joshua M Cooper
- Section of Cardiac Electrophysiology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Timothy Martens
- Department of Cardiac Surgery, Loma Linda University Medical Center, Loma Linda, California
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Colan SD, Sleeper LA. Longitudinal Variation in Presence and Severity of Cardiac Valve Regurgitation in Healthy Children. J Am Soc Echocardiogr 2020; 33:1400-1406. [PMID: 32741595 DOI: 10.1016/j.echo.2020.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/15/2020] [Accepted: 05/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The goal of this study was to document the frequency and longitudinal variation in the presence and severity of echocardiographically documented valvular regurgitation (VR) in healthy children free of evidence of heart disease. We hypothesized that significant variation is common, and our specific aim was to determine change in prevalence and severity of VR in children free of heart disease. METHODS The presence of VR was documented on each of the four valves, and the severity of regurgitation was assessed as the body surface area (BSA)-adjusted width of the vena contracta on each of two sequential echocardiograms in healthy children free of clinical and echocardiographic evidence of heart disease. RESULTS We included 200 children ages 10.0 ± 4.5 years, BSA = 1.2 ± 0.43 m2, at the first exam and 12.8 ± 4.9 years, BSA = 1.42 ± 0.44 m2, at the second exam. Frequency of VR was similar on the two exams (tricuspid = 61.5% vs 57.0%, pulmonary = 55.5 vs 57.5%, mitral = 14.5% vs 16.0%, aortic = 3.0 vs 3.5%). The frequency of new appearance was similar to the frequency of resolution of VR for all four valves. For instances where the severity of VR was classified as trace versus mild, the frequency of change from mild to trace between the two exams was similar to the frequency of change from trace to mild. CONCLUSIONS In healthy children with no evidence of heart disease, there is substantial temporal variation in the presence and severity of tricuspid and pulmonary VR. The prevalence of mitral and aortic VR is lower in healthy children, but temporal variation is also noted for these valves. The finding of new-onset echocardiographic trace or mild VR cannot be assumed to represent incident valve pathology.
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Affiliation(s)
- Steven D Colan
- Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Gatti G, Dell'Angela L, Morosin M, Maschietto L, Pinamonti B, Benussi B, Forti G, Nicolosi GL, Sinagra G, Pappalardo A. Flexible band versus rigid ring annuloplasty for functional tricuspid regurgitation: two different patterns of right heart reverse remodelling. Interact Cardiovasc Thorac Surg 2016; 23:79-89. [PMID: 26993479 DOI: 10.1093/icvts/ivw047] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/18/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Annuloplasty bands and rings are widely used to treat functional tricuspid regurgitation (TR). However, the question as to which is the ideal annuloplasty device remains open. Early and late outcomes of tricuspid valve annuloplasty with flexible band (B-TVA) or rigid ring (R-TVA) are compared in the present study. METHODS Between 1999 and 2014, 462 consecutive patients (mean age, 69.2 ± 9.5 years) with grade ≥1+ functional TR (graded from 0 to 3+) underwent either B-TVA (n = 345; mean EuroSCORE II 9.2 ± 10.8%) or R-TVA (n = 117; mean EuroSCORE II 12 ± 13.4%) in addition to other cardiac procedures at the authors' institution. RESULTS One-to-one propensity score-matched analysis resulted in 98 pairs with similar baseline characteristics and operative risk. Hospital mortality was 7.5% after B-TVA and 12% after R-TVA (P = 0.14). R-TVA was associated with higher rates of low cardiac output (10.1 vs 17.9%, P = 0.025) and transient complete atrioventricular block (10.3 vs 17.2%, P = 0.046). Among the matched pairs, there were no significant differences in hospital mortality (5.1 vs 9.2%, P = 0.27) and perioperative complications. Both in overall series and matched pairs, between B-TVA and R-TVA patients, there were no significant differences in freedom from all-cause death (P = 0.29 and 0.91), cardiac and cerebrovascular deaths (P = 0.63 and 0.87) and grade ≥2+ TR (P = 0.68 and 0.77). Right atrial and tricuspid valve reverse remodelling combined with right ventricular reverse remodelling occurred after R-TVA but not after B-TVA. CONCLUSIONS B-TVA and R-TVA are equally effective in the treatment of functional TR. However, R-TVA causes over time a more complete right heart reverse remodelling.
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Affiliation(s)
- Giuseppe Gatti
- Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Luca Dell'Angela
- Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Marco Morosin
- Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Luca Maschietto
- Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Bruno Pinamonti
- Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Bernardo Benussi
- Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Gabriella Forti
- Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Gian Luigi Nicolosi
- Department of Cardiology, Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy
| | - Gianfranco Sinagra
- Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Aniello Pappalardo
- Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy
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Pant S, Corsini C, Baker C, Hsia TY, Pennati G, Vignon-Clementel IE. Data assimilation and modelling of patient-specific single-ventricle physiology with and without valve regurgitation. J Biomech 2015; 49:2162-2173. [PMID: 26708918 DOI: 10.1016/j.jbiomech.2015.11.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
A closed-loop lumped parameter model of blood circulation is considered for single-ventricle shunt physiology. Its parameters are estimated by an inverse problem based on patient-specific haemodynamics measurements. As opposed to a black-box approach, maximizing the number of parameters that are related to physically measurable quantities motivates the present model. Heart chambers are described by a single-fibre mechanics model, and valve function is modelled with smooth opening and closure. A model for valve prolapse leading to valve regurgitation is proposed. The method of data assimilation, in particular the unscented Kalman filter, is used to estimate the model parameters from time-varying clinical measurements. This method takes into account both the uncertainty in prior knowledge related to the parameters and the uncertainty associated with the clinical measurements. Two patient-specific cases - one without regurgitation and one with atrioventricular valve regurgitation - are presented. Pulmonary and systemic circulation parameters are successfully estimated, without assumptions on their relationships. Parameters governing the behaviour of heart chambers and valves are either fixed based on biomechanics, or estimated. Results of the inverse problem are validated qualitatively through clinical measurements or clinical estimates that were not included in the parameter estimation procedure. The model and the estimation method are shown to successfully capture patient-specific clinical observations, even with regurgitation, such as the double peaked nature of valvular flows and anomalies in electrocardiogram readings. Lastly, biomechanical implications of the results are discussed.
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Affiliation(s)
- Sanjay Pant
- Inria Paris-Rocquencourt & Sorbonne Universités UPMC Paris 6, Laboratoire Jacques-Louis Lions, France.
| | - Chiara Corsini
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Italy
| | - Catriona Baker
- Cardiac Unit, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, London, UK
| | - Tain-Yen Hsia
- Cardiac Unit, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, London, UK
| | - Giancarlo Pennati
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Italy
| | - Irene E Vignon-Clementel
- Inria Paris-Rocquencourt & Sorbonne Universités UPMC Paris 6, Laboratoire Jacques-Louis Lions, France.
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Gustavsen KA, Saunders AB, Young BD, Winter RL, Hoppes SM. Echocardiographic and radiographic findings in a cohort of healthy adult green iguanas (Iguana iguana). J Vet Cardiol 2014; 16:185-96. [PMID: 25127666 DOI: 10.1016/j.jvc.2014.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/26/2014] [Accepted: 05/28/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To describe characteristics of echocardiography and cranial coelomic radiography in a cohort of iguanas. ANIMALS Twenty apparently healthy adult green iguanas (Iguana iguana) from a reptile sanctuary. METHODS Physical examination, radiography, two-dimensional and color Doppler echocardiography were performed to assess cardiac structures and function, and any related normal or abnormal findings were recorded. RESULTS Echocardiographic examination was possible without sedation and allowed visualization of the great vessels, atria, and ventricle. Some structures could not be evaluated in a minority of the iguanas due to individual differences in bony conformation and imaging quality. Suspected abnormal echocardiographic findings in 3 iguanas included pericardial effusion (n = 1) and enlarged caudal vena cava and/or sinus venosus (n = 2). Objective measurements were repeatable as assessed by within-subject coefficient of variation, and reliable as assessed by intra-observer intraclass correlation coefficient. Left atrial and ventricular measurements were significantly correlated with body weight. Valve regurgitation was common, with atrioventricular valve regurgitation present in 53% (9/17) and aortic or pulmonic valve regurgitation in 71% (12/17) of otherwise normal iguanas. A heart murmur was not appreciated during examination of any of the iguanas. Heart size cannot be measured radiographically due to superimposition and silhouetting of other coelomic structures. Echocardiographic or radiographic findings consistent with mineralization of the great vessels were present in 76% of iguanas (13/17). CONCLUSIONS Echocardiography in iguanas is well tolerated without sedation and allowed both subjective evaluation and structural measurements. Valve regurgitation and great vessel mineralization were commonly observed in this cohort of apparently healthy adult iguanas.
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