[en] Background Early recognition of left-sided congestive heart failure (CHF) in dogs with degenerative mitral valve disease (DMVD) is important because it influences medical therapy, timing of follow-up, and outcome.HypothesisPulmonary vein diameter-to-pulmonary artery diameter ratio (PV/PA) measured by echocardiography can predict CHF.AnimalsNinety-eight client-owned dogs, 37 controls, and 61 dogs with DMVD.Methods Prospective clinical cohort study. History, physical examination and Doppler-echocardiography were performed. Dogs were classified as International Small Animal Cardiac Health Council class I, II or III. Congestive heart failure was identified in a subset of 56 dogs based on radiographic findings. The PV/PA was measured in bidimensional (2D) and M-mode by 2 investigators blinded to the radiologists’ conclusions.ResultsInterobserver coefficients of variation for PV/PA acquisition and measurement were <10%. The PV/PA in control dogs was approximately 1 and increased with class of heart failure. The presence of CHF could be best predicted by measuring PV/PA in 2D echocardiography (cut-off, 1.7; area under the curve, 0.98; CI, 0.97–0.98; P < .001) with a sensitivity of 96% and a specificity of 91%.Conclusion and clinical importanceThe PV/PA is a simple and reproducible echocardiographic variable that increases with class of heart failure and may help discriminate dogs in CHF from asymptomatic dogs with DMVD. Additional studies are required to determine whether PV/PA might provide additional information in the integrated interpretation of Doppler-echocardiographic indices of left ventricular filling pressures and could be used for rapid assessment of CHF in dogs in a critical care setting.
Disciplines :
Veterinary medicine & animal health
Author, co-author :
Merveille, Anne-Christine ; Université de Liège > Dép. clinique des animaux de compagnie et des équidés (DCA) > Pathologie médicale des petits animaux
Bolen, Géraldine ; Université de Liège > Dép. clinique des animaux de compagnie et des équidés (DCA) > Imagerie médicale
Buchanan JW. Chronic valvular disease (endocardiosis) in dogs. Adv Vet Sci Comp Med 1977;21:75-106.
Borgarelli M, Savarino P, Crosara S, et al. Survival characteristics and prognostic variables of dogs with mitral regurgitation attributable to myxomatous valve disease. J Vet Intern Med e 2008;22:120-128.
Atkins C, Bonagura J, Ettinger S, et al. Guidelines for the diagnosis and treatment of canine chronic valvular heart disease. J Vet Intern Med 2009;23:1142-1150.
Schober KE, Hart TM, Stern JA, et al. Effects of treatment on respiratory rate, serum natriuretic peptide concentration, and Doppler echocardiographic indices of left ventricular filling pressure in dogs with congestive heart failure secondary to degenerative mitral valve disease and dilated cardiomyopathy. J Am Vet Med Assoc 2011;239:468-479.
Hansson K, Haggstrom J, Kvart C, et al. Reader performance in radiographic diagnosis of signs of mitral regurgitation in cavalier King Charles spaniels. J Small Anim Pract 2009;50(Suppl. 1):44-53.
Henriksson L, Sundin A, Smedby O, et al. Assessment of congestive heart failure in chest radiographs. Observer performance with two common film-screen systems. Acta Radiol 1990;31:469-471.
Serres F, Pouchelon JL, Poujol L, et al. Plasma N-terminal pro-B-type natriuretic peptide concentration helps to predict survival in dogs with symptomatic degenerative mitral valve disease regardless of and in combination with the initial clinical status at admission. J Vet Cardiol 2009;11:103-121.
Moesgaard SG, Falk T, Teerlink T, et al. Brain-natriuretic peptide and cyclic guanosine monophosphate as biomarkers of myxomatous mitral valve disease in dogs. Vet J 2011;189:349-352.
Fine DM, DeClue AE, Reinero CR. Evaluation of circulating amino terminal-pro-B-type natriuretic peptide concentration in dogs with respiratory distress attributable to congestive heart failure or primary pulmonary disease. J Am Vet Med Assoc 2008;232:1674-1679.
Fox PR, Oyama MA, Hezzell MJ, et al. Relationship of plasma N-terminal pro-brain natriuretic peptide concentrations to heart failure classification and cause of respiratory distress in dogs using a 2nd generation ELISA assay. J Vet Intern Med 2015;29:171-179.
MacDonald KA, Kittleson MD, Munro C, et al. Brain natriuretic peptide concentration in dogs with heart disease and congestive heart failure. J Vet Intern Med 2003;17:172-177.
Tarnow I, Olsen LH, Kvart C, et al. Predictive value of natriuretic peptides in dogs with mitral valve disease. Vet J 2009;180:195-201.
Misbach C, Chetboul V, Concordet D, et al. Basal plasma concentrations of N-terminal pro-B-type natriuretic peptide in clinically healthy adult small size dogs: Effect of body weight, age, gender and breed, and reference intervals. Res Vet Sci 2013;95:879-885.
Kellihan HB, Oyama MA, Reynolds CA, et al. Weekly variability of plasma and serum NT-proBNP measurements in normal dogs. J Vet Cardiol 2009;11(Suppl. 1):S93-S97.
Sjostrand K, Wess G, Ljungvall I, et al. Breed differences in natriuretic peptides in healthy dogs. J Vet Intern Med 2014;28:451-457.
Schober KE, Hart TM, Stern JA, et al. Detection of congestive heart failure in dogs by Doppler echocardiography. J Vet Intern Med 2010;24:1358-1368.
Birettoni F, Caivano D, Giorgi ME, et al. A Novel Echocardiographic Index in the Dog: Pulmonary Vein: Pulmonary Artery Diameter. Presented at the 20th Annual ECVIM-CA congress Toulouse (abstract).
Chetboul V, Tissier R. Echocardiographic assessment of canine degenerative mitral valve disease. J Vet Cardiol 2012;14:127-148.
Fox PR, Sisson D, Moïse NS Textbook of Canine and Feline Cardiology. Principles and Clinical Practice. 2nd ed. Philadelphia: Saunders Company; 1999.
Dukes-McEwan J, et al. Proposed guidelines for the diagnosis of canine idiopathic dilated cardiomyopathy. J Vet Cardiol 2003;5:7-19.
Cornell CC, Kittleson MD, Della Torre P, et al. Allometric scaling of M-mode cardiac measurements in normal adult dogs. J Vet Intern Med 2004;18:311-321.
Buchanan JW, Bucheler J. Vertebral scale system to measure canine heart size in radiographs. J Am Vet Med Assoc 1995;206:194-199.
Borgarelli M, Haggstrom J. Canine degenerative myxomatous mitral valve disease: Natural history, clinical presentation and therapy. Vet Clin North Am Small Anim Pract 2010;40:651-663.
Reynolds CA, Brown DC, Rush JE, et al. Prediction of first onset of congestive heart failure in dogs with degenerative mitral valve disease: The PREDICT cohort study. J Vet Cardiol 2012;14:193-202.
Bonagura JD, Schober KE. Can ventricular function be assessed by echocardiography in chronic canine mitral valve disease? J Small Anim Pract 2009;50(Suppl. 1):12-24.