BackgroundSeverity of pulmonary hypertension (PH) in dogs is related to clinical signs and prognosis.Hypothesis/ObjectivesWe hypothesized that Doppler echocardiographic (DE) indices of pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) are influenced by independent factors that create clinically important variability of DE‐based estimates of PH in dogs.AnimalsThirty‐eight client owned dogs with naturally acquired degenerative atrioventricular valve disease and tricuspid regurgitation (TR).MethodsDogs were prospectively enrolled, and target variables were acquired during 4 echocardiographic study periods (lateral recumbency, standing, lateral recumbency after a 6‐minute walk test [6MWT], and lateral recumbency after sedation with butorphanol 0.25 mg/kg IM). Statistical methods included repeated measures ANOVA, mixed model analysis, and Chi‐squared test of association.ResultsThere was a significant increase in peak TR flow velocity (TRFV; P < 0.01) after sedation in 78% of dogs, with TRFV increasing by >0.4 m/s in 42% of dogs, independent of stroke volume. A significant effect of study period on DE‐estimated PVR was not found (P = 0.15). There were negligible effects of sonographer, body position, and 6MWT on echocardiographic variables of PH. Clinically relevant cyclic variation of TRFV was found. There was an association between estimation of right atrial pressure based on subjective assessment and estimation based on cranial vena cava collapsibility (P = 0.03).Conclusions and Clinical ImportanceThe increase in TRFV observed with sedation could change assessment of PH severity and impact prognostication and interpretation of treatment response. Further studies with invasive validation are needed.

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Background: Left-sided congestive heart failure (CHF) is characterized by increased filling pressures and related Doppler echocardiographic (DE) filling patterns.Hypothesis: Doppler echocardiographic variables of left ventricular filling derived from transmitral flow, pulmonary vein flow, and tissue Doppler can be used to detect CHF in cats with hypertrophic cardiomyopathy (HCM).Animals: Forty-seven client-owned cats.Methods: Prospective clinical cohort study. Cats underwent physical examination, thoracic radiography, analysis of N-terminal pro-brain natriuretic peptide (NT-proBNP), and transthoracic echocardiography and were divided into 3 agematched groups: Group 1 (apparently healthy control), Group 2 (preclinical HCM), and Group 3 (HCM and CHF). Measured and calculated variables included respiratory rate, DE estimates, serum NT-proBNP concentration, and radiographic CHF score. Groups were compared using ANOVA, and receiver operating characteristic (ROC) curve and multivariate analyses were used to identify diagnostic cutoffs for the detection of CHF.Results: Fifteen cats were in Group 1, 17 in Group 2, and 15 in Group 3. The ROC analysis indicated that the ratio of peak velocity of early diastolic transmitral flow to peak velocity of late diastolic transmitral flow (area under the curve [AUC], 1.0; diagnostic cutoff, 1.77; P = .001), ratio of left atrial size to aortic annular dimension Abbreviations: A, peak velocity of late diastolic transmitral flow; A 0 , peak velocity of late diastolic mitral annular motion measured at the lateral mitral annulus; Adur, duration of late diastolic transmitral flow wave; Ao, aortic annular dimension; ARdur, duration of late diastolic pulmonary vein atrial reversal flow wave; AUC, area under the ROC curve; CHF, congestive heart failure; CI, confidence interval; CV, coefficient of variation; D, peak velocity of diastolic pulmonary vein flow; DCM, dilated cardiomyopathy; DE, Doppler echocardiography; DMVD, degenerative mitral valve disease; E, peak velocity of early diastolic transmitral flow; E 0 , peak velocity of early diastolic mitral annular motion measured at the lateral mitral annulus; EAfus, peak velocity of fused early and late transmitral flow velocities; E 0 A 0 fus, peak velocity of the fused early and late diastolic tissue Doppler waveforms measured at the lateral mitral annulus; HCM, hypertrophic cardiomyopathy; IVRT, isovolumic relaxation time; IVSd, thickness of the interventricular septum at end-diastole; LA, left atrial; LAD, left atrial diameter; LV, left ventricular; LVFP, left ventricular filling pressure; LVID d , left ventricular internal dimension at end-diastole; LVID s , left ventricular internal dimension at end-systole; LV-SF, left ventricular shortening fraction; NT-proBNP, Nterminal pro-brain natriuretic peptide; PV, pulmonary vein; PV AR, peak velocity of the late diastolic pulmonary vein atrial reversal flow wave; PV ARdur, duration of the late diastolic pulmonary vein atrial reversal flow wave; ROC curve, receiver operating characteristic curve...

Pulmonary valve stenosis (PS) is one of the most commonly diagnosed congenital heart defects in dogs. Currently, transthoracic echocardiography (TTE) is the standard modality used to evaluate PS. Image acquisition by TTE can be challenging in some brachycephalic breeds of dogs. The use of echocardiographic-gated CT angiography (ECG-gated CTA) in veterinary medicine is limited. This retrospective method comparison study investigated right and left ventricular outflow diameters by sedated ECG-gated CTA and unsedated TTE in 14 brachycephalic dogs with PS and 12 brachycephalic dogs without PS. Measurements of ventricular outflow structures were made in early systole and end diastole for both modalities and then compared for significance between systolic and diastolic phases, as well as between the two modalities. Ratios of the pulmonary trunk diameter to the aorta at different locations (aortic valve, aortic annulus, and ascending aorta) and in different planes (transverse, sagittal) were compared between dogs with PS and without PS, as well as within dogs, by both TTE and ECG-gated CTA. Transthoracic echocardiography and ECGgated CTA both detected significantly greater pulmonary trunk to aorta ratios in dogs with PS at all aortic locations (P < 0.05). Pulmonary valve to aortic valve ratios were significantly smaller in dogs with PS (P < 0.05). Pulmonary trunk to aorta and pulmonary valve to aorta ratios were achieved with good anatomic detail using ECG-gated CTA. Ratios of the pulmonary trunk and pulmonary valve relative to the aorta may be useful to evaluate for PS using a modality that is underutilized for cardiac assessment. K E Y W O R D Saorta, canine, cardiac angiography, pulmonary trunk INTRODUCTIONPulmonary valve stenosis is one of the most commonly diagnosed congenital heart defects in dogs. 1,2 Brachycephalic breeds including the Boxer, English bulldog, and French bulldog are known to have a disproportionately high prevalence of pulmonary valve stenosis compared to other breeds. 2 Pulmonary valve stenosis is described Abbreviations: ECG-gated CTA, electrocardiographic-gated computed tomographic angiography; PS, pulmonary valve stenosis; PT:AoA S , pulmonary trunk to aortic annulus ratio in the sagittal plane; PT:AoV T , pulmonary trunk to aortic valve ratio in the transverse plane; PT:AscAo S , pulmonary trunk to ascending aorta ratio in the sagittal plane; PT:AscAo T , pulmonary trunk to ascending aorta ratio in the transverse plane; PV:AoA S , pulmonary valve to aortic annulus ratio in the sagittal plane; PV:AoV T , pulmonary valve to aortic valve ratio in the transverse plane; TTE, transthoracic echocardiography Previous presentation: Presented as a Poster at the 2017 Boehringer Ingelheim NIH National Veterinary Scholars Symposium in Bethesda, MD. as a narrowing of the right ventricular outflow tract at the level of the pulmonary valve, which is often associated with dilatation of the pulmonary trunk. 3 In dogs, lesions of pulmonary valve stenosis include valve fusion, valve thickening, and valve hypopl...