Assessment of Lung Ultrasound B‐Lines in Dogs with Different Stages of Chronic Valvular Heart Disease

Abstract

BackgroundIn dogs with chronic valvular heart disease (CVHD), early recognition of pulmonary edema (PE) is of paramount importance. Recent studies in dogs showed that lung ultrasound examination (LUS) is a useful technique to diagnose cardiogenic PE.ObjectivesTo describe LUS features in dogs with different stages of CVHD, and to determine its diagnostic accuracy in detecting PE using thoracic radiography as the reference standard.AnimalsSixty‐three dogs with CVHD.MethodsProspective, multicenter, cross‐sectional study. Each dog underwent physical examination, echocardiography, thoracic radiography, and LUS. The LUS findings were classified as absent, rare, numerous, or confluent B‐lines. Sensitivity, specificity, and positive and negative predictive values of LUS B‐lines to identify PE were calculated using thoracic radiography as the reference standard.ResultsDogs in stage B1 had absent or rare B‐lines in 14 of 15 cases (93.3%). Dogs in stage B2 had absent or rare B‐lines in 16 of 18 cases (88.9%). All dogs in stage C, without radiographic signs of PE, had absent or rare B‐lines. Dogs in stage C, with radiographic signs of PE, had numerous or confluent B‐lines in 18 of 20 cases (90%). Lung ultrasound examination detected PE with a sensitivity of 90%, specificity of 93%, and with positive and negative predictive values of 85.7 and 95.2%, respectively.Conclusions and Clinical ImportanceLung ultrasound examination showed good diagnostic accuracy to identify cardiogenic PE and might be helpful in staging dogs with CVHD. Lung ultrasound examination should be considered as a new, noninvasive diagnostic tool for clinicians managing CVHD in dogs.

From bedside to bench: lung ultrasound for the assessment of pulmonary edema in animal models

“…Despite the growing body of evidence demonstrating the usefulness of LUS in heart failure patients, its application in animal models has thus far been scarce. Although LUS has been successfully applied in dogs (Rademacher et al 2014;Vezzosi et al 2017) and pigs (Gargani et al 2007;Jambrik et al 2010), it has not been utilized in the evaluation of corresponding large animal models of cardiovascular disease. To date, the only study reporting the use of LUS in a preclinical model of heart failure has been in mice (Villalba-Orero et al 2017).…”

Diagnosis of pulmonary contusions with point‐of‐care lung ultrasonography and thoracic radiography compared to thoracic computed tomography in dogs with motor vehicle trauma: 29 cases (2017‐2018)

“…LUS relies on ultrasonographic artifacts to diagnose normal lung or increased extravascular lung water (B-lines and C-lines) at the pulmonary-pleural surface, previously described elsewhere. 6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] , Multiple human trauma studies have demonstrated that LUS has high sensitivity when compared to "gold standard" TCT for detecting PC. 6,10 , In Soldati et al, LUS was 94.6% sensitive and 96.1% specific for identifying PC when compared to TCT, and TXR were 27% sensitive and 100% specific for PC.…”

Evaluation of point‐of‐care thoracic ultrasound and NT‐proBNP for the diagnosis of congestive heart failure in cats with respiratory distress

“…These B‐lines, also called “lung rockets,” are linear, hyperechoic, laser‐like artifacts that extend from the pleural‐pulmonary interface to the far aspect of the ultrasound screen without fading and that move synchronously with respiration . Many studies in humans and a few veterinary studies have shown that the presence of numerous B‐lines in patients presenting with respiratory distress is suggestive of CHF. Conversely, the absence of B‐lines strongly refutes the diagnosis of CHF .…”