Clinical Characteristics of 53 Dogs with Doppler-Derived Evidence of Pulmonary Hypertension: 1992–1996

Abstract

Pulmonary hypertension occurs as a primary or secondary disorder of the pulmonary vasculature. Doppler echocardiography provides a noninvasive tool for the estimation of pulmonary arterial pressure when tricuspid regurgitation or pulmonic insufficiency is present. The cardiology database at Colorado State University was reviewed, and echocardiographic records from cases diagnosed with pulmonary hypertension were evaluated. Application of the modified Bernoulli equation to the maximal instantaneous velocity of a right-sided regurgitant jet provided evidence of pulmonary hypertension in 53 dogs over a 4-year period. Tricuspid regurgitant velocity > or = 2.8 m/second or pulmonic insufficiency velocity > or = 2.2 m/second was considered abnormal and indicative of pulmonary hypertension. Tricuspid regurgitant gradients in 51 dogs ranged from 32 to 145 mm Hg (mean, 63.0 mm Hg; median, 57.0 mm Hg; 25th-75th percentiles, 45.2-76.5 mm Hg). Pulmonic insufficiency gradients in 8 dogs ranged from 20 to 100 mm Hg (mean, 59.5 mm Hg; median, 61.5 mm Hg; 25th-75th percentiles, 32.0-84.5 mm Hg). Affected dogs ranged in age from 2 months to 16 years. Clinical signs were characteristic of cardiopulmonary disease, but a relatively high frequency of syncope was noted (12 of 53 dogs, 23%). Pulmonary hypertension was probably due to increased pulmonary vascular resistance in 23 dogs, pulmonary overcirculation in 2 dogs, and pulmonary venous hypertension in 23 dogs. Five dogs lacked a clinically recognizable cardiopulmonary cause of pulmonary vascular disease. Our results suggest that pulmonary hypertension can occur as a complication of commonly encountered cardiopulmonary diseases, and that Doppler echocardiography can facilitate recognition of this condition.

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

“…The predominantly small breed, middle to older age dogs in our study closely reflect the demographics of dogs at risk for these conditions 7, 18, 25, 27. The AUC for the ROC curve analysis to distinguish cardiac from noncardiac cause of respiratory distress was 0.84 (Fig 3).…”

“…Echocardiographic variables (averaging at least 3 heart beats) included left ventricular posterior wall thickness at end‐diastole, interventricular septal thickness at end‐diastole, left ventricular internal dimension at end‐diastole (LVIDd), left ventricular internal dimension at end‐systole (LVIDs);23 and left atrial dimension at end‐diastole (LAd) and left atrial to aortic root ratio (LA : Ao ratio) using LAd and aortic root (Ao) from the right parasternal, short axis, basilar view 24. Maximal transtricuspid peak systolic tricuspid regurgitation (TR) velocity was measured by Doppler echocardiography to estimate systolic pulmonary hypertension, graded as mild, moderate, or severe 25, 26. Accordingly, each dog was classified into 1 of 4 clinical cohorts (Fig 1, Table 1): group 1—asymptomatic, healthy dogs without HD; group 2—asymptomatic, healthy dogs with HD but not CHF; group 3—dogs with respiratory distress attributable to respiratory disease; group 4—dogs with respiratory distress from pulmonary edema and CHF.…”

Diagnostic Value of Right Pulmonary Artery Distensibility Index in Dogs with Pulmonary Hypertension: Comparison with Doppler Echocardiographic Estimates of Pulmonary Arterial Pressure

“…Once enrolled, dogs underwent the specific echocardiographic examination outlined below, which is considered a continuation of the first clinical echocardiographic study. Dogs were allocated to 1 of 4 groups according to the estimated peak tricuspid regurgitation systolic pressure gradient (TRPG) derived from the peak systolic TR jet velocity via the simplified Bernoulli equation (PG = 4 × velocity 2 ): (1) control group, TRPG <36 mmHg, (2) TRPG of 36–50 mmHg, (3) TRPG of 50–75 mmHg and (4) TRPG >75 mmHg 4. None of the dogs in the control group could be taking medications known to affect the cardiovascular or respiratory system and had to have normal RV systolic function based on recently published body weight‐specific reference intervals for fractional area change (FAC) 20.…”

“…Pulmonary hypertension is commonly encountered in dogs affected with myxomatous mitral valve disease (MMVD), thromboembolic disease, parasitic disease (e.g, dirofilariasis, angiostrongyliasis), congenital cardiac shunts and various respiratory diseases 1, 2, 3, 4, 5, 6, 7. It adversely affects the quality of life and exercise tolerance and can cause syncope,4, 8 frequently influences diagnostic and therapeutic decisions,7 and is associated with a worse outcome in dogs with MMVD 2. Thus, screening for PH is an important part of the diagnostic evaluation in dogs exhibiting clinical signs of PH such as syncope, or affected with diseases commonly associated with PH.…”

Holter Monitoring of Small Breed Dogs with Advanced Myxomatous Mitral Valve Disease with and without a History of Syncope

“…Dogs with PAH often present with a history of syncope and PAH has also been associated with MMVD 49, 50, 51, 52. In this study, blood pressure and PAH assessed via peak TR velocity did not differ much between dogs with and without a history of syncope (Table 1).…”