Comparison of different radiographic scores with associated echocardiographic measurements and prediction of heart enlargement in dogs with and without myxomatous mitral valve disease

Levicar, Charanthorn; Granados-Soler, José Luis; Freise, Fritjof; Raue, Jonathan; Nolte, Ingo; Bach, Jan-Peter

doi:10.1016/j.jvc.2022.08.004

Cited by 10 publications

(25 citation statements)

References 45 publications

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“…For the radiographic assignment, proposed cut-off values were used. *—data from Levicar et al, 2022 [ 17 ].…”

Section: Figurementioning

confidence: 99%

“…The importance of evaluating LA size is based on the fact that LA enlargement is a crucial factor in assessing the risk of present or future congestive heart failure (CHF) [ 3 , 7 , 13 ]. Additionally, detection of LA enlargement can help to distinguish stage B1 patients from stage B2 patients [ 14 , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…Different radiographic signs (e.g., the elevation of the left mainstem bronchus or bulging of the cardiac silhouette in the LA area) have been described to detect LA enlargement [ 7 , 10 , 19 ]. However, evaluating these signs is highly subjective and can be imprecise [ 7 , 17 ]. To ensure an objective radiologic evaluation, cardiac size is commonly quantified with radiographic measurements using anatomical landmarks [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

“…This question has been examined in several previous studies [ 15 , 16 , 34 , 35 ]. Recently, the authors developed cut-off values measured by a specialized veterinarian and showed a lot of potential for staging MMVD patients [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Methods of Radiographic Measurements of Heart and Left Atrial Size in Dogs with and without Myxomatous Mitral Valve Disease: Intra- and Interobserver Agreement and Practicability of Different Methods

Levicar

Nolte

Granados-Soler

et al. 2022

Animals

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Dogs suffering from Myxomatous Mitral Valve Disease (MMVD) show a potential heart enlargement, especially in the left atrium, detectable by radiography. Due to digital radiography, different radiographic measurements estimate cardiac size quite uncomplicatedly. The Vertebral Heart Size (VHS), Radiographic Left Atrial Dimension (RLAD), Left Atrial Width (LAWidth), and the Vertebral Left Atrial Size (VLAS) used anatomical landmarks for measuring cardiac size in relation to the vertebral column. This study aimed to compare VHS, RLAD, LAWidth, and VLAS measured in conventional and inverted radiographs by veterinarians with different levels of experience in healthy dogs and dogs with MMVD. The reliability and user-friendliness of these measurements were evaluated, and the staging was compared to the echocardiography staging. A total of 50 unaffected dogs and 150 dogs with MMVD in stages B1, B2, and C were assessed. Three veterinarians with different levels of experience examined 200 conventional radiographs and their corresponding inverted radiographs blinded to the echocardiographic and clinical examination results. Analyses were performed to compare the measurements’ grading and determine anatomical landmarks with measurement difficulties. Additionally, inter- and intraobserver agreement was assessed using intraclass correlation coefficient, and the agreement between radiographic and echocardiographic staging was compared using the kappa coefficient. The VHS, LAWidth, and VLAS were easier to define than the RLAD. The interobserver agreement was almost perfect for VHS (0.962) and good for the other radiographic measurements (RLAD: 0.778, LAWidth: 0.772, VLAS: 0.858). The VHS assigned the most dogs to the correct stage. However, VHS, RLAD, LAWidth, and VLAS presented an almost perfect intraobserver agreement. The dorsal left atrial margin of the RLAD was the most difficult measurement point to identify. The VHS is the most reproducible radiographic method for measuring the canine heart size and shows the highest agreement with echocardiography. An observer-related influence could be detected for RLAD, LAWidth, and VLAS.

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“…For the radiographic assignment, proposed cut-off values were used. *—data from Levicar et al, 2022 [ 17 ].…”

Section: Figurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Methods of Radiographic Measurements of Heart and Left Atrial Size in Dogs with and without Myxomatous Mitral Valve Disease: Intra- and Interobserver Agreement and Practicability of Different Methods

Levicar

Nolte

Granados-Soler

et al. 2022

Animals

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“…Several objective methods, such as the cardiothoracic ratio (CTR), cardiac size-to-intercostal space, and vertebral heart score (VHS), have been proposed. In addition, the radiographic left atrial dimension (RLAD) [ 6 , 7 , 8 ] and vertebral left atrial size (VLAS) [ 7 , 8 , 9 , 10 , 11 ] were recently proposed to evaluate the left atrial size on the thoracic radiograph. The CTR was adapted from human medicine [ 12 ] for use in dogs.…”

Section: Introductionmentioning

confidence: 99%

Thoracic Vertebral Length-to-Height Ratio, a Promising Parameter to Predict the Vertebral Heart Score in Normal Welsh Corgi Pembroke Dogs

Tangpakornsak

Saisawart

Sutthigran

et al. 2023

Veterinary Sciences

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The vertebral heart score (VHS) is the sum of the ratio of the cardiac dimensions to the number of thoracic vertebrae, starting from the fourth thoracic vertebra (T4) to the intervertebral disk space (IVS). Breed-specific VHSs, in most cases, were different from the original reference value. Characteristics of the thoracic vertebrae and IVS may influence this variation. This study was conducted to investigate the characteristics of the T4 and IVS on the thoracic radiographs of Corgis in comparison with other small-to-medium breed dogs to evaluate the Corgi-specific VHSs in healthy dogs. The ratio of the T4’s length/height (T4L/H) was significantly different among dog breeds but not the IVS between the T4 and T5. The T4L/H was highest in the Shih Tzu and lowest in Beagle dogs. The Corgi-specific VHS obtained from the ventrodorsal radiograph was significantly higher than that from the dorsoventral radiograph, but a significant difference was not observed between the right and left lateral radiographs. In contrast, the Corgi-specific VHS derived from the right lateral thoracic radiograph was significantly lower than the reference value. This may be correlated with the characteristics of the thoracic vertebrae of Corgis, which were slightly higher than those of the other breeds.

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Utility of vertebral left atrial size and vertebral heart size to aid detection of congestive heart failure in dogs with respiratory signs

Ross,

Visser,

Sbardellati

et al. 2023

Veterinary Internal Medicne

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BackgroundDifferentiating cardiogenic vs noncardiogenic causes of respiratory signs can be challenging when echocardiography is unavailable. Radiographic vertebral left atrial size (VLAS) and vertebral heart size (VHS) have been shown to predict echocardiographic left heart size, with VLAS specifically estimating left atrial size.Hypothesis/ObjectivesCompare the diagnostic accuracy of VLAS and VHS to predict left‐sided congestive heart failure (CHF) in dogs presenting with respiratory signs.AnimalsOne‐hundred fourteen dogs with respiratory signs and radiographic pulmonary abnormalities.MethodsRetrospective cross‐sectional study. Dogs had to have an echocardiogram and thoracic radiographs obtained within 24 hours. Diagnosis of CHF was confirmed based on the presence of respiratory signs, cardiac disease, LA enlargement, and cardiogenic pulmonary edema.ResultsFifty‐seven dogs had CHF and 57 did not have CHF. Compared to VHS (area under the curve [AUC] 0.85; 95% confidence interval [CI], 0.77‐0.91), VLAS was a significantly (P = .03) more accurate predictor of CHF (AUC, 0.92; 95% CI, 0.85‐0.96). Optimal cutoff for VLAS was >2.3 vertebrae (sensitivity, 93.0%; specificity, 82.5%). Murmur grade (P = .02) and VLAS (P < .0001) were independently associated with CHF and VHS was not. Increased VHS (54%) was significantly (P = .01) more common than increased VLAS (24%) in dogs without CHF. Results were similar in a subsample of older and smaller dogs.Conclusions and Clinical ImportanceWhen echocardiography is unavailable, VLAS and murmur grade have clinically utility to aid in differentiating cardiogenic from noncardiogenic respiratory signs. These findings might be especially useful to help rule out CHF in dogs with increased VHS that present with respiratory signs.

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Comparison of different radiographic scores with associated echocardiographic measurements and prediction of heart enlargement in dogs with and without myxomatous mitral valve disease

Cited by 10 publications

References 45 publications

Methods of Radiographic Measurements of Heart and Left Atrial Size in Dogs with and without Myxomatous Mitral Valve Disease: Intra- and Interobserver Agreement and Practicability of Different Methods

Methods of Radiographic Measurements of Heart and Left Atrial Size in Dogs with and without Myxomatous Mitral Valve Disease: Intra- and Interobserver Agreement and Practicability of Different Methods

Thoracic Vertebral Length-to-Height Ratio, a Promising Parameter to Predict the Vertebral Heart Score in Normal Welsh Corgi Pembroke Dogs

Utility of vertebral left atrial size and vertebral heart size to aid detection of congestive heart failure in dogs with respiratory signs

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