Diagnostic value of the pulmonary vein-to-right pulmonary artery ratio in dogs with pulmonary hypertension of precapillary origin

The prevalence of pulmonary hypertension assessed using the pulmonary vein‐to‐right pulmonary artery ratio and its association with survival in West Highland white terriers with canine idiopathic pulmonary fibrosis

“…Two CIPF WHWTs had the PV/PA measured either in 2D or MM only (1 dog respectively), due to respiratory related artifacts. Using the cut-off value for PV/PA measured in 2D of < 0.7 corresponding to a TRPG > 50mmHg [ 14 ], moderate to severe PH was identified in 15/24 (63 %) WHWTs affected with CIPF and in 1/19 (5 %) CTRLs ( P = 0.0002). The one WHWT affected with CIPF for which PV/PA (2D) was not measured had a PV/PA (MM) of 0.960 and a TRPG of 28.4mmHg, suggesting the absence of PH.…”

“…This is particularly true in WHWTs affected with CIPF as they are frequently presented with laborious breathing that can impair proper Doppler beam alignment. In this study, we used the newly described PV/PA echocardiographic parameter as a surrogate diagnostic tool for pre-capillary PH [ 14 ]. We estimated a 60 % overall prevalence for moderate to severe PH in our cohort of 25 WHWTs affected with CIPF by using this parameter.…”

“…Among the other echocardiographic parameters currently available to non-invasively assess the presence of pre-capillary PH, the pulmonary vein-to-right pulmonary artery ratio (PV/PA) has recently been demonstrated to be one of the most accurate at predicting PAP estimated by peak tricuspid regurgitation systolic pressure gradient (TRPG) [ 14 ]. Indeed, PV/PA has been demonstrated to provide a good accuracy for the diagnosis of moderate to severe pre-capillary PH (defined as TRPG > 50mmHg) using a cutoff value of < 0.70 (sensitivity = 96 %, specificity = 82 %) [ 14 ].…”

“…We hypothesized that PH occurs at a high prevalence rate in WHWTs affected with CIPF at initial diagnosis and has a negative impact on survival. The primary aim of this study was to estimate the prevalence of PH at diagnosis, in a cohort of WHWTs affected with CIPF, compared with a group of breed-matched healthy controls (CTRLs) using PV/PA echocardiographic parameter [ 14 ]. As a secondary aim, we explored whether the presence of PH at initial diagnosis of CIPF impacted survival time.…”

ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs

“…D6. If not already performed, echocardiography to assess the probability of PH should be considered when thoracic CT angiography shows ≥1 of the following: A pulmonary trunk‐to‐descending aorta ratio ≥1.4 Evidence of RA and RV enlargement A decreased pulmonary vein‐to‐PA ratio; an increased pulmonary trunk‐to‐ascending aorta ratio, or an increased RV‐to‐LV ratio The presence of pulmonary arterial filling defects A mosaic attenuation pattern showing small vessels in a region of decreased attenuation (ie, hypoperfusion) on an inspiratory scan that fails to show accentuation of the mosaic attenuation pattern on an expiratory scan (ie, ruling out air trapping) Perivascular diffuse nodular to ill‐defined patchy ground‐glass opacity with a global distribution, compatible with pulmonary capillary hemangiomatosis (PCH) or pulmonary veno‐occlusive disease (PVOD) Consensus in 7/7 members of the panel and 5/5 advisory reviewers Comments: Although measurement of RV (and perhaps RA) enlargement evaluated on contrast CT scan is suspected to be a viable metric for PH, peer‐reviewed studies in dogs with PH have not yet been published. Additionally, signalment and physical examination should be used to discriminate dogs with pulmonary valve stenosis that also may have findings a‐c above . …”