Prognostic value of echocardiographic indices of left atrial morphology and function in dogs with myxomatous mitral valve disease

Abstract

BackgroundThe prognostic relevance of left atrial (LA) morphological and functional variables, including those derived from speckle tracking echocardiography (STE), has been little investigated in veterinary medicine.ObjectivesTo assess the prognostic value of several echocardiographic variables, with a focus on LA morphological and functional variables in dogs with myxomatous mitral valve disease (MMVD).AnimalsOne‐hundred and fifteen dogs of different breeds with MMVD.MethodsProspective cohort study. Conventional morphologic and echo‐Doppler variables, LA areas and volumes, and STE‐based LA strain analysis were performed in all dogs. A survival analysis was performed to test for the best echocardiographic predictors of cardiac‐related death.ResultsMost of the tested variables, including all LA STE‐derived variables were univariate predictors of cardiac death in Cox proportional hazard analysis. Because of strong correlation between many variables, only left atrium to aorta ratio (LA/Ao > 1.7), mitral valve E wave velocity (MV E vel > 1.3 m/s), LA maximal volume (LAVmax > 3.53 mL/kg), peak atrial longitudinal strain (PALS < 30%), and contraction strain index (CSI per 1% increase) were entered in the univariate analysis, and all were predictors of cardiac death. However, only the MV E vel (hazard ratio [HR], 4.45; confidence interval [CI], 1.76‐11.24; P < .001) and LAVmax (HR, 2.32; CI, 1.10‐4.89; P = .024) remained statistically significant in the multivariable analysis.Conclusions and Clinical ImportanceThe assessment of LA dimension and function provides useful prognostic information in dogs with MMVD. Considering all the LA variables, LAVmax appears the strongest predictor of cardiac death, being superior to LA/Ao and STE‐derived variables.

Multiple retrospective analysis of survival and evaluation of cardiac death predictors in a population of dogs affected by degenerative mitral valve disease in ACVIM class C treated with different therapeutic protocols

“…In line with the literature, we found that LA/Ao and E wave velocity are predictors of CD [35]. The increase in LA/Ao ratio and E-wave values corresponds to an increased risk of CD.…”

“…In this study the MST of ACVIM C patients belonging to different therapeutic groups was in accordance with those reported in the literature, although the more complex therapeutic scheme (groups 2 and 3) was associated with a shorter survival time [5,13,35,36,37]. This is despite the fact that patients with more advanced DMVD need more complex cardioactive therapy.…”

“…The univariate analysis also revealed the E/A ratio, EDVI, ESVI, Allo(d), Allo(s), age and spironolactone administration as predictors of CD. However, only the LA/Ao ratio proved to be significantly correlated in the multivariate analysis, as reported in the literature [35,37].…”

Effect of temperature variation on hospital admissions and outcomes in dogs with myxomatous mitral valve disease and new onset pulmonary edema

“…Various prognostic indicators have been investigated in dogs with MMVD, in particular using various echocardiographic techniques, and different clinical variables associated with cardiac mortality have been identified [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Among them, breed of dog, advanced age, and body weight (BW) � 20 kg, as well as degree of mitral valve pathology; left atrial (LA) and left ventricular (LV) dilation and dysfunction; increased LA pressure; right ventricular dysfunction; development of atrial fibrillation (AF) and pulmonary hypertension (PH); and increased concentration of circulating cardiac biomarkers (e.g., NT-pro-BNP) have been associated with a worse prognosis [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. On the contrary, use of several drugs, including ACE-inhibitors, pimobendan, and spironolactone has a proven positive effect both on the quality and duration of life in dogs with MMVD [19][20][21][22][23][24].…”

Echocardiographic Features in Canine Myxomatous Mitral Valve Disease: An Animal Model for Human Mitral Valve Prolapse

“…Therefore, the 2D-SMOD may be a better method for the estimation of LA volume, if the 3D-EC is not available. One study found the LA volume indices including LA maximal volume (LAVmax) and LA minimal volume (LAVmin) using the ALM was useful to predict survival time when cardiac-related death was only considered [50]. In this study, the LAVmax > 3.53 mL/kg indicated high mortality risk in dogs with MMVD.…”