Pulmonary hypertension in canine degenerative mitral valve disease

Kellihan, Heidi B.; Stepien, Rebecca L.

doi:10.1016/j.jvc.2012.01.001

Cited by 95 publications

(190 citation statements)

References 94 publications

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“…This could explain why 2D‐based indices in this study (RPAD index, MPA:Ao) were often more accurate in predictors of PH. Furthermore, predicting a TRPG >50 mmHg (suggestive of at least moderate PH) is an important and clinically relevant finding, as the presence of at least moderate PH often influences therapeutic decisions,1 provides important prognostic information,2 and suggests that PH could become refractory to therapy in dogs with MMVD 25…”

Section: Discussionmentioning

confidence: 99%

“…A value of TRPG >50 mmHg was chosen as an additional cutoff because moderate PH has implications for therapeutic intervention,1 suggesting the presence of irreversible PH,25 and has been demonstrated to be associated with a worse outcome in dogs with myxomatous mitral valve disease (MMVD) 2. Optimal cutoff values were chosen for each indirect echocardiographic PH index from all combinations of sensitivity and specificity based on the highest Youden index (Youden index = [sensitivity−specificity] + 1).…”

Section: Methodsmentioning

confidence: 99%

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

Visser

Johnson

et al. 2016

Veterinary Internal Medicne

109

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BackgroundNoninvasive diagnosis of pulmonary hypertension (PH) primarily relies upon Doppler echocardiography of tricuspid regurgitation (TR). However, TR might be absent or difficult to measure.Hypothesis/ObjectivesTo determine the diagnostic value of right pulmonary artery distensibility (RPAD) index for prediction of Doppler‐derived estimates of pulmonary artery (PA) pressure compared to other indices of PH in dogs.AnimalsSixty‐nine client‐owned dogs with TR.MethodsProspective observational study. Dogs were allocated to groups according to TR pressure gradient (TRPG): TRPG <36 mmHg (control, n = 22), TRPG 36–50 (n = 16), TRPG 50–75 (n = 14) and TRPG >75 mmHg (n = 17). Right pulmonary artery distensibility index, acceleration time to peak PA flow (AT), AT: ejection time of PA flow (AT:ET) and main PA size: aorta size (MPA:Ao) were calculated in each dog.ResultsRight pulmonary artery distensibility index demonstrated the strongest correlation (r = −0.90; P < .0001) to TRPG followed by MPA:Ao (r = 0.78; P < .0001), AT (r = −0.69; P < .0001) and AT:ET (r = −0.68; P < .0001). RPAD index possessed the most accurate cutoff (<29.5%; Sensitivity [Sn] 0.84, Specificity [Sp] 0.95) to predict TRPG >50 mmHg compared to AT (<53.9 ms; Sn 0.74, Sp 0.87), AT:ET (<0.30; Sn 0.61, Sp 0.97) and MPA:Ao (>1.04; Sn 0.94, Sp 0.74). All intra‐ and interobserver measurement variabilities exhibited coefficients of variation ≤13%.Conclusions and Clinical ImportanceRight pulmonary artery distensibility index is an accurate predictor of TRPG and should be particularly useful if TR is absent or difficult to measure.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Visser

Johnson

et al. 2016

Veterinary Internal Medicne

109

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“…A total of 5 dogs (9.4%) had confirmed or probable PAH (Table 2), the prevalence in the overall referral population being 0.5 % and 1 % of dogs with valvular disease. (1,6,8,9,14,15,16,17,22,23,24). The degree of hypoxia that can cause PAH likely exists in a large number of dogs with both upper and lower airway obstructive diseases (9).…”

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confidence: 99%

Retrospective Investigation on the Prevalence of Pulmonary Hypertension in Dogs with Bronchial and Upper Respiratory Diseases

Locatelli

Montrasio

Spalla

et al. 2016

Macedonian Veterinary Review

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Original Scientific ArticleMac Vet Rev 2016; 39 (1): [83][84][85][86][87][88][89][90] Bronchial and upper respiratory diseases have been associated with hypoxia and subsequent development of pulmonary arterial hypertension (PAH). However, there are no known studies assessing the prevalence of PAH in dogs with these conditions. The aim of this study was to assess the frequency of PAH in dogs with bronchial and upper respiratory diseases. Medical records of dogs with confirmed diagnosis (by endoscopic examination) of bronchial and/or upper respiratory diseases referred for cardiovascular investigation (January 2009 -May 2013 were retrospectively reviewed. Diagnosis of PAH was made by echocardiography (tricuspid regurgitation > 2.8 m/s and/or pulmonic regurgitation > 2.2 m/s); possible PAH was diagnosed when two or more specific echocardiographic findings were present. 52 dogs (30 with upper respiratory diseases, 17 with bronchial disease and 5 with both) were included. Diagnosis of PAH was performed in 3 dogs (5.7%). Two dogs were considered as probably affected by PAH; a total of 5 dogs (9.4%) resulted in being affected or probably affected by PAH. Our study shows that the prevalence of PAH in dogs with bronchial and/or upper respiratory diseases is low; PAH seems to occur mostly in older dogs and/or with very advanced disease: echocardiography may therefore be a useful tool in this category of patients. INTRODUCTIONIn veterinary medicine, pulmonary arterial hypertension (PAH) is defined as pulmonary arterial systolic pressure greater than 25 mmHg (1). Right-heart catheterization is considered the "gold standard" in order to diagnose PAH (2,3,4). However it is rarely performed in veterinary medicine (1,3,4). In the absence of right ventricular (RV) outfl ow tract obstruction (e.g. pulmonary stenosis) or significant right-sided volume overload (e.g. tricuspid valve dysplasia), pulmonary arterial pressure can be inferred non-invasively with Doppler echocardiography, either by calculation of RETROSPECTIVE INVESTIGATION ON THE PREVALENCE OF PULMONARY HYPERTENSION IN DOGS WITH BRONCHIAL AND UPPER RESPIRATORY DISEASESChiara Locatelli, Daniela Montrasio, Ilaria Spalla, Giulia Riscazzi, Matteo Gobbetti, Alice Savarese, Stefano Romussi, Paola G. Brambilla Milano, Via Celoria 10, 20133 Milan, Italy Received 10 October 2015; Received in revised form 11 January 2016; Accepted 20 January 2016 the maximal velocity of the regurgitant fl ow across the tricuspid (systolic pulmonary arterial pressure) or across the pulmonary valve (diastolic pulmonary arterial pressure) using the modified Bernoulli equation (4,5,6). Department of Veterinary Sciences and Public Health (DIVET), Università degli Studi diThe severity of PAH is classified as mild, moderate, and severe based on the estimated pulmonary arterial pressure, with slight variations in cut off values among reports, in dogs affected by cardiovascular diseases (6,7,8).PAH may occur through three mechanisms: increased left atrial pressure, increased pulmonary blood f...

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“…High PAP values above the reference range indicate PH, which can result from pre-and post-capillary haemodynamic changes (Kellihan and Stepien 2012). PH is a wellrecognised clinical condition in human patients and can be primary or secondary to various diseases of the pulmonary vasculature (Galie et al 2009).…”

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confidence: 99%

“…CDMD can lead to left heart dilation and increased left atrial pressure, causing elevated pulmonary venous pressure (post-capillary PH), pulmonary oedema and chronic post-capillary hypoxia. (Kellihan and Stepien 2012). HWD infested by Dirofilaria immitis and associated thromboembolism is the most commonly reported cause of severe pre-capillary PH in dogs (Sasaki et al 1992).…”

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confidence: 99%

Echocardiographic assessment of right heart indices in dogs with elevated pulmonary artery pressure associated with chronic respiratory disorders, heartworm disease, and chronic degenerative mitral valvular disease

Tai¹,

Huang²

2013

Vet. Med. - Czech

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ABSTRACT:The aim of this study was to evaluate right ventricular (RV) remodeling and right heart failure associated with different causes of elevated pulmonary arterial pressure (PAP) in dogs. In total, 169 client-owned dogs with tricuspid regurgitation (TR) and 40 client-owned clinically healthy dogs were included. Dogs with TR were further categorised as suffering from chronic respiratory disorders (CRD), heartworm disease (HWD), mild/ moderate chronic degenerative mitral valvular disease (CDMD), and severe CDMD. Among the echocardiographic indices of the right heart, no significant difference in the tricuspid annular plane systolic excursion to aortic root diameter ratio was found among the clinical healthy controls and the four different TR categories. No significant differences in TR peak velocity and pulmonic regurgitation peak velocity were found among dogs in the four different TR categories. The ratio of the right to left ventricular basal diameter in the right ventricular-focused view was significantly higher in dogs with chronic respiratory disorders and dogs with heartworms. Left ventricular compression quantified using the eccentricity index and the ratio of the main pulmonary artery to aortic root diameter were significantly higher in dogs with HWD. Their right ventricular acceleration to ejection time (AT/ET) was significantly lower in dogs with HWD. Based on these findings, we conclude that right heart indices are affected by CRD, HWD, and moderate to severe CDMD. However, right heart indices derived from left heart measurements might be underestimated in dogs with CDMD.Keywords: left ventricular eccentricity indices; mean electrical axis; pulmonary hypertension; right heart remodelling; tricuspid annular plane systolic excursion List of abbreviationsAo = aortic root diameter, AT = acceleration time, CDMD = chronic degenerative mitral valvular disease, CRD = chronic respiratory disorders, CV = coefficient of variation, ECG = electrocardiography, ET = ejection time, HWD = heartworm disease, LA/Ao = left atrial/aortic root ratio, LVD = left ventricular basal diameter, LV-EI = left ventricular eccentricity index, MEA = mean electrical axis, MPA = main pulmonary artery, PAP = pulmonary arterial pressure, PH = pulmonary hypertension, PR = pulmonic valve regurgitation, RVD = right ventricular basal diameter, SBP = systemic blood pressure, SD = standard deviation, TAPSE = tricuspid annular plane systolic excursion, TR = tricuspid regurgitation, VHS = vertebral heart scale Pulmonary hypertension (PH) is defined by high diastolic or systolic PAP and may lead to right ventricular concentric or eccentric hypertrophy, right atrial enlargement, and right-sided heart failure (Serres et al. 2006). High PAP values above the reference range indicate PH, which can result from pre-and post-capillary haemodynamic changes (Kellihan and Stepien 2012). PH is a wellrecognised clinical condition in human patients and can be primary or secondary to various diseases of the pulmonary vasculature (Galie et al. 2009). Primar...

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Pulmonary hypertension in canine degenerative mitral valve disease

Cited by 95 publications

References 94 publications

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

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

Retrospective Investigation on the Prevalence of Pulmonary Hypertension in Dogs with Bronchial and Upper Respiratory Diseases

Echocardiographic assessment of right heart indices in dogs with elevated pulmonary artery pressure associated with chronic respiratory disorders, heartworm disease, and chronic degenerative mitral valvular disease

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