Pulmonary Vein‐to‐Pulmonary Artery Ratio is an Echocardiographic Index of Congestive Heart Failure in Dogs with Degenerative Mitral Valve Disease

Abstract

BackgroundEarly recognition of left‐sided congestive heart failure (CHF) in dogs with degenerative mitral valve disease (DMVD) is important because it influences medical therapy, timing of follow‐up, and outcome.HypothesisPulmonary vein diameter‐to‐pulmonary artery diameter ratio (PV/PA) measured by echocardiography can predict CHF.AnimalsNinety‐eight client‐owned dogs, 37 controls, and 61 dogs with DMVD.MethodsProspective clinical cohort study. History, physical examination and Doppler‐echocardiography were performed. Dogs were classified as International Small Animal Cardiac Health Council class I, II or III. Congestive heart failure was identified in a subset of 56 dogs based on radiographic findings. The PV/PA was measured in bidimensional (2D) and M‐mode by 2 investigators blinded to the radiologists’ conclusions.ResultsInterobserver coefficients of variation for PV/PA acquisition and measurement were <10%. The PV/PA in control dogs was approximately 1 and increased with class of heart failure. The presence of CHF could be best predicted by measuring PV/PA in 2D echocardiography (cut‐off, 1.7; area under the curve, 0.98; CI, 0.97–0.98; P < .001) with a sensitivity of 96% and a specificity of 91%.Conclusion and clinical importanceThe PV/PA is a simple and reproducible echocardiographic variable that increases with class of heart failure and may help discriminate dogs in CHF from asymptomatic dogs with DMVD. Additional studies are required to determine whether PV/PA might provide additional information in the integrated interpretation of Doppler‐echocardiographic indices of left ventricular filling pressures and could be used for rapid assessment of CHF in dogs in a critical care setting.

Interobserver agreement between non‐cardiologist veterinarians and a cardiologist after a 6‐hour training course for echographic evaluation of basic echocardiographic parameters and caudal vena cava diameter in 15 healthy Beagles

“…Care was taken to place the M‐mode cursor perpendicular to the interventricular septum and between the 2 papillary muscles. PV/PA was measured in MM as previously described . The CVC was assessed both via a subxiphoid view (CVC‐SubX) with the probe oriented cranially, and via a dorso‐lateral window (CVC‐DL), caudal to the last rib with the probe placed in a ventromedial direction (see Figure and Table ).…”

“…As there are no preexisting data for CVC variables, it was arbitrary decided that a difference of ± 0.25 cm should be considered nonacceptable (in light of the small size of the evaluated vessel). Based on prior veterinary cardiology studies, the coefficient of variation (CoV) was also calculated as an indicator of reproducibility. A one‐way analysis of variance was performed to estimate the CoV where the factor was represented by the dog (evaluated by the cardiologist and the non‐cardiologists).…”

Echocardiographic identification of atrial‐related structures and vessels in horses validated by computed tomography of casted hearts

“…These vessels are of particular interest to study atrial tachyarrhythmia pathophysiology in horses and might become a target for future treatment strategy. In addition, as in small animal medicine, PV diameter or flow measurements could be useful to assess specific heart disease such as mitral regurgitation severity .…”

Platelet proteome changes in dogs with congestive heart failure

“…/body weight (kg) 0.294 (65). For PV/PA estimation, PV and PA diameters were measured by M-Mode echo at RPSLA 4-chamber view as previously described (72).…”