Reproducibility of echocardiographic indices of left atrial size in dogs with subclinical myxomatous mitral valve disease

Abstract

Background: Reliability of echocardiographic measurements of left atrial (LA) size, an important marker of disease severity, has not been reported in dogs with myxomatous mitral valve disease (MMVD). Objectives: To define and compare reliability of left atrial dimension/diameter (LAD), LAD indexed to aortic valve diameter (LAD/AoD), left atrium-to-aortic root ratio (LA/Ao), left atrial volume acquired from a right parasternal long-axis (LAV RPLx), and left apical view (LAV LAP) in dogs with subclinical MMVD. Animals: Nine dogs with subclinical MMVD. Methods: Prospective reproducibility study. Dogs underwent 12 echocardiographic examinations by 2 operators on the mornings and afternoons of 3 nonconsecutive days within 1 week. Reliability (measurement variability) was quantified using coefficients of variation (CV) and 95% repeatability/reproducibility coefficients (95% RC). A mixed-model analysis of variance (ANOVA) was used to determine if time of day, day, and operator were significant sources of variability for each index. Results: Linear measurements (LAD, LAD/AoD, and LA/Ao) exhibited less within-day, between-day, and interoperator variability (CVs, 3.9%-12.5%) than did volume estimate measurements (LAV RPLx and LAV LAP ; CVs, 11.8%-17.9%). Of the linear measurements, LA/Ao exhibited greater variability (CVs, 9.9%-12.5%) compared to LAD and LAD/AoD (CVs, 3.9%-4.9%). Operator was a significant (P = .005) source of variability for LA/Ao. Conclusions and Clinical Importance: Compared to other linear measurements, LA/Ao was the least reproducible and most dependent on operator. The 95% RC for each LA size index are provided to help identify clinically relevant changes (beyond intraoperator or interoperator variability) during serial echocardiographic examinations of dogs with subclinical MMVD.

Performance of Different Echocardiographic Measurements of Left Atrial Size in Dogs by Observers with Different Levels of Experience

“…While data about repeatability and reproducibility are not available for LA APD5CH and LA area, in our study we found similar intraobserver ICCs for LA:Ao and LA APD , to what recently reported in another study, where measurements were performed by a trained diagnostic imaging resident on a selected group of healthy dogs [ 17 ]. The interobserver ICCs that we found in this study for LA:Ao and LA APD , are instead slightly higher than previously reported in both healthy dogs and dogs affected by myxomatous valvular degeneration, even though all the observers in these studies were reported to have received some training [ 17 , 22 ]. This is explained by the different forms of interobserver ICC.…”

Volumetric quantification identifies some left atrial dilations undetected by left atrium:aorta ratio measurements: A prospective echocardiographic study in 155 Cavalier King Charles Spaniels with and without degenerative mitral valve disease

“…From a practical point of view, this also suggests that considering linear LA measurements only, may lead to an erroneous left heart evaluation, which will not be the case when using volumetric methods only. The high negative prognostic value of LA enlargement has been demonstrated in DMVD dogs [ 11 , 37 , 38 ], with LA volume being the strongest predictor of cardiac-related death, highly superior to all other parameters of LA size and function including LA/Ao ratios [ 43 , 44 ]. Therefore, as in human cardiology [ 45 ], LA volumetric quantification should the method of first choice for assessing LA size particularly to stratify ACVIM stage B dogs.…”

Differentially expressed platelet activation-related genes in dogs with stage B2 myxomatous mitral valve disease

“…2 C, Additional file 1 ), and LA:AO had the highest correlation coefficient. Interestingly, LA:AO is a convenient and body size-independent measurement, and it is also a typical index for evaluating the size of LA of dogs with MMVD [ 8 , 23 ]. Thus, the turquoise module was used for subsequent analysis, because it is likely to correlate more closely correlated with cardiac remodeling.…”