ABSTRACT. The objective of the present study was to evaluate the usefulness of the vertebral heart score (VHS) in coughing dogs with chronic degenerative mitral valve disease (MVD). Survey thoracic radiographs of 90 dogs with a history of cough and clinical and echocardiographic evidence of MVD were evaluated by 2 independent observers. The observers were asked to first determine the origin of the cough as cardiac, non-cardiac or mixed and then to measure the VHS. Agreement regarding diagnosis of the origin of cough was obtained (kappa=0.64) in 69 dogs. Of these 69 dogs, 28 (41%), 32 (46%) and 9 (13%) had a cough of cardiac, non-cardiac and mixed origin, respectively. The dogs with a cough of non-cardiac origin had a significantly lower VHS (mean ± SD, 11 ± 0.9) compared with those of dogs with a cough of cardiac or mixed origin (12.8 ± 1 and 12.9 ± 0.9, respectively). Receiver operating characteristic curve analysis showed that a VHS ≤ 11.4 is fairly accurate for exclusion of a cough of cardiac origin in dogs with MVD. The results indicate that the VHS may be an additional tool for differentiating the origin of cough in dogs with MVD. KEY WORDS: canine and feline, cardiology, echocardiography, heart, radiology.J. Vet. Med. Sci. 71(1): 9-13, 2009The term "cardiac cough" is frequently used in the clinical setting as well as in veterinary textbooks to define the origin of cough in dogs affected by cardiac disorders. Chronic degenerative mitral valve disease (MVD) with associated mitral regurgitation (MR) is the most common canine cardiovascular disease [5] and coughing is the most common presenting complaint in dogs with MVD [10]. This symptom may be related to different pathophysiological mechanisms secondary to cardiac dilatation and dysfunction caused by MVD. Among the main consequences of MVD are dorsal elevation and compression of the trachea and/or dorsal elevation of the left main stem bronchus by the dilated left atrium, pulmonary congestion and pulmonary interstitial and/or alveolar transudate secondary to increased pulmonary capillary pressure [10]. The above mechanisms may be responsible for cough in dogs with MR [2]. Nevertheless, cough can be a consequence of different respiratory disorders that may concurrently affect dogs with MVD [1]. In particular, the same dogs (i.e., small or middle-sized, aged dogs) most commonly affected by MVD are predisposed to some respiratory disorders leading to cough (e.g., chronic bronchitis, lower airway collapse and interstitial lung disease) [12,21,24]. Thus, both respiratory and cardiac diseases may contribute to cough in some cases.The vertebral heart score (VHS) is a method for objectively evaluating the dimensions of the cardiac silhouette in thoracic radiograms and was first described by Buchanan and Bücheler in the dog [7]. Using this method, the cardiac long and short axis are measured on the lateral thoracic view and are then compared with the thoracic spine. The VHS is the vertebral scale sum of the long and short axes, each measured caudally from the crania...