Clinical features and outcome in 25 dogs with respiratory‐associated pulmonary hypertension treated with sildenafil

Abstract

Background: Pulmonary hypertension (PH) can develop secondary to many common cardiopulmonary diseases, and the use of sildenafil has improved care of affected dogs.Objective: To evaluate response to sildenafil in dogs with respiratory-associated PH.Animals: Twenty-five dogs with PH.Methods: Prospective clinical trial. Doppler echocardiography identified dogs with moderate to severe PH, and additional tests were performed to detect underlying diseases. A 17-point quality of life (QOL) questionnaire was completed, and sildenafil was prescribed, along with other medications deemed necessary for the management of clinically diagnosed respiratory diseases. After 30 days, dogs returned to the hospital for repeat echocardiogram and QOL survey.Results: The median age was 12.4 years, and most dogs were small breed dogs (median weight, 6.5 kg). Syncope (64%), cough (56%), and respiratory difficulty (32%) were the most common presenting complaints. Respiratory diseases associated with PH included tracheobronchomalacia, pulmonary fibrosis, inflammatory airway disease, and brachycephalic syndrome, with multiple diseases in some dogs. Eight of 25 dogs (32%) died or were euthanized within 1 month. In the remaining dogs, tricuspid regurgitation pressure gradient (83.0 ± 17.4 mm Hg before, 55.4 ± 17.4 mm Hg after) and QOL scores were significantly improved after 1 month of sildenafil. Fifty percent mortality was reached 6 months after study entry, with 4 dogs alive 5 years after diagnosis.Conclusions and Clinical Importance: Sildenafil responsiveness is variable in dogs with respiratory-associated PH, but improved QOL was demonstrated in dogs surviving >1 month, and long-term survival was noted in some cases.

The prevalence of pulmonary hypertension assessed using the pulmonary vein‐to‐right pulmonary artery ratio and its association with survival in West Highland white terriers with canine idiopathic pulmonary fibrosis

“…The most likely explanation for the lack of association between survival and PH in our cohort of WHWTs affected with CIPF is that all WHWTs affected with CIPF suffering from PH at diagnosis were subsequently treated with sildenafil and then regularly followed as part of the CIPF-project to adjust treatment recommendations. Sildenafil treatment in pre-capillary PH has been shown to lower PAP from baseline, improve quality of life, and expand likelihood of survival in dogs [ 21 – 23 ]. Accordingly, sildenafil administration in our cohort of CIPF WHWTs affected with pre-capillary PH could have contributed to improved survival and prevented identification of an association between the presence of PH at diagnosis and outcome.…”

Survival characteristics and prognostic importance of echocardiographic measurements of right heart size and function in dogs with pulmonary hypertension

“…Pulmonary hypertension (PH) is a secondary complication of many commonly encountered cardiopulmonary disorders and is an increasingly recognized clinically important finding in dogs. [1][2][3][4][5] It is commonly associated with and can lead to clinical signs such as exercise intolerance, breathing difficulty, and exertional syncope and can cause right heart failure. [4][5][6][7][8][9][10] Reports have suggested that a tricuspid regurgitation pressure gradient (PG) > 55 mm Hg and ≥47 mm Hg is associated with an increased risk of death in dogs with myxomatous mitral valve disease (MMVD) 5 and respiratory disease/hypoxia, 4 is the primary metric used to estimate pulmonary arterial pressure and helps to assess the echocardiographic probability a dog has PH.…”

Prospective evaluation of the efficacy of inhaled steroids administered via the AeroDawg spacing chamber in management of dogs with chronic cough

“… 26 This survey was successfully applied to dogs with respiratory disease in a study of pulmonary hypertension. 27 The FETCH survey provides assessment of QOL with significant overlap in clinical signs observed in both cardiac and respiratory disease but does not evaluate cough in depth. Therefore, at the time of enrollment, 2, 4, and 6 weeks, owners also completed a cough survey, which assessed cough characteristics (frequency, duration, severity), ease of administration of inhaled medications, and corticosteroid‐related adverse effects using a visual analog scale (VAS; Figures S1 and S2 ).…”