Clinical Severity Score System in Dogs with Degenerative Mitral Valve Disease

Abstract

Background: Several risk factors already have been determined for dogs with degenerative mitral valve disease (DMVD). Risk factors often have been considered in isolation and have not always taken into account additional information provided by the history and physical examination (PE).Hypothesis/Objectives: Data obtained from history and PE of dogs with DMVD provide prognostic information and can be used for risk stratification.Animals: Client-owned dogs (n = 244) with DMVD recruited from first opinion practice. Methods: Prospective longitudinal follow-up of dogs with DMVD. History and PE data were obtained at 6-month intervals and analyzed with time-dependent Cox models to derive relative risk of cardiac death. Independent hazard ratios were used to derive a clinical severity score (CSS), the prognostic value of which was evaluated by analyzing the median survival times for different risk groups and ROC analysis. Analysis of the progression of CSS over time also was undertaken.Results: History of cough, exercise intolerance, decreased appetite, breathlessness (difficulty breathing) and syncope with PE findings of heart murmur intensity louder than III/VI and absence of respiratory sinus arrhythmia were independently associated with outcome and allowed development of the CSS. Clinical severity score distinguished groups of dogs with significantly different outcomes.Conclusions and Clinical Importance: Routinely obtained clinical findings allow risk stratification of dogs with DMVD. Results of ancillary diagnostic tests may be complementary to history and PE findings and always should be interpreted in conjunction with these findings.

Coughing in dogs: what is the evidence for and against a cardiac cough?

“…Therefore, the explanation that cough is caused by cardiomegaly and concomitant airway abnormalities, rather than pulmonary oedema, appeared to be supported also by these results (Lopez‐Alvarez et al . ).…”

“…Lopez‐Alvarez et al . () reported that coughing appeared independently associated with higher hazard of cardiac‐related death. However, in this study, dogs developed cough during the clinical progress of their disease at a much earlier stage than they developed overt signs of CHF.…”

Prognostic value of echocardiographic indices of left atrial morphology and function in dogs with myxomatous mitral valve disease

“…Therefore, the study of prognostic indicators of mortality in this population of animals is of primary importance. Several studies have focused on evaluating clinical and echocardiographic variables that may predict cardiac mortality in dogs with MMVD . Because echocardiography is the most commonly used diagnostic test in assessing dogs with cardiac disease, it is also the most studied technique for stratification of dogs with cardiac disease.…”

“…Several studies have focused on evaluating clinical and echocardiographic variables that may predict cardiac mortality in dogs with MMVD. [4][5][6][7] Because echocardiography is the most commonly used diagnostic test in assessing dogs with cardiac disease, it is also the most studied technique for stratification of dogs with cardiac disease. Different Doppler variables, two-dimensional (2D) echocardiographic indicators of mitral valve (MV) pathology, and degree of left atrial (LA) dilatation are strong predictors of cardiac-related death in dogs with MMVD.…”

Multiple retrospective analysis of survival and evaluation of cardiac death predictors in a population of dogs affected by degenerative mitral valve disease in ACVIM class C treated with different therapeutic protocols

“…The lengthening of MST and a good quality of life (QoL) are significant aspects of the therapeutic strategy, and both are very important for the owners. The achievement of a longer MST in our study compared to the literature might be explained by the good compliance of the owners over time, even given the complex protocols [38]. Prospective studies are needed to investigate the compliance effects of owners and the influence of more standardized therapeutic protocols on the QoL and the survival of dogs with DMVD.…”