Echocardiographic assessment of right ventricular systolic function in conscious healthy dogs: Repeatability and reference intervals

BackgroundStudies evaluating right ventricular (RV) structural and functional abnormalities in feline hypertrophic cardiomyopathy (HCM) are limited.HypothesisRight ventricular structural and functional abnormalities are present in cats with HCM and are associated with clinical severity.AnimalsEighty‐one client‐owned cats.MethodsRetrospective 2‐dimensional (2D) echocardiographic study. Right atrial diameter (RAD), RV free wall thickness (RVFWd), RV internal dimension (RVIDd), RV fractional area change (FAC), and tricuspid annular plane systolic excursion (TAPSE) were measured in control cats (n = 26), cats with subclinical HCM (subclinical HCM; n = 31), and cats with HCM and congestive heart failure (HCM + CHF; n = 24).ResultsRight heart size (RAD, RVFWd, and RVIDd) and RV function (FAC and TAPSE) significantly (all P < .05) increased and decreased, respectively, in the HCM + CHF group compared with controls. In the subclinical HCM group, only RVFWd was significantly (P < .05) higher than in controls. Compared with reference intervals derived from controls, 29% of cats with HCM had increased RVFWd. Increased left ventricular free wall thickness, increased RVIDd and decreased TAPSE independently correlated with increased left atrial size. Cats with HCM and pleural effusion were significantly more likely to have increased RVFWd and had increased RAD and decreased TAPSE compared with cats without pleural effusion.Conclusions and Clinical ImportanceRight ventricular remodeling and dysfunction occur in some cats with HCM and may be associated with clinical severity. Our results support involvement of RV in the pathophysiology of HCM in some cats and support echocardiographic assessment of the RV in cats with HCM.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Echocardiographic Assessment of Right Ventricular Size and Function in Cats With Hypertrophic Cardiomyopathy

Visser

Sloan

Stern

2017

“…Dogs were allocated to 1 of 4 groups according to the estimated peak tricuspid regurgitation systolic pressure gradient (TRPG) derived from the peak systolic TR jet velocity via the simplified Bernoulli equation (PG = 4 × velocity 2 ): (1) control group, TRPG <36 mmHg, (2) TRPG of 36–50 mmHg, (3) TRPG of 50–75 mmHg and (4) TRPG >75 mmHg 4. None of the dogs in the control group could be taking medications known to affect the cardiovascular or respiratory system and had to have normal RV systolic function based on recently published body weight‐specific reference intervals for fractional area change (FAC) 20. In dogs with a TRPG > 36 mmHg (suggestive of at least mild PH), a search for an underlying cause or additional diagnostic testing was performed at the discretion of the attending clinician.…”

Section: Methodsmentioning

confidence: 99%

“…Right ventricular percent FAC was calculated using the formula: FAC = ([RVA D −RVA S ]/RVA D ) × 100. Fractional area change values were compared to body weight‐specific reference intervals 20. Right ventricular size was assessed from the same view as FAC and, for the purposes of this study, the presence of (severe) RV enlargement was deemed present if the RV chamber and/or wall thickness was subjectively greater than that of the left ventricle 4…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Value of Right Pulmonary Artery Distensibility Index in Dogs with Pulmonary Hypertension: Comparison with Doppler Echocardiographic Estimates of Pulmonary Arterial Pressure

Visser

Johnson

et al. 2016

109

BackgroundNoninvasive diagnosis of pulmonary hypertension (PH) primarily relies upon Doppler echocardiography of tricuspid regurgitation (TR). However, TR might be absent or difficult to measure.Hypothesis/ObjectivesTo determine the diagnostic value of right pulmonary artery distensibility (RPAD) index for prediction of Doppler‐derived estimates of pulmonary artery (PA) pressure compared to other indices of PH in dogs.AnimalsSixty‐nine client‐owned dogs with TR.MethodsProspective observational study. Dogs were allocated to groups according to TR pressure gradient (TRPG): TRPG <36 mmHg (control, n = 22), TRPG 36–50 (n = 16), TRPG 50–75 (n = 14) and TRPG >75 mmHg (n = 17). Right pulmonary artery distensibility index, acceleration time to peak PA flow (AT), AT: ejection time of PA flow (AT:ET) and main PA size: aorta size (MPA:Ao) were calculated in each dog.ResultsRight pulmonary artery distensibility index demonstrated the strongest correlation (r = −0.90; P < .0001) to TRPG followed by MPA:Ao (r = 0.78; P < .0001), AT (r = −0.69; P < .0001) and AT:ET (r = −0.68; P < .0001). RPAD index possessed the most accurate cutoff (<29.5%; Sensitivity [Sn] 0.84, Specificity [Sp] 0.95) to predict TRPG >50 mmHg compared to AT (<53.9 ms; Sn 0.74, Sp 0.87), AT:ET (<0.30; Sn 0.61, Sp 0.97) and MPA:Ao (>1.04; Sn 0.94, Sp 0.74). All intra‐ and interobserver measurement variabilities exhibited coefficients of variation ≤13%.Conclusions and Clinical ImportanceRight pulmonary artery distensibility index is an accurate predictor of TRPG and should be particularly useful if TR is absent or difficult to measure.

“…Furthermore, the clinical and prognostic importance of STE variables has been demonstrated in numerous pathophysiologic conditions typically associated with abnormal LA function, including MMVD, atrial fibrillation, systemic hypertension, and dilated, as well as hypertrophic, cardiomyopathy 3, 4, 10, 16, 17. The majority of STE studies in dogs to date focused on the evaluation of mechanical ventricular properties 18, 19, 20, 21, 22, 23, 24, 25, 26, 27. Few data are available regarding the application of this technique for LA assessment28, 29, 30, and no studies have focused on the evaluation of LA STE‐derived strain in dogs with cardiac disease.…”

mentioning

confidence: 99%

Assessment of Left Atrial Deformation and Function by 2‐Dimensional Speckle Tracking Echocardiography in Healthy Dogs and Dogs With Myxomatous Mitral Valve Disease

Toaldo

Romito

Guglielmini

et al. 2017

BackgroundThe assessment of left atrial (LA) function by 2‐dimensional speckle tracking echocardiography (STE) holds important clinical implications in human medicine. Few similar data are available in dogs.ObjectivesTo assess LA function by STE in dogs with and without myxomatous mitral valve disease (MMVD), analyzing LA areas, systolic function, and strain.AnimalsOne hundred and fifty dogs were divided according to the American College of Veterinary Internal Medicine classification of heart failure: 23 dogs in class A, 52 in class B1, 36 in class B2, and 39 in class C + D.MethodsProspective observational study. Conventional morphologic and Doppler variables, LA areas, and STE‐based LA strain analysis were performed in all dogs and results were compared among groups. Correlation analysis was carried out between LA STE variables and other echocardiographic variables.ResultsVariability study showed good reproducibility for all the tested variables (coefficient of variation <16%). Left atrial areas, fractional area change, peak atrial longitudinal strain (PALS), peak atrial contraction strain, and contraction strain index (CSI) differed significantly between groups B2 and C + D and all the other groups (overall P < .001), whereas only PALS differed between groups B1 and A (P = .01). Left atrial areas increased with progression of the disease, whereas LA functional parameters decreased. Only CSI increased nonsignificantly from group A to group B1 and then progressively decreased. Thirty‐one significant correlations (P < .001, r > .3) were found between conventional left heart echocardiographic variables and LA areas and strain variables.Conclusions and Clinical ImportanceLeft atrial STE analysis provides useful information on atrial function in the dog, highlighting a progressive decline in atrial function with worsening of MMVD.