Echocardiographic evaluation of the right ventricular dimension and systolic function in dogs with pulmonary hypertension

Abstract

BackgroundRight ventricular (RV) enlargement and dysfunction are associated with prognosis in humans with pulmonary hypertension (PH).Hypothesis/ObjectivesTo assess RV size and systolic function in dogs with PH and to determine if they are associated with disease severity and right‐sided congestive heart failure (R‐CHF).Animals89 dogs with PH and 74 healthy dogs.MethodsProspective observational study. PH was classified according to the tricuspid regurgitation pressure gradient. RV end‐diastolic area (RVEDA) index was calculated as RVEDA divided by body surface area. RV systolic function was assessed with the tricuspid annular plane systolic excursion (TAPSE) and the RV fractional area change (FAC) normalized for body weight (TAPSEn and FACn, respectively).ResultsRVEDA index was higher in dogs with moderate PH (10.8 cm2/m2; range, 6.2‐14.4 cm2/m2) and severe PH (12.4 cm2/m2; range, 7.7‐21.4 cm2/m2) than in those with mild PH (8.4 cm2/m2; range, 4.8‐11.6 cm2/m2) and control dogs (8.5 cm2/m2; range, 2.8‐11.6 cm2/m2; P < .001). RVEDA index was significantly higher in dogs with R‐CHF (13.7 cm2/m2; range, 11.0‐21.4 cm2/m2) than in dogs without R‐CHF (9.4 cm2/m2; range, 4.8‐17.1 cm2/m2; P < .001). The severity of tricuspid regurgitation (TR) was the only independent predictor of the RVEDA index (P < .001). TAPSEn and FACn were not significantly different among varying degrees of PH severity and between dogs with and without R‐CHF.Conclusions and Clinical ImportanceThe RVEDA index can be used to evaluate RV size in dogs. It can provide additional information in dogs with PH and predict R‐CHF. Severity of TR is the main determinant of RV enlargement in dogs with PH.

Noninvasive assessment of fluid responsiveness for emergency abdominal surgery in dogs with pulmonary hypertension: Insights into high-risk companion animal anesthesia

“…Left ventricular systolic function was assessed by fractional shortening (FS), which was measured by M-mode. The peak tricuspid value (TRV) was measured using continuous-wave Doppler imaging on a left apical 4-chamber view [ 28 ]. Dogs were deemed to have PH if TRV > 3 m/s [ 28 ].…”

“…The peak tricuspid value (TRV) was measured using continuous-wave Doppler imaging on a left apical 4-chamber view [ 28 ]. Dogs were deemed to have PH if TRV > 3 m/s [ 28 ]. Risk for general anesthesia of animals to tolerate emergency surgical intervention has been carefully assessed by veterinary anesthesiologists (KS and TM).…”

ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs

“…These echocardiographic signs of PH largely involve assessment of the ventricles (left ventricular and RV size and remodeling, 19,21 systolic flattening of the interventricular septum, 17 and RV systolic function 19,[23][24][25][26][27]33 ), the pulmonary artery (pulmonary artery size [17][18][19] and flow profile, 13,17,28,34 ), and the RA and caudal vena cava (RA 19,21 and caudal vena cava size 19 ). Unfortunately, there is a lack of agreement on how best to assess (ie, measure and quantify) these echocardiographic variables in dogs with PH, and specific echocardiographic guidelines are beyond the scope of this consensus statement.…”

“…Recommendations in Tables 2 and 3 for echocardiographic assessment of PH pertain to the use of a probability-based approach for the assessment PH for all causes of PH (groups 1-6, Table 4). In addition to criteria in Tables 2 and 3 Right atrial enlargement 19,20 Underfilling or decreased size of the left ventricle a Peak early diastolic PR velocity >2.5 m/s Enlargement of the caudal vena cava 19 Right ventricular hypertrophy (wall thickening, chamber dilation, or both) 19,21 RPAD index <30% 17,22 Right ventricular systolic dysfunction 19 Given the limitations of the veterinary literature (eg, single case reports or small case series, retrospective study design, frequent presence of confounding comorbid conditions contributing to PH, lack of uniform and rigorous diagnostic testing to definitively rule out comorbid conditions, among others), not all panelists agree with provided references to support the disease as the cause of PH. Larger, prospective carefully designed studies will be required to provide the necessary evidence to further refine this classification scheme.…”

“…These signs involve 3 anatomic sites: (1) ventricles, (2) pulmonary artery (although pulmonary artery is the commonly used term in clinical practice, the preferred anatomic term for the main pulmonary artery is pulmonary trunk and herein we consider them synonymously), and (3) RA and caudal vena cava (Table ). These echocardiographic signs of PH largely involve assessment of the ventricles (left ventricular and RV size and remodeling, systolic flattening of the interventricular septum, and RV systolic function), the pulmonary artery (pulmonary artery size and flow profile,), and the RA and caudal vena cava (RA and caudal vena cava size). Unfortunately, there is a lack of agreement on how best to assess (ie, measure and quantify) these echocardiographic variables in dogs with PH, and specific echocardiographic guidelines are beyond the scope of this consensus statement.…”