Focused Cardiac Ultrasound to Detect Pre-capillary Pulmonary Hypertension

Abstract

BackgroundEarly recognition of pre-capillary (PC) pulmonary hypertension (PH) benefits dogs, allowing earlier treatment and improving prognosis. The value of focused cardiac ultrasound (FCU) to diagnose PH and assess its severity has not been investigated yet.HypothesisA subjective 10-point FCU pulmonary hypertension score (PHS) allows diagnosis and assessment of severity of PCPH.AnimalsThis study involved fifty client-owned dogs.MethodsDogs, recruited between September 2017 and February 2020, were classified into four categories (no, mild, moderate, and severe PH; C1 to C4, respectively). C1 and C2, and C3 and C4 were regrouped as group 1 and group 2, respectively. A blinded general practitioner assessed four FCU cineloops. Five echocardiographic parameters were subjectively scored, resulting in a total score of 0–10. Non-parametric tests compared global scores between categories and groups. A receiver operating characteristic (ROC) curve determined the cutoff value to differentiate group 1 and group 2. A gray zone approach allowed diagnosing or excluding moderate to severe PH with 90% certitude.ResultsGlobal scores were significantly higher for C4 than for C1, C2, and C3. Global scores of G2 were significantly higher than G1. The ROC curve indicated a cutoff value of 5, discriminating group 1 from group 2 with a sensitivity of 77% and a specificity of 100%. A score of ≥5/10 allowed diagnosing moderate to severe PH with ≥90% certainty while a score of ≤2/10 excluded PH with ≥90% certainty.Conclusions and Clinical SignificanceModerate to severe PCPH can be accurately detected by non-cardiologists using a 10-point FCU PHS score.

Assessing primary care veterinarians’ use of and confidence in performing point‐of‐care ultrasound

“…Pulmonary hypertension was one of the lowest‐scoring cardiovascular pathologies. One study demonstrated that POCUS was not sensitive in screening for pulmonary hypertension, 31 whereas another found that, with a more complete protocol and training, diagnosis of pulmonary hypertension was improved 32 . It follows that most respondents to our survey lack confidence in using POCUS for diagnosis.…”

“…One study demonstrated that POCUS was not sensitive in screening for pulmonary hypertension, 31 whereas another found that, with a more complete protocol and training, diagnosis of pulmonary hypertension was improved. 32 It follows that most respondents to our survey lack confidence in using POCUS for diagnosis. No standardised protocol for CV-POCUS has been described, and assessments remain subjective.…”

Retrospective evaluation of a right heart parameter score in the assessment of precapillary pulmonary hypertension in dogs (2017–2021): 135 cases

“…1 Right heart changes secondary to PH include right ventricular hypertrophy, PA/trunk enlargement, right ventricular or atrial enlargement, flattening of the interventricular septum, and prominent papillary muscles. 1,3,6,[11][12][13][14] Signs of a congestive state have also been evaluated in patients with PH including CVC distention, gallbladder edema, hepatic vein distention, and peritoneal effusion. 1,3,11,12,15 A previous study reported that an echocardiographic 10-point pulmonary hypertension score (PHS), based on these anatomical changes, accurately identified patients with moderate to severe PCPH.…”

“…1,3,6,[11][12][13][14] Signs of a congestive state have also been evaluated in patients with PH including CVC distention, gallbladder edema, hepatic vein distention, and peritoneal effusion. 1,3,11,12,15 A previous study reported that an echocardiographic 10-point pulmonary hypertension score (PHS), based on these anatomical changes, accurately identified patients with moderate to severe PCPH. 11 Patients with PH are often presenting on an emergent basis and have a worse prognosis than patients without PH (in both people and animals).…”

“…1,3,11,12,15 A previous study reported that an echocardiographic 10-point pulmonary hypertension score (PHS), based on these anatomical changes, accurately identified patients with moderate to severe PCPH. 11 Patients with PH are often presenting on an emergent basis and have a worse prognosis than patients without PH (in both people and animals). 1,[16][17][18] If emergency clinicians were able to rapidly, and reliably, infer a patient had moderate to severe PH, then appropriate treatment could be implemented more rapidly, which could have a positive effect on prognosis.…”