Prognostic value of right pulmonary artery distensibility in dogs with pulmonary hypertension

Abstract

The right pulmonary artery distensibility (RPAD) index has been used in dogs with pulmonary hypertension (PH) caused by heartworm infection, myxomatous mitral valve disease, or patent ductus arteriosus. We hypothesized that this index correlates with the tricuspid regurgitation pressure gradient (TRPG) assessed by echocardiography and could predict survival in dogs with PH secondary to various causes. To assess this hypothesis, the medical records of 200 client-owned dogs at a referral institution were retrospectively reviewed. The RPAD index and the ratios of acceleration time to peak pulmonary artery flow (AT) and to the ejection time of pulmonary artery flow (ET) were recorded for each dog. The owners were contacted for follow-up assessments. The findings indicated that the RPAD index was correlated with the TRPG (R 2 = 0. 362, p < 0.001). The survival time was significantly shorter in dogs with an RPAD index ≤ 21% that were followed up for 3 months and in dogs with an RPAD index ≤ 24% that were followed up for 1 year. Thus, the RPAD index was correlated with the TRPG and could predict the clinical outcome in dogs with PH caused by various diseases. This index could be used to evaluate the severity of PH in dogs without tricuspid regurgitation.

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

“…Right ventricular function was significantly worse in dogs with PH not secondary to LHD when compared to dogs with PH secondary to LHD. However, survival times were not significantly different between dogs with PH secondary to LHD (ie, MMVD) and dogs Numerous studies have documented that RA enlargement (increased RAA), 19 RV enlargement (increased RVAd), 20 PA enlargement (increased PV/Ao), 7,14 and reduced RPAD index [14][15][16][17] are common in dogs with PH and that RV systolic dysfunction (reduced TAPSE) occurs in some dogs with PH. 21,22 Right ventricular enlargement and systolic dysfunction, PA enlargement or reduced RPAD index, and RA enlargement are considered to be clinically useful echocardiographic signs of PH and help assess the probability of PH.…”

“…These measurements are largely based on characteristic cardiac changes that occur secondary to PH and have been previously evaluated in dogs diagnosed with PH. For example, the pulmonary artery might dilate, 7,14 exhibit reduced distensibility (quantified by the right pulmonary artery distensibility [RPAD] index), [14][15][16][17] or both. The blood flow profile in the pulmonary artery might exhibit a shortened acceleration time when indexed to ejection time (AT/ET).…”

Intracardiac heartworms in dogs: Clinical and echocardiographic characteristics in 72 cases (2010‐2019)

“…34 Values < 30% indicated reduced RPAD and values < 22% were consistent with severe PH. 24,34,35 Tricuspid valve regurgitation (TR) and pulmonary valve regurgitation (PR) were recorded as present, absent, or in the case of TR, present but unable to be measured owing to the presence of intracardiac heartworms. Peak velocity of tricuspid (systolic timing) and pulmonary (early diastolic timing) valve regurgitation was measured when Doppler recordings were available.…”

CTPA pulmonary artery distensibility in assessment of severity of acute pulmonary embolism and right ventricular function

“…Frequent follow-up, screening tests or treatment responses are needed clinically, so an alternative non-invasive method is desirable. [ 23 ] CTPA is now widely used in clinical practice. Many studies have demonstrated that this rapid, accurate, and non-invasive method can acquire embolism information for APE and also provide functional RV information.…”