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

Abstract

Background The clinical relevance of echocardiographic measurements of right heart size and function in dogs with pulmonary hypertension (PH) is unknown. Objective To determine if echocardiographic measurements of right heart size and right ventricular (RV) function are associated with survival times in dogs with PH. Animals Eighty‐two client‐owned dogs. Methods Retrospective study where data from medical records and baseline echocardiographic examinations were collected and measured in a standardized manner. Owners or primary veterinarians were contacted for outcome data. Results Enlargement of the right atrium (88%), RV (69%), and pulmonary artery (72%) was common. One‐third of the cases had reduced RV function quantified by two‐dimensional echocardiography‐derived tricuspid annular plane systolic excursion (TAPSE). Decreased TAPSE was significantly ( P = .008) more common in dogs with PH not secondary to left heart disease (LHD; 43%) compared to dogs with PH secondary to LHD (14%) but median survival times (182, 95% confidence interval [CI] = 39‐309 versus 298, 95% CI = 85‐314 days, respectively) were not significantly different ( P = .78). Right atrial area (hazard ratio [HR] = 2.72, 95% CI = 1.58‐4.70), TAPSE < 3.23 mm/kg 0.284 (HR = 2.19, 95% CI = 1.28‐3.74), and right heart failure (HR = 2.05, 95% CI = 1.18‐3.57) were independently associated with shorter survival time ( P ≤ .04). Conclusions and Clinical Importance Right atrial area, RV function (TAPSE < 3.23 mm/kg 0.284 ), and right heart failure offer clinically relevant prognostic information in dogs with PH. Results support the quantitative assessment of right heart size and function in dogs with PH.

Pulmonary Vascular Resistance Estimated by Echocardiography in Dogs With Myxomatous Mitral Valve Disease and Pulmonary Hypertension Probability

“…Dogs with R-CHF in this study also showed RV dysfunction based on a decrease in RV-SL and RV-SrL and increased RV afterload based on TR velocity. Additionally, previous studies have reported that right heart dilatation is associated with the presence of R-CHF and shorter survival time ( 19 , 33 ). Therefore, our results suggest that the PVRecho2 and RVIDd index may provide additional information to determine the presence of R-CHF in dogs with MMVD.…”

Echocardiographic reference intervals for right ventricular indices, including 3‐dimensional volume and 2‐dimensional strain measurements in healthy dogs

“…Therefore, it can be an important index for RV assessment in diseases that lead to RV volume or pressure overload or systolic dysfunction, such as PH. 5 , 6 , 7 The reduction in RV systolic function in dogs with PH might result in consequences for treatment or life expectancy. Also in dogs with myxomatous mitral valve disease, the RV function indices might serve as additional prognostic factors.…”

“…The RV plays an important role in many diseases affecting left heart, 1 , 2 right heart, 3 , 4 and causing pulmonary hypertension (PH). 5 , 6 , 7 …”

Right ventricular systolic and diastolic function assessed by two-dimensional speckle tracking echocardiography in dogs with myxomatous mitral valve disease

“…It can induce various changes in the right heart, such as right ventricular (RV) hypertrophy, dilatation, and dysfunction, which might eventually lead to rightsided congestive heart failure (R-CHF) [12,46]. Recent study has reported that RV dilatation and systolic dysfunction were associated with worse outcomes in dogs with PH [45]. Additionally, several human studies have reported that RV diastolic dysfunction was also induced by PH through hypertrophy, fibrosis, and stiffening of RV cardiomyocytes [4-6, 27, 29, 41].…”