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1.
Bruce W. Keene Clarke E. Atkins John D. Bonagura Philip R. Fox Jens Hggstrm Virginia Luis Fuentes Mark A. Oyama John E. Rush Rebecca Stepien Masami Uechi 《Journal of veterinary internal medicine / American College of Veterinary Internal Medicine》2019,33(3):1127-1140
This report, issued by the ACVIM Specialty of Cardiology consensus panel, revises guidelines for the diagnosis and treatment of myxomatous mitral valve disease (MMVD, also known as endocardiosis and degenerative or chronic valvular heart disease) in dogs, originally published in 2009. Updates were made to diagnostic, as well as medical, surgical, and dietary treatment recommendations. The strength of these recommendations was based on both the quantity and quality of available evidence supporting diagnostic and therapeutic decisions. Management of MMVD before the onset of clinical signs of heart failure has changed substantially compared with the 2009 guidelines, and new strategies to diagnose and treat advanced heart failure and pulmonary hypertension are reviewed. 相似文献
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Shoma MIKAWA Yuichi MIYAGAWA Noriko TODA Yoshinori TOMINAGA Naoyuki TAKEMURA 《The Journal of veterinary medical science / the Japanese Society of Veterinary Science》2015,77(1):7-13
Pulmonary hypertension (PH) often occurs due to a left heart disease, such as
myxomatous mitral valve disease (MMVD), in dogs and is diagnosed using Doppler
echocardiography and estimated pulmonary arterial pressure. Diagnosis of PH in dogs
requires expertise in echocardiography: however, the examination for PH is difficult to
perform in a clinical setting. Thus, simple and reliable methods are required for the
diagnosis of PH in dogs. The purpose of this study was to develop models using multiple
logistic regression analysis to detect PH due to left heart disease in dogs with MMVD
without echocardiography. The medical records of dogs with MMVD were retrospectively
reviewed, and 81 dogs were included in this study and classified into PH and non-PH
groups. Bivariate analysis was performed to compare all parameters between the groups, and
variables with P values of <0.25 in bivariate analysis were included
in multiple logistic regression analysis to develop models for the detection of PH. In
multiple logistic regression analysis, the model included a vertebral heart scale short
axis of >5.2 v, and a length of sternal contact of >3.3 v was considered suitable
for the detection of PH. The predictive accuracy of this model (85.9%) was judged
statistically adequate, and therefore, this model may be useful to screen for PH due to
left heart disease in dogs with MMVD without echocardiography. 相似文献
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David Dickson Domenico Caivano Jose Novo Matos Nuala Summerfield Mark Rishniw 《Journal of Veterinary Cardiology》2017,19(6):469-479
Objectives
To provide reference intervals for 2-dimensional linear and area-based estimates of left atrial (LA) function in healthy dogs and to evaluate the ability of estimates of LA function to differentiate dogs with subclinical myxomatous mitral valve disease (MMVD) and similarly affected dogs with congestive heart failure (CHF).Animals
Fifty-two healthy adult dogs, 88 dogs with MMVD of varying severity.Methods
Linear and area measurements from 2-dimensional echocardiographs in both right parasternal long and short axis views optimized for the left atrium were used to derive estimates of LA active emptying fraction, passive emptying fraction, expansion index, and total fractional emptying. Differences for each estimate were compared between healthy and MMVD dogs (based on ACVIM classification), and between MMVD dogs with subclinical disease and CHF that had similar LA dimensions. Diagnostic utility at identifying CHF was examined for dogs with subclinical MMVD and CHF. Relationships with bodyweight were assessed.Results
All estimates of LA function decreased with increasing ACVIM stage of mitral valve disease (p<0.05) and showed negative relationships with increasing LA size (all r2 values < 0.2), except for LA passive emptying fraction, which did not differ or correlate with LA size (p=0.4). However, no index of LA function identified CHF better than measurements of LA size. Total LA fractional emptying and expansion index showed modest negative correlations with bodyweight.Conclusions
Estimates of LA function worsen with worsening MMVD but fail to discriminate dogs with CHF from those with subclinical MMVD any better than simple estimates of LA size. 相似文献5.
Distribution of alveolar‐interstitial syndrome in dogs and cats with respiratory distress as assessed by lung ultrasound versus thoracic radiographs 下载免费PDF全文
Jessica L. Ward DVM DACVIM Gregory R. Lisciandro DVM DACVECC Teresa C. DeFrancesco DVM DACVIM DACVECC 《Journal of Veterinary Emergency and Critical Care》2018,28(5):415-428
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G. Menciotti M. Borgarelli M. Aherne S. Wesselowski J. Häggström I. Ljungvall S.M. Lahmers J.A. Abbott 《Journal of Veterinary Cardiology》2017,19(2):113-123
Objective
To assess differences in morphology of the mitral valve (MV) between healthy dogs and dogs affected by myxomatous mitral valve disease (MMVD) using real-time transthoracic three-dimensional echocardiography (RT3DE).Animals
Thirty-four were normal dogs and 79 dogs were affected by MMVD.Methods
Real-time transthoracic three-dimensional echocardiography mitral datasets were digitally recorded and analyzed using dedicated software. The following variables were obtained and compared between healthy dogs and dogs with MMVD at different stages: antero-posterior annulus diameter, anterolateral-posteromedial annulus diameter, commissural diameter, annulus height, annulus circumference, annulus area, anterior leaflet length, anterior leaflet area, posterior leaflet length, posterior leaflet area, non-planar angle, annulus sphericity index, tenting height, tenting area, tenting volume, the ratio of annulus height and commissural diameter.Results
Dogs with MMVD had a more circular MV annulus compared to healthy dogs as demonstrated by an increased annulus sphericity index (p=0.0179). Affected dogs had a less saddle-shaped MV manifest as a decreased annulus height to commissural width ratio (p=0.0004). Tenting height (p<0.0001), area (p<0.0001), and volume (p<0.0001) were less in affected dogs.Conclusions
Real-time transthoracic three-dimensional echocardiography analysis demonstrated that dogs affected by MMVD had a more circular and less saddle-shaped MV annulus, as well as reduced tenting height area and volume, compared to healthy dogs. Multiple variables differed between dogs at different stages of MMVD. Diagnostic and prognostic utility of these variables, and the significance of these changes in the pathogenesis and natural history of MMVD, require further attention. 相似文献7.
S Crosara M Borgarelli M Perego J Häggström G La Rosa A Tarducci RA Santilli 《Australian veterinary journal》2010,88(10):386-392
Objective Describe the presence of arrhythmias in dogs with myxomatous mitral valve disease (MMVD) and the potential association with class of heart failure and left atrial enlargement. Compare the standard electrocardiogram (ECG) with Holter monitoring for assessing heart rate (HR). Experimental procedure The study group of 36 dogs weighing less than 20 kg was divided into MMVD and no clinical signs (preclinical) or MMVD and clinical signs (clinical). A standard echocardiogram, ECG and 24-h Holter recording were obtained in all dogs. Results Minimum and mean Holter HRs were higher in the clinical group than in the preclinical group. Clinical dogs had more ventricular arrhythmias than preclinical dogs. An enlarged left atrium was associated with the presence of more supraventricular arrhythmias. Conclusions Arrhythmias are a common finding in dogs with MMVD and Holter monitoring is a reliable tool for both HR monitoring and diagnosis. 相似文献
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Objective
Myxomatous mitral valve disease (MMVD) induces progressive left atrial (LA) enlargement. The LA modulates left ventricular filling and performance through its reservoir, conduit, and contractile function. Assessment of LA size and function may provide valuable information on the level of cardiac compensation. Left atrial function in dogs with naturally occurring MMVD remains largely unexplored. The objective of this study was to evaluate LA volume and function in dogs with naturally occurring MMVD.Animals
This prospective study included 205 client-owned dogs of different breeds, 114 healthy dogs, and 91 dogs with MMVD of different disease severities.Methods
Using two-dimensional echocardiography, the biplane area-length method was applied to assess LA volume and calculate volumetric indices of LA reservoir, conduit, and contractile function.Results
Left atrial volume and LA stroke volume increased, whereas LA reservoir and contractile function decreased with increasing disease severity. A maximal LA volume <2.25mL/kg was the optimal cut off identified for excluding congestive heart failure in dogs with chronic MMVD with a sensitivity of 96% and a specificity of 100%. An active LA emptying fraction <24% and/or a LA expansion index <126% were suggestive of congestive heart failure in dogs with chronic MMVD with a sensitivity of 77% and a specificity of 89% and a sensitivity of 82% and a specificity of 82%, respectively.Conclusion
Dogs with MMVD appear to have larger LA volumes with poorer LA function. Deteriorating LA function, characterized by a decreasing reservoir and active contractile function, was evident in dogs with MMVD with increasing disease severity. 相似文献9.
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Ljungvall I Höglund K Carnabuci C Tidholm A Häggström J 《Journal of veterinary internal medicine / American College of Veterinary Internal Medicine》2011,25(5):1036-1043
Background: Left ventricular (LV) remodeling occurs in response to chronic volume overload. Real‐time 3‐dimensional (RT3D) echocardiography offers new modalities for LV assessment. Objective: To investigate LV changes in shape and volume in response to different severities of naturally acquired myxomatous mitral valve disease (MMVD) in dogs by RT3D echocardiography. Animals: Sixty‐five client‐owned dogs. Methods: Prospectively recruited dogs were classified by standard echocardiography into healthy, mild, moderate, and severe MMVD groups. Endocardial border tracking of LV RT3D dataset was performed, from which global and regional (automatically acquired basal, mid, and apical segments based on LV long‐axis length) end‐diastolic (EDV) and end‐systolic volumes (ESV), LV long‐axis length, and sphericity index were obtained. Results: Global and regional EDV and ESV (indexed to body weight) were most prominently increased in dogs with severe MMVD. All 3 regional LV segments contributed to increased global EDV and ESV with increasing MMVD severity, but mid‐EDV contributed the most to the global EDV increase. Furthermore, LV long‐axis length and LV sphericity index increased with increasing MMVD severity. Basal and apical EDV segments displayed the strongest association with sphericity index (P < .0001). Conclusions and Clinical Importance: The most prominent LV volume expansion was found in dogs with severe MMVD. Increased EDV, primarily in the mid‐segment, leads to rounding of LV apical and basal segments in response to increasing MMVD severity. Assessment of LV volume and shape potentially could allow early detection of dogs at risk for rapid progression into congestive heart failure. 相似文献
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Adrian Boswood Sonya G. Gordon Jens Häggström Martin Vanselow Gerhard Wess Rebecca L. Stepien Mark A. Oyama Bruce W. Keene John Bonagura Kristin A. MacDonald Mark Patteson Sarah Smith Philip R. Fox Karen Sanderson Richard Woolley Viktor Szatmári Pierre Menaut Whitney M. Church M. Lynne O'Sullivan Jean-Philippe Jaudon Jan-Gerd Kresken John Rush Kirstie A. Barrett Steven L. Rosenthal Ashley B. Saunders Ingrid Ljungvall Michael Deinert Eric Bomassi Amara H. Estrada Maria J. Fernandez Del Palacio N. Sydney Moise Jonathan A. Abbott Yoko Fujii Alan Spier Michael W. Luethy Roberto A. Santilli Masami Uechi Anna Tidholm Christoph Schummer Philip Watson 《Journal of veterinary internal medicine / American College of Veterinary Internal Medicine》2020,34(3):1108-1118
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Prognostic value of echocardiographic indices of left atrial morphology and function in dogs with myxomatous mitral valve disease 下载免费PDF全文
Marco Baron Toaldo Giovanni Romito Carlo Guglielmini Alessia Diana Nazzareno G. Pelle Barbara Contiero Mario Cipone 《Journal of veterinary internal medicine / American College of Veterinary Internal Medicine》2018,32(3):914-921
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D. Caivano M. Rishniw F. Birettoni V. Patata M.E. Giorgi F. Porciello 《Journal of Veterinary Cardiology》2018,20(2):102-114
Introduction
Left atrial (LA) function can provide useful information in dogs with myxomatous mitral valve disease (MMVD). Recently, we have demonstrated the feasibility of measuring LA longitudinal deformation using speckle-tracking echocardiography (STE) to estimate LA function in healthy dogs. Whether LA strain and strain rate variables provide additional information about LA function and clinical cardiac status in dogs with MMVD remains unexplored.Animals
Ninety-six client-owned dogs of different breeds with MMVD were prospectively enrolled.Methods
LA longitudinal deformation was evaluated in each dog by STE and different STE variables were used to assess LA function.Results
No STE variables differed between American College of Veterinary Internal Medicine Stage B1 and B2 dogs but were lower in Stage C dogs. Peak atrial longitudinal average strain < 27.9%, left-atrial-to-aortic ratio > 2.2 and peak atrial contraction average strain < 7.25% discriminated symptomatic MMVD dogs by receiver operating characteristic analysis with sensitivity and specificity of 100% and 100% (95% confidence interval [CI] 91–100%), 92% (95% CI 78–98%) and 98% (95% CI 87–100%), 100% (95% CI 91–100%) and 95% (95% CI 83–99%), respectively. In 12 dogs with similar left-atrial-to-aortic ratio, peak atrial longitudinal average strain and peak atrial contraction average strain differentiated dogs with subclinical disease from those with congestive heart failure (CHF).Conclusion
Dogs with MMVD in CHF appear to have lower LA longitudinal strain and strain rate variables compared with dogs with subclinical disease. Further studies are needed to establish if our initial findings can provide useful information for the diagnosis, treatment, and prognosis of dogs with MMVD. 相似文献17.
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Kittleson MD Brown WA 《Journal of veterinary internal medicine / American College of Veterinary Internal Medicine》2003,17(1):84-88
Previous studies have demonstrated that regurgitant fraction can be measured by using the proximal isovelocity surface area (PISA) method. For this study, we utilized this Doppler echocardiographic method to estimate the magnitude of mitral regurgitation in dogs with myxomatous mitral valve disease. Seventeen older, small dogs with chronic mitral regurgitation and no to mild myocardial failure were studied. A blinded observer judged the clinical severity of mitral regurgitation to be mild, moderate, or severe by using echocardiographic assessment of left heart size. The regurgitant fraction was calculated by using the PISA method and spectral Doppler echocardiography. The regurgitant fraction was compared to the clinical assessment of severity for each dog and to calculations of left atrial size. Five dogs had clinically mild mitral regurgitation. Four of these dogs had a regurgitant fraction between 22 and 41%, whereas 1 had a regurgitant fraction of 73%. The 3 dogs with clinical evidence of moderate mitral regurgitation had a regurgitant fraction of 46-65%. All 9 dogs with clinically severe mitral regurgitation had a regurgitant fraction greater than 75% (78-88%). The regurgitant fraction was statistically different between each group (P < .001). A good but curvilinear relationship was found between left atrial size and regurgitant fraction (r2 = 0.72). In this study, dogs with clinically severe mitral regurgitation consistently had hemodynamically severe regurgitation (regurgitant fraction > 75%), whereas dogs with clinically mild to moderate disease had lesser degrees of regurgitation. Good correlation was found between regurgitant fraction and left atrial size. We conclude that the major determinant of left atrial size and disease severity in dogs with mitrial regurgitation is the degree of mitral regurgitation. 相似文献
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Associations between thoracic radiographic changes and severity of pulmonary arterial hypertension diagnosed in 60 dogs via Doppler echocardiography: A retrospective study 下载免费PDF全文
Dustin S. Adams Angela J. Marolf Alejandro Valdés‐Martínez Elissa K. Randall Annette M. Bachand 《Veterinary radiology & ultrasound》2017,58(4):454-462
Doppler echocardiography is a noninvasive method for estimating and grading pulmonary arterial hypertension. No current literature associates significance of radiographic findings with severity of pulmonary arterial hypertension. We hypothesized that the number and conspicuity of radiographic findings suggestive of pulmonary arterial hypertension would be greater based on the severity of pulmonary arterial hypertension. Dogs with pulmonary arterial hypertension and normal control dogs were included in this retrospective, case control study. Three radiologists blinded to echocardiographic results scored thoracic radiographs for right ventricular and main pulmonary artery enlargement and pulmonary lobar artery enlargement, tortuosity, and blunting by multiple methods. Presence or absence of each finding was scored in an additive fashion and averaged for each grade of pulmonary arterial hypertension severity. Seventy‐one dogs (60 dogs with pulmonary arterial hypertension and 11 control dogs) of which some had multiple studies were included: 20 mild, 21 moderate, 25 severe, and 11 absent pulmonary arterial hypertension. The following radiographic findings were significantly associated with increasing pulmonary arterial hypertension severity: right ventricular enlargement by “reverse D” and “3/5–2/5 cardiac ratio” methods, main pulmonary artery enlargement, and caudal lobar artery enlargement by the “3rd rib” method. Mean scores for severe pulmonary arterial hypertension and normal dogs were significantly different (P‐value < 0.0001). Mean scores between different pulmonary arterial hypertension grades increased with severity but were not statistically significant. Individually and in combination, radiographic findings performed poorly in differentiating severity of pulmonary arterial hypertension. Findings indicated that thoracic radiographs should be utilized in conjunction with Doppler echocardiography in a complete diagnostic work‐up for dogs with suspected pulmonary arterial hypertension. 相似文献
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IntroductionFew studies have evaluated the utility of echocardiographic indices of right ventricular (RV) function in predicting prognosis in dogs with myxomatous mitral valve disease (MMVD).AnimalsSixty-seven client-owned dogs were diagnosed with MMVD.Materials and methodsclinical cohort study. Dogs diagnosed with American college of veterinary internal medicine (ACVIM) stage B2, C or D between April 2014 and March 2017 were enrolled. Long-term outcomes were assessed by telephone or from the medical record. The primary end-point was defined as cardiac-related death. Echocardiographic indices of RV function, including the RV Tei index, free wall and septal RV longitudinal strain, were obtained. Univariable and multivariable Cox proportional hazard analyses were used to identify variables predictive of cardiac-related death.ResultsTwenty-four dogs died during the follow-up period. The median follow-up time was 482 days, and the median survival time for dogs with cardiac-related death was 230 days. For cardiac-related death, peak early diastolic mitral inflow velocity, ACVIM stage C or D, tricuspid regurgitation velocity, RV Tei index and RV end-diastolic area were predictors in univariable Cox proportional hazard analysis. In multivariable Cox proportional analysis adjusted for the left atrial to aorta ratio, peak early diastolic mitral inflow velocity and ACVIM stage, an increase in the Tei index by 0.1 increased the hazard ratio of cardiac-related death by 33% (95% confidence interval, 16–70%; P = 0.002).ConclusionsIn dogs with MMVD, RV dysfunction assessed by the Tei index is an independent predictor of cardiac-related death. 相似文献