Diagnostic value of echo-Doppler and tissue Doppler imaging in dogs with pulmonary arterial hypertension

BACKGROUND: Diagnosis of pulmonary arterial hypertension (PAH) relies on Doppler measurement of pulmonic and tricuspid regurgitation (TR). However, these are not always detectable. HYPOTHESIS: Tissue Doppler imaging (TDI), a novel noninvasive ultrasound technique, provides indirect but sensitive and specific assessment of elevated systolic pulmonary artery pressure (SPAP) in dogs. ANIMALS: One hundred and five dogs with TR. METHODS: Prospective observational study. Dogs were categorized as presenting normal (group 1, n = 45), mildly increased (group 2, n = 19), or moderately to severely increased (group 3, n = 41) SPAP, based on TR peak velocities (< 2.5, 2.5-3.0, and > 3.0 m/s, respectively). Ten quantitative echo-Doppler- and TDI-derived variables were assessed, including the main pulmonary arterial diameter to aortic diameter ratio, pulmonary flow acceleration time, and acceleration-to-ejection time ratio, the Tei index of right ventricular function, and 6 longitudinal basal right ventricular TDI variables. RESULTS: A significant correlation was observed between SPAP and each of the 10 tested variables (P < .05). Conventional echo-Doppler variables were less discriminating than the TDI for predicting increased SPAP. The combined systolic and diastolic right TDI index had the highest sensitivity and specificity (89% and 93% respectively, for a cutoff of 11.8 cm/s) and could discriminate between dogs in group 1 from dogs in group 2. CONCLUSIONS AND CLINICAL IMPORTANCE: TDI provided effective predictors of systolic PAH and demonstrated that both alterations in right-sided systolic and diastolic myocardial function can occur with mild increases in SPAP.     

Systolic and diastolic myocardial dysfunction in cats with hypertrophic cardiomyopathy or systemic hypertension

BACKGROUND: Hypertrophic cardiomyopathy (HCM) and chronic systemic hypertension (SHT) can both lead to left-ventricular hypertrophy (LVH) in cats. Assessment of LVH-associated myocardial dysfunction could provide new insights in the understanding of the pathophysiology of these diseases. HYPOTHESIS: Quantification of left-ventricular free-wall (LVFW) motion using tissue Doppler imaging (TDI) could permit differentiation of feline HCM from SHT-related LVH (LVH-SHT). ANIMALS: A total of 108 cats of different breeds were enrolled in this study: 35 cats with HCM, 17 with concentric LVH and SHT, and 56 healthy cats as a control group. METHODS: All cats were examined by conventional echocardiography and 2-dimensional color TDI. RESULTS: Radial and longitudinal diastolic LVFW velocities were similarly altered in cats with HCM and LVH-SHT, compared to controls. Systolic velocities were also lower in the groups with hypertrophy than in the controls, for longitudinal but not radial motion. To determine whether these diastolic and systolic alterations could also be observed in cats without LVFW hypertrophy, we performed a subgroup analysis in cats with a normal M-mode examination, that is, with only a localized subaortic interventricular septum hypertrophy. A significant radial and longitudinal diastolic dysfunction was still observed in both the HCM and LVH-SHT groups compared to controls, and systolic dysfunction was detected in the longitudinal motion. CONCLUSIONS: LVFW motion is similarly altered in cats with HCM and LVH-SHT. This dysfunction occurs independently of the presence of myocardial hypertrophy, demonstrating that TDI is capable of detecting systolic and diastolic segmental functional changes in nonhypertrophied wall segments in cats with HCM and SHT.     

Assessment of regional systolic and diastolic myocardial function using tissue Doppler and strain imaging in dogs with dilated cardiomyopathy

BACKGROUND: Tissue Doppler Imaging (TDI) or strain (St) imaging could provide sensitive indices for early detection and treatment follow-up of canine dilated cardiomyopathy (DCM). Analysis of TDI and St features in dogs with overt DCM is a prerequisite before using these new criteria in prospective screenings of predisposed families or in clinical trials. HYPOTHESIS: Radial and longitudinal right and left myocardial motion, assessed by TDI and St variables, is altered in dogs with DCM. ANIMALS: Case records for 26 dogs; 14 with DCM and 12 healthy controls of comparable age and weight were reviewed. METHODS: A retrospective analysis was conducted of conventional echocardiography, 2-dimensional color TDI, and St imaging data. RESULTS: The DCM group was characterized by decreases in radial and longitudinal systolic velocity gradients of the left ventricular free wall (LVFW), radial and longitudinal absolute values of peak systolic St of the LVFW, and longitudinal systolic right ventricular (RV) velocities (all P < .001 versus control) associated with longitudinal postsystolic contraction waves in 7/14 dogs. Early diastolic LVFW velocities also were decreased for longitudinal (P < .01) and radial (P < .05) motions. All radial LVFW, longitudinal basal LVFW, and RV systolic velocities were negatively correlated with heart rate (P < .01). CONCLUSIONS AND CLINICAL IMPORTANCE: LV contractility along both the short and long axes is impaired in dogs with spontaneous DCM, as is systolic RV and diastolic LVFW function. These myocardial alterations are associated with an inverse force-frequency relationship. Studies now are needed to determine the comparative sensitivity of TDI and St variables for the early detection of canine DCM.     

Tissue Doppler imaging and gradient echo cardiac magnetic resonance imaging in normal cats and cats with hypertrophic cardiomyopathy

Cats with hypertrophic cardiomyopathy (HCM) often develop diastolic dysfunction, which can lead to development of left congestive heart failure. Tissue Doppler imaging (TDI) echocardiography has emerged as a useful, noninvasive method for assessing diastolic function in cats. Cardiac magnetic resonance imaging (cMRI) has been performed in cats and accurately quantifies left ventricular (LV) mass in normal cats. However, assessment of cardiac function in cats by cMRI has not been performed. Six normal Domestic Shorthair cats and 7 Maine Coon cats with moderate to severe HCM were sedated, and TDI of the lateral mitral annulus was performed. Peak early diastolic velocity (Em) was measured from 5 nonconsecutive beats. Cats were anesthetized with propofol and electrocardiogram-gated gradient echo cMRI was performed during apnea after hyperventilation. Short-axis images of the LV extending from the mitral annulus to the apex were obtained throughout the cardiac cycle. LV mass at end systole and LV volumes throughout the cardiac cycle were quantified according to Simpson's rule. To assess the possible influence of propofol on diastolic function, TDI was performed on the 7 cats with HCM while sedated and then while anesthetized with propofol. Em was significantly lower in cats with HCM than normal cats (6.7 +/- 1.3 cm/s versus 11.6 +/- 1.9 cm/s, P < .001, respectively). There was no difference in the cMRI indices of diastolic function in normal and HCM cats. Propofol did not reduce diastolic function (Em) in cats with HCM but mildly reduced systolic myocardial velocity (S) in Maine Coon cats with HCM that were anesthetized with propofol (P = .87 and P = .03, respectively).     

Echocardiographic and radiographic changes associated with systemic hypertension in cats

The purpose of this study was to assess the effects of systemic hypertension (SHT) on echocardiographic and radiographic cardiovascular variables in affected cats compared with healthy geriatric cats. Secondary objectives were to determine whether there were any relationships between these findings and age or systolic blood pressure (SBP). Fifteen healthy cats (>8 years of age with normal SBP) and 15 hypertensive cats (SBP > 180 mm Hg) were studied. Each cat was evaluated for standard echocardiographic parameters and 4 different aortic root dimensions. Seventeen variables were measured from right lateral and dorsoventral radiographic views. Left ventricle wall thickness was greater in the SHT group (5.1 +/- 0.9 mm) than in the healthy cats (4.2 +/- 0.5 mm). Left ventricular hypertrophy in the SHT cats often was not severe, and mean measures were considered normal. Some cats had asymmetrical septal hypertrophy (ASH) in the basilar portion of the septum as determined from the 2-dimensional view of the left ventricular outflow tract. ASH was greater in cats with SHT. Comparisons of the proximal ascending aorta indicated the presence of dilatation in the SHT cats, and comparison of the ascending aorta to the aortic annulus was helpful in differentiating between the 2 groups. The distal aortic root measurements and ratios evaluated by echocardiography were significantly different between the 2 groups of cats (P = .0001) and were significantly correlated with SBP (P = .0001) but not age (P > .3).     

Doppler echocardiographic prediction of pulmonary hypertension in West Highland white terriers with chronic pulmonary disease

BACKGROUND: Pulmonary hypertension (PH) is commonly diagnosed by Doppler echocardiography (DE) of tricuspid regurgitation (TR). However, TR may be absent or difficult to measure. HYPOTHESIS: Doppler-derived systolic time intervals of pulmonary artery (PA) flow may be used to predict PH in dogs. ANIMALS: Seventy-three healthy dogs and 45 West Highland white terriers (WHWT) with interstitial pulmonary disease (IPD). METHODS: Echocardiographic studies, including determination of right ventricular acceleration time (AT), ejection time (ET), and AT : ET ratio; right ventricular shortening fraction (RV-SF); and TR velocity, were performed. Pulmonary hypertension was defined by TR >3.1 m/s. RESULTS: In healthy WHWT, AT (median, range) was 73 ms (53 to 104) and AT : ET was 0.40 (0.28 to 0.55). AT : ET was minimally affected by age (R2 = 0.04, 95% confidence interval [CI] 0.01-0.07, P < .001) but not by heart rate, body weight, or RV-SF. In all WHWT with TR, AT and AT : ET were inversely related to calculated systolic PA pressure (R2 = 0.52, 95% CI 0.42-0.62, P < .001 and R2 = 0.36, 95% CI 0.29-0.42, P = .001). Clinical cutoffs to predict systolic PH were defined for AT (58 ms; sensitivity [Se] 88% and specificity [Sp] 80%) and AT : ET (0.31; Se 73% and Sp 87%). CONCLUSION AND CLINICAL IMPORTANCE: PH is common in WHWT with IPD. Analysis of right ventricular AT and AT : ET may be predictive of PH and should be particularly useful if TR is absent.     

Noninvasive assessment of systolic left ventricular torsion by 2-dimensional speckle tracking imaging in the awake dog: repeatability, reproducibility, and comparison with tissue Doppler imaging variables

BACKGROUND: Left ventricular (LV) torsional deformation plays an important role in myocardial function. However, it has never been assessed in the awake dog, because magnetic resonance imaging and sonomicrometry have been the only methods available so far. HYPOTHESIS: Two dimensional speckle tracking echocardiography (STE), a new ultrasound imaging technique, provides a repeatable and reproducible noninvasive assessment of systolic LV wringing motion in the awake dog. ANIMALS: Six healthy dogs were used to determine the repeatability and reproducibility of STE variables (study 1). These variables also were prospectively assessed in a population of 35 healthy dogs (study 2). METHODS: Peak LV basal and apical systolic rotations were measured by STE from right parasternal short-axis views using automatic frame-to-frame tracking of gray-scale speckle patterns. Systolic LV torsion (LVtor, degrees ) was defined as apical rotation relative to the base. RESULTS: All within-day and between-day coefficients of variation were <20% (6.8-18.0%). Amplitude of apical systolic rotation was significantly higher (P < .001) than the basal value (5.4 +/- 3.2 degrees and -3.1 +/- 1.3 degrees , respectively). Global LVtor was significantly correlated with systolic longitudinal LV myocardial velocity gradient assessed by tissue Doppler (P < .05), but not with either systolic radial LV myocardial velocity gradient or the ratio of early mitral inflow velocity to early mitral annular velocity (Em/Ea). CONCLUSIONS AND CLINICAL IMPORTANCE: Speckle tracking echocardiography is a repeatable and reproducible method for assessing systolic LV torsional deformation. The combination of these new STE indices with tissue Doppler variables could provide a new approach for quantifying canine LV systolic function.     

Pulsed tissue Doppler imaging in normal cats and cats with hypertrophic cardiomyopathy

Myocardial motion was quantified in normal cats (n = 25) and cats with hypertrophic cardiomyopathy (HCM) (n = 23) using the pulsed tissue Doppler imaging (TDI) technique. A physiologic nonuniformity was documented in the myocardial motion of normal cats, which was detected as higher early diastolic velocities, acceleration, and deceleration in the interventricular septum compared with the left ventricular free wall (LVFW). HCM cats exhibited lower early diastolic velocities, acceleration, and deceleration and also prolonged isovolumic relaxation time compared with normal cats. These differences were detected mainly along the longitudinal axis of the heart. A cutoff value of E' in the LVFW along the longitudinal axis >7.2 cm/s discriminated normal from HCM cats with a sensitivity of 92% and a specificity of 87%. The physiologic nonuniformity of myocardial motion during diastole was lost in affected cats. Systolic impairment (decreased late-systolic velocities in most segments along the longitudinal axis and decreased early systolic acceleration in both mitral annular sites) was evident in HCM cats irrespective of the presence of left ventricular outflow tract obstruction and congestive heart failure. Postsystolic thickening was recorded in the LVFW along the longitudinal axis only in affected cats (n = 6) and was another finding indicative of systolic impairment in the HCM of this species. This study identified both diastolic and systolic impairment in cats with HCM compared with normal cats. The study also documents the normal physiologic nonhomogeneity in myocardial motion in cats and the subsequent loss of this feature in the HCM diseased state.     

Tissue Doppler imaging in Maine Coon cats with a mutation of myosin binding protein C with or without hypertrophy

BACKGROUND: The cardiac myosin binding protein C gene is mutated in Maine Coon (MC) cats with familial hypertrophic cardiomyopathy. HYPOTHESES: Early diastolic mitral annular velocity is incrementally reduced from normal cats to MC cats with only an abnormal genotype to MC cats with abnormal genotype and hypertrophy. ANIMALS: Group 1 consisted of 6 normal domestic shorthair cats, group 2 of 6 MC cats with abnormal genotype but no hypertrophy, and group 3 of 15 MC cats with hypertrophy and abnormal genotype. METHODS: The genotype and echocardiographic phenotype of cats were determined, and the cats were divided into the 3 groups. Tissue Doppler imaging (TDI) of the lateral mitral annulus from the left apical 4-chamber view was performed. Five nonconsecutive measurements of early diastolic mitral annular velocity (EM) or summated early and late diastolic velocity (EAsum) and heart rate were averaged. RESULTS: There was an ordered reduction in Em-EAsum as group number increased (group 1, range 9.7-14.7 cm/s; group 2, range 7.5-13.2 cm/s; group 3, range 4.5-14.1 cm/s; P = .001). Using the lower prediction limit for normal Em-EAsum, the proportion of cats with normal Em-EAsum decreased as the group number increased (P = .001). However, Em-EAsum was reduced in only 3 of 6 cats in group 2. CONCLUSION: The incremental reduction of Em-EAsum as group severity increased indicates that diastolic dysfunction is an early abnormality that occurs before hypertrophy development. TDI measurement of Em or EAsum of the lateral mitral annulus is an insensitive screening test for identification of phenotypically normal, genotypically affected cats.     

Peak mean myocardial velocities and velocity gradients measured by color M-mode tissue Doppler imaging in healthy cats

We sought to assess the feasibility of recording the myocardial velocity gradients (MVGs) and mean myocardial velocities (MMVs) measured by color M-mode tissue Doppler imaging (TDI) in the free wall of unsedated normal cats (n = 18) with a 7.4-MHz probe equipped to record TDI images. The peak MVG and MMV values during the different phases of the cardiac cycle corresponded to certain color velocity patterns occurring in the left ventricular free wall (LVFW). Biphasic shifts were recorded in the tracings of both the MVG and MMV during early diastole (E1 and E2) as well as during the isovolumic relaxation (IVR) and isovolumic contraction (IVC) phases. Stepwise regression analysis showed that age was the only significant predictor for the peak MVG values during the 2nd phase of early diastole (E2) (r = -0.79, r2 = 0.63, and P < .001). The peak late diastolic MVG values were associated positively with age (r = 0.50, r2 = 0.25, and P < .05). The peak MMV values showed a negative association with age during E2 (r = -0.71, r2 = 0.50, and P < .001) as well as during early systole (Se) (r = -0.55, r2 = 0.30, and P < .05) and late systole (SI) (r = -0.62, r2 = 0.39, and P < .01). A positive association was found between age and the peak MMV values during late diastole (r = 0.54, r2 =- 0.29, and P < .05). The MVG values showed cyclic variations consistent with wall thickness changes. The accuracy of velocity determination and the spatial resolution of the system used were validated with a phantom. To our knowledge, this study is the 1st report of the application of this technique to the myocardium of cats,providing insights into the physiology of myocardial motion. It provides reference ranges of the peak MVG and MMV values for future studies of feline myocardial diseases.     

Assessment of left atrial appendage flow velocity and its relation to spontaneous echocardiographic contrast in 89 cats with myocardial disease

The hypotheses of this prospective study were that (1) left atrial appendage (LAA) blood flow velocities can be recorded in cats with myocardial disease by transthoracic Doppler echocardiography, (2) LA enlargement, LA mechanical dysfunction, and left ventricular (LV) diastolic abnormalities are associated with decreased LAA flow velocities, and (3) low LAA flow velocities predict the appearance of spontaneous echocardiographic contrast in cats with cardiomyopathy. Transthoracic 2-dimensional, M-mode, and Doppler echocardiographic studies were performed in 89 cats with hypertrophic, restrictive, dilated, or unclassified cardiomyopathy or with hyperthyroid heart disease. Maximal LAA flow velocity (LAAmax) was decreased (P < .001) in cats with cardiomyopathy (median, 0.28 m/s; range, 0.08-1.35) compared to normal cats. Associated with decreased LAA flow velocities were increased LA size, decreased LA function, increased severity of LV diastolic dysfunction, and the presence of congestive heart failure. Multivariate logistic regression analysis detected an LAAmax <0.20 m/s as the only independent variable to predict LA spontaneous echocardiographic contrast (odds ratio, 30.1; 95% confidence interval [CI], 4.1 222.3; P < .001). Receiver operating characteristic analysis performed to predict spontaneous echocardiographic contrast indicated an area under the curve of 0.88 (95% CI, 0.80-0.95; P < .001) with sensitivities of 100 and 74% and specificities of 69 and 83% for LAAmax <0.25 and <0.20 m/s, respectively. Thus, low LAA flow velocities identified a subgroup of patients at increased risk of spontaneous echocardiographic contrast and possible thromboembolism. These findings may have important clinical implications for anticoagulation therapy and prognostication in cats with cardiomyopathy.     

Left ventricular radial colour and longitudinal pulsed-wave tissue Doppler echocardiography in 39 healthy domestic pet rabbits

This paper reports radial colour and longitudinal mitral annulus pulsed-wave tissue Doppler findings in a large cohort of healthy, adult pet rabbits. Thirty-nine rabbits (22 Dwarf Lops, 14 French Lops and three Alaskans) underwent conscious echocardiography. The median age of the rabbits was 22 months and the median weight was 2.8 kg (Dwarf Lop 2.4 kg/French Lop 6.0 kg). Adequate radial colour and longitudinal pulsed-wave tissue Doppler traces were obtained in 100% and 85% of cases, respectively. Most systolic tissue Doppler parameters were significantly higher in French Lops than in Dwarf Lops. Separation of mitral inflow diastolic waves was present in 40% of cases using conventional spectral Doppler and in >60% of cases using pulsed-wave tissue Doppler which could be beneficial when evaluating diastolic function in rabbits. This study can be used as a reference for normal echocardiographic tissue Doppler values for adult rabbits undergoing conscious echocardiography in clinical practice.     

Quantification of pulmonary to systemic flow ratio by a Doppler echocardiographic method in the normal dog: Repeatability, reproducibility, and reference ranges

Objective

To determine if the pulmonary to systemic flow ratio (Qp/Qs) could be assessed in healthy awake dogs using Doppler echocardiography.

Background

Qp/Qs could provide reliable information in assessing the severity of intracardiac shunts (ICS) by quantifying pulmonary overcirculation. Qp/Qs has been validated against electromagnetic flowmeter methods in experimental canine models. However, its clinical applicability in awake dogs has never been assessed.

Animals, materials and methods

Six healthy dogs were used to determine the repeatability and reproducibility of the technique (Study 1); Qp/Qs was then prospectively assessed in 50 healthy dogs (Study 2). In both studies Qp/Qs was calculated in awake animals using a standardized Doppler echocardiographic method.

Results

Within- and between-day coefficients of variation for Qp/Qs were <10% (Study 1). For Study 2, a relatively wide range of Qp/Qs was found (reference range = 0.71-1.29; mean ± SD = 1.00 ± 0.15).

Conclusions

Qp/Qs can be assessed with good repeatability and reproducibility in healthy dogs. However, the wide range of Qp/Qs obtained in the healthy population may suggest a limited usefulness of this variable for accurately assessing ICS severity in diseased animals. This needs to be assessed in further prospective and longitudinal studies including a large number of animals with ICS of various grades.     

Tissue Doppler imaging for detection of radial and longitudinal myocardial dysfunction in a family of cats affected by dystrophin-deficient hypertrophic muscular dystrophy

Diagnosis of feline hypertrophic cardiomyopathy currently is based on the presence of myocardial hypertrophy detected using conventional echocardiography. The accuracy of tissue Doppler imaging (TDI) for earlier detection of the disease has never been described. The objective of this sudy was to quantify left ventricular free wall (LVFW) velocities in cats with hypertrophic muscular dystrophy (HFMD) during preclinical cardiomyopathy using TDI. The study animals included 22 healthy controls and 7 cats belonging to a family of cats with HFMD (2 affected adult males, 2 heterozygous adult females, one 2.5-month-old affected male kitten, and 2 phenotypically normal female kittens from the same litter). All cats were examined via conventional echocardiography and 2-dimensional color TDI. No LVFW hypertrophy was detected in the 2 carriers or in the affected kitten when using conventional echocardiography and histologic examination, respectively. The LVFW also was normal for 1 affected male and at the upper limit of normal for the 2nd male. Conversely, LVFW dysfunction was detected in all affected and carrier cats with HFMD when using TDI. TDI consistently detects LVFW dysfunction in cats with HFMD despite the absence of myocardial hypertrophy. Therefore, TDI appears more sensitive than conventional echocardiography in detecting regional myocardial abnormalities.     

Echocardiographic measurement of cardiac valvular thickness in healthy cows,cows with bacterial endocarditis,and cows with cardiorespiratory diseases

ObjectiveTo determine valvular thickness in healthy cows, cows with bacterial endocarditis, and cows with various cardiorespiratory diseases.Animals40 healthy Holstein adult cows (CONTROL), 6 adult cows with confirmed bacterial endocarditis (BE), and 10 cows with other cardiorespiratory disorders (NONBE).MethodsProspective study using right transthoracic echocardiographic examination in CONTROL, BE and NONBE cows. The valvular thicknesses of all cows were assessed in four different locations for all cardiac valves, and the maximal value was used for further analysis.ResultsThe mean [±standard deviation (SD)] maximal thicknesses of the tricuspid, mitral, aortic, and pulmonary valves in the CONTROL group were 0.69 ± 0.10 cm, 0.85 ± 0.21 cm, 0.72 ± 0.17 cm, and 0.58 ± 0.12 cm, respectively. The maximal valvular thicknesses were less than 0.97 cm for the tricuspid, less than 0.91 cm for pulmonary, less than 1.05 cm for the aortic, and less than 1.28 cm for the mitral. In BE cows, the maximal valvular thickness of affected valves (median: 4.22 cm; range: 2.52–6.97 cm) and non affected valves (median: 0.75 cm; range: 0.45–1.52 cm) were significantly different (P = 0.0004). The maximal valvular thicknesses of the NONBE valves as well as the unaffected valves in the BE group were not significantly different compared to the CONTROL group valves.ConclusionsUsing the mean ± 2SD formula for each valve in healthy cows, a thickness of tricuspid, mitral, aortic or pulmonary valves greater than 0.85 cm, 1.27 cm, 1.06 cm or 0.82 cm respectively should raise the suspicion of valvular bacterial endocarditis.     

Echocardiographic evaluation including tissue Doppler imaging in New Zealand white rabbits sedated with ketamine and midazolam

Limited data are available on the use of more recent echocardiographic parameters in the rabbit. Echocardiographic examination, including conventional echocardiography and tissue Doppler imaging (TDI), was performed on 26 male New Zealand white rabbits under ketamine–midazolam sedation. Particular emphasis was placed on the more recent systolic and diastolic parameters, such as myocardial performance index (Tei index) and mitral annular motion (from septal and lateral sides of the left ventricle) obtained using pulsed TDI.Parameters that assessed systolic and diastolic function (fractional shortening, Tei index, and maximal mitral E- and A-wave velocities) were comparable to those reported in the literature for rabbits in the awake state. The less cardiodepressive anaesthetic protocol could offer a good alternative in performing echocardiographic evaluation whenever such caution is necessary. TDI is feasible in healthy rabbits and potentially suitable for the investigation of left ventricle systolic and diastolic function.     

Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats

Consensus Statements of the American College of Veterinary Internal Medicine (ACVIM) provide veterinarians with guidelines regarding the pathophysiology, diagnosis, or treatment of animal diseases. The foundation of the Consensus Statement is evidence-based medicine, but if such evidence is conflicting or lacking, the panel provides interpretive recommendations on the basis of their collective expertise. The Consensus Statement is intended to be a guide for veterinarians, but it is not a statement of standard of care or a substitute for clinical judgment. Topics of statements and panel members to draft the statements are selected by the Board of Regents with input from the general membership. A draft prepared and input from Diplomates is solicited at the ACVIM Forum and via the ACVIM Web site and incorporated in a final version. This Consensus Statement was approved by the Board of Regents of the ACVIM before publication.