Methods and reliability of echocardiographic assessment of left atrial size and mechanical function in horses

OBJECTIVE: To assess the feasibility, describe the techniques, and determine the reliability of transthoracic echocardiography for characterization of left atrial (LA) size and LA mechanical function in horses. ANIMALS: 6 healthy adult horses. PROCEDURES: Repeated echocardiographic examinations were performed independently by 2 observers in standing, unsedated horses by use of 2-dimensional echocardiography, pulsed-wave flow Doppler, and tissue Doppler imaging (TDI) techniques. Test reliability was determined by estimating measurement variability, within-day interobserver variability, and between-day inter- and intraobserver variability of all echocardiographic variables. Variability was expressed as the coefficient of variation (CV) and the absolute value below which the difference between 2 measurements will lie with 95% probability. RESULTS: Most echocardiographic variables of LA size had low overall variability (CV, < 15%). Among the 2-dimensional indices of LA mechanical function, area-based and volume-based ejection phase indices had moderate between-day variability (CV usually < 25%). Transmitral Doppler flow indices were characterized by low to high between-day variability (CV, 6% to 35%). The TDI wall motion velocities had high between-day variability (CV, > 25%), whereas most TDI-derived time intervals had low variability (CV, < 15%). CONCLUSIONS AND CLINICAL RELEVANCE: LA size and mechanical function can be reliably assessed in standing, unsedated horses by use of 2-dimensional echocardiography, transmitral blood flow velocity profiles, and analyses of LA wall motion by use of TDI. These results may provide useful recommendations for echocardiographic assessment of LA size and function in horses.     

TWO-DIMENSIONAL ECHOCARDIOGRAPHY IN THE NORMAL CAT

Two-dimensional echocardiography (2DE) and M-mode echocardiography were used to image the heart of 13 clinically healthy cats. Seven awake cats and six cats tranquilized with a combination of acetylpromazine and ketamine were studied. Six cats were studied by 2DE on 3 consecutive days to assess repeatability of the study. Long-axis and short-axis echocardiographic tomograms were obtained from the right parasternal location, and these images were used to determine internal cardiac dimensions, ventricular and septal wall thicknesses, repeatability of the study, and interobserver variability. Some but not all parameters were significantly (P < 0.05) related to body weight. Significant correlations (P <0.05) were found between measurements obtained by long-axis and by short-axis image planes. Comparison of parameters measured by 2DE and M-mode echocardiography demonstrated minimal differences between mean values. Repeatability of the 2DE study was good with 14 of 16 parameters having a mean percent error less than 10%. Interobserver variability was acceptable for some but not all parameters. The study indicates that repeatable 2DE tomograms can be obtained in the cat and that quantitation of cardiac anatomy is possible with this imaging technique.     

DOPPLER ECHOCARDIOGRAPHY IN THE DOG: MEASUREMENT VARIABILITY AND REPRODUCIBILITY

Serial Doppler echocardiographic examinations were carried out in random order on six boxer dogs, on 3 separate days, by two experienced Doppler echocardiographers, to assess measurement variability and reproducibility of 65 parameters. Large numbers of parameters exhibited significant differences for each of the categories of intraobserver, interobserver, interday and interoperator. The coefficients of variation for all parameters measured ranged from 5.03 to 46.43%, but most were less than 20%. In general, least variation was found for the intraobserver category, and the best reproducibility for M-mode and left ventricular volumetric data. The worst reproducibility was found for tricuspid inflow and pulmonary venous flow measurements. The results of this study suggest differences greater than 20% for serial scans must be achieved to document genuine change, although the specific data should be consulted. Furthermore, variability and reproducibility are improved if a single experienced operator/observer acquires and measures serial scans.     

Methods and Reliability of Tissue Doppler Imaging for Assessment of Left Ventricular Radial Wall Motion in Horses

Background: Noninvasive assessment of left ventricular (LV) function is incompletely studied in horses.
Objectives: The goals of this study were to investigate the feasibility, techniques, and reliability of tissue Doppler imaging (TDI) for characterization of LV radial wall motion in healthy horses.
Animals: Three Standardbreds, 3 Thoroughbreds; age 8–14 years; body weight 517–606 kg.
Methods: Repeated echocardiographic examinations were performed by 2 observers in unsedated horses using TDI. Test reliability was determined by estimating measurement variability, within-day interobserver variability, and between-day interobserver and intraobserver variability of all echocardiographic variables. Variability was expressed as coefficient of variation (CV) and the absolute value below which the difference between 2 measurements will lie with 95% probability.
Results: Assessment of LV radial wall motion by TDI was feasible in all horses. Measurement variabilities were very low (CV < 5%) to low (CV 5–15%) for most variables. Within-day interobserver variability as well as between-day interobserver and intraobserver variabilities were low to moderate (CV 16–25%) for most variables. All pulsed-wave TDI variables of systolic LV function showed very low to low variability, whereas some of the variables of LV diastolic and LA function showed moderate to high (CV > 25%) variability. Pulsed-wave TDI variables appeared more reliable than color TDI variables.
Conclusions and Clinical Importance: Measurement of TDI indices of LV function is feasible and reliable in adult Standardbred and Thoroughbred horses. The clinical relevance of LV function assessment by TDI remains to be determined.     

Use of tissue Doppler imaging to confirm the diagnosis of dilated cardiomyopathy in a dog with equivocal echocardiographic findings

A 1-year-old healthy female Great Dane was referred for an echocardiographic examination prior to anesthesia and surgical correction of prolapse of the right third eyelid gland. Findings of a physical examination were normal. Conventional 2-dimensional and M-mode echocardiography revealed equivocal findings of dilated cardiomyopathy (DCM). Conversely, tissue Doppler imaging revealed a dramatic decrease in systolic and early diastolic radial myocardial velocity gradients, which were related to a decrease in endocardial velocities. Four months later, the diagnosis of DCM was confirmed via conventional echocardiography. In dogs with equivocal conventional echocardiographic findings of DCM, severe myocardial alterations may be detected via tissue Doppler imaging and this technique may enable early diagnosis of radial myocardial dysfunction.     

SOURCES AND MAGNITUDE OF VARIATION OF ECHOCARDIOGRAPHIC MEASUREMENTS IN NORMAL STANDARDBRED HORSES

The purpose of this study was to assess the intraobserver variation of various echocardiographic measures in standardbred trotters. Serial echocardiographic examinations were carried out on eight standardbred mares by one ultrasonographer for 5 separate days. During each examination, five nonconsecutive cardiac cycles (frames) were recorded and an average obtained for each individual measure. Various echocardiographic measures were obtained by use of two-dimensional (2-D), M-mode, color flow Doppler and pulsed wave Doppler echocardiography. The total variation in the echocardiographic measurements was split into three levels: the variation between horses, the day-to-day variation within individual horses, and finally the variation within horse on the same day of examination (intercardiac cycle variation). The intraclass correlation coefficient (ICC) was calculated for each measure. The ICC represents the variability of the measurements because of differences between the horses. In general the 2-D, M-mode and color flow Doppler measures had higher ICC values (ICC from 0.63 to 0.95) than the pulsed wave Doppler measures (ICC from 0.24 to 0.46), and the former measures were more repeatable than the pulsed wave measures. Exceptions to that were left ventricular free wall in diastole, the pulmonary artery in systole and the left ventricular mass, which all had low repeatability (ICC from 0.22 to 0.49). The results were used to calculate the relative differences that must be detected to diagnose a statistically significant change between two measurements in an individual horse. Differences from 4.2% to 21.8% must be achieved to document significant changes between serial measurements. A general tendency is that the color flow and pulsed wave Doppler measures require a larger relative difference (11.4-21.8%) between the measures to point out statistically significant cardiac changes than the 2-D and M-mode measures (4.2-13.9%).     

Colour M-mode tissue Doppler imaging in healthy cats and cats with hypertrophic cardiomyopathy

OBJECTIVES: To determine whether decreased diastolic and systolic myocardial velocity gradient between the endocardium and the epicardium exist in the left ventricle of cats with hypertrophic cardiomyopathy. METHODS: Myocardial velocity gradient and mean myocardial velocities were measured by colour M-mode tissue Doppler imaging in the left ventricular free wall of 20 normal cats and 17 cats with hypertrophic cardiomyopathy. RESULTS: The peak myocardial velocity gradient (sec(-1)) during the first (E1) (5.71+/-1.75 versus 11.38+/-3.1, P<0.001) and second phase (E2) (3.09+/-1.53 versus 7.02+/-3.1, P=0.005) of early diastole and also the maximum early diastolic myocardial velocity gradient (Emax) (6.12+/-2.1 versus 10.76+/-3.2, P<0.001) were reduced in cats with hypertrophic cardiomyopathy compared with normal cats. Peak myocardial velocity gradient during early systole (Se) was lower in affected cats than in normal cats (6.26+/-2.08 versus 8.67+/-2.83, P=0.006). Affected cats had a lower peak mean myocardial velocities (mm/s) during the two isovolumic periods (IVRb and IVCb) compared with normal cats (2.97+/-6.76 versus 12.74+/-5.5 and 22.28+/-9.96 versus 38.65+/-10.1, P<0.001, respectively). CLINICAL SIGNIFICANCE: This study shows that hypertrophic cardiomyopathy cats have decreased myocardial velocity gradient during both diastole and systole and also altered myocardial motion during the two isovolumic periods. Myocardial velocity gradients recorded by colour M-mode tissue Doppler imaging can discriminate between the healthy and diseased myocardium.     

Intraobserver and interobserver repeatability of ocular biometric measurements obtained by means of B-mode ultrasonography in dogs

OBJECTIVE: To assess intra- and interobserver repeatability of ocular biometric measurements obtained by means of high-resolution B-mode ultrasonography in dogs. Animals-6 Beagles without ocular abnormalities. PROCEDURES: B-mode ultrasonography was performed bilaterally with a 10.5-MHz broadband compact linear array transducer. All measurements were made on 2 different occasions by 2 observers. The Bland-Altman method was used to assess agreement between measurements obtained by the 2 observers and between the 2 sets of measurements obtained by each observer. RESULTS: Intra- and interobserver repeatability was highest for larger measurements, such as depth of the eye and depth of the anterior chamber. When repeatability was examined, bias was significantly different from 0 for only a few measurements, but the percentage difference between observations was as high as 180% for some measurements. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that most measurements of intraocular distances and structures obtained by means of high-resolution B-mode ultrasonography have acceptable intra- and interobserver repeatability. However, the percentage difference between observations can be high for smaller measurements.     

TWO-DIMENSIONAL COLOR TISSUE DOPPLER IMAGING DETECTS MYOCARDIAL DYSFUNCTION BEFORE OCCURRENCE OF HYPERTROPHY IN A YOUNG MAINE COON CAT

A 20-month-old healthy male Maine Coon cat was referred for a cardiovascular evaluation. Physical examination and electrocardiogram were normal. The end-diastolic subaortic interventricular septal thickness (6 mm; reference range: < or = 6mm) and the mitral flow late diastolic velocity (0.89 m/s; reference range: 0.2-0.8m/s) were within the upper ranges. However, M-mode echocardiography did not reveal any sign of hypertrophic cardiomyopathy (HCM). Tissue Doppler imaging (TDI) identified a marked left ventricular free wall dysfunction characterized by decreased myocardial velocities in early diastole, increased myocardial velocities in late diastole and the presence of postsystolic contractions both at the base and the apex for the longitudinal motion. One year later, the diagnosis of HCM was confirmed by conventional echocardiography and the cat died suddenly 2 months later. This report demonstrates for the first time in spontaneous HCM the sensitivity of TDI for early diagnosis of myocardial dysfunction and suggests that TDI should form part of the screening techniques for early diagnosis of feline HCM.     

Tissue Doppler imaging and echo-Doppler findings associated with a mitral valve stenosis with an immobile posterior valve leaflet in a bull terrier

A mitral valve stenosis was diagnosed in a 2-year-old female Bull Terrier by use of two-dimensional (2-D) and M-mode echocardiography, colour-flow imaging and spectral Doppler examinations. Tissue Doppler Imaging was also performed to assess the segmental radial myocardial motion. The mitral valve stenosis was characterized by a decreased mitral orifice area/left ventricle area ratio (0.14), an increased early diastolic flow velocity (E wave = 1.9 m/s), a prolonged pressure half-time (106 ms) and a decreased E-F slope (4.5 cm/s) on pulsed-wave Doppler examination. This mitral stenosis was associated with an immobile posterior leaflet, as seen on 2-D and M-mode echocardiography. Immobility of the posterior mitral leaflet is considered to be a rare finding in humans and, to our knowledge, has not been precisely documented in dogs with mitral valve stenosis.     

Tissue Doppler Imaging and Two-Dimensional Speckle Tracking of Left Ventricular Function in Healthy Horses After Clenbuterol Application

The cardiac effects of high dosages of the ß²-adrenergic agent clenbuterol have been the focus of several histological, biochemical and echocardiographic studies in the past. Possible effects of a therapeutic dosage on myocardial contractility and velocities have not been evaluated using tissue Doppler imaging (TDI) and two-dimensional speckle tracking (2DST) in equine medicine. Twenty-five healthy horses were treated over 14 days with clenbuterol in a normal dosage (0.8 μg/kg every 12 hours). Before and after the treatment, an echocardiographic examination was performed using B-mode, M-mode, color flow Doppler, and tissue Doppler imaging (TDI). In all horses, the radial and circumferential myocardial functions were recorded in the right parasternal short-axis view (SAX). Pulsed-wave (PW) and color TDI were used for evaluation of peak and mean myocardial velocities; myocardial deformation was documented in 2DST. An improvement of diastolic function after clenbuterol treatment was demonstrated by a significant increase of the early diastolic radial wall motion velocity (E_m) in all myocardial sections except the right ventricular free wall (RVFW) in TDI, as well as an increase of the E/A quotient in the left ventricular free wall (LVFW) and the interventricular septum (IVS). Shortened time intervals, in particular in the LVFW and a tendency of increase of all deformation parameters showed improved relaxation characteristics of the cardiac muscle after treatment. The results can be interpreted as beginning physiologic cardiac hypertrophy due to clenbuterol treatment. No signs of increased rigidity or reduced compliance of the heart muscle could be found at the applied dosage. This study demonstrates the sensitivity of TDI and 2DST in equine cardiology to detect myocardial remodeling before the appearance of obvious findings in conventional echocardiographic techniques. This technique can be used to detect pharmacologic effects on myocardial function.     

DIASTOLIC MITRAL REGURGITATION DETECTED BY PULSED WAVE DOPPLER ECHOCARDIOGRAPHY AND COLOR FLOW DOPPLER MAPPING IN FIVE DOGS AND TWO CATS WITH SECOND- AND THIRD-DEGREE ATRIOVENTRICULAR BLOCK

M-mode echocardiography, color flow Doppler mapping, and pulsed wave Doppler echocardiography were used to characterize diastolic mitral regurgitation in five dogs and two cats with second- and third-degree atrioventricular block. Incomplete closure and partial reopening of the mitral valve following nonconducted P-waves were demonstrated by m-mode echocardiography. Low velocity reflux of blood into the left atrium after nonconducted P-waves was imaged by color-flow Doppler mapping and spectral Doppler echocardiography. Late diastolic mitral regurgitation was not observed in clinically normal control dogs or cats, but a low velocity, mid-diastolic flow reversal was detected in the dogs. This probably represented normal physiologic intravalvular flow. Diastolic mitral regurgitation is a common echocardiographic finding, in dogs and cats with, second- and third-degree atrioventricular block.     

M-MODE AND DOPPLER ECHOCARDIOGRAPHIC FINDINGS IN NORMAL FERRETS SEDATED WITH KETAMINE HYDROCHLORIDE AND MIDAZOLAM

M-mode and Doppler echocardiographic values were obtained from 30 normal adult ferrets (14 neutered females, 13 neutered males, 3 intact males) sedated with an intramuscular combination of ketamine hydrochloride and midazolam. Routine M-mode measurements of the left and right ventricle, left atrium (LA) and aorta (AO) and Doppler measurements of aortic and pulmonic outflow, and mitral inflow were recorded. The following values were calculated: LA:AO diameter, ratio of peak E: peak A wave velocity (E:A ratio) for mitral inflow, and stroke volume (SV), cardiac output (CO) and cardiac index (CI) for both pulmonary and aortic outflow tracts. Maximal aortic velocities (AOmax) and velocity-time integral values (AO VTI) were significantly less than corresponding pulmonary outflow tract values (PAmax, PA VTI) but there was no difference in calculated values for SV, CO or CI. Calculated CO values were in the range expected based on the size of the species. Difficulties in aligning the aortic outflow tract for Doppler imaging may make pulmonary outflow Doppler values more consistent for use in estimating volume flow in ferrets.     

Standardised imaging technique for guided M-mode and Doppler echocardiography in the horse.

Eighteen echocardiographic images useful for diagnostic imaging, M-mode echocardiography, and Doppler echocardiography of the equine heart were standardised by relating the position of the axial beam to various intracardiac landmarks. The transducer orientation required for each image was recorded in 14 adult horses by describing the degree of sector rotation and the orientation of the axial beam relative to the thorax. Repeatable images could be obtained within narrow limits of angulation and rotation for 14 of the 18 standardised images evaluated. Twenty-seven National Hunt horses were subsequently examined using this standardised technique. Selected cardiac dimensions were measured from two-dimensional and guided M-mode studies. Satisfactory results were achieved in 26 of the 27 horses. There was no linear correlation between any of the measured cardiac values and bodyweight. There was no significant difference between measurements taken from the left and the right hemithorax. Six horses were imaged on three consecutive days to assess the repeatability of the measurements. No significant difference was found between measurements obtained on different days. This study demonstrates a method for standardised echocardiographic evaluation of the equine heart that is repeatable, valuable for teaching techniques of equine echocardiography, applicable for diagnostic imaging and quantification of cardiac size, and useful for the evaluation of blood-flow patterns by Doppler ultrasound.     

The intra‐ and intertester repeatability of radiographic elbow incongruity grading is high in chondrodystrophic dog breeds

Elbow incongruity is a form of elbow dysplasia that causes osteoarthritis, pain, and lameness, and it is common in chondrodystrophic dog breeds. The objective of this retrospective secondary analysis study was to evaluate the intra‐ and interobserver repeatability of a novel radiographic incongruity grading system for assessing elbow incongruity in three chondrodystrophic dog breeds—the dachshund, Skye Terrier, and Glen of Imaal Terrier. We conducted an observer agreement study that included 220 mediolateral antebrachial radiographs from 110 dogs with the elbow in 90° flexion. The radiographs were independently assessed by three observers at three time points, using a four‐stepped grading scale. The proportion of agreement and Kappa coefficient were calculated. Both the intra‐ and interobserver proportions of agreement were substantial when three grades were required to be identical (.705‐.777 and .609, respectively), and almost perfect for two identical grades (.991‐1.000 and .991, respectively). Some differences in repeatability between breeds were noted; specifically, the intraobserver repeatability was higher in the dachshund, and the interobserver repeatability was lower in the Glen of Imaal Terrier. Our study showed that the radiographic imaging protocol and incongruity grading system have high repeatability when assessing elbow incongruity in chondrodystrophic dog breeds.     

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.     

Doppler ultrasonographic features of thoracic limb arteries in clinically normal horses

OBJECTIVES: To determine blood flow velocities and indices from spectral waveforms obtained by use of Doppler ultrasonography of thoracic limb arteries of horses and to assess interobserver and patient variability associated with the technique. ANIMALS: 9 clinically normal adult horses. PROCEDURE: Left thoracic limb arteries of 8 nonsedated horses were examined at 5 sites by use of pulsed-wave Doppler ultrasonography to determine a range of values for peak systolic, end diastolic, and mean velocities and resistive and pulsatility indices. Interobserver and patient variabilities were determined by 2 operators repeating similar measurements on 1 horse 8 times at weekly intervals. RESULTS: A range of values for each variable measured at the 5 selected sites was obtained. For each variable, strong positive correlations (R > or = 0.7) were detected for > 70% of the site-to-site comparisons made (excluding the coronary band). Among horses, resistive index varied least, whereas over time, mean velocity varied least. Waveform characteristics were consistent with resistive (n = 5) or nonresistive (4) patterns. In the single-horse experiment, waveform characteristics were consistent throughout the 8 weeks, and operator effects were not detected. CONCLUSIONS AND CLINICAL RELEVANCE: Doppler ultrasonography of no one site resulted in more reliable measurements of blood flow characteristics in thoracic limb arteries of horses. Mean velocity and resistive index were the least variable measurements made. Pulsed-wave Doppler ultrasonography may be a useful technique for evaluating diseases that alter normal thoracic limb arterial blood flow in horses.     

Evaluation of Right Ventricular Myocardial Function in Healthy Horses With Recurrent Airway Obstruction Using Tissue Doppler Imaging

It has been described in humans that chronic obstructive bronchitis leads to pathologic changes, especially in the right ventricular myocardium due to hypoxia, which can be assessed by tissue Doppler imaging (TDI). In our study, different TDI techniques, that is, pulsed-wave TDI and color TDI, were evaluated for applicability in different scan planes (apical long-axis view and short-axis view) for the analysis of right ventricular myocardial function in six healthy horses (control) and six horses affected with recurrent airway obstruction (RAO) (RAO group). Tissue Doppler imaging was applicable to all scan planes described. Myocardial movement directions in general and the absolute values of TDI parameters were assessable. Significantly reduced early diastolic filling velocities (E), elevated late diastolic filling velocities (A), thereby decreased E/A quotient, prolonged electromechanical coupling periods between electrocardiograph Q-wave and maximal velocities, and compensatory elevated systolic strain as well as diminished displacement could be observed in horses with RAO compared with the control group. To conclude, equine right ventricular myocardial function is assessable by TDI. Significant changes of right ventricular myocardial function could be demonstrated by TDI in horses with RAO compared with matched healthy controls. The hypothesis that RAO potentially leads to right ventricular dysfunction detectable by TDI before conventional echocardiography changes are evident is supported by this explorative study.     

An interobserver and intraobserver study of buccal mucosal bleeding time in Greyhounds

Two observers experienced with the buccal mucosal bleeding-time technique using a standardised device (Surgicutt) performed the test on 20 Greyhounds, to evaluate interobserver and intraobserver repeatability. The interobserver and intraobserver repeatability were both about 2 minutes. The results indicated that, for any two readings within a dog, the buccal mucosal bleeding time may differ by up to +/- 2 minutes. A single reading was accurate to within +/- 80 seconds. Sixty-one Greyhounds were used to establish a reference interval for the buccal mucosal bleeding time, and to assess the relationship between the buccal mucosal bleeding time and plasma von Willebrand factor concentration. The mean was 129.5 (SD 44.2) seconds. The reference interval was 53 to 235 seconds, which was slightly lower than non-greyhounds. No significant correlation (r=-0. 18, P=0.17) between the buccal mucosal bleeding time and plasma von Willebrand factor concentration was found in the 61 Greyhounds, where plasma von Willebrand factor concentration was in the range 29 to 160 Canine Units dL(-1).