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- Echocardiographic measures to evaluating progression in MMVD
Min-Suk Kim DVM, Jiyoung Kim DVM, MS, Min Woong Seo DVM, MS, and Chul Park DVM, PhD
Background
The study investigates the utility of the pulmonary-vein-to-pulmonary-artery ratio (PV:PA) in assessing the progression of myxomatous mitral valve degeneration (MMVD) in dogs. MMVD is the most prevalent cardiac disease in dogs, especially small breeds, older dogs, and females in North America. This disease often results in mitral regurgitation (MR), varying clinical presentations, and could lead to cardiogenic pulmonary edema or be a lifelong condition with minimal quality-of-life impact.
Methods
This retrospective study included 80 client-owned dogs, categorized based on the American College of Veterinary Internal Medicine (ACVIM) consensus guidelines into MMVD (n=65) and controls (n=15) from 2020 to 2023. The evaluation involved echocardiograms, thoracic radiographs, and several measurements to analyze the correlation between PV:PA and other cardiac indices. Statistical analyses utilized Spearman correlation and ROC curve analyses to evaluate PV:PA's diagnostic value.
Results
PV:PA showed significant differences across different stages of MMVD and controls, correlating with conventional cardiac indices like vertebral heart size and left atrium-to-aorta ratio. The ROC curve analysis indicated an area under the curve (AUC) of 0.83 and 0.81 for distinguishing between stages B1 and B2, and B2 and C, respectively, with specific cutoff values proposed for these stages.
Limitations
The study's limitations include its retrospective nature, potential bias due to overrepresentation of certain breeds (e.g., Maltese), and uncontrolled variables like the administration of treatments such as pimobendan and furosemide, which could affect cardiac parameters. Additionally, the study did not directly measure left atrial pressure, which could provide more direct insights into cardiac function.
Conclusions
The study concludes that PV:PA is a promising echocardiographic index for evaluating MMVD in dogs, effectively distinguishing between different disease stages and correlating well with other established cardiac indices. It offers a potentially valuable tool for clinical assessments, especially in stages where other indices might not yet show significant changes. Further prospective studies are encouraged to validate and refine the use of PV:PA in clinical settings.
Representative right-sided long-axis 4-chamber view 2-D echocardiographic images showing the trailing-edge to leading-edge diameters of the right pulmonary vein (PV; asterisk) and right pulmonary artery (PA; double asterisks) as measured in a retrospective study of 80 client-owned dogs that were either healthy (controls; A) or had myxomatous mitral valve degeneration (MMVD; B) between August 5, 2020, and July 19, 2023. PA and PV were measured at end systole, 1 frame before the mitral valve opens, or end of the T wave. When PV or PA were not visualized well, a modified view was used to measure a PV and PA diameter. In the modified view, the probe was moved forward parallel to the direction of the marker, and the sector width was narrowed to enhance the resolution.
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