Radiographic lung congestion scores in dogs with acute congestive heart failure caused by myxomatous mitral valve disease

Liza Koster, Jenna Vogel, Cary M. Springer, Silke Hecht 

Background: The page is a scientific article published in the Journal of Veterinary Internal Medicine in 2023. It is about the use of a modified lung congestion score (LCS) to assess the severity and prognosis of dogs with acute congestive heart failure (CHF) caused by myxomatous mitral valve disease (MMVD).

Study: The study was a retrospective analysis of 35 dogs that were hospitalized at the University of Tennessee College of Veterinary Medicine (UTCVM) with a diagnosis of acute CHF secondary to MMVD. The authors aimed to describe the distribution of the lung edema pattern, and to determine if there was a significant association between the LCS and time until recurrence or death.

Methods: The authors used a modified LCS that assigned a score from 0 to 3 for each of the six lung lobes based on the presence and degree of lung infiltrates on thoracic radiographs. The LCS was then corrected for the number of lobes that could be visualized. The authors also collected data on the dogs’ signalment, weight, echocardiographic variables, furosemide administration, and outcome. They used descriptive statistics, correlations, and t-tests to analyze the data.

Results: The mean corrected LCS was 0.48 (SD 0.19). The most common pattern of lung edema was symmetric (40% of dogs) and focal (caudal) but more commonly right-sided when asymmetric (40% vs 20%). The median number of days after initial diagnosis of acute CHF to readmission and death was 150 days (range 4-572) and 266 days (range 5-965), respectively. No significant association between the corrected LCS and time until recurrence or death was found. There was a negative significant correlation between the time interval of furosemide administration and corrected LCS. No association was found between the corrected LCS and echocardiographic variables.

Limitations: The study had several limitations, such as the small sample size, the retrospective design, the lack of standardized care and follow-up, the variation in the timing of radiographs and furosemide administration, the subjectivity of the LCS, and the possibility of misclassification of dogs with non-cardiogenic edema or comorbidities.

Conclusions: The authors concluded that the modified LCS did not have prognostic value in predicting outcome in dogs with acute CHF because of MMVD. They suggested that thoracic radiographs might not be able to accurately estimate lung fluid content and severity of lung edema in dogs. They recommended further studies to compare the utility of different diagnostic modalities, such as lung ultrasound, biomarkers, and clinical examination, in assessing lung congestion and guiding therapy in dogs with CHF.

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