Focused Cardiac Ultrasound to Detect Pre-capillary Pulmonary Hypertension

peer reviewedBackgroundEarly recognition of pre-capillary (PC) pulmonary hypertension (PH) benefits dogs, allowing earlier treatment and improving prognosis. The value of focused cardiac ultrasound (FCU) to diagnose PH and assess its severity has not been investigated yet.HypothesisA subjective 10-point FCU pulmonary hypertension score (PHS) allows diagnosis and assessment of severity of PCPH.AnimalsThis study involved fifty client-owned dogs.MethodsDogs, recruited between September 2017 and February 2020, were classified into four categories (no, mild, moderate, and severe PH; C1 to C4, respectively). C1 and C2, and C3 and C4 were regrouped as group 1 and group 2, respectively. A blinded general practitioner assessed four FCU cineloops. Five echocardiographic parameters were subjectively scored, resulting in a total score of 0–10. Non-parametric tests compared global scores between categories and groups. A receiver operating characteristic (ROC) curve determined the cutoff value to differentiate group 1 and group 2. A gray zone approach allowed diagnosing or excluding moderate to severe PH with 90% certitude.ResultsGlobal scores were significantly higher for C4 than for C1, C2, and C3. Global scores of G2 were significantly higher than G1. The ROC curve indicated a cutoff value of 5, discriminating group 1 from group 2 with a sensitivity of 77% and a specificity of 100%. A score of ≥5/10 allowed diagnosing moderate to severe PH with ≥90% certainty while a score of ≤2/10 excluded PH with ≥90% certainty.Conclusions and Clinical SignificanceModerate to severe PCPH can be accurately detected by non-cardiologists using a 10-point FCU PHS score

Left Ventricular Eccentricity Index for Assessment of Precapillary Pulmonary Hypertension in Dogs

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Mitral endocarditis secondary to Listeria monocytogenes in a dog

peer reviewedA Beauceron was evaluated for a 3-week history of unresponsive immune-mediated polyarthritis and meningitis. Physical examination revealed a previously unreported grade III/VI left apical systolic heart murmur. Based on the echocardiographic examination and blood culture, a diagnosis of mitral valve infective endocarditis secondary to Listeria monocytogenes was made. Despite extensive workup, no definitive primary focus of infection was identified in this case. The endocarditis was suspected to have triggered secondary immune-mediated polyarthritis and meningitis. The dog was treated with empirical antimicrobial combination therapy and immunosuppressives, and fully recovered from infection. No relapse was documented 5 months after discontinuation of treatment. Cardiomegaly secondary to persistent mitral regurgitation had developed. This is the first description of endocarditis secondary to L. monocytogenes in a dog

THORACIC AND CARDIAC POINT-OF-CARE ULTRASOUND FINDINGS IN DOGS WITH NECROPSY CONFIRMED PULMONARY THROMBOEMBOLISM

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The impact of chronic RV pressure overload on right and left heart morphology and function

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Association of decreased bodyweight-independent tricuspid annular plane systolic excursion (TAPSE) measured in M-mode with clinical signs of heart failure and cardiac death in dogs with pre-capillary pulmonary hypertension.

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Left ventricular eccentricity index to assess precapillary pulmonary hypertension in dogs.

peer reviewed[en] INTRODUCTION: Interventricular septal flattening, frequently present in pulmonary hypertension (PH) can be quantified by the left ventricular eccentricity index (EI) measured at end-diastole (EId), end-systole (EIs) and at maximal septal flattening (EIm). In humans, EI correlates with invasive pulmonary arterial pressure. The aim of this study was to evaluate if EI correlates with parameters of right heart remodeling (RHR) and if EI is a quantitative marker of PH in dogs. MATERIALS AND METHODS: Left ventricular eccentricity indices were retrospectively measured in four groups (no, mild, moderate and severe PH) with interpretable tricuspid and/or pulmonary regurgitation. RESULTS: Ninety-seven dogs were included, with no (n = 29), mild (n = 13), moderate (n = 25) and severe (n = 30) PH. The intra- and inter-observer variability for EI measurements ranged from 2 % to 11 %. All EI were significantly elevated in severe compared to no, mild and moderate PH (P < 0.0005). In the moderate group, EIs and EIm were higher compared to the no PH group (P < 0.01). Tricuspid and pulmonary regurgitation pressure gradients and RHR parameters correlated with EId, EIs and EIm in all groups. Optimal cut-off values discriminating moderate and severe PH from no and mild PH were 1.24 (Sensitivity (Se) 60 %; Specificity (Sp) 90 %) for EId, 1.34 (Se 67 %; Sp 95 %) for EIs and 1.37 (Se 76 %; Sp 83 %) for EIm. CONCLUSIONS: Left ventricular eccentricity indices are reproducible echocardiographic variables increasing with severity of PH. Dogs with moderate and severe PH can be discriminated from dogs with no or mild PH using EIs and EIm

Ratio of tricuspid annular plane systolic excursion on systolic pulmonary arterial pressure as a prognostic factor in canine pre-capillary pulmonary hypertension

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