Journal of Biomedical and Translational Research

Research Institute of Veterinary Medicine Chungbuk National University (충북대학교 동물의학연구소)
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Echocardiographic evaluation of heart failure in dogs with myxomatous mitral valve disease: a retrospective study

  • Han, Donghyun (Center of the Heart Clinic, Jukjeon Animal Medical Center) ;
  • Lee, Dong-Guk (Center of the Heart Clinic, Jukjeon Animal Medical Center) ;
  • Jung, Dong-In (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University)
  • Received : 2018.11.20
  • Accepted : 2018.12.10
  • Published : 2018.12.31
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Abstract

Echocardiography is one of the most useful diagnostic techniques for differentiating heart disease as well as mitral valve lesion. Forty client-owned small breed dogs (weight, 2.3-13.2 kg) aged between 8-17 years with myxomatous mitral valve degeneration (MMVD) were included in the present study. The diagnosis of MMVD in dogs was made based on the clinical signs, chest radiography data, and echocardiographic findings. Echocardiographic examinations were conducted in accordance with recommended standards for dogs. M-mode, Doppler, and 2D echocardiography were performed in left and right lateral recumbency. 2D echocardiography was used to measure LA and Ao diameter from 2D short axis at the level of the aortic valve. In the comparison of conventional echocardiography indices in dogs with different stages of heart failure with MMVD, significant differences were observed in E/A ratio (p=0.005), EDV (p<0.001), EDVI (p<0.001), E-peak velocity (p= 0.001), ESV (p=0.028), ESVI (p=0.004), LA (p<0.001), LA/Ao Ratio (p<0.001), LVIDd (p<0.001), LVIDd/Ao Ratio (p<0.001), LVIDs (p=0.036), LVIDs/Ao Ratio (p=0.002), and MR Velocity (p=0.026). In addition, distinct correlations were found in EDV (r=0.712), LA/Ao ration (r=0.830), LVIDd (r=0.724), and LVIDd/Ao ratio (r=0.759). This study found that known conventional echocardiographic indices, including EDV, LA/Ao ratio, LVIDd dimension, and LVIDd/Ao ratio correlated with the severity of MMVD in point of significant differences and distinct correlations.

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References

  1. Boon JA. Acquired heart disease: mitral insufficiency. In: Boon JA (ed.). Manual of veterinary echocardiography. Baltimore: Williams & Wilkins; 1998. p. 261-286.
  2. Gouni V, Serres FJ, Pouchelon JL, Tissier R, Lefebvre HP, Nicolle AP, Sampedrano CC, Chetboul V. Quantification of mitral valve regurgitation in dogs with degenerative mitral valve disease by use of the proximal isovelocity surface area method. J Am Vet Med Assoc 2007;231:399-406. https://doi.org/10.2460/javma.231.3.399
  3. Kittleson MD, Brown WA. Regurgitant fraction measured by using the proximal isovelocity surface area method in dogs with chronic myxomatous mitral valve disease. J Vet Intern Med 2003;17:84-88. https://doi.org/10.1111/j.1939-1676.2003.tb01327.x
  4. Muzzi RA, de Araujo RB, Muzzi LA, Pena JL, Silva EF. Regurgitant jet area by Doppler color flow mapping: quantitative assessment of mitral regurgitation severity in dogs. J Vet Cardiol 2003;5:33-38. https://doi.org/10.1016/S1760-2734(06)70050-9
  5. Bonagura JD, Schober KE. Can ventricular function be assessed by echocardiography in chronic canine mitral valve disease? J Small Anim Pract 2009;50:12-24. https://doi.org/10.1111/j.1748-5827.2009.00803.x
  6. Chiavegato D, Borgarelli M, D'Agnolo G, Santilli RA. Pulmonary hypertension in dogs with mitral regurgitation attributable to myxomatous valve disease. Vet Radiol Ultrasound 2009;50:253-258. https://doi.org/10.1111/j.1740-8261.2009.01529.x
  7. Serres F, Chetboul V, Tissier R, Poujol L, Gouni V, Carlos Sampedrano C, Pouchelon JL. Comparison of 3 ultrasound methods for quantifying left ventricular systolic function: correlation with disease severity and prognostic value in dogs with mitral valve disease. J Vet Intern Med 2008;22:566-577. https://doi.org/10.1111/j.1939-1676.2008.0097.x
  8. Serres FJ, Chetboul V, Tissier R, Carlos Sampedrano C, Gouni V, Nicolle AP, Pouchelon JL. Doppler echocardiography-derived evidence of pulmonary arterial hypertension in dogs with degenerative mitral valve disease: 86 cases (2001-2005). J Am Vet Med Assoc 2006; 229:1772-1778. https://doi.org/10.2460/javma.229.11.1772
  9. Stepien RL. Pulmonary arterial hypertension secondary to chronic left-sided cardiac dysfunction in dogs. J Small Anim Pract 2009;50:34-43. https://doi.org/10.1111/j.1748-5827.2009.00802.x
  10. Bonagura JD, Herring DS. Echocardiography. Acquired heart disease. Vet Clin North Am Small Anim Pract 1985;15:1209-1224. https://doi.org/10.1016/S0195-5616(85)50366-6
  11. Kvart C, Haggstrom J. Acquired valvular heart disease. In: Ettinger S, Feldman E (eds.). Textbook of veterinary internal medicine. 6th ed. Philadelphia: WB Saunders; 2005. p. 1022-1039.
  12. Terzo E, Di Marcello M, McAllister H, Glazier B, Lo Coco D, Locatelli C, Palermo V, Brambilla PG. Echocardiographic assessment of 537 dogs with mitral valve prolapse and leaflet involvement. Vet Radiol Ultrasound 2009;50:416-422. https://doi.org/10.1111/j.1740-8261.2009.01559.x
  13. Buchanan JW, Kelly AM. Endocardial splitting of the left atrium in the dog with hemorrhage and hemopericardium. Vet Radiol Ultrasound 1964;5:28-38. https://doi.org/10.1111/j.1740-8261.1964.tb01302.x
  14. Peddle GD, Buchanan JW. Acquired atrial septal defects secondary to rupture of the atrial septum in dogs with degenerative mitral valve disease. J Vet Cardiol 2010;12:129-134. https://doi.org/10.1016/j.jvc.2010.03.002
  15. Sadanaga KK, MacDonald MJ, Buchanan JW. Echocardiography and surgery in a dog with left atrial rupture and hemopericardium. J Vet Intern Med 1990;4:216-221. https://doi.org/10.1111/j.1939-1676.1990.tb00900.x
  16. Katayama K, Tajimi T, Guth BD, Matsuzaki M, Lee JD, Seitelberger R, Peterson KL. Early diastolic filling dynamics during experimental mitral regurgitation in the conscious dog. Circulation 1988;78:390-400. https://doi.org/10.1161/01.CIR.78.2.390
  17. O'Gara P, Sugeng L, Lang R, Sarano M, Hung J, Raman S, Fischer G, Carabello B, Adams D, Vannan M. The role of imaging in chronic degenerative mitral regurgitation. JACC Cardiovasc Imaging 2008;1:221-237. https://doi.org/10.1016/j.jcmg.2008.01.011
  18. Kienle R, Thomas W. Echocardiography. In: Nyland TG, Mattoon JS (eds.). Small animal diagnostic ultrasound. 2nd ed. Philadelphia: WB Saunders; 2002. p. 354-423.
  19. Kittleson MD, Eyster GE, Knowlen GG, Bari Olivier N, Anderson LK. Myocardial function in small dogs with chronic mitral regurgitation and severe congestive heart failure. J Am Vet Med Assoc 1984;184:455-459.
  20. Chetboul V, Tissier R. Echocardiographic assessment of canine degenerative mitral valve disease. J Vet Cardiol 2012;14:127-148. https://doi.org/10.1016/j.jvc.2011.11.005
  21. Atkins C, Bonagura J, Ettinger S, Fox P, Gordon S, Haggstrom J, Hamlin R, Keene B, Luis-Fuentes V, Stepien R. Guidelines for the diagnosis and treatment of canine chronic valvular heart disease. J Vet Intern Med 2009;23:1142-1150. https://doi.org/10.1111/j.1939-1676.2009.0392.x
  22. Olsen LH, Haggstrom J, Petersen HD. Acquired valvular heart disease. In: Ettinger SJ, Feldman E (eds.). Textbook of veterinary internal medicine. 7th ed. Philadel phia: W.B. Saunders; 2010. p. 1299-1319.
  23. Borgarelli M, Savarino P, Crosara S, Santilli RA, Chiavegato D, Poggi M, Bellino C, La Rosa G, Zanatta R, Haggstrom J, Tarducci A. Survival characteristics and prognostic variables of dogs with mitral regurgitation attributable to myxomatous valve disease. J Vet Intern Med 2008;22:120-128. https://doi.org/10.1111/j.1939-1676.2007.0008.x
  24. Hezzell MJ, Boswood A, Moonarmart W, Elliott J. Selected echocardiographic variables change more rapidly in dogs that die from myxomatous mitral valve disease. J Vet Cardiol 2012;14:269-279. https://doi.org/10.1016/j.jvc.2012.01.009
  25. Uretsky S, Supariwala A, Nidadovolu P, Khokhar SS, Comeau C, Shubayev O, Campanile F, Wolff SD. Quantification of left ventricular remodeling in response to isolated aortic or mitral regurgitation. J Cardiovasc Magn Reson 2010;12:32. https://doi.org/10.1186/1532-429X-12-32
  26. Gaasch WH, Levine HJ, Quinones MA, Alexander JK. Left ventricular compliance: mechanisms and clinical implications. Am J Cardiol 1976;38:645-653. https://doi.org/10.1016/S0002-9149(76)80015-X
  27. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 2000;102:1788-1794. https://doi.org/10.1161/01.CIR.102.15.1788
  28. Schober KE, Bonagura JD, Scansen BA, Stern JA, Ponzio NM. Estimation of left ventricular filling pressure by use of Doppler echocardiography in healthy anesthetized dogs subjected to acute volume loading. Am J Vet Res 2008; 69:1034-1049. https://doi.org/10.2460/ajvr.69.8.1034
  29. Schober KE, Stern JA, DaCunha DN, Pedraza-Toscano AM, Shemanski D, Hamlin RL. Estimation of left ventricular filling pressure by Doppler echocardiography in dogs with pacing-induced heart failure. J Vet Intern Med 2008; 22:578-585. https://doi.org/10.1111/j.1939-1676.2008.0099.x
  30. Stefanadis C, Dernellis J, Toutouzas P. A clinical appraisal of left atrial function. Eur Heart J 2001;22:22-36. https://doi.org/10.1053/euhj.1999.2581
  31. Aurigemma G, Douglas P, Gaasch W. Quantitative evaluation of left ventricular structure, wall stress, and systolic function. In: Otto C (eds.). The practice of clinical echocardiography. 2nd ed. Philadelphia: WB Saunders Company; 2002. p. 65-87.
  32. Kittleson M. Left ventricular function and failure-part I. Comp Cont Ed 1994;16:287-308.
  33. Kittleson M. Left ventricular function and failure-part II. Comp Cont Ed 1994;16:1001-1017.
  34. Oh JK, Appleton CP, Hatle LK, Nishimura RA, Seward JB, Tajik AJ. The noninvasive assessment of left ventricular diastolic function with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 1997; 10:246-270. https://doi.org/10.1016/S0894-7317(97)70062-2
  35. Oyama MA, Sisson DD, Bulmer BJ, Constable PD. Echocardiographic estimation of mean left atrial pressure in a canine model of acute mitral valve insufficiency. J Vet Intern Med 2004;18:667-672. https://doi.org/10.1111/j.1939-1676.2004.tb02604.x
  36. Schober KE, Hart TM, Stern JA, Li X, Samii VF, Zekas LJ, Scansen BA, Bonagura JD. Detection of congestive heart failure in dogs by Doppler echocardiography. J Vet Intern Med 2010;24:1358-1368. https://doi.org/10.1111/j.1939-1676.2010.0592.x
  37. Schober KE, Hart TM, Stern JA, Li X, Samii VF, Zekas LJ, Scansen BA, Bonagura JD. Effects of treatment on respiratory rate, serum natriuretic peptide concentration, and Doppler echocardiographic indices of left ventricular filling pressure in dogs with congestive heart failure secondary to degenerative mitral valve disease and dilated cardiomyopathy. J Am Vet Med Assoc 2011;239:468-479. https://doi.org/10.2460/javma.239.4.468
  38. Patel AR, Mochizuki Y, Yao J, Pandian NG. Mitral regurgitation: comprehensive assessment by echocar-diography. Echocardiography 2000;17:275-283. https://doi.org/10.1111/j.1540-8175.2000.tb01138.x
  39. Thomas CV, Coker ML, Zellner JL, Handy JR, Crumbley AJ, Spinale FG. Increased matrix metalloproteinase activity and selective upregulation in LV myocardium from patients with end-stage dilated cardiomyopathy. Circulation 1998;97:1708-1715. https://doi.org/10.1161/01.CIR.97.17.1708
  40. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ, American Society of Echocardiography. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;4:237-261.
  41. Boon JA. The M-mode and Doppler examination. In: Boon JA (ed.). Veterinary echocardiography. 2nd ed. West Sussex: Jone Wiley & Sons; 2011. p. 101-152.
  42. Bruch C, Stypmann J, Gradaus R, Breithardt G, Wichter T. Usefulness of tissue Doppler imaging for estimation of filling pressures in patients with primary or secondary pure mitral regurgitation. Am J Cardiol 2004;93:324-328. https://doi.org/10.1016/j.amjcard.2003.10.012
  43. Nagueh SF, Sun H, Kopelen HA, Middleton KJ, Khoury DS. Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler. J Am Coll Cardiol 2001;37:278-285. https://doi.org/10.1016/S0735-1097(00)01056-1