Survival characteristics and prognostic importance of echocardiographic measurements of right heart size and function in dogs with pulmonary hypertension

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Abstract

Background

The clinical relevance of echocardiographic measurements of right heart size and function in dogs with pulmonary hypertension (PH) is unknown.

Objective

To determine if echocardiographic measurements of right heart size and right ventricular (RV) function are associated with survival times in dogs with PH.

Animals

Eighty‐two client‐owned dogs.

Methods

Retrospective study where data from medical records and baseline echocardiographic examinations were collected and measured in a standardized manner. Owners or primary veterinarians were contacted for outcome data.

Results

Enlargement of the right atrium (88%), RV (69%), and pulmonary artery (72%) was common. One‐third of the cases had reduced RV function quantified by two‐dimensional echocardiography‐derived tricuspid annular plane systolic excursion (TAPSE). Decreased TAPSE was significantly ( P = .008) more common in dogs with PH not secondary to left heart disease (LHD; 43%) compared to dogs with PH secondary to LHD (14%) but median survival times (182, 95% confidence interval [CI] = 39‐309 versus 298, 95% CI = 85‐314 days, respectively) were not significantly different ( P = .78). Right atrial area (hazard ratio [HR] = 2.72, 95% CI = 1.58‐4.70), TAPSE < 3.23 mm/kg ^0.284 (HR = 2.19, 95% CI = 1.28‐3.74), and right heart failure (HR = 2.05, 95% CI = 1.18‐3.57) were independently associated with shorter survival time ( P ≤ .04).

Conclusions and Clinical Importance

Right atrial area, RV function (TAPSE < 3.23 mm/kg ^0.284), and right heart failure offer clinically relevant prognostic information in dogs with PH. Results support the quantitative assessment of right heart size and function in dogs with PH.

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Most cited references 41

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Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology.

Anton Vonk-Noordegraaf, Francois Haddad, Kelly Chin … (2013)

Survival in patients with pulmonary arterial hypertension (PAH) is closely related to right ventricular (RV) function. Although pulmonary load is an important determinant of RV systolic function in PAH, there remains a significant variability in RV adaptation to pulmonary hypertension. In this report, the authors discuss the emerging concepts of right heart pathobiology in PAH. More specifically, the discussion focuses on the following questions. 1) How is right heart failure syndrome best defined? 2) What are the underlying molecular mechanisms of the failing right ventricle in PAH? 3) How are RV contractility and function and their prognostic implications best assessed? 4) What is the role of targeted RV therapy? Throughout the report, the authors highlight differences between right and left heart failure and outline key areas of future investigation. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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Tricuspid annular displacement predicts survival in pulmonary hypertension.

Paul R Forfia, Micah R. Fisher, Stephen Mathai … (2006)

Right ventricular (RV) function is an important determinant of prognosis in pulmonary hypertension. However, noninvasive assessment of the RV function is often limited by complex geometry and poor endocardial definition. To test whether the degree of tricuspid annular displacement (tricuspid annular plane systolic excursion [TAPSE]) is a useful echo-derived measure of RV function with prognostic significance in pulmonary hypertension. We prospectively studied 63 consecutive patients with pulmonary hypertension who were referred for a clinically indicated right heart catheterization. Patients underwent right heart catheterization immediately followed by transthoracic echocardiogram and TAPSE measurement. In the overall cohort, a TAPSE of less than 1.8 cm was associated with greater RV systolic dysfunction (cardiac index, 1.9 vs. 2.7 L/min/m2; RV % area change, 24 vs. 33%), right heart remodeling (right atrial area index, 17.0 vs. 12.1 cm(2)/m), and RV-left ventricular (LV) disproportion (RV/LV diastolic area, 1.7 vs. 1.2; all p < 0.001), versus a TAPSE of 1.8 cm or greater. In patients with pulmonary arterial hypertension (PAH; n = 47), survival estimates at 1 and 2 yr were 94 and 88%, respectively, in those with a TAPSE of 1.8 cm or greater versus 60 and 50%, respectively, in subjects with a TAPSE less than 1.8 cm. The unadjusted risk of death (hazard ratio) in patients with a TAPSE less than 1.8 versus 1.8 cm or greater was 5.7 (95% confidence interval, 1.3-24.9; p = 0.02) for the PAH cohort. For every 1-mm decrease in TAPSE, the unadjusted risk of death increased by 17% (hazard ratio, 1.17; 95% confidence interval, 1.05-1.30; p = 0.006), which persisted after adjusting for other echocardiographic and hemodynamic variables and baseline treatment status. TAPSE powerfully reflects RV function and prognosis in PAH.

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Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension.

Ronald J. Raymond, Alan L Hinderliter, Park W. Willis … (2002)

The aim of this study was to evaluate the relationships between echocardiographic findings and clinical outcomes in patients with severe primary pulmonary hypertension (PPH). Primary pulmonary hypertension is associated with abnormalities of right heart structure and function that contribute to the poor prognosis of the disease. Echocardiographic abnormalities associated with PPH have been described, but the prognostic significance of these findings remains poorly characterized. Echocardiographic studies, invasive hemodynamic measurements and 6-min walk tests were performed and outcomes prospectively followed in 81 patients with severe PPH. Subjects were participants in a 12-week randomized trial examining the effects of prostacyclin plus conventional therapy compared with conventional therapy alone. During the mean follow-up period of 36.9 +/- 15.4 months, 20 patients died and 21 patients underwent transplantation. Pericardial effusion (p = 0.003) and indexed right atrial area (p = 0.005) were predictors of mortality. Pericardial effusion (p = 0.017), indexed right atrial area (p = 0.012) and the degree of septal shift in diastole (p = 0.004) were predictors of a composite end point of death or transplantation. In multivariable analyses incorporating clinical, hemodynamic and echocardiographic variables, pericardial effusion and an enlarged right atrium remained predictors of adverse outcomes. Six-minute walk results, mixed venous oxygen saturation and initial treatment randomization were also independently associated with a poor prognosis. Pericardial effusion, right atrial enlargement and septal displacement are echocardiographic abnormalities that reflect the severity of right heart failure and predict adverse outcomes in patients with severe PPH. These characteristics may help identify patients appropriate for more intensive medical therapy or earlier transplantation.

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Author and article information

Contributors

Lance C. Visser:

ORCID: https://orcid.org/0000-0002-3563-0737

lcvisser@ucdavis.edu

Journal

Journal ID (nlm-ta): J Vet Intern Med

Journal ID (iso-abbrev): J. Vet. Intern. Med

Journal ID (doi): 10.1111/(ISSN)1939-1676

Journal ID (publisher-id): JVIM

Title: Journal of Veterinary Internal Medicine

Publisher: John Wiley & Sons, Inc. (Hoboken, USA )

ISSN (Print): 0891-6640

ISSN (Electronic): 1939-1676

Publication date (Electronic): 05 June 2020

Publication date (Print): July 2020

Volume: 34

Issue: 4 ( doiID: 10.1111/jvim.v34.4 )

Pages: 1379-1388

Affiliations

[ ¹ ] Department of Medicine and Epidemiology School of Veterinary Medicine, University of California, Davis Davis California USA

Author notes

[*] [* ] Correspondence

Lance C. Visser, Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Avenue, Davis, CA 95616.

Email: lcvisser@ 123456ucdavis.edu

Author information

Lance C. Visser https://orcid.org/0000-0002-3563-0737

Lynelle R. Johnson https://orcid.org/0000-0002-5331-5626

Article

Publisher ID: JVIM15826

DOI: 10.1111/jvim.15826

PMC ID: 7379050

PubMed ID: 32501601

SO-VID: 7c087e63-c905-4741-ad8c-88ed56c89201

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date received : 04 December 2019

Date revision received : 13 May 2020

Date accepted : 20 May 2020

Page count

Figures: 2, Tables: 4, Pages: 10, Words: 7706

Funding

Funded by: American Kennel Club Canine Health Foundation , open-funder-registry 10.13039/100001458;

Award ID: Grant 01982

Custom metadata

source-schema-version-number 2.0

cover-date July 2020

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.5 mode:remove_FC converted:24.07.2020

ScienceOpen disciplines: Veterinary medicine

Keywords: canine,doppler echocardiography,mitral valve disease,postcapillary,precapillary,pulmonary vascular resistance

Data availability:

ScienceOpen disciplines: Veterinary medicine

Keywords: canine, doppler echocardiography, mitral valve disease, postcapillary, precapillary, pulmonary vascular resistance

Survival characteristics and prognostic importance of echocardiographic measurements of right heart size and function in dogs with pulmonary hypertension

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Most cited references 41

Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology.

Tricuspid annular displacement predicts survival in pulmonary hypertension.

Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension.

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