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      Clinical Severity Score System in Dogs with Degenerative Mitral Valve Disease

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          Abstract

          Background

          Several risk factors already have been determined for dogs with degenerative mitral valve disease ( DMVD). Risk factors often have been considered in isolation and have not always taken into account additional information provided by the history and physical examination ( PE).

          Hypothesis/Objectives

          Data obtained from history and PE of dogs with DMVD provide prognostic information and can be used for risk stratification.

          Animals

          Client‐owned dogs (n = 244) with DMVD recruited from first opinion practice.

          Methods

          Prospective longitudinal follow‐up of dogs with DMVD. History and PE data were obtained at 6‐month intervals and analyzed with time‐dependent Cox models to derive relative risk of cardiac death. Independent hazard ratios were used to derive a clinical severity score ( CSS), the prognostic value of which was evaluated by analyzing the median survival times for different risk groups and ROC analysis. Analysis of the progression of CSS over time also was undertaken.

          Results

          History of cough, exercise intolerance, decreased appetite, breathlessness (difficulty breathing) and syncope with PE findings of heart murmur intensity louder than III/VI and absence of respiratory sinus arrhythmia were independently associated with outcome and allowed development of the CSS. Clinical severity score distinguished groups of dogs with significantly different outcomes.

          Conclusions and Clinical Importance

          Routinely obtained clinical findings allow risk stratification of dogs with DMVD. Results of ancillary diagnostic tests may be complementary to history and PE findings and always should be interpreted in conjunction with these findings.

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          Most cited references28

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          Survival characteristics and prognostic variables of dogs with mitral regurgitation attributable to myxomatous valve disease.

          There are few studies evaluating the natural history and prognostic variables in chronic mitral valve disease (CMVI) in a heterogeneous population of dogs. To estimate survival and prognostic value of clinical and echocardiographic variables in dogs with CMVI of varying severity. Five hundred and fifty-eight dogs belonging to 36 breeds were studied. Dogs were included after clinical examination and echocardiography. Long-term outcome was assessed by telephone interview with the owner. The mean follow-up time was 22.7 +/- 13.6 months, and the median survival time was 19.5 +/- 13.2 months. In univariate analysis, age>8 years, syncope, HR>140 bpm, dyspnea, arrhythmias, class of heart failure (International Small Animal Cardiac Health Council), furosemide therapy, end-systolic volume-index (ESV-I)>30 mL/m(2), left atrial to aortic root ratio (LA/Ao)>1.7, E wave transmitral peak velocity (Emax)>1.2 m/s, and bilateral mitral valve leaflet engagement were associated with survival time when all causes of death were included. For the cardiac-related deaths, all the previous variables except dyspnea and EDV-I>100 mL/m(2) were significantly associated with survival time. Significant variables in multivariate analysis (all causes of death) were syncope, LA/Ao>1.7 m/s, and Emax>1.2 m/s. For cardiac-related death, the only significant variable was LA/Ao>1.7. Mild CMVI is a relatively benign condition in dogs. However, some clinical variables can identify dogs at a higher risk of death; these variables might be useful to identify individuals that need more frequent monitoring or therapeutic intervention.
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            Why clinicians are natural bayesians.

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              Survival characteristics and prognostic variables of dogs with preclinical chronic degenerative mitral valve disease attributable to myxomatous degeneration.

              Preclinical myxomatous mitral valve degeneration (MMVD) includes a heterogeneous group of dogs. Therefore, identifying risk factors for progression of the disease is of clinical importance. To investigate survival time and risk factors for clinical and echocardiographic variables taken at initial examination for clinical progression in preclinical MMVD dogs. A total of 256 dogs with stage B1 or B2 MMVD. Medical records of 256 dogs with preclinical MMVD were reviewed retrospectively. Long-term outcome was assessed by telephone interview. Dogs alive at the time of phone interview were asked to return to the hospital for re-evaluation of their cardiac status. Seventy of 256 (27.3%) dogs died during the observation period. The median survival time, regardless of cause of death, was 588 (range 75-1,668) days. The presence of a murmur was associated with an increased risk of death (AHR 2.14; 95% CI 1.12, 4.11; P = 0.022). Thirty (12%) deaths were considered cardiac related. LA/Ao > 1.4 was the only negative predictor (AHR 2.64; 1.13, 6.13; P = 0.024) for cardiac-related deaths. Eighty-three dogs were re-examined, of which 34 progressed to a more advanced stage of MMVD. The presence of Emax > 1.2 (AHR 2.75; 95% CI 1.01, 7.48; P = 0.047) and cough (AHR 7.89; 95% CI 3.18, 20.07; P < 0.001) were significant in the multivariate analysis. Preclinical MMVD represents a relatively benign condition in dogs. Clinicians might find stratification of this dog population according to risk factors based on clinical and echocardiographic findings helpful in determining treatment. Copyright © 2011 by the American College of Veterinary Internal Medicine.
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                Author and article information

                Journal
                J Vet Intern Med
                J. Vet. Intern. Med
                10.1111/(ISSN)1939-1676
                JVIM
                Journal of Veterinary Internal Medicine
                John Wiley and Sons Inc. (Hoboken )
                0891-6640
                1939-1676
                27 March 2015
                Mar-Apr 2015
                : 29
                : 2 ( doiID: 10.1111/jvim.2015.29.issue-2 )
                : 575-581
                Affiliations
                [ 1 ] Department of Clinical Sciences and ServicesRoyal Veterinary College LondonUK
                [ 2 ] Department of Comparative Biomedical SciencesRoyal Veterinary College LondonUK
                [ 3 ] Department of Production and Population HealthRoyal Veterinary College LondonUK
                [ 4 ] Research OfficeRoyal Veterinary College LondonUK
                [ 5 ]Present address: Department of Clinical Sciences and Public Health Faculty of Veterinary ScienceMahidol University Nakhon PathomThailand
                [ 6 ]Present address: Department of Clinical Studies‐Philadelphia School of Veterinary MedicineUniversity of Pennsylvania Philadelphia PA
                Author notes
                [*] [* ]Corresponding author: J. López‐Alvarez, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire AL9 7TA, UK; e‐mail: jordilopeza@ 123456gmail.com .
                Author information
                http://orcid.org/0000-0001-6082-1343
                http://orcid.org/0000-0003-0888-208X
                Article
                JVIM12544
                10.1111/jvim.12544
                4895509
                25818211
                818de766-d169-4e64-91e1-fcc707ba7b3f
                Copyright © 2015 by the American College of Veterinary Internal Medicine
                History
                : 05 June 2014
                : 18 October 2014
                : 23 December 2014
                Page count
                Pages: 7
                Categories
                Standard Article
                Standard Articles
                Custom metadata
                2.0
                jvim12544
                March/April 2015
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.8.9 mode:remove_FC converted:06.05.2016

                Veterinary medicine
                clinical diagnosis,history,natriuretic peptide,physical examination,survival analysis

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