Diagnostic Value of Selected Echocardiographic Variables to Identify Pulmonary Hypertension in Dogs with Myxomatous Mitral Valve Disease

Abstract

Background

Pulmonary hypertension ( PH) is commonly associated with myxomatous mitral valve disease ( MMVD). Because dogs with PH present without measureable tricuspid regurgitation ( TR), it would be useful to investigate echocardiographic variables that can identify PH.

Aim

To investigate associations between estimated systolic TR pressure gradient ( TRPG) and dog characteristics and selected echocardiographic variables.

Animals

156 privately owned dogs.

Materials and Methods

Prospective observational study comparing the estimations of TRPG with dog characteristics and selected echocardiographic variables in dogs with MMVD and measureable TR.

Results

Tricuspid regurgitation pressure gradient was significantly ( P < .05) associated with body weight corrected right ( RVIDDn) and left ( LVIDDn) ventricular end‐diastolic and systolic ( LVIDSn) internal diameters, pulmonary arterial ( PA) acceleration to deceleration time ratio ( AT/ DT), heart rate, left atrial to aortic root ratio ( LA/ Ao), and the presence of congestive heart failure. Four variables remained significant in the multiple regression analysis with TRPG as a dependent variable: modeled as linear variables LA/ Ao ( P < .0001) and RVIDDn ( P = .041), modeled as second order polynomial variables: AT/ DT ( P = .0039) and LVIDDn ( P < .0001) The adjusted R ² ‐value for the final model was 0.45 and receiver operating characteristic curve analysis suggested the model's performance to predict PH, defined as 36, 45, and 55 mmHg as fair (area under the curve [ AUC] = 0.80), good ( AUC = 0.86), and excellent ( AUC = 0.92), respectively.

Conclusion and Clinical Importance

In dogs with MMVD, the presence of PH might be suspected with the combination of decreased PA AT/ DT, increased RVIDDn and LA/ Ao, and a small or great LVIDDn.