Schober Karsten E, Wetli Ellen, Drost Wm Tod
Department of Veterinary Clinical Sciences, The Ohio State University, 601 Vernon L Tharp Street, Columbus, OH 43210.
Vet Radiol Ultrasound. 2014 Jul-Aug;55(4):359-67. doi: 10.1111/vru.12131. Epub 2013 Dec 12.
The aims of this study were to evaluate left atrial size in cats with acute left-sided congestive heart failure. We hypothesized that left atrial size as determined by thoracic radiography can be normal in cats with acute left-sided congestive heart failure. One hundred cats with acute left-sided congestive heart failure in which thoracic radiography and echocardiography were performed within 12 h were identified. Left atrial size was evaluated using right lateral and ventrodorsal radiographs. Measurements were compared to two-dimensional echocardiographic variables of left atrial size and left ventricular size. On echocardiography, left atrial enlargement was observed in 96% cats (subjective assessment) whereas maximum left atrial dimension was increased (>15.7 mm) in 93% cats. On radiographs left atrial enlargement (subjective assessment) was found in 48% (lateral view), 53% (ventrodorsal view), and 64% (any view) of cats whereas left atrial enlargement was absent in 36% of cats in both views. Agreement between both methods of left atrial size estimation was poor (Cohen's kappa 0.17). Receiver operating characteristic curve analysis identified a maximum echocardiographic left atrial dimension of approximately 20 mm as the best compromise (Youden index) between sensitivity and specificity in the prediction of radiographic left atrial enlargement. Left atrial enlargement as assessed by thoracic radiography may be absent in a clinically relevant number of cats with congestive heart failure. Therefore, normal left atrial size on thoracic radiographs does not rule out presence of left-sided congestive heart failure in cats with clinical signs of respiratory distress.
本研究的目的是评估急性左侧充血性心力衰竭猫的左心房大小。我们假设，通过胸部X线摄影确定的左心房大小在急性左侧充血性心力衰竭猫中可能是正常的。确定了100只急性左侧充血性心力衰竭的猫，这些猫在12小时内进行了胸部X线摄影和超声心动图检查。使用右侧位和腹背位X线片评估左心房大小。将测量结果与左心房大小和左心室大小的二维超声心动图变量进行比较。在超声心动图检查中，96%的猫观察到左心房扩大（主观评估），而93%的猫左心房最大直径增加（>15.7 mm）。在X线片上，48%（侧位片）、53%（腹背位片）和64%（任何视图）的猫发现左心房扩大（主观评估），而在两种视图中，36%的猫未发现左心房扩大。两种左心房大小估计方法之间的一致性较差（科恩kappa系数为0.17）。受试者工作特征曲线分析确定，超声心动图左心房最大直径约20 mm是预测X线片左心房扩大时敏感性和特异性之间的最佳折衷点（约登指数）。在临床上相当数量的充血性心力衰竭猫中，胸部X线摄影评估的左心房扩大可能不存在。因此，胸部X线片上左心房大小正常并不能排除有呼吸窘迫临床体征的猫存在左侧充血性心力衰竭。
