黏液瘤性二尖瓣疾病犬肺动脉高压的患病率及其预后意义
Prevalence and prognostic importance of pulmonary hypertension in dogs with myxomatous mitral valve disease.
作者信息
Borgarelli M, Abbott J, Braz-Ruivo L, Chiavegato D, Crosara S, Lamb K, Ljungvall I, Poggi M, Santilli R A, Haggstrom J
机构信息
Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA.
出版信息
J Vet Intern Med. 2015 Mar-Apr;29(2):569-74. doi: 10.1111/jvim.12564.
BACKGROUND
Pulmonary hypertension (PH) is common in dogs with myxomatous mitral valve disease (MMVD) but its effect on clinical outcome has not been investigated.
HYPOTHESIS/OBJECTIVES: The presence of PH worsens the outcome in dogs with MMVD. To compare survival times of dogs with MMVD and PH to those without PH.
ANIMALS
Two hundred and twelve client-owned dogs.
METHODS
Case review study. Medical records of dogs diagnosed with ACVIM stage B2 and C MMVD between January 2010 and December 2011 were retrospectively reviewed. Long-term outcome was determined by telephone interview or from the medical record. End of the observation period was March 2013. PH was identified if tricuspid regurgitation peak velocity was >3 m/s.
RESULTS
Two hundred and twelve were identified. Eighty-three dogs (39%) had PH. PH was more commonly identified in stage C compared to B2 (P < .0001). One hundred and five (49.5%) dogs died during the observation period. Median survival time for the entire study population was 567 days (95% CI 512-743). Stage C (P = .003), the presence of PH (P = .009), left atrial to aortic root ratio (LA/Ao) >1.7 (P = .0002), normalized left-ventricular end-diastolic diameter (LVEDn) >1.73 (P = .048), and tricuspid regurgitation pressure gradient (TRPG) >55 mmHg (P = .009) were associated with worse outcomes in the univariate analyses. The presence of TRPG >55 mmHg (HR 1.8 95% CI 1-2.9; P = .05) and LA/Ao > 1.7 (HR 2 95% CI 1.2-3.4; P = .01) remained significant predictors of worse outcome in the multivariate analysis.
CONCLUSIONS AND CLINICAL IMPORTANCE
In dogs with MMVD, moderate to severe PH worsens outcome.
背景
肺动脉高压（PH）在患有黏液瘤性二尖瓣疾病（MMVD）的犬中很常见，但尚未对其对临床结局的影响进行研究。
假设/目的：PH的存在会使患有MMVD的犬的预后恶化。比较患有MMVD和PH的犬与未患PH的犬的生存时间。
动物
212只客户拥有的犬。
方法
病例回顾研究。回顾性分析2010年1月至2011年12月期间诊断为ACVIM B2期和C期MMVD的犬的病历。通过电话访谈或病历确定长期结局。观察期截止至2013年3月。如果三尖瓣反流峰值速度>3 m/s，则确定存在PH。
结果
共确定212只犬。83只犬（39%）患有PH。与B2期相比，C期更常发现PH（P <.0001）。105只（49.5%）犬在观察期内死亡。整个研究群体的中位生存时间为567天（95%可信区间512 - 743）。在单因素分析中，C期（P =.003）、PH的存在（P =.009）、左心房与主动脉根比率（LA/Ao）>1.7（P =.0002）、标准化左心室舒张末期直径（LVEDn）>1.73（P =.048）和三尖瓣反流压力梯度（TRPG）>55 mmHg（P =.009）与较差的结局相关。在多因素分析中，TRPG>55 mmHg（HR 1.8，95%可信区间1 - 2.9；P =.05）和LA/Ao>1.7（HR 2，95%可信区间1.2 - 3.4；P =.01）仍然是较差结局的显著预测因素。
结论及临床意义
在患有MMVD的犬中，中度至重度PH会使预后恶化。
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