Caivano D, Dickson D, Martin M, Rishniw M
Department of Veterinary Medicine, University of Perugia, Perugia, 06126, Italy.
HeartVets, Porthcawl, Wales, CF36 5LD, UK.
J Small Anim Pract. 2018 Mar;59(3):161-166. doi: 10.1111/jsap.12760. Epub 2017 Oct 11.
The aims of this study were to determine whether murmur intensity in adult dogs with pulmonic stenosis or subaortic stenosis reflects echocardiographic disease severity and to determine whether a six-level murmur grading scheme provides clinical advantages over a four-level scheme.
In this retrospective multi-investigator study on adult dogs with pulmonic stenosis or subaortic stenosis, murmur intensity was compared to echocardiographically determined pressure gradient across the affected valve. Disease severity, based on pressure gradients, was assessed between sequential murmur grades to identify redundancy in classification. A simplified four-level murmur intensity classification scheme ('soft', 'moderate', 'loud', 'palpable') was evaluated.
In total, 284 dogs (153 with pulmonic stenosis, 131 with subaortic stenosis) were included; 55 dogs had soft, 59 had moderate, 72 had loud and 98 had palpable murmurs. 95 dogs had mild stenosis, 46 had moderate stenosis, and 143 had severe stenosis. No dogs with soft murmurs of either pulmonic or subaortic stenosis had transvalvular pressure gradients greater than 50 mmHg. Dogs with loud or palpable murmurs mostly, but not always, had severe stenosis. Stenosis severity increased with increasing murmur intensity. The traditional six-level murmur grading scheme provided no additional clinical information than the four-level descriptive murmur grading scheme.
A simplified descriptive four-level murmur grading scheme differentiated stenosis severity without loss of clinical information, compared to the traditional six-level scheme. Soft murmurs in dogs with pulmonic or subaortic stenosis are strongly indicative of mild lesions. Loud or palpable murmurs are strongly suggestive of severe stenosis.
本研究旨在确定患有肺动脉瓣狭窄或主动脉瓣下狭窄的成年犬的杂音强度是否反映超声心动图检查的疾病严重程度，并确定六级杂音分级方案是否比四级方案具有临床优势。
在这项针对患有肺动脉瓣狭窄或主动脉瓣下狭窄的成年犬的回顾性多研究者研究中，将杂音强度与通过超声心动图确定的受影响瓣膜两端的压力阶差进行比较。根据压力阶差评估疾病严重程度，在连续的杂音级别之间进行评估以确定分类中的冗余情况。评估了一种简化的四级杂音强度分类方案（“柔和”、“中度”、“响亮”、“可触及”）。
总共纳入了284只犬（153只患有肺动脉瓣狭窄，131只患有主动脉瓣下狭窄）；55只犬有柔和杂音，59只犬有中度杂音，72只犬有响亮杂音，98只犬有可触及杂音。95只犬有轻度狭窄，46只犬有中度狭窄，143只犬有重度狭窄。患有肺动脉瓣或主动脉瓣下狭窄柔和杂音的犬，其跨瓣膜压力阶差均未超过50 mmHg。有响亮或可触及杂音的犬大多（但并非总是）患有重度狭窄。狭窄严重程度随杂音强度增加而增加。传统的六级杂音分级方案相比四级描述性杂音分级方案并未提供更多临床信息。
与传统的六级方案相比，简化的描述性四级杂音分级方案在不丢失临床信息的情况下区分了狭窄严重程度。患有肺动脉瓣或主动脉瓣下狭窄的犬出现柔和杂音强烈提示为轻度病变。响亮或可触及杂音强烈提示为重度狭窄。
