Mattin M J, Boswood A, Church D B, Brodbelt D C
Royal Veterinary College, University of London, London, The United Kingdom.
J Vet Intern Med. 2019 Mar;33(2):432-444. doi: 10.1111/jvim.15251. Epub 2018 Oct 24.
Prognostic risk factors were identified for dogs with degenerative mitral valve disease (DMVD) monitored by veterinary cardiologists. The value of these measurements has not been determined in the wider primary care setting.
To evaluate whether plasma cardiac biomarkers and data obtained from routine history-taking and physical examination are predictive of survival in dogs with DMVD attending primary care practice.
Eight-hundred and ninety-three dogs with a presumptive diagnosis of DMVD recruited from 79 primary care veterinary practices in the United Kingdom.
Prospective cohort study. Primary care veterinary practitioners recorded clinical data. Plasma N-terminal pro B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) were measured at presentation. Cox regression models evaluated associations between risk factor variables and hazard of death (all-cause mortality and cardiac-related death). Flexible parametric models generated predicted survival probabilities for dogs with different combinations of prognostic risk factor variable values.
Dogs with higher NT-proBNP and cTnI concentrations, higher heart rates, older dogs, females, and those reported to be exercise intolerant, dyspneic, and diagnosed with selected comorbidities had an increased hazard of death due to any cause. Dogs with higher concentrations of plasma biomarkers, higher heart rates, and heart murmur intensities, those with exercise intolerance and those receiving potent diuretics had a higher hazard of cardiac-related death.
Cardiac biomarkers and key clinical findings identified in this study can help primary care veterinary practitioners identify dogs with DMVD that are at highest risk of death.
兽医心脏病专家对患有退行性二尖瓣疾病(DMVD)的犬只进行监测,确定了预后风险因素。这些测量值在更广泛的基层医疗环境中的价值尚未确定。
评估血浆心脏生物标志物以及从常规病史采集和体格检查中获得的数据是否可预测就诊于基层医疗机构的DMVD犬只的生存情况。
从英国79家基层医疗兽医诊所招募的893只初步诊断为DMVD的犬只。
前瞻性队列研究。基层医疗兽医从业者记录临床数据。就诊时测量血浆N末端B型利钠肽原(NT-proBNP)和心肌肌钙蛋白I(cTnI)。Cox回归模型评估风险因素变量与死亡风险(全因死亡率和心脏相关死亡率)之间的关联。灵活参数模型生成具有不同预后风险因素变量值组合的犬只的预测生存概率。
NT-proBNP和cTnI浓度较高、心率较高、年龄较大的犬只、雌性犬只以及据报告不耐运动、呼吸困难且被诊断患有特定合并症的犬只因任何原因导致死亡的风险增加。血浆生物标志物浓度较高、心率较高和心脏杂音强度较大的犬只、不耐运动的犬只以及接受强效利尿剂治疗的犬只心脏相关死亡的风险较高。
本研究中确定的心脏生物标志物和关键临床发现可帮助基层医疗兽医从业者识别出DMVD死亡风险最高的犬只。