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即时超声右心标志物在犬中度至重度肺动脉高压筛查中的应用。

The utility of point-of-care ultrasound right-sided cardiac markers as a screening test for moderate to severe pulmonary hypertension in dogs.

机构信息

College of Veterinary Medicine, University of Missouri, Columbia, MO, 65211, USA.

Hill Country Veterinary Specialists, Spicewood, TX, 78669, USA.

出版信息

Vet J. 2019 Aug;250:6-13. doi: 10.1016/j.tvjl.2019.05.013. Epub 2019 May 31.

Abstract

Dogs with respiratory disease can develop pulmonary hypertension (PH), a comorbid condition that can impact therapy and prognosis. Without confirmation using the criterion standard of echocardiography, this complication may be missed. Point-of-care ultrasound (POCUS) is a simple, non-invasive screening test that may suggest PH. It was hypothesized that in dogs POCUS right-sided cardiac markers (R-SCM) at the subxiphoid view would predict moderate to severe PH confirmed by echocardiography. Forty-three client-owned dogs that underwent respiratory evaluation with POCUS and echocardiography were included. POCUS R-SCM evaluated in the subxiphoid view included subjective caudal vena cava distention (CVC), CVC >1cm, gallbladder wall edema and ascites. PH was defined by tricuspid regurgitation pressure gradient (TRPG) as mild (30-49.9mmHg), moderate (50-74.9mmHg) or severe (>75mmHg). POCUS subxiphoid views were blindly evaluated post hoc and compared to echocardiography. Chi square test and one-way ANOVA were used to evaluate correlations between POCUS R-SCM and echocardiographic diagnosis of moderate to severe PH. Twenty-six dogs with PH, and 17 dogs without PH, were enrolled. There was no significant difference in the presence or absence of any R-SCM between dogs with and without PH. When dogs with no PH and mild PH were grouped and compared to dogs with moderate to severe PH (i.e., dogs for which treatment for PH would be recommended), no significant differences in R-SCM were noted. POCUS R-SCM using the CVC view was not a sensitive screening test to identify dogs with PH in this study population.

摘要

患有呼吸系统疾病的犬可能会发展为肺动脉高压(PH),这是一种合并症,可能会影响治疗和预后。如果不使用超声心动图的标准来确认,这种并发症可能会被遗漏。床边超声(POCUS)是一种简单、非侵入性的筛查试验,可能提示存在 PH。本研究假设,在犬中,通过剑突下切面的 POCUS 右心指标(R-SCM)可以预测经超声心动图确认的中度至重度 PH。本研究共纳入 43 只接受呼吸评估和 POCUS 及超声心动图检查的患犬。在剑突下切面评估的 POCUS R-SCM 包括主观下腔静脉扩张(CVC)、CVC>1cm、胆囊壁水肿和腹水。PH 定义为三尖瓣反流压力梯度(TRPG)为轻度(30-49.9mmHg)、中度(50-74.9mmHg)或重度(>75mmHg)。POCUS 剑突下切面在事后进行盲法评估,并与超声心动图进行比较。卡方检验和单向方差分析用于评估 POCUS R-SCM 与超声心动图诊断中度至重度 PH 之间的相关性。本研究共纳入 26 只 PH 犬和 17 只非 PH 犬。PH 犬和非 PH 犬之间 R-SCM 的存在或缺失没有显著差异。当无 PH 和轻度 PH 的犬与中度至重度 PH 的犬(即建议进行 PH 治疗的犬)分组进行比较时,R-SCM 没有显著差异。在本研究人群中,使用 CVC 视图的 POCUS R-SCM 不是一种敏感的筛查试验来识别 PH 犬。

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