Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan.
J Vet Intern Med. 2023 May-Jun;37(3):856-865. doi: 10.1111/jvim.16686. Epub 2023 Mar 30.
Progression to combined post- and pre-capillary pulmonary hypertension (PH) provides prognostic information in human patients with post-capillary PH. Pulmonary vascular resistance estimated by echocardiography (PVRecho) is useful for the stratification of dogs with myxomatous mitral valve disease (MMVD) and detectable tricuspid regurgitation.
To evaluate the prognostic value of PVRecho in dogs with MMVD.
Fifty-four dogs with MMVD and detectable tricuspid regurgitation.
Prospective cohort study. All dogs underwent echocardiography. The PVRecho was calculated based on tricuspid regurgitation and the velocity-time integral of the pulmonary artery flow. To evaluate the influence of echocardiographic variables on cardiac-related deaths, Cox proportional hazard analysis was performed. Additionally, Kaplan-Meier curves classified by PVRecho tertiles were made and compared using log-rank tests to evaluate the influence of PVRecho on all-cause mortality and cardiac-related death.
The median follow-up time was 579 days. Forty-one dogs with MMVD (PH severity [number]: no or mild, 21/33; moderate, 11/11; severe, 9/10) died during the study. In the multivariable Cox proportional hazard analysis adjusted for age, sildenafil administration, and American College of Veterinary Internal Medicine stage of MMVD, left atrial to aortic diameter ratio and PVRecho remained significant (adjusted hazard ratio [95% confidence interval]: 1.2 [1.1-1.3] and 2.1 [1.6-3.0], respectively). Higher PVRecho showed a significant association with lower survival rates.
Left atrial enlargement and high PVRecho were independent prognostic factors in dogs with MMVD and detectable tricuspid regurgitation.
进展为毛细血管后和毛细血管前肺动脉高压（PH）为患有毛细血管后 PH 的人类患者提供预后信息。超声心动图（PVRecho）估计的肺血管阻力（PVRecho）对于患有黏液瘤性二尖瓣疾病（MMVD）和可检测到三尖瓣反流的犬进行分层很有用。
评估 PVRecho 在患有 MMVD 的犬中的预后价值。
54 只患有 MMVD 和可检测到三尖瓣反流的犬。
前瞻性队列研究。所有犬均接受超声心动图检查。根据三尖瓣反流和肺动脉血流速度时间积分计算 PVRecho。为了评估超声心动图变量对心脏相关死亡的影响，进行了 Cox 比例风险分析。此外，制作了按 PVRecho 三分位数分类的 Kaplan-Meier 曲线，并使用对数秩检验进行比较，以评估 PVRecho 对全因死亡率和心脏相关死亡率的影响。
中位随访时间为 579 天。研究期间，41 只 MMVD 犬（PH 严重程度[数量]：无或轻度，21/33；中度，11/11；严重，9/10）死亡。在多变量 Cox 比例风险分析中，调整年龄、西地那非治疗和 MMVD 的美国兽医内科学院阶段后，左心房至主动脉直径比和 PVRecho 仍然具有显著意义（调整后的危险比[95%置信区间]：1.2[1.1-1.3]和 2.1[1.6-3.0]）。较高的 PVRecho 与较低的生存率显著相关。
左心房扩大和高 PVRecho 是患有 MMVD 和可检测到三尖瓣反流的犬的独立预后因素。
