Kamata Saho, Morita Tomoya, Yamasaki Masahiro
Laboratory of Veterinary Small Animal Internal Medicine, Cooperative Department of Veterinary Medicine, Faculty of Agriculture, Iwate University, Morioka, Japan.
Vet Radiol Ultrasound. 2025 Jan;66(1):e13459. doi: 10.1111/vru.13459. Epub 2024 Nov 12.
Since the prognosis of myxomatous mitral valve disease (MMVD) varies, its characterization is clinically relevant, and renal impairment has been identified as one of its associated factors. Intrarenal Doppler ultrasonography (IRD), an intrarenal hemodynamic assessment method, is useful for predicting cardiac- and renal-related death but cannot detect early changes in dogs with preclinical MMVD. Contrast-enhanced ultrasonography (CEUS), another intrarenal hemodynamic assessment method, may identify earlier changes; however, renal perfusion evaluations using CEUS have not yet been performed on dogs with MMVD. We hypothesized that CEUS detects changes earlier than IRD in dogs with preclinical MMVD. This prospective, cross-sectional study examined renal perfusion in dogs without cardiac disease and preclinical MMVD dogs of different American College of Veterinary Internal Medicine stages using CEUS and compared it with IRD indices. Twenty-three dogs with MMVD (ten stage B1 and thirteen stage B2) and 12 control dogs without cardiac disease were included. The rise times of the renal cortex and medulla were measured from a time-intensity curve. The rise time of the cortex was longer in dogs with stage B2 MMVD than in control dogs, while that of the medulla was shortened in the right ventricular dysfunction group in stage B2. No changes were observed in IRD indices (the resistance index and venous impedance index). In conclusion, CEUS detected changes in renal perfusion in dogs with preclinical MMVD even when IRD indices remained unchanged, suggesting the utility of CEUS in evaluations of renal perfusion in MMVD dogs.
由于黏液瘤样二尖瓣疾病（MMVD）的预后各不相同，对其特征进行描述具有临床意义，并且肾功能损害已被确定为其相关因素之一。肾内多普勒超声检查（IRD）是一种肾内血流动力学评估方法，有助于预测心脏和肾脏相关的死亡，但无法检测临床前MMVD犬的早期变化。对比增强超声检查（CEUS）是另一种肾内血流动力学评估方法，可能会发现更早的变化；然而，尚未对患有MMVD的犬进行使用CEUS的肾灌注评估。我们假设CEUS在临床前MMVD犬中比IRD更早地检测到变化。这项前瞻性横断面研究使用CEUS检查了无心脏病的犬以及处于美国兽医内科学会不同阶段的临床前MMVD犬的肾灌注情况，并将其与IRD指标进行比较。纳入了23只患有MMVD的犬（10只B1期和13只B2期）和12只无心脏病的对照犬。从时间强度曲线测量肾皮质和髓质的上升时间。B2期MMVD犬的皮质上升时间比对照犬长，而B2期右心室功能障碍组的髓质上升时间缩短。IRD指标（阻力指数和静脉阻抗指数）未观察到变化。总之，即使IRD指标保持不变，CEUS也能检测到临床前MMVD犬的肾灌注变化，这表明CEUS在评估MMVD犬的肾灌注方面具有实用性。
