Predictive value of three-dimensional echocardiographic variables on development of myxomatous mitral valve disease in dogs
Myxomatous mitral valve disease (MMVD) is the most common acquired cardiovascular disease and the most common cause of congestive heart failure (CHF) in dogs. Cavalier King Charles Spaniels (CKCS) is one of the breeds most commonly affected by MMVD and disease progression has been shown to occur...
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| Formato: | H3 |
| Lenguaje: | Inglés sueco |
| Publicado: |
SLU/Dept. of Clinical Sciences (until 231231)
2022
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| Materias: |
| _version_ | 1855573016601165824 |
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| author | Isaksson, Moa |
| author_browse | Isaksson, Moa |
| author_facet | Isaksson, Moa |
| author_sort | Isaksson, Moa |
| collection | Epsilon Archive for Student Projects |
| description | Myxomatous mitral valve disease (MMVD) is the most common acquired cardiovascular disease
and the most common cause of congestive heart failure (CHF) in dogs. Cavalier King Charles
Spaniels (CKCS) is one of the breeds most commonly affected by MMVD and disease progression
has been shown to occur at a younger age among CKCS, when compared to other breeds. The age
of onset of MMVD is an inherited trait among CKCS and the geometry of the mitral valve has
recently become of interest among veterinary researchers to obtain deeper understanding of the
currently partly understood pathogenesis. Findings suggest that dogs with MMVD and many healthy
CKCS share an altered three-dimensional (3D) geometry of the mitral valve annulus, which differs
from healthy dogs of other investigated breeds. In this comparison, the mitral valve annulus has
been shown to lack the normal saddle-shaped appearance, instead it had a flattened appearance
among many of the healthy CKCS and dogs with MMVD. This flattening has been proposed as a
factor contributing to the early onset of disease progression in CKCS.
The object of this thesis was to evaluate whether a flattening of the mitral valve (MV) in healthy
dogs might contribute to an accelerated progression of MMVD. It was hypothesized that MV
variables indicative of flattening, when measured with real-time 3D transthoracic echocardiography
(RT3D-TTE), might be used as a prognostic test to determine dogs at risk for progression of early
onset or severe MMVD.
The study was conducted as a follow-up of dogs with preexisting RT3D-TTE datasets, obtained
6 years earlier during an initial study that aimed to describe morphological mitral valve variations
between healthy CKCS and non-CKCS. The present study included a follow-up questionnaire,
distributed to and returned by owners of dogs with preexisting RT3D-TTE datasets, designed to
evaluate cause of death (cardiac/non-cardiac) and possible progression to congestive heart failure
(CHF) for deceased dogs. The questionnaire also facilitated staging of disease severity among dogs
still alive, and owners of alive dogs were invited for a follow-up examination; including auscultation
and new standard echocardiographic examination, as well as new RT3D-TTE examination. The
following RT3D-TTE MV variables; annulus height (AnH), normalized tenting volume (nTnV),
tenting area (TnA) and tenting height (TnH) - proposed to be representative of a flattened appearance
of the MV annulus - were measured in datasets from the initial study and compared to the dogs'
disease stage at follow-up.
Information was received from a total of 24 dogs (n=18 CKCS and n=6 non-CKCS) from the
initial cohort of 29 healthy dogs, 62.5% of these dogs were reported by owners as still alive at time
of follow up. Deceased dogs made up 37.5% of the studied population (n=6 CKCS and n=3 nonCKCS). None of the owners of deceased dogs reported cardiac-related deaths, and only one of the
deceased CKCS was reported by the owner as having progressed to CHF pre-mortem. The mean
age at follow-up for the CKCS (alive and deceased) was 8.6 years [SD 0.43] and among all the
CKCS, 56% had developed a heart murmur discovered by a veterinarian at a mean age of 7.8 years
[SD 2.6]. Three dogs; n=2 CKCS and n=1 non-CKCS, had progressed to stage B2, i.e. MMVD and
signs of volume overload. These dogs had presented with a pronounced flattening of the mitral valve
annulus at initial study, as they aggregated at the lower numerical range regarding all four variables.
In conclusion, this particular cohort of dogs were represented by mainly preclinical cases of
MMVD, with the exception of one CKCS that had progressed to CHF pre-mortem. Three dogs that
had presented with a flattened mitral valve annulus at the initial study, tended to have progressed to
MMVD with echocardiographic signs of left sided volume overload at follow-up. |
| format | H3 |
| id | RepoSLU18170 |
| institution | Swedish University of Agricultural Sciences |
| language | Inglés swe |
| publishDate | 2022 |
| publishDateSort | 2022 |
| publisher | SLU/Dept. of Clinical Sciences (until 231231) |
| publisherStr | SLU/Dept. of Clinical Sciences (until 231231) |
| record_format | eprints |
| spelling | RepoSLU181702023-02-03T00:15:08Z Predictive value of three-dimensional echocardiographic variables on development of myxomatous mitral valve disease in dogs Prediktivt värde av tredimensionella ekokardiografiska variabler för utvecklingen av myxomatös klaffsjukdom Isaksson, Moa Cavalier King Charles Spaniel myxomatous mitral valve disease three-dimensional echocardiography prognosis Myxomatous mitral valve disease (MMVD) is the most common acquired cardiovascular disease and the most common cause of congestive heart failure (CHF) in dogs. Cavalier King Charles Spaniels (CKCS) is one of the breeds most commonly affected by MMVD and disease progression has been shown to occur at a younger age among CKCS, when compared to other breeds. The age of onset of MMVD is an inherited trait among CKCS and the geometry of the mitral valve has recently become of interest among veterinary researchers to obtain deeper understanding of the currently partly understood pathogenesis. Findings suggest that dogs with MMVD and many healthy CKCS share an altered three-dimensional (3D) geometry of the mitral valve annulus, which differs from healthy dogs of other investigated breeds. In this comparison, the mitral valve annulus has been shown to lack the normal saddle-shaped appearance, instead it had a flattened appearance among many of the healthy CKCS and dogs with MMVD. This flattening has been proposed as a factor contributing to the early onset of disease progression in CKCS. The object of this thesis was to evaluate whether a flattening of the mitral valve (MV) in healthy dogs might contribute to an accelerated progression of MMVD. It was hypothesized that MV variables indicative of flattening, when measured with real-time 3D transthoracic echocardiography (RT3D-TTE), might be used as a prognostic test to determine dogs at risk for progression of early onset or severe MMVD. The study was conducted as a follow-up of dogs with preexisting RT3D-TTE datasets, obtained 6 years earlier during an initial study that aimed to describe morphological mitral valve variations between healthy CKCS and non-CKCS. The present study included a follow-up questionnaire, distributed to and returned by owners of dogs with preexisting RT3D-TTE datasets, designed to evaluate cause of death (cardiac/non-cardiac) and possible progression to congestive heart failure (CHF) for deceased dogs. The questionnaire also facilitated staging of disease severity among dogs still alive, and owners of alive dogs were invited for a follow-up examination; including auscultation and new standard echocardiographic examination, as well as new RT3D-TTE examination. The following RT3D-TTE MV variables; annulus height (AnH), normalized tenting volume (nTnV), tenting area (TnA) and tenting height (TnH) - proposed to be representative of a flattened appearance of the MV annulus - were measured in datasets from the initial study and compared to the dogs' disease stage at follow-up. Information was received from a total of 24 dogs (n=18 CKCS and n=6 non-CKCS) from the initial cohort of 29 healthy dogs, 62.5% of these dogs were reported by owners as still alive at time of follow up. Deceased dogs made up 37.5% of the studied population (n=6 CKCS and n=3 nonCKCS). None of the owners of deceased dogs reported cardiac-related deaths, and only one of the deceased CKCS was reported by the owner as having progressed to CHF pre-mortem. The mean age at follow-up for the CKCS (alive and deceased) was 8.6 years [SD 0.43] and among all the CKCS, 56% had developed a heart murmur discovered by a veterinarian at a mean age of 7.8 years [SD 2.6]. Three dogs; n=2 CKCS and n=1 non-CKCS, had progressed to stage B2, i.e. MMVD and signs of volume overload. These dogs had presented with a pronounced flattening of the mitral valve annulus at initial study, as they aggregated at the lower numerical range regarding all four variables. In conclusion, this particular cohort of dogs were represented by mainly preclinical cases of MMVD, with the exception of one CKCS that had progressed to CHF pre-mortem. Three dogs that had presented with a flattened mitral valve annulus at the initial study, tended to have progressed to MMVD with echocardiographic signs of left sided volume overload at follow-up. Myxomatös klaffsjukdom (MMVD) är den vanligaste förvärvade hjärtsjukdomen samt den vanligaste orsaken till kongestiv hjärtsvikt (CHF) hos hund. Cavalier king charles spaniel (CKCS) är en av de raser som vanligtvis drabbas av MMVD och sjukdomsutveckling sker vid en tidigare ålder än hos andra raser. Debutåldern av MMVD är ärftligt hos CKCS och mitralisklaffens geometri har på senaste tiden vunnit intresse hos veterinära forskare i sökandet efter ökad förståelse kring den i nuläget ofullständigt förstådda patogenesen bakom MMVD. Resultat från dessa studier föreslår att hundar med MMVD och många friska CKCS delar en avvikande tredimensionell (3D) arkitektur på mitralisklaffens annulus, som skiljer sig i jämförelser med friska hundar av andra raser som undersökts. I denna jämförelse visades att mitralisklaffens annulus saknade den normala sadellika formen, istället hade annuluset ett mer tillplattat utseende hos många friska CKCS och hundar med MMVD. Detta har föreslagits som en bidragande faktor till den tidiga sjukdomsutvecklingen hos CKCS. Målet med denna studie var att utvärdera om en tillplattning av mitralisklaffen (MV) hos en grupp friska hundar kan ha bidragit till en tidigare utveckling av MMVD. Hypotesen var att MVvariabler som indikerar tillplattning, mätta med realtids tredimensionellt transthorakalt hjärtultraljud (RT3D-TTE), kan användas som ett prognostiskt test för att upptäcka vilka hundar som riskerar att utveckla tidig eller allvarlig MMVD. Studien var utformad som en uppföljning av hundar som hade undersökts med RT3D-TTE 6 år tidigare, i en studie som syftade till att beskriva morfologiska mitralisklaffsskillnader mellan friska CKCS och icke-CKCS. Uppföljningen bestod av ett frågeformulär, som distribuerades till och fylldes i av ägare, till hundar som hade deltagit i den tidigare studien. Formuläret var utformat för att undersöka dödsorsak (hjärtorsak/annan orsak) samt eventuell progression till CHF hos avlidna hundar. Hundägarnas formulärsvar möjliggjorde kategorisering enligt sjukdomsallvarlighet för hundar som fortfarande levde. Ägarna till de levande hundarna erbjöds även uppföljande undersökning av hundarna; med auskultation, hjärtultraljud och RT3DTTE. Följande RT3D-TTE MV-variabler; annulus höjd (AnH), normaliserad tältningvolym (nTnV), tältningsarea (TnA) och tältningshöjd (TnH) – har föreslagits representera ett tillplattat utseende hos MV annuluset. Variablerna mättes i RT3D-TTE-bilder från den initiala studien och jämfördes mot hundarnas allvarlighetsgrad av MMVD vid uppföljning. Information samlades in från totalt 24 av hundarna (n=18 CKCS och n=6 icke-CKCS) ur den initiala studiepopulationen av 29 friska hundar, 62,5 % av dessa hundar rapporterades av ägarna som fortfarande i livet vid uppföljningen. De avlidna hundarna utgjorde 37,5% av studiepopulationen (n=6 CKCS och n=3 icke-CKCS). Ingen av de avlidna hundarna uppgavs av ägaren ha dött av hjärtorsak och endast en av de avlidna CKCS uppgavs av ägaren ha utvecklat CHF före sin död. Medelåldern vid uppföljning för samtliga CKCS inkluderade (levande och avlidna) var 8,6 år [SD 0,43], och bland alla CKCS hade 56 % utvecklat ett blåsljud som upptäckts av veterinär vid en medelålder av 7,8 år [SD 2,6]. Tre hundar; n=2 CKCS och n=1 icke-CKCS, hade fortskridit till sjukdomsstadium B2, dvs. MMVD med tecken på volymöverfyllnad. Vid den initiala studien hade dessa hundar ett tillplattat mitralisannulus, då de fördelades i det lägre spannet på samtliga fyra variabler. Slutsatserna var att studiepopulationen huvudsakligen utgjordes av hundar med preklinisk MMVD, med undantaget för en CKCS som utvecklat CHF innan sin död. Tre hundar med tillplattat mitralisannulus vid den initiala studien, tenderade att ha utvecklat MMVD med ekokardiografiska tecken på vänstersidig volymöverfyllnad vid uppföljningen. SLU/Dept. of Clinical Sciences (until 231231) 2022 H3 eng swe https://stud.epsilon.slu.se/18170/ |
| spellingShingle | Cavalier King Charles Spaniel myxomatous mitral valve disease three-dimensional echocardiography prognosis Isaksson, Moa Predictive value of three-dimensional echocardiographic variables on development of myxomatous mitral valve disease in dogs |
| title | Predictive value of three-dimensional echocardiographic
variables on development of myxomatous mitral valve disease
in dogs |
| title_full | Predictive value of three-dimensional echocardiographic
variables on development of myxomatous mitral valve disease
in dogs |
| title_fullStr | Predictive value of three-dimensional echocardiographic
variables on development of myxomatous mitral valve disease
in dogs |
| title_full_unstemmed | Predictive value of three-dimensional echocardiographic
variables on development of myxomatous mitral valve disease
in dogs |
| title_short | Predictive value of three-dimensional echocardiographic
variables on development of myxomatous mitral valve disease
in dogs |
| title_sort | predictive value of three-dimensional echocardiographic
variables on development of myxomatous mitral valve disease
in dogs |
| topic | Cavalier King Charles Spaniel myxomatous mitral valve disease three-dimensional echocardiography prognosis |