Diagnostic Value of Right Pulmonary Artery Distensibility Index in Dogs with Pulmonary Hypertension

Comparison with Doppler Echocardiographic Estimates of Pulmonary Arterial Pressure

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Abstract

Background: Noninvasive diagnosis of pulmonary hypertension (PH) primarily relies upon Doppler echocardiography of tricuspid regurgitation (TR). However, TR might be absent or difficult to measure. Hypothesis/Objectives: To determine the diagnostic value of right pulmonary artery distensibility (RPAD) index for prediction of Doppler-derived estimates of pulmonary artery (PA) pressure compared to other indices of PH in dogs. Animals: Sixty-nine client-owned dogs with TR. Methods: Prospective observational study. Dogs were allocated to groups according to TR pressure gradient (TRPG): TRPG <36 mmHg (control, n = 22), TRPG 36-50 (n = 16), TRPG 50-75 (n = 14) and TRPG >75 mmHg (n = 17). Right pulmonary artery distensibility index, acceleration time to peak PA flow (AT), AT: ejection time of PA flow (AT:ET) and main PA size: aorta size (MPA:Ao) were calculated in each dog. Results: Right pulmonary artery distensibility index demonstrated the strongest correlation (r = -0.90; P < .0001) to TRPG followed by MPA:Ao (r = 0.78; P < .0001), AT (r = -0.69; P < .0001) and AT:ET (r = -0.68; P < .0001). RPAD index possessed the most accurate cutoff (<29.5%; Sensitivity [Sn] 0.84, Specificity [Sp] 0.95) to predict TRPG >50 mmHg compared to AT (<53.9 ms; Sn 0.74, Sp 0.87), AT:ET (<0.30; Sn 0.61, Sp 0.97) and MPA:Ao (>1.04; Sn 0.94, Sp 0.74). All intra- and interobserver measurement variabilities exhibited coefficients of variation ≤13%. Conclusions and Clinical Importance: Right pulmonary artery distensibility index is an accurate predictor of TRPG and should be particularly useful if TR is absent or difficult to measure.

Original languageEnglish (US)
JournalJournal of Veterinary Internal Medicine
DOIs
StateAccepted/In press - 2016

Fingerprint

pulmonary artery
disease diagnosis
Pulmonary Hypertension
Pulmonary Artery
hypertension
Arterial Pressure
Tricuspid Valve Insufficiency
lungs
Dogs
Lung
dogs
Pressure
Observer Variation
Doppler Echocardiography
echocardiography
observational studies
aorta
Observational Studies
Aorta
Prospective Studies

Keywords

  • Canine
  • Echocardiography
  • Prediction
  • Pulmonary vascular resistance
  • Right pulmonary artery distensibility

ASJC Scopus subject areas

  • veterinary(all)

Cite this

@article{c72dac033dae4d18b350a1ee837f5221,
title = "Diagnostic Value of Right Pulmonary Artery Distensibility Index in Dogs with Pulmonary Hypertension: Comparison with Doppler Echocardiographic Estimates of Pulmonary Arterial Pressure",
abstract = "Background: Noninvasive diagnosis of pulmonary hypertension (PH) primarily relies upon Doppler echocardiography of tricuspid regurgitation (TR). However, TR might be absent or difficult to measure. Hypothesis/Objectives: To determine the diagnostic value of right pulmonary artery distensibility (RPAD) index for prediction of Doppler-derived estimates of pulmonary artery (PA) pressure compared to other indices of PH in dogs. Animals: Sixty-nine client-owned dogs with TR. Methods: Prospective observational study. Dogs were allocated to groups according to TR pressure gradient (TRPG): TRPG <36 mmHg (control, n = 22), TRPG 36-50 (n = 16), TRPG 50-75 (n = 14) and TRPG >75 mmHg (n = 17). Right pulmonary artery distensibility index, acceleration time to peak PA flow (AT), AT: ejection time of PA flow (AT:ET) and main PA size: aorta size (MPA:Ao) were calculated in each dog. Results: Right pulmonary artery distensibility index demonstrated the strongest correlation (r = -0.90; P < .0001) to TRPG followed by MPA:Ao (r = 0.78; P < .0001), AT (r = -0.69; P < .0001) and AT:ET (r = -0.68; P < .0001). RPAD index possessed the most accurate cutoff (<29.5{\%}; Sensitivity [Sn] 0.84, Specificity [Sp] 0.95) to predict TRPG >50 mmHg compared to AT (<53.9 ms; Sn 0.74, Sp 0.87), AT:ET (<0.30; Sn 0.61, Sp 0.97) and MPA:Ao (>1.04; Sn 0.94, Sp 0.74). All intra- and interobserver measurement variabilities exhibited coefficients of variation ≤13{\%}. Conclusions and Clinical Importance: Right pulmonary artery distensibility index is an accurate predictor of TRPG and should be particularly useful if TR is absent or difficult to measure.",
keywords = "Canine, Echocardiography, Prediction, Pulmonary vascular resistance, Right pulmonary artery distensibility",
author = "Visser, {Lance C} and Im, {M. K.} and Johnson, {Lynelle R} and Stern, {Joshua A}",
year = "2016",
doi = "10.1111/jvim.13911",
language = "English (US)",
journal = "Journal of Veterinary Internal Medicine",
issn = "0891-6640",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Diagnostic Value of Right Pulmonary Artery Distensibility Index in Dogs with Pulmonary Hypertension

T2 - Comparison with Doppler Echocardiographic Estimates of Pulmonary Arterial Pressure

AU - Visser, Lance C

AU - Im, M. K.

AU - Johnson, Lynelle R

AU - Stern, Joshua A

PY - 2016

Y1 - 2016

N2 - Background: Noninvasive diagnosis of pulmonary hypertension (PH) primarily relies upon Doppler echocardiography of tricuspid regurgitation (TR). However, TR might be absent or difficult to measure. Hypothesis/Objectives: To determine the diagnostic value of right pulmonary artery distensibility (RPAD) index for prediction of Doppler-derived estimates of pulmonary artery (PA) pressure compared to other indices of PH in dogs. Animals: Sixty-nine client-owned dogs with TR. Methods: Prospective observational study. Dogs were allocated to groups according to TR pressure gradient (TRPG): TRPG <36 mmHg (control, n = 22), TRPG 36-50 (n = 16), TRPG 50-75 (n = 14) and TRPG >75 mmHg (n = 17). Right pulmonary artery distensibility index, acceleration time to peak PA flow (AT), AT: ejection time of PA flow (AT:ET) and main PA size: aorta size (MPA:Ao) were calculated in each dog. Results: Right pulmonary artery distensibility index demonstrated the strongest correlation (r = -0.90; P < .0001) to TRPG followed by MPA:Ao (r = 0.78; P < .0001), AT (r = -0.69; P < .0001) and AT:ET (r = -0.68; P < .0001). RPAD index possessed the most accurate cutoff (<29.5%; Sensitivity [Sn] 0.84, Specificity [Sp] 0.95) to predict TRPG >50 mmHg compared to AT (<53.9 ms; Sn 0.74, Sp 0.87), AT:ET (<0.30; Sn 0.61, Sp 0.97) and MPA:Ao (>1.04; Sn 0.94, Sp 0.74). All intra- and interobserver measurement variabilities exhibited coefficients of variation ≤13%. Conclusions and Clinical Importance: Right pulmonary artery distensibility index is an accurate predictor of TRPG and should be particularly useful if TR is absent or difficult to measure.

AB - Background: Noninvasive diagnosis of pulmonary hypertension (PH) primarily relies upon Doppler echocardiography of tricuspid regurgitation (TR). However, TR might be absent or difficult to measure. Hypothesis/Objectives: To determine the diagnostic value of right pulmonary artery distensibility (RPAD) index for prediction of Doppler-derived estimates of pulmonary artery (PA) pressure compared to other indices of PH in dogs. Animals: Sixty-nine client-owned dogs with TR. Methods: Prospective observational study. Dogs were allocated to groups according to TR pressure gradient (TRPG): TRPG <36 mmHg (control, n = 22), TRPG 36-50 (n = 16), TRPG 50-75 (n = 14) and TRPG >75 mmHg (n = 17). Right pulmonary artery distensibility index, acceleration time to peak PA flow (AT), AT: ejection time of PA flow (AT:ET) and main PA size: aorta size (MPA:Ao) were calculated in each dog. Results: Right pulmonary artery distensibility index demonstrated the strongest correlation (r = -0.90; P < .0001) to TRPG followed by MPA:Ao (r = 0.78; P < .0001), AT (r = -0.69; P < .0001) and AT:ET (r = -0.68; P < .0001). RPAD index possessed the most accurate cutoff (<29.5%; Sensitivity [Sn] 0.84, Specificity [Sp] 0.95) to predict TRPG >50 mmHg compared to AT (<53.9 ms; Sn 0.74, Sp 0.87), AT:ET (<0.30; Sn 0.61, Sp 0.97) and MPA:Ao (>1.04; Sn 0.94, Sp 0.74). All intra- and interobserver measurement variabilities exhibited coefficients of variation ≤13%. Conclusions and Clinical Importance: Right pulmonary artery distensibility index is an accurate predictor of TRPG and should be particularly useful if TR is absent or difficult to measure.

KW - Canine

KW - Echocardiography

KW - Prediction

KW - Pulmonary vascular resistance

KW - Right pulmonary artery distensibility

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U2 - 10.1111/jvim.13911

DO - 10.1111/jvim.13911

M3 - Article

JO - Journal of Veterinary Internal Medicine

JF - Journal of Veterinary Internal Medicine

SN - 0891-6640

ER -