Kim, Sun Hwa
(College of Veterinary Medicine, Chungnam National University)
,
Seo, Kyoung Won
(College of Veterinary Medicine, Chungnam National University)
,
Song, Kun Ho
(College of Veterinary Medicine, Chungnam National University)
Left atrial enlargement (LAE) is an important diagnostic factor in dogs with myxomatous mitral valve disease (MMVD). It is associated with the onset of congestive heart failure (CHF). Recently, a new radiographic left atrial measurement called vertebral left atrial size (VLAS) was introduced. This c...
Left atrial enlargement (LAE) is an important diagnostic factor in dogs with myxomatous mitral valve disease (MMVD). It is associated with the onset of congestive heart failure (CHF). Recently, a new radiographic left atrial measurement called vertebral left atrial size (VLAS) was introduced. This can be considered as a left atrial enlargement above 2.3. It appears to be related to the severity of MMVD. However, serial changes in VLAS in relation to disease progression and improvement in patients have yet to be studied. This study aims to assess the value of VLAS as a left atrial size monitoring indicator by examining correlations with VHS, LA/Ao ratio and LVIDDN, and comparing serial changes in dogs. A total of 126 dogs were studied with their owners' consent. The dogs were classified into four MMVD groups (Control, B1, B2, C-D) following the ACVIM Guideline by performing a physical examination, radiography and echocardiography. Besides, 24 and 17 dogs were reevaluated to compare values in relation to the progression and improvement of MMVD. VLAS showed significant increase according to the progress of the MMVD stage. This was the same in the Maltese breed group. A strong positive correlation was found between LVIDDN, VHS, LA/Ao ratio, and VLAS. The results of this study found VLAS to be significantly different according to left atrium size, and there was a correlation between disease progression and VLAS levels in each dog. Therefore, VLAS may be used to detect changes in left atrium size as an additional monitoring index of MMVD.
Left atrial enlargement (LAE) is an important diagnostic factor in dogs with myxomatous mitral valve disease (MMVD). It is associated with the onset of congestive heart failure (CHF). Recently, a new radiographic left atrial measurement called vertebral left atrial size (VLAS) was introduced. This can be considered as a left atrial enlargement above 2.3. It appears to be related to the severity of MMVD. However, serial changes in VLAS in relation to disease progression and improvement in patients have yet to be studied. This study aims to assess the value of VLAS as a left atrial size monitoring indicator by examining correlations with VHS, LA/Ao ratio and LVIDDN, and comparing serial changes in dogs. A total of 126 dogs were studied with their owners' consent. The dogs were classified into four MMVD groups (Control, B1, B2, C-D) following the ACVIM Guideline by performing a physical examination, radiography and echocardiography. Besides, 24 and 17 dogs were reevaluated to compare values in relation to the progression and improvement of MMVD. VLAS showed significant increase according to the progress of the MMVD stage. This was the same in the Maltese breed group. A strong positive correlation was found between LVIDDN, VHS, LA/Ao ratio, and VLAS. The results of this study found VLAS to be significantly different according to left atrium size, and there was a correlation between disease progression and VLAS levels in each dog. Therefore, VLAS may be used to detect changes in left atrium size as an additional monitoring index of MMVD.
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제안 방법
Before commencement of the study, the owner’s consent of all of the dogs was obtained. A diagnosis of MMVD was made based on cardiovascular symptoms, physical examinations, blood analyses, thoracic radiography, and echocardiography. Dogs with MMVD were categorized into B1, B2, and C-D groups following the ACVIM Guideline (15).
All echocardiographic examinations were performed using an iU22® (Phillips, Bothell, WA, USA) to diagnose MMVD based on characteristic mitral regurgitation and mitral valve prolapse detected by color doppler imaging in the left apical 4 chamber view in conjunction with two-dimensional echocardiography.
VHS and VLAS were measured using a digital caliper in the right lateral view as described in earlier reports (6,18). For measurement of VLAS, the length from the ventral aspect of the carina to the junction of the posterior border of the left atrium and the dorsal border of the caudal vena cava was measured. Following the VHS measurement method, this measurement was then converted to be expressed as a total unit of vertebral length (15,18,21).
The result revealed that VLAS showed significant increase according to the progress of the MMVD stage. Further studies focusing on various breeds are needed to establish a breed reference range for the universal clinical application of VLAS. The left atrium is a three-dimensional (3D) structure that dilates asymmetrically with variable sizes and shapes (14,22).
대상 데이터
There was a total of 126 dogs in this study (Table 1). All dogs were client-owned and were examined at the veterinary medical teaching hospital of Chungnam National University between March 2016 and September 2019. Before commencement of the study, the owner’s consent of all of the dogs was obtained.
96). The ACVIM B1, B2, and C-D groups comprised 36 dogs, 24 dogs, and 27 dogs, respectively. The median ages of groups B1, B2, and C-D were 12.
The dogs examined in this study were classified by breed as follows: Maltese (n = 60), Shih-Tzu (n = 31), Yorkshire Terrier (n = 12), Poodle (n = 7), Mongrel (n = 5), Schnauzer (n = 5), Cocker Spaniel (n = 3), Pomeranian (n = 2) and Beagle (n = 1). The control group consisted of 24 dogs with a median age of 9 years (6.0-12.3) and a median weight of 4.0 kg (3.28-4.96). The ACVIM B1, B2, and C-D groups comprised 36 dogs, 24 dogs, and 27 dogs, respectively.
The study population consisted of 126 dogs, and the characteristic data for age, weight, sex, and breed of the four groups were summarized (Table 1). The dogs examined in this study were classified by breed as follows: Maltese (n = 60), Shih-Tzu (n = 31), Yorkshire Terrier (n = 12), Poodle (n = 7), Mongrel (n = 5), Schnauzer (n = 5), Cocker Spaniel (n = 3), Pomeranian (n = 2) and Beagle (n = 1). The control group consisted of 24 dogs with a median age of 9 years (6.
The study population consisted of 126 dogs, and the characteristic data for age, weight, sex, and breed of the four groups were summarized (Table 1). The dogs examined in this study were classified by breed as follows: Maltese (n = 60), Shih-Tzu (n = 31), Yorkshire Terrier (n = 12), Poodle (n = 7), Mongrel (n = 5), Schnauzer (n = 5), Cocker Spaniel (n = 3), Pomeranian (n = 2) and Beagle (n = 1).
There was a total of 126 dogs in this study (Table 1). All dogs were client-owned and were examined at the veterinary medical teaching hospital of Chungnam National University between March 2016 and September 2019.
In addition, 24 and 17 dogs were included to compare the values in relation to the progression and improvement of MMVD. Twenty-four dogs, including Stage B2 (n = 14) and C-D (n = 10), showed onset and worsening of symptoms after three months to three years. Seventeen dogs, including Stage B2 (n = 8) and C-D (n = 9), showed improvement after three months to one year of treatment intervention.
데이터처리
In this study, the values among the four groups were compared using the Kruskal-Wallis test, and post hoc tests were performed using the Bonferroni correction. Besides, Pearson correlation coefficients were calculated to assess correlations between VLAS and other values (VHS, LA/Ao ratio, LVIDDN), and Paired t-tests were performed to compare the values before and after disease progression and improvement. A P value of < 0.
이론/모형
The values in each group, including age, weight, VHS, LA/Ao ratio, LVIDDN, and VLAS were presented as median and interquartile ranges (IQR). In this study, the values among the four groups were compared using the Kruskal-Wallis test, and post hoc tests were performed using the Bonferroni correction. Besides, Pearson correlation coefficients were calculated to assess correlations between VLAS and other values (VHS, LA/Ao ratio, LVIDDN), and Paired t-tests were performed to compare the values before and after disease progression and improvement.
성능/효과
001). Also, correlation between VHS, LA/Ao ratio, LVIDDN and VLAS variation (Table 6), VLAS variation showed positive correlation with VHS (R = 0.860), LA/Ao ratio (R = 0.837), and LVIDDN variation (R = 0.783).
Second, we compared VLAS among one specific breed group, Maltese. The results identified that VLAS significantly changed according to the progression and improvement of MMVD, and VLAS variation tends to increase as VHS, LA/Ao, and LVIDDN variations increase. This positive correlation supports the case for considering VLAS as an additional monitoring factor given that VLAS increases with progress and decreases with improvement.
Thus, periodic monitoring of the patient is important, and X-ray is more efficient in terms of cost and time. The results of this study have confirmed that regular monitoring of VLAS may be helpful in detecting changes in left atrium size as an additional monitoring index of MMVD.
In one study, left atrial size was measured using the trachea bifurcation angle (16). The results showed a significant difference between the left atrial enlargement group and the control group; however, there was no significant difference between mild, moderate, and severe LAE groups, so this was insufficient to be used as a diagnostic tool with low sensitivity.
In our study, correlations with VHS and LVIDDN were also examined. The results showed that VLAS has a significant positive correlation with not only LA/Ao ratio, but also VHS and LVIDDN thereby indicating the possibility that this value reflects cardiac remodeling.
, USA). The values in each group, including age, weight, VHS, LA/Ao ratio, LVIDDN, and VLAS were presented as median and interquartile ranges (IQR). In this study, the values among the four groups were compared using the Kruskal-Wallis test, and post hoc tests were performed using the Bonferroni correction.
When evaluating the correlations between VLAS and the other values (Table 4), VLAS was found to have a positive correlation with VHS (R = 0.827), LA/Ao ratio (R = 0.826) and LVIDDN (R = 0.756). We compared the differences in VHS, LA/Ao ratio, LVIDDN, and VLAS in each patient after disease progression and improvement (Table 5) (Fig 2).
후속연구
In a study comparing volume-based method and linear methods (LA/Ao ratio), LA/Ao ratio and the LA volume showed a curvilinear relationship, which derived very different value as the volume increases (14). To achieve higher accuracy than LA/Ao ratio, further study is needed to compare the correlation between VLAS and LAV and to determine the cutoff value of VLAS through LAV.
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