Retrospective evaluation of a right heart parameter score in the assessment of precapillary pulmonary hypertension in dogs (2017–2021): 135 cases

IF 1.1 3区农林科学 Q3 VETERINARY SCIENCES

Journal of veterinary emergency and critical care Pub Date : 2024-05-29 DOI:10.1111/vec.13394

Rebecca R. Gelé DVM, Priscilla Burnotte DVM, Annelies Valcke DVM, Thomas G. Walker DVM, DACVECC, Christopher R. Kennedy BVetMed, DACVECC, Anne-Christine Merveille DMV, PhD, DECVIM, Kris Gommeren DVM, PhD, DECVIM, DECVECC

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引用次数: 0

Abstract

Objective

To determine if emergency and critical care residents can identify moderate to severe precapillary pulmonary hypertension on cardiologist-obtained cineloops using a pulmonary hypertension score (PHS) and report the interobserver variability of the PHS.

Design

Multicenter, retrospective, case–control study from 2017 to 2021.

Setting

Private referral center and veterinary teaching hospital.

Animals

One hundred and thirty-five client-owned dogs that underwent diagnostic echocardiography.

Interventions

None.

Measurements and Main Results

Medical records of dogs with stage B1 myxomatous mitral valve disease (MMVD) and dogs diagnosed with precapillary pulmonary hypertension (PCPH) via echocardiograms were reviewed. Dogs were categorized by a cardiologist into 5 groups (normal, B1 MMVD, mild, moderate, and severe PCPH) based on Doppler pulmonary pressure gradients and right heart morphology. Cineloops from each case were subjectively evaluated by emergency and critical care residents for the presence of right atrial and ventricular enlargement, right ventricular hypertrophy, interventricular septal flattening, and pulmonary artery and trunk enlargement to form a composite pulmonary hypertension score out of 8 (PHS8). When available, signs of peritoneal effusion and distention of the caudal vena cava were subjectively assessed to generate a pulmonary hypertension score out of 10 (PHS10). There was excellent discrimination of moderate to severe PCPH versus grouped absent to mild PCPH using PHS8 (area under the receiver operator curve [AUC] [95% confidence interval, CI] = 0.90 [0.84–0.95], P < 0.0001) and PHS10 (AUC [95% CI] = 0.89 [0.81–0.97], P < 0.0001). PHS8 ≥3 was 64% sensitive and 98% specific for moderate to severe PCPH (positive likelihood ratio [LR+] 32, negative likelihood ration [LR−] 0.37). PHS10 ≥ 3.3 was 64% sensitive and 92% specific for moderate to severe PCPH (LR+ 8, LR− 0.39). Interobserver agreement was good to excellent (intraclass correlation coefficient [ICC] = 0.74 [95% CI: 0.66–0.80], n = 135).

Conclusions

Residents identified moderate to severe PCPH in dogs using PHS on cineloops previously obtained by a cardiologist. The interrater agreement was good to excellent with limited training. Prospective studies to determine if residents can obtain diagnostic images for PHS are warranted.

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在评估犬毛细血管前肺动脉高压时对右心参数评分的回顾性评估（2017-2021 年）：135例

目的：确定急诊和重症监护住院医师能否使用肺动脉高压评分（PHS）在心脏病专家获得的心电图上识别中度至重度毛细血管前肺动脉高压，并报告 PHS 的观察者间变异性：2017年至2021年的多中心、回顾性、病例对照研究：私立转诊中心和兽医教学医院：135只接受超声心动图诊断的客户自养犬：测量和主要结果对患有B1期肌瘤性二尖瓣病（MMVD）的犬和通过超声心动图诊断为毛细血管前肺动脉高压（PCPH）的犬的病历进行回顾。心脏病专家根据多普勒肺压力梯度和右心形态将狗分为 5 组（正常、B1 MMVD、轻度、中度和重度 PCPH）。急诊和重症监护住院医师对每个病例的 Cineloops 进行主观评估，以确定是否存在右心房和右心室增大、右心室肥厚、室间隔变平以及肺动脉和肺动脉干增大，从而得出肺动脉高压综合评分（满分 8 分，PHS8）。如果有腹腔积液和尾腔静脉膨胀的迹象，则对其进行主观评估，以得出肺动脉高压的满分 10 分（PHS10）。使用 PHS8 对中度至重度 PCPH 与分组缺失至轻度 PCPH 进行了很好的鉴别（接收器运算曲线下面积 [AUC] [95% 置信区间，CI] = 0.90 [0.84-0.95]，P 结论）：住院医师使用 PHS 对心脏科医生之前获得的心音环识别犬的中度至重度 PCPH。在有限的培训条件下，他们之间的一致性良好至极佳。有必要进行前瞻性研究，以确定住院医师能否获得 PHS 的诊断图像。

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来源期刊

Journal of veterinary emergency and critical care 农林科学-兽医学

CiteScore

2.50

自引率

15.40%

发文量

121

审稿时长

18-36 weeks

期刊介绍： The Journal of Veterinary Emergency and Critical Care’s primary aim is to advance the international clinical standard of care for emergency/critical care patients of all species. The journal’s content is relevant to specialist and non-specialist veterinarians practicing emergency/critical care medicine. The journal achieves it aims by publishing descriptions of unique presentation or management; retrospective and prospective evaluations of prognosis, novel diagnosis, or therapy; translational basic science studies with clinical relevance; in depth reviews of pertinent topics; topical news and letters; and regular themed issues. The journal is the official publication of the Veterinary Emergency and Critical Care Society, the American College of Veterinary Emergency and Critical Care, the European Veterinary Emergency and Critical Care Society, and the European College of Veterinary Emergency and Critical Care. It is a bimonthly publication with international impact and adheres to currently accepted ethical standards.