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. 2016 Mar-Apr;30(2):543-52.
doi: 10.1111/jvim.13911. Epub 2016 Feb 19.

Diagnostic Value of Right Pulmonary Artery Distensibility Index in Dogs with Pulmonary Hypertension: Comparison with Doppler Echocardiographic Estimates of Pulmonary Arterial Pressure

L C Visser  1 , M K Im  1 , L R Johnson  1 , J A Stern  1
Affiliations

Diagnostic Value of Right Pulmonary Artery Distensibility Index in Dogs with Pulmonary Hypertension: Comparison with Doppler Echocardiographic Estimates of Pulmonary Arterial Pressure

L C Visser et al. J Vet Intern Med. 2016 Mar-Apr.

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.

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Figures

Figure 1
Figure 1
Representative measurement and calculation of the right pulmonary artery distensibility (RPAD) index in a dog with a peak tricuspid regurgitation systolic pressure gradient (TRPG) <36 mmHg. RPA, right pulmonary artery; RPAD, RPA at its minimum diameter in diastole; RPAS, RPA at its maximum diameter in systole; RA, right atrium; RV, right ventricle; Ao, aorta; PA, pulmonary artery.
Figure 2
Figure 2
Scatter plots illustrating significant (all P < .0001) correlations (r) between peak tricuspid regurgitation systolic pressure gradient (TRPG) and the 4 indirect echocardiographic indices of pulmonary hypertension: right pulmonary artery distensibility (RPAD) index (upper left), acceleration time to peak pulmonary artery flow (AT; upper right), acceleration time to peak pulmonary artery flow to ejection time of pulmonary artery flow ratio (AT:ET; lower left), and main pulmonary artery to aorta internal diameter ratio (MPA:Ao; lower right). The solid line within each scatter plot represents the line of best fit.
Figure 3
Figure 3
Receiver operating characteristic (ROC) curves of the 4 indirect echocardiographic indices of PH: right pulmonary artery distensibility (RPAD) index (upper left), acceleration time to peak pulmonary artery flow (AT; upper right), acceleration time to peak pulmonary artery flow to ejection time of pulmonary artery flow ratio (AT:ET; lower left), and main pulmonary artery to aorta internal diameter ratio (MPA:Ao; lower right) for the prediction of peak tricuspid regurgitation systolic pressure gradient (TRPG) >50 mmHg in 69 dogs. AUC, area under the ROC curve; CI, confidence interval.
See this image and copyright information in PMC

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