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. 2022 Sep 2;17(9):e0274085.
doi: 10.1371/journal.pone.0274085. eCollection 2022.

Breed-specific values for vertebral heart score (VHS), vertebral left atrial size (VLAS), and radiographic left atrial dimension (RLAD) in pugs without cardiac disease, and their relationship to Brachycephalic Obstructive Airway Syndrome (BOAS)

Pia Saskia Wiegel  1 , Rebekka Mach  1 , Ingo Nolte  1 , Fritjof Freise  2 , Charanthorn Levicar  1 , Kristina Merhof  1 , Jan-Peter Bach  1
Affiliations

Breed-specific values for vertebral heart score (VHS), vertebral left atrial size (VLAS), and radiographic left atrial dimension (RLAD) in pugs without cardiac disease, and their relationship to Brachycephalic Obstructive Airway Syndrome (BOAS)

Pia Saskia Wiegel et al. PLoS One. .

Abstract

This prospective study aims to establish reference ranges for vertebral heart score (VHS), vertebral left atrial size (VLAS), and radiographic left atrial dimension (RLAD) in pugs. The impact of clinical severity of Brachycephalic Obstructive Airway Syndrome (BOAS), gender, body condition score, and body weight on VHS, VLAS, and RLAD were investigated. Intra- and interobserver correlation was determined. Correlation of radiographic scores to echocardiographic left atrial dimension was inspected. Additionally, for VLAS and RLAD, correlation to VHS was examined. Additionally, an assessment of thoracic and vertebral malformations was performed. Forty-seven privately owned pugs underwent physical examination, echocardiography, and thoracic radiography to determine cardiac health. Thirty-two pugs were eligible for establishing reference ranges for VHS in right lateral radiographs, which was 11.25 ± 0.62 (95% range, 10.1-12.8). Reference ranges for VHS in left lateral, and for VLAS and RLAD in right lateral radiograph were determined in 30 pugs. The VHS in left lateral radiograph was 11.01 ± 0.70 (95% range, 9.4-12.6), VLAS was 1.96 ± 0.38 (95% range, 1.1-2.8), and RLAD was 1.59 ± 0.34 (95% range, 0.7-2.4). Clinical severity of BOAS did not show any impact on radiographic measurements. For VLAS, a significant correlation to VHS was detected by all observers. No other variables had a consistent influence on the radiographic scores given by all observers. Interobserver agreement was almost perfect for VHS (0.89 on right lateral and 0.91 on left lateral image), moderate for VLAS (0.49), and fair for RLAD (0.22). More than one third of the entire study population (18 of 47 pugs) showed at least one thoracic cavity or spine abnormality, often leading to considerable changes in vertebral body shape and size.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Right lateral thoracic radiograph of a two-year-old male pug.
The green lines illustrate the measurement of the vertebral heart score (VHS), revealing a VHS of 11.4v in this subject.
Fig 2
Fig 2. Right lateral thoracic radiograph of the same two-year-old male pug as in Fig 1, depicting the method for determining vertebral left atrial size (VLAS).
In this case, VLAS turned out to be 1.6v.
Fig 3
Fig 3. Measurement of radiographic left atrial dimension (RLAD) in a right lateral thoracic radiograph of the same two-year-old male pug as in Figs 1 and 2, being 1.3v in this subject.
Fig 4
Fig 4. Assessment of eligibility.
Fig 5
Fig 5. Right laterolateral thoracic radiograph of a five-year-old female pug showing irregularly shaped and trapezoid thoracic vertebrae throughout the thoracic spine (marked with asterisks), leading to exclusion from radiographic measurements.
Fig 6
Fig 6. Right laterolateral thoracic radiograph of a four-year-old male pug with misshaped vertebral bodies from T4 to T8 (marked with asterisks), considerably influencing radiographic vertebral scores.
See this image and copyright information in PMC

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