• 1.

    Häggström J, Hansson K, Kvart C, et al. Relationship between different natriuretic peptides and severity of naturally acquired mitral regurgitation in dogs with chronic myxomatous valve disease. J Vet Cardiol 2000; 2:716.

    • Search Google Scholar
    • Export Citation
  • 2.

    Oyama MA, Fox PR, Rush JE, et al. Clinical utility of serum N-terminal pro-B-type natriuretic peptide concentration for identifying cardiac disease in dogs and assessing disease severity. J Am Vet Med Assoc 2010; 232:14961503.

    • Search Google Scholar
    • Export Citation
  • 3.

    Serres F, Chetboul V, Tissier R, et al. Chordae tendineae rupture in dogs with degenerative mitral valve disease: prevalence, survival, and prognostic factors (114 cases, 2001–2006). J Vet Intern Med 2007; 21:258264.

    • Search Google Scholar
    • Export Citation
  • 4.

    Keene BW, Bonagura JD. Management of heart failure in dogs. In: Bonagura JD, Twedt DC, eds. Current veterinary therapy XIV. St Louis: Sounders Elsevier, 2009; 769780.

    • Search Google Scholar
    • Export Citation
  • 5.

    Van de Werf F, Minten J, Carmeliet P. The genesis of the third and fourth heart sounds. A pressure-flow study in dogs. J Clin Invest 1984; 73:14001407.

    • Search Google Scholar
    • Export Citation
  • 6.

    Balbarini A, Limbruno U, Bertoli D. Evaluation of pulmonary vascular pressures in cardiac patients: the role of the chest roentgenogram. J Thorac Imag 1991; 6:6268.

    • Search Google Scholar
    • Export Citation
  • 7.

    Turner AF, Lau FYK, Jacobson G. A method for the estimation of pulmonary venous and arterial pressures from the routine chest roentgenogram. Am J Roentgenol Radium Ther Nucl Med 1972; 116:97106.

    • Search Google Scholar
    • Export Citation
  • 8.

    Oyama MA, Rush JE, Rozanski EA, et al. Assessment of serum N-terminal pro-B-type natriuretic peptide concentration for differentiation of congestive heart failure from primary respiratory tract disease as the cause of respiratory signs in dogs. J Am Vet Med Assoc 2009; 235:13191325.

    • Search Google Scholar
    • Export Citation
  • 9.

    Schober KE, Bonagura JD, Scansen BA, et al. Estimation of left ventricular filling pressure by use of Doppler echocardiography in healthy anesthetized dogs subjected to acute volume loading. Am J Vet Res 2008; 69:10341049.

    • Search Google Scholar
    • Export Citation
  • 10.

    Schober KE, Luis Fuentes V, Bonagura JD. Comparison between invasive hemodynamic measurements and noninvasive assessment of left ventricular diastolic function by use of Doppler echocardiography in healthy anesthetized cats. Am J Vet Res 2003; 64:93103.

    • Search Google Scholar
    • Export Citation
  • 11.

    Schober KE, Stern JA, DaCunha DN, et al. Estimation of left ventricular filling pressure by Doppler echocardiography in dogs with pacing-induced heart failure. J Vet Intern Med 2008; 22:578585.

    • Search Google Scholar
    • Export Citation
  • 12.

    Wang L, Lahtinen S, Lentz L, et al. Feasibility of using an implantable system to measure thoracic congestion in an ambulatory chronic heart failure canine model. Pacing Clin Electrophysiol 2005; 28:401411.

    • Search Google Scholar
    • Export Citation
  • 13.

    Asano K, Masuda K, Okumura M, et al. Plasma atrial and brain natriuretic peptide levels in dogs with congestive heart failure. J Vet Med Sci 1999; 6:523529.

    • Search Google Scholar
    • Export Citation
  • 14.

    Borgarelli M, Santilli RA, Chiavegato D, et al. Prognostic indicators for dogs with dilated cardiomyopathy. J Vet Intern Med 2006; 20:104110.

    • Search Google Scholar
    • Export Citation
  • 15.

    Fine DM, DeClue AE, Reinero CR. Evaluation of circulating amino terminal-pro-B-type natriuretic peptide concentration in dogs with respiratory distress attributable to congestive heart failure or primary pulmonary disease. J Am Vet Med Assoc 2008; 232:16741679.

    • Search Google Scholar
    • Export Citation
  • 16.

    Haeggstroem J, Hansson K, Kvart C, et al. Effects of naturally-acquired decompensated mitral valve regurgitation on the renin-angiotensin-aldosterone system and atrial natriuretic peptide concentration in dogs. Am J Vet Res 1997; 58:7782.

    • Search Google Scholar
    • Export Citation
  • 17.

    MacDonald KA, Kittleson MD, Munro C, et al. Brain natriuretic peptide concentration in dogs with heart disease and congestive heart failure. J Vet Intern Med 2003; 17:172177.

    • Search Google Scholar
    • Export Citation
  • 18.

    O'Sullivan ML, O'Grady MR, Minors LS. Plasma big endothelin-1, atrial natriuretic peptide, aldosterone, and norepinephrine concentrations in normal Doberman pinschers and Doberman pinschers with dilated cardiomyopathy. J Vet Intern Med 2007; 21:9299.

    • Search Google Scholar
    • Export Citation
  • 19.

    Tarnow I, Olsen LH, Kvart C, et al. Predictive value of natriuretic peptides in dogs with mitral valve disease. Vet J 2009; 180:195201.

  • 20.

    Schober KE, Hart TM, Stern JA, et al. Detection of congestive heart failure in dogs by Doppler echocardiography. J Vet Intern Med 2010; 24:13581368.

    • Search Google Scholar
    • Export Citation
  • 21.

    Rishniw M, Erb HN. Evaluation of four 2-dimensional echocardiographic methods of assessing left atrial size in dogs. J Vet Intern Med 2000; 14:429435.

    • Search Google Scholar
    • Export Citation
  • 22.

    Schober KE, Luis Fuentes V, McEwan JD, et al. Pulmonary venous flow characteristics as assessed by transthoracic pulsed Doppler echocardiography in normal dogs. Vet Radiol Ultrasound 1998; 39:3341.

    • Search Google Scholar
    • Export Citation
  • 23.

    Appleton CP, Firstenberg MS, Garcia MJ, et al. The echo-Doppler evaluation of left ventricular diastolic function. A current perspective. Cardiol Clin 2000; 18:513546.

    • Search Google Scholar
    • Export Citation
  • 24.

    Schober KE, Luis Fuentes V. Effects of age, body weight, and heart rate on transmitral and pulmonary venous flow in clinically normal dogs. Am J Vet Res 2001; 62:14471454.

    • Search Google Scholar
    • Export Citation
  • 25.

    Serres F, Pouchelon JL, Poujol L, et al. Plasma N-terminal pro-B-type natriuretic peptide concentration helps to predict survival in dogs with symptomatic degenerative mitral valve disease regardless of and in combination with the initial clinical status at admission. J Vet Cardiol 2009; 11:103122.

    • Search Google Scholar
    • Export Citation
  • 26.

    Omland T. Advances in congestive heart failure management in the intensive care unit: B-type natriuretic peptides in evaluation of acute heart failure. Crit Care Med 2008; 36: S17S20.

    • Search Google Scholar
    • Export Citation
  • 27.

    Wu AH, Smith A. Biological variation of the natriuretic peptides and their role in monitoring patients with heart failure. Eur J Heart Fail 2004; 6:355358.

    • Search Google Scholar
    • Export Citation
  • 28.

    Maisel AS. Use of BNP levels in monitoring hospitalized heart failure patients with heart failure. Heart Fail Rev 2010; 8:339344.

  • 29.

    Zile MR, Bennett TD, St John Sutton M, et al. Transition from chronic compensated to acute decompensated heart failure. Pathophysiological insights obtained from continuous monitoring of intracardiac pressures. Circulation 2008; 118:14331441.

    • Search Google Scholar
    • Export Citation
  • 30.

    Cioffi G, Tarantani L, Stefenelli C, et al. Changes in plasma N-terminal proBNP levels and ventricular filling pressures during intensive unloading therapy in elderly with decompensated congestive heart failure and preserved left ventricular systolic function. J Card Fail 2006; 12:608615.

    • Search Google Scholar
    • Export Citation
  • 31.

    Wu AH, Smith A, Apple F. Optimum blood collection intervals for B-type natriuretic peptide testing in patients with heart failure. Am J Cardiol 2004; 93:15621563.

    • Search Google Scholar
    • Export Citation
  • 32.

    Knebel F, Schimke I, Pliet K, et al. NT-proBNP in acute heart failure: correlation with invasively measured hemodynamic parameters during recompensation. J Card Fail 2010; 11: S38S41.

    • Search Google Scholar
    • Export Citation
  • 33.

    Schmidt MK, Reynolds CA, Estrada AH, et al. Effect of azotemia on serum N-terminal proBNP concentration in dogs with normal cardiac function: a pilot study. J Vet Cardiol 2009; 11:8186.

    • Search Google Scholar
    • Export Citation
  • 34.

    Raffan E, Loureiro J, Dukes-McEwan J, et al. The cardiac biomarker NT-proBNP is increased in dogs with azotemia. J Vet Intern Med 2009; 23:11841189.

    • Search Google Scholar
    • Export Citation
  • 35.

    Richards AM, Lainchbury JG, Nicholls MG, et al. BNP in hormone-guided treatment of heart failure. Trends Endocrinol Metab 2002; 13:151155.

    • Search Google Scholar
    • Export Citation
  • 36.

    Troughton RW, Frampton CM, Yandle TG, et al. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide concentrations. Lancet 2000; 355:11261130.

    • Search Google Scholar
    • Export Citation
  • 37.

    Gackowski A, Isnard R, Golmard JL, et al. Comparison of echocardiography and plasma B-type natriuretic peptide for monitoring the response to treatment in acute heart failure. Eur Heart J 2004; 25:17881796.

    • Search Google Scholar
    • Export Citation
  • 38.

    Guyton AC, Lindsey AW. Effect of elevated left atrial pressure and decreased plasma protein concentration on the development of pulmonary edema in dogs. Circ Res 1959; 1:649657.

    • Search Google Scholar
    • Export Citation
  • 39.

    Gehlbach BK, Geppert E. The pulmonary manifestations of left heart failure. Chest 2004; 125:669682.

  • 40.

    Poole-Wilson PA, Buller NP. Causes of symptoms in chronic congestive heart failure and implications for treatment. Am J Cardiol 1988; 62: 31A39A.

    • Search Google Scholar
    • Export Citation
  • 41.

    Appleton CP, Hatle LK, Popp RL, et al. Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 1988; 12:426440.

    • Search Google Scholar
    • Export Citation
  • 42.

    Diwan A, McCulloch M, Lawrie GM, et al. Doppler estimation of left ventricular filling pressures in patients with mitral valve disease. Circulation 2005; 111:32813289.

    • Search Google Scholar
    • Export Citation
  • 43.

    Ohno M, Cheng CP, Little WC. Mechanism of altered patterns of left ventricular filling during the development of congestive heart failure. Circulation 1994; 89:22412250.

    • Search Google Scholar
    • Export Citation
  • 44.

    Masutani S, Little WC, Hasegawa H, et al. Restrictive left ventricular filling pattern does not result from increased left atrial pressure alone. Circulation 2008; 117:15501554.

    • Search Google Scholar
    • Export Citation
  • 45.

    Jacques DC, Pinsky MR, Severyn D, et al. Influence of alterations in loading on mitral annular velocity by tissue Doppler echocardiography and its associated ability to predict filling pressures. Chest 2004; 126:19101918.

    • Search Google Scholar
    • Export Citation
  • 46.

    Oyama MA, Sisson DD, Bulmer BJ, et al. Echocardiographic estimation of mean left atrial pressure in a canine model of acute mitral valve insufficiency. J Vet Intern Med 2004; 18:667672.

    • Search Google Scholar
    • Export Citation
  • 47.

    Teshima K, Asano K, Sasaki Y, et al. Assessment of left ventricular function using pulsed tissue Doppler imaging in healthy dogs and dogs with spontaneous mitral regurgitation. J Vet Med Sci 2005; 67:12071215.

    • Search Google Scholar
    • Export Citation
  • 48.

    Mullens W, Borowski AG, Curtin RJ, et al. Tissue Doppler imaging in the estimation of intracardiac filling pressure in decompensated patients with advanced systolic heart failure. Circulation 2009; 119:6270.

    • Search Google Scholar
    • Export Citation
  • 49.

    Nagueh SF, Middleton KJ, Kopelen HA, et al. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 1997; 15:15271533.

    • Search Google Scholar
    • Export Citation
  • 50.

    Bruch C, Stypmann J, Gradaus R, et al. Usefulness of tissue Doppler imaging for estimation of filling pressures in patients with primary and secondary pure mitral regurgitation. Am J Cardiol 2004; 93:324328.

    • Search Google Scholar
    • Export Citation
  • 51.

    Olson JJ, Costa SP, Young CE, et al. Early mitral filling/diastolic mitral annular velocity ratio is not a reliable predictor of left ventricular filling pressure in the setting of severe mitral regurgitation. J Am Soc Echocardiogr 2006; 19:8387.

    • Search Google Scholar
    • Export Citation
  • 52.

    Gonzales-Vilchez F, Ayuela J, Ares M, et al. Comparison of Doppler echocardiography, color M-mode Doppler, and Doppler tissue imaging for estimation of pulmonary capillary wedge pressure. J Am Soc Echocardiogr 2002; 15:12451250.

    • Search Google Scholar
    • Export Citation
  • 53.

    Feissel M, Maizel J, Robles G, et al. Clinical relevance of echocardiography in acute severe dyspnea. J Am Soc Echocardiogr 2009; 22:11591164.

    • Search Google Scholar
    • Export Citation
  • 54.

    Myreng Y, Smiseth OA. Assessment of left ventricular relaxation by Doppler echocardiography. Comparison of isovolumic relaxation time and transmitral flow velocities with time constant of isovolumic relaxation. Circulation 1990; 81:260266.

    • Search Google Scholar
    • Export Citation
  • 55.

    Dickstein K. Diagnosing acute heart failure. The mathematician and the clinician (edit). J Am Coll Cardiol 2009; 54:15221523.

  • 56.

    Hansson K, Häggström J, Kvart C, et al. Reader performance in radiographic diagnosis of signs of mitral regurgitation in cavalier King Charles spaniels. J Small Anim Pract 2009; 50 (suppl 1): 4453.

    • Search Google Scholar
    • Export Citation
  • 57.

    Staub CN, Nagano H, Pearce ML. Pulmonary edema in dogs, especially the sequence of fluid accumulation in lungs. J Appl Physiol 1967; 22:227240.

    • Search Google Scholar
    • Export Citation
  • 58.

    Kellihan HB, Oyama MA, Reynolds CA, et al. Weekly variability of plasma and serum NT-proBNP measurements in normal dogs. J Vet Cardiol 2009; 11:9397.

    • Search Google Scholar
    • Export Citation
  • 59.

    Ishikawa T, Tanaka R, Suzuki S, et al. Daily rhythms of left atrial pressure in Beagle dogs with mitral valve regurgitation. J Vet Intern Med 2009; 23:824831.

    • Search Google Scholar
    • Export Citation

Advertisement

Effects of treatment on respiratory rate, serum natriuretic peptide concentration, and Doppler echocardiographic indices of left ventricular filling pressure in dogs with congestive heart failure secondary to degenerative mitral valve disease and dilated cardiomyopathy

Karsten E. Schober DVM, PhD1, Taye M. Hart DVM2, Joshua A. Stern DVM3, Xiaobai Li PhD4, Valerie F. Samii DVM, DACVR5, Lisa J. Zekas DVM, DACVR, DABVP6, Brian A. Scansen DVM, MS, DACVIM7, and John D. Bonagura DVM, MS, DACVIM8
View More View Less
  • 1 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.
  • | 2 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.
  • | 3 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.
  • | 4 Center for Biostatistics, The Ohio State University, Columbus, OH 43220.
  • | 5 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.
  • | 6 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.
  • | 7 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.
  • | 8 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

Abstract

Objective—To evaluate the effects of treatment on respiratory rate, serum natriuretic peptide concentrations, and Doppler echocardiographic indices of left ventricular filling pressure in dogs with congestive heart failure (CHF) secondary to degenerative mitral valve disease (MVD) and dilated cardiomyopathy (DCM).

Design—Prospective cohort study.

Animals—63 client-owned dogs.

Procedures—Physical examination, thoracic radiography, analysis of natriuretic peptide concentrations, and Doppler echocardiography were performed twice, at baseline (examination 1) and 5 to 14 days later (examination 2). Home monitoring of respiratory rate was performed by the owners between examinations.

Results—In dogs with MVD, resolution of CHF was associated with a decrease in respiratory rate, serum N-terminal probrain natriuretic peptide (NT-proBNP) concentration, and diastolic functional class and an increase of the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic lateral mitral annulus motion (E:Ea Lat). In dogs with DCM, resolution of CHF was associated with a decrease in respiratory rate and serum NT-proBNP concentration and significant changes in 7 Doppler echocardiographic variables, including a decrease of E:Ea Lat and the ratio of peak velocity of early diastolic transmitral flow to isovolumic relaxation time. Only respiratory rate predicted the presence of CHF at examination 2 with high accuracy.

Conclusions and Clinical Relevance—Resolution of CHF was associated with predictable changes in respiratory rate, serum NT-proBNP concentration, and selected Doppler echocardiographic variables in dogs with DCM and MVD. Home monitoring of respiratory rate was simple and was the most useful in the assessment of successful treatment of CHF.

Contributor Notes

Dr. Hart's present address is Veterinary Medical Center, University of Minnesota, Saint Paul, MN 55108.

Dr. Stern's present address is Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164.

Funded by a grant from the Morris Animal Foundation.

Presented in part at the Annual Forum of the American College of Veterinary Internal Medicine, Montreal, June 2009.

The authors thank Kathryn Meurs, John Mattoon, Nicole Ponzio, Laura Spayd, Agnieszka Kent, Patty Mueller, Becky Conners, and Richard Cober for technical assistance.

Address correspondence to Dr. Schober (schober.4@osu.edu).