Diagnostic value of the pulmonary vein-to-right pulmonary artery ratio in dogs with pulmonary hypertension of precapillary origin.

Abstract

INTRODUCTION: Non-invasive diagnosis of pulmonary hypertension (PH) relies on estimation of pulmonary arterial pressure (PAP) via Doppler echocardiographic measurement of tricuspid regurgitation pressure gradient (TRPG). The pulmonary vein-to-right pulmonary artery ratio (PV/PA) recently has been described for the detection of pulmonary venous congestion. Whether this variable could be used to detect the presence of precapillary PH is unknown. The objective of the present study was to investigate the diagnostic value of PV/PA for prediction of TRPG, as a surrogate of PAP, in dogs with PH of precapillary origin. ANIMALS: Sixty-seven client-owned dogs were included in the study. METHODS: This was a retrospective study. Dogs with a measurable TRPG were included and classified into group 1 (TRPG&#xa0;<&#xa0;30&#xa0;mmHg), group 2 (TRPG 30-49&#xa0;mmHg), group 3 (TRPG 50-80&#xa0;mmHg), or group 4 (TRPG&#xa0;>&#xa0;80&#xa0;mmHg). The PV/PA, acceleration time-to-ejection time ratio of pulmonary artery flow, main pulmonary artery diameter-to-aortic diameter ratio, and right pulmonary artery distensibility index were measured retrospectively from cineloops in each dog. RESULTS: The PV/PA measured by both two-dimensional (2D) and time-motion&#xa0;mode(MM) echocardiography decreased proportionally with PH severity. Using regression analysis, PV/PA (2D) was identified as the strongest predictor for TRPG (R&#xa0;=&#xa0;0.70, p&#xa0;<&#xa0;0.0001) among other variables studied, with a good diagnostic accuracy (area under the curve&#xa0;=&#xa0;0.94) for moderate PH (TRPG&#xa0;>&#xa0;50&#xa0;mmHg) using a cutoff value of < 0.70 (sensitivity&#xa0;=&#xa0;96%, specificity&#xa0;=&#xa0;82%). CONCLUSIONS: Results of the present study suggest that PV/PA can be useful as an additional, non-invasive, and indirect variable to identify precapillary PH in dogs.