Efficacy of a mitral regurgitation severity index to predict long-term outcome in dogs with myxomatous mitral valve disease.

BACKGROUND: Predicting progression of myxomatous mitral valve disease (MMVD) in dogs can be challenging. HYPOTHESIS/OBJECTIVES: The mitral regurgitation severity index (MRSI) will predict time to congestive heart failure (CHF) and all-cause death in dogs with MMVD. ANIMALS: Eight hundred sixty-nine client-owned dogs. METHODS: Retrospective study pooling data from 4 previous samples including dogs with MMVD stage B2 or C. MRSI was calculated as: (heart rate [HR]/120) × left atrium-to-aorta ratio (LA:Ao) × (age in years/10) × 100. Alternative MRSI formulas substituting radiographic measures of left atrial size were also calculated. Cox proportional hazard modeling and time-dependent receiver-operator characteristic curves quantified prognostic performance. RESULTS: For Stage B2 pooled samples, MRSI > 156 was predictive of time to CHF (median 407 vs 1404 days; area under the curve [AUC] 0.68; hazard ratio 3.02 [95% CI 1.9-4.9]; P < .001). MRSI > 173 was predictive of all-cause death (median survival 868 vs 1843 days; AUC 0.64; hazard ratio 4.26 [95% CI 2.4-7.5]; P < .001). MRSI showed superior predictive value compared to the individual variables of HR, LA:Ao, and age. Variations of the MRSI equation substituting radiographic vertebral left atrial size for LA:Ao were also significantly predictive of outcome in stage B2. MRSI was not consistently predictive of outcome in Stage C. CONCLUSIONS AND CLINICAL IMPORTANCE: MRSI was predictive of outcome (onset of CHF and all-cause death) in MMVD Stage B2, demonstrating utility as a useful prognostic tool. Echocardiographic LA:Ao can be effectively replaced by radiographically determined LA size in the MRSI formula.

Use of physical examination, electrocardiography, radiography, and biomarkers to predict echocardiographic stage B2 myxomatous mitral valve disease in preclinical Cavalier King Charles Spaniels.

INTRODUCTION: Cavalier King Charles Spaniels (CKCS) are predisposed to developing myxomatous mitral valve disease (MMVD). Dogs with stage B2 MMVD benefit from medication. OBJECTIVES: To develop (1) breed-specific cut-offs for individual screening tests and (2) predictive models utilizing physical examination (PE), ECG, radiograph, and blood-based biomarker variables in combination for identification of echocardiographic stage B2 MMVD in preclinical CKCS. ANIMALS: Adult, preclinical CKCS not receiving cardiac medications (N = 226). MATERIALS AND METHODS: Prospective, cross-sectional study. Enrolled CKCS underwent PE, ECG, radiography, Doppler blood pressure measurement, echocardiography, and biomarker testing. Dogs were grouped by MMVD stage using echocardiography only. The discriminatory ability of individual tests to identify stage B2 was assessed, and prediction models were developed using variables derived from four 'tests' (PE, ECG, radiography, and biomarkers). RESULTS: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and radiographic vertebral heart size (VHS) had the best discriminatory ability of individual diagnostic tests to differentiate stage A/B1 CKCS from stage B2, with an area under the curve (AUC) of 0.855 and 0.843, respectively. An NT-proBNP ≥1138 pmol/L or a VHS ≥11.5 had high specificity for predicting stage B2 (90.1% and 90.6%, respectively). Prediction models incorporating variables from multiple tests had better discriminatory ability than single tests. The four-test prediction model had an AUC of 0.971. Three and two-test models had AUCs ranging between 0.925-0.959 and 0.895-0.949, respectively. CONCLUSIONS: Both NT-proBNP and VHS have good utility for predicting echocardiographic stage B2 MMVD in CKCS as individual tests. Prediction models incorporating multiple test variables have superior discriminatory ability.

A morphological study comparing heart size measurement on chest radiograph with echocardiography in local population.

OBJECTIVE: To investigate heart size on chest X-ray via cardiothoracic ratio, and to correlate it with echocardiographic measurements. METHODS: The comparative analytical, cross-sectional study was conducted at the Pakistan Navy Station Shifa Hospital, Karachi, between January 2021 and July 2021. The radiological parameters were measured on chest X-rays posterior-anterior view, and the echocardiographic parameters were measured using 2-dimensional transthoracic echocardiography. The absence or presence of cardiomegaly on both imaging modalities was modelled as a binary categorical variable and compared. Data was analysed using SPSS 23. RESULTS: Of the 79 participants, 44(55.7%) were males and 35(44.3%) were females. The mean age of the sample was 52.71±14.54 years. There were 28(35.44%) enlarged hearts on chest X-ray and 46(58.22%) on echocardiography. The sensitivity and specificity of chest X-ray were 54.35% and 90.90%, respectively. The positive and negative predictive values were 89.28% and 58.82%, respectively. The accuracy of chest X-ray in identifying an enlarged heart was 69.62%. CONCLUSIONS: The cardiac silhouette on a chest X-ray could demonstrate heart size through simple measurements with high specificity and reasonable accuracy. However, a normal heart size on chest X-ray may not have a normal function.

Methods of Radiographic Measurements of Heart and Left Atrial Size in Dogs with and without Myxomatous Mitral Valve Disease: Intra- and Interobserver Agreement and Practicability of Different Methods.

Dogs suffering from Myxomatous Mitral Valve Disease (MMVD) show a potential heart enlargement, especially in the left atrium, detectable by radiography. Due to digital radiography, different radiographic measurements estimate cardiac size quite uncomplicatedly. The Vertebral Heart Size (VHS), Radiographic Left Atrial Dimension (RLAD), Left Atrial Width (LAWidth), and the Vertebral Left Atrial Size (VLAS) used anatomical landmarks for measuring cardiac size in relation to the vertebral column. This study aimed to compare VHS, RLAD, LAWidth, and VLAS measured in conventional and inverted radiographs by veterinarians with different levels of experience in healthy dogs and dogs with MMVD. The reliability and user-friendliness of these measurements were evaluated, and the staging was compared to the echocardiography staging. A total of 50 unaffected dogs and 150 dogs with MMVD in stages B1, B2, and C were assessed. Three veterinarians with different levels of experience examined 200 conventional radiographs and their corresponding inverted radiographs blinded to the echocardiographic and clinical examination results. Analyses were performed to compare the measurements' grading and determine anatomical landmarks with measurement difficulties. Additionally, inter- and intraobserver agreement was assessed using intraclass correlation coefficient, and the agreement between radiographic and echocardiographic staging was compared using the kappa coefficient. The VHS, LAWidth, and VLAS were easier to define than the RLAD. The interobserver agreement was almost perfect for VHS (0.962) and good for the other radiographic measurements (RLAD: 0.778, LAWidth: 0.772, VLAS: 0.858). The VHS assigned the most dogs to the correct stage. However, VHS, RLAD, LAWidth, and VLAS presented an almost perfect intraobserver agreement. The dorsal left atrial margin of the RLAD was the most difficult measurement point to identify. The VHS is the most reproducible radiographic method for measuring the canine heart size and shows the highest agreement with echocardiography. An observer-related influence could be detected for RLAD, LAWidth, and VLAS.

Comparison of different radiographic scores with associated echocardiographic measurements and prediction of heart enlargement in dogs with and without myxomatous mitral valve disease.

INTRODUCTION: Staging of myxomatous mitral valve disease (MMVD) requires an echocardiographic examination along with thoracic radiographs. The aims of this study were to calculate mean values for radiographic scores vertebral heart size (VHS), left atrial width (LAWidth), radiographic left atrial dimension (RLAD), and vertebral left atrial size (VLAS) in conventional and grayscale inverted images in healthy dogs and dogs with different stages of MMVD, and to find cutoff values for a stage assignment. ANIMALS: One hundred fifty dogs in different stages of MMVD and 50 unaffected dogs were evaluated. METHODS: Radiographic scores, echocardiographic left atrium-to-aorta ratio and normalized left ventricular internal dimension at end-diastole, and results of a clinical examination were obtained. Analyses were performed to evaluate the correlation between radiographic scores and echocardiographic values, to determine cutoff values for a radiographic stage assignment, and to compare measurements in conventional and inverted radiographs. RESULTS: After excluding breed-specific higher VHS, the means of VHS, LAWidth, RLAD, and VLAS were similar in the control group and stage B1. All radiographic scores increased in stages B2 and C. The cutoff values identifying heart enlargement, and therefore differentiating stages B1 and B2, were 11.0 for VHS, 1.8 for LAWidth, 2.0 for RLAD, and 2.3 for VLAS. Besides RLAD, scores were similar in conventional and inverted radiographs. CONCLUSION: Cutoff values for the different radiographic scores for stage assignment were calculated. Radiographic cardiac scores using either conventional or inverted grayscale could be a tool to differentiate between different stages of MMVD when echocardiography is unavailable.

Vertebral heart size and vertebral left atrial size reference ranges in healthy Maltese dogs.

The most common cardiac measurements on thoracic radiography in veterinary medicine are vertebral heart size (VHS) and vertebral left atrial size (VLAS). Previously published studies have demonstrated evidence that reference ranges for these measures vary among different dog breeds, however reference ranges for Maltese breed dogs are currently lacking. We hypothesized that VHS and VLAS in healthy Maltese dogs would not be influenced by sex, age, or bodyweight. This retrospective, reference interval study aimed to describe reference intervals for VHS and VLAS in a sample of clinically healthy Maltese dogs and assess the intra- and interobserver variabilities for VLAS and VHS measurements. A total of 81 clinically healthy Maltese dogs were included, with healthy status being based on a complete cardiologic examination. Thoracic radiography in right lateral recumbency was performed for all dogs. The intra- and interobserver variability assessments of VHS and VLAS were based on measurements independently performed by three observers. The mean VHS was 9.53 ± 0.46 vertebrae (v). The median and interquartile range (IQR) for VLAS was 2 v (IQR, 1.8-2.1v). A statistically significant moderate positive correlation was observed between VHS and VLAS (P < .01, r = 0.416). Both VHS and VLAS showed an almost perfect intraobserver agreement. Interobserver agreement was almost perfect for VHS and substantial for VLAS. Findings supported previous studies recommending the use of breed-specific reference values for VHS and VLAS, and provided background data for future radiographic evaluations of Maltese dogs with clinical signs of cardiac disease.

Vertebral Heart Scale for the Brittany Spaniel: Breed-Specific Range and Its Correlation with Heart Disease Assessed by Clinical and Echocardiographic Findings.

The vertebral heart scale (VHS) was proposed by Buchanan and Bucheler as an objective method for estimating heart size in dogs. However, several studies have reported significant variation between breeds. The purpose of this retrospective study was to evaluate the VHS and to suggest a useful upper limit for normal heart size in Brittany Spaniels. The VHS was measured using a right lateral view in twenty-eight normal dogs and fifteen dogs with myxomatous mitral valve disease. The mean ± SD (standard deviation) VHS was 10.6 ± 0.2 vertebrae (v) in the normal dogs, which differs significantly from the mean VHS of 9.7 ± 0.5 v in Buchanan's original study with dogs of various breeds. The VHS in the dogs with myxomatous mitral valve disease was 11.9 ± 1.1 v. With a threshold value of 11.1 vertebrae, the sensitivity, specificity, positive and negative predictive values for diagnosing a cardiomegaly are 90%, 72%, 53% and 96%, respectively.

Radiographic Measurements of the Cardiac Silhouette and Comparison with Other Radiographic Landmarks in Wild Galahs (Eolophus roseicapilla).

BACKGROUND: Part of the diagnostic workup for cardiac diseases is radiographic imaging. To determine an enlarged heart, species-specific reference values are necessary. Wild birds are rarely diagnosed with cardiac disease, and only a few studies have been done to investigate the cardiac silhouette in wild birds. METHODS: In this retrospective study, the cardiac silhouette of 36 wild galahs, presented at the hospital, was investigated in relation to other anatomic landmarks like the thoracic width, clavicula width, synsacrum width, distance between the third and fourth rib, distance of the clavicula, and length and height of the sternum using a digital DICOM viewer. RESULTS: The cardiac width was significant compared to the thoracic width with a minimum to maximum of 50 to 65%. The cardiac width compared with the coracoid width also showed significant results with a minimum to maximum range of 570 to 743%. A significant correlation was found between the weight and the cardiac width and length. CONCLUSION: The cardiac silhouette in wild galahs is easily measured in both radiographic views, and the heart size can be compared to other anatomical landmarks.

Estimation of vertebral heart size and cardiothoracic ratio in Persian cats.

The study aimed to determine the reference values related to vertebral heart size (VHS) and cardiothoracic ratio (CTR), which are effective in the evaluation of the thorax diseases and especially cardiomegaly of the brachycephalic cats using the morphometric data of thorax and heart obtained from the radiographic images of the thoracic region of the Persian cats. It was determined that lying position during radiography did not affect VHS and CTR values. Also, the sex factor did not have a significance on these values. The fact that the VHS value of 8.16 thoracic vertebrae averagely found in the Persian cats is higher than 7.5 thoracic vertebrae value averagely stated in the studies conducted with the cats of different breeds is considered since the breed is brachycephalic.

Radiographic quantification of left atrial size in dogs with myxomatous mitral valve disease.

BACKGROUND: In the absence of echocardiography, identification of cardiomegaly via thoracic radiography is a necessary criterion for classification of disease severity in dogs with myxomatous mitral valve disease (MMVD). OBJECTIVE: Modified-vertebral left atrial size (M-VLAS) facilitates objective radiographic assessment of the left atrium (LA) in 2 dimensions and identifies LA enlargement more accurately than existing methods. ANIMALS: Sixty-four dogs with various stages of MMVD and 6 control healthy dogs. METHODS: Retrospective case-control study. Medical records were searched for dogs with varying severity of MMVD. Modified-vertebral left atrial size, vertebral left atrial size (VLAS), vertebral heart size (VHS), and radiographic left atrial dimension (RLAD) were measured from thoracic radiographs and compared with echocardiographically derived measurements. RESULTS: Positive correlation to LA/Ao was identified for M-VLAS (r = 0.77, P < .001), VLAS (r = 0.76, P < .001), RLAD (r = 0.75, P < .001), and VHS (r = 0.67, P < .001). Receiver operating characteristic analyzes provided an area under the curve of 0.97 (95% CI, 0.94-1.00) for M-VLAS, which was superior to VHS (0.90, 95% CI, 0.94-1.00, P = .03) in identifying dogs with LA/Ao ≥1.6. A cut-off value of ≥3.4 vertebrae using M-VLAS provided 92.7% sensitivity and 93.1% specificity in predicting LA enlargement. CONCLUSIONS AND CLINICAL IMPORTANCE: M-VLAS, which is superior to VHS, offers an accurate and repeatable way to radiographically identify LA enlargement in dogs with MMVD.

Right ventricular undersizing is associated with increased 1-year mortality.

OBJECTIVES: Right heart hemodynamic management is critical, because many post-heart transplantation (HTx) complications are related to right ventricular (RV) failure. However, current guidelines on size and sex matching rely primarily on weight matching, with recent literature using total ventricular mass (TVM), which places less emphasis on the impact of RV mass (RVM) matching. The aim of the present study was to analyze the relationship of RVM matching and survival after HTx. METHODS: We performed the retrospective analysis using the UNOS database of adult HTx performed between January 1997 and December 2017. Previously validated equations were used to calculate TVM and RVM. The percent difference in ventricular mass in the donor and recipient pair was used for the size mismatch. All donor-recipient pairs were divided into 4 RVM groups by their mismatch ratio. We analyzed RVM matching and explored how RVM undersizing impacted outcomes. The primary outcome measure was 1-year survival; secondary outcomes measured included stroke and dialysis within 1 year and functional status. RESULTS: A total of 38,740 donor-recipient pairs were included in our study. The 4 RVM match groupings were as follows: <0%, 0% to 20%, 20% to 40%, and >40%. Utilization of donors who were older and of female sex resulted in greater RVM undersizing. Survival analysis demonstrated patients with RVM undersizing had worse 1-year survival (P < .001). RVM undersizing was an independent predictor of higher 1-year mortality (hazard ratio, 1.23; 95% confidence interval, 1.11 to 1.34; P < .001). RVM undersizing was also associated with higher rates of dialysis within 1-year of transplantation and poorer postoperative functional status. CONCLUSIONS: RVM undersizing is an independent predictor for worse 1-year survival. Donors who are older and female have lower absolute predicted RVM and may be predisposed to RVM undersizing. RVM-undersized transplantation requires careful risk/benefit considerations.

Right Heart Size and Right Ventricular Reserve in Pulmonary Hypertension: Impact on Management and Prognosis.

Various parameters reflecting right heart size, right ventricular function and capacitance have been shown to be prognostically important in patients with pulmonary hypertension (PH). In the advanced disease, patients suffer from right heart failure, which is a main reason for an impaired prognosis. Right heart size has shown to be associated with right ventricular function and reserve and is correlated with prognosis in patients with PH. Right ventricular reserve, defined as the ability of the ventricle to adjust to exercise or pharmacologic stress, is expressed by various parameters, which may be determined invasively by right heart catheterization or by stress-Doppler-echocardiography as a noninvasive approach. As the term "right ventricular contractile reserve" may be misleading, "right ventricular output reserve" seems desirable as a preferred term of increase in cardiac output during exercise. Both right heart size and right ventricular reserve have been shown to be of prognostic importance and may therefore be useful for risk assessment in patients with pulmonary hypertension. In this article we aim to display different aspects of right heart size and right ventricular reserve and their prognostic role in PH.

Utility of radiographic measurements to predict echocardiographic left heart enlargement in dogs with preclinical myxomatous mitral valve disease.

BACKGROUND: Evaluation of left heart size helps determine disease severity in dogs with myxomatous mitral valve disease (MMVD). HYPOTHESIS/OBJECTIVES: Determine the ability of radiographic vertebral heart size (VHS) and vertebral left atrial size (VLAS) to predict LHEECHO in dogs with preclinical MMVD. ANIMALS: Seventy client-owned dogs with MMVD and no historical or present clinical or radiographic evidence of congestive heart failure (CHF). METHODS: Retrospective cross-sectional study of dogs with same-day echocardiography and thoracic radiography. Receiver-operating characteristic (ROC) curves were used to assess the ability of VHS, VLAS, and VHS + VLAS to discern dogs with and without LHEECHO , and clinically relevant cutpoints for these radiographic measurements were selected. RESULTS: The ability of VHS and VHS + VLAS to predict LHEECHO was moderate (area under the curve [AUC]VHS = 0.851; 95% CI, 0.762-0.941; AUCVHS + VLAS = 0.865; 0.783-0.947), and performance of VLAS and VHS + VLAS was not different from that of VHS alone. A VHS cutpoint of >10.8 had sensitivity = 91.1% (76.3%-98.1%) and specificity = 69.4% (51.9%-83.7%) for predicting LHEECHO . A cutpoint of >11.7 had sensitivity = 32.4% (17.4%-50.5%) and specificity = 97.2% (85.5%-99.9%) for predicting LHEECHO . Thirty (43%) of the 70 dogs had a VHS value of 10.9 to 11.7. CONCLUSIONS AND CLINICAL IMPORTANCE: Vertebral heart size >11.7 identified dogs with LHEECHO and VHS ≤ 10.8 excluded dogs with LHEECHO . A large percentage of dogs had VHS values intermediate to these cutpoints.

Fluctuating environments during early development can limit adult phenotypic flexibility: insights from an amphibious fish.

The interaction between developmental plasticity and the capacity for reversible acclimation (phenotypic flexibility) is poorly understood, particularly in organisms exposed to fluctuating environments. We used an amphibious killifish (Kryptolebias marmoratus) to test the hypotheses that organisms reared in fluctuating environments (i) will make no developmental changes to suit any one environment because fixing traits to suit one environment could be maladaptive for another, and (ii) will be highly phenotypically flexible as adults because their early life experiences predict high environmental variability in the future. We reared fish under constant (water) or fluctuating (water-air) environments until adulthood and assessed a suite of traits along the oxygen cascade (e.g. neuroepithelial cell density and size, cutaneous capillarity, gill morphology, ventricle size, red muscle morphometrics, terrestrial locomotor performance). To evaluate the capacity for phenotypic flexibility, a subset of adult fish from each rearing condition was then air-exposed for 14 days before the same traits were measured. In support of the developmental plasticity hypothesis, traits involved with O2 sensing and uptake were largely unaffected by water-air fluctuations during early life, but we found marked developmental changes in traits related to O2 transport, utilization and locomotor performance. In contrast, we found no evidence supporting the phenotypic flexibility hypothesis. Adult fish from both rearing conditions exhibited the same degree of phenotypic flexibility in various O2 sensing- and uptake-related traits. In other cases, water-air fluctuations attenuated adult phenotypic flexibility despite the fact that phenotypic flexibility is hypothesized to be favoured when environments fluctuate. Overall, we conclude that exposure to environmental fluctuations during development in K. marmoratus can dramatically alter the constitutive adult phenotype, as well as diminish the scope for phenotypic flexibility in later life.

Norwich terriers possess a greater vertebral heart scale than the canine reference value.

Previous studies have demonstrated evidence that normal reference ranges for radiographic vertebral heart scale values can vary among dog breeds. The purpose of this retrospective, observational study was to determine whether the normal vertebral heart scale values published by Buchanan and Bücheler for lateral radiographs are applicable to the Norwich terrier. Secondary objectives were to determine if clinical signs of respiratory disease, age, sex, weight, body condition score, recumbency, or thoracic depth-to-width ratio had any influence on vertebral heart scale measurements in this breed. The electronic medical record systems of two universities were reviewed and Norwich terriers were included in the study if they had orthogonal thoracic radiographs performed and no historical or radiographic evidence of cardiopulmonary disease. A vertebral heart scale was calculated for each patient. Sixty-one client-owned, Norwich terrier dogs with no clinical signs of cardiovascular disease were evaluated. The vertebral heart scale for Norwich terriers without evidence of cardiac disease (10.6 ± 0.6) was found to be significantly greater than the canine reference value of 9.7 ± 0.5 initially established by Buchanan and Bücheler. No significant correlation was found between clinical signs of respiratory disease, sex, age, thoracic depth-to-width ratio or lateral recumbency, and vertebral heart scale. Norwich terriers with a body condition score ≥6 had a significantly higher vertebral heart scale than those with a body condition score ≤5. Breed-specific ranges and body condition scores need to be considered when interpreting vertebral heart scale values for Norwich terriers.

Predicted heart mass is the optimal metric for size match in heart transplantation.

BACKGROUND: Donor-recipient size match is traditionally assessed by body weight. We assessed the ability of 5 size match metrics-predicted heart mass (PHM), weight, height, body mass index (BMI) and body surface area (BSA)-to predict 1-year mortality after heart transplant and to assess the effect of size match on donor heart turn down for size. METHODS: The study cohort comprised 19,168 adult heart transplant recipients in the United Network for Organ Sharing registry between 2007 and 2016. Each size match metric was divided into 7 equally sized groups using the donor-recipient ratio for each metric. Single and multivariable Cox proportional hazard models for mortality 1 year after transplant were constructed. RESULTS: Recipients in the severely (donor-recipient PHM ratio 0.54-0.86) undersized group for PHM experienced increased mortality, with a hazard ratio of 1.34 (95% confidence interval, 1.13-1.59; p < 0.001). There was no increased risk of death at 1 year if donors were undersized for weight, height, BMI, or BSA. We found that 32% of heart offers turned down for donor size would be acceptable using a PHM threshold of 0.86 or greater and that 14% of offers accepted (most of which are female donor to male recipient) were below this threshold. CONCLUSIONS: PHM is the optimal donor-recipient size match metric for prediction of mortality after heart transplant. Many offers turned down for donor size were above the threshold for adequacy of size match by PHM identified, and thus, the use of PHM could improve donor heart utilization and post-transplant survival.

Right ventricular size and function under riociguat in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (the RIVER study).

BACKGROUND: Riociguat is a soluble guanylate cyclase stimulator approved for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTPEH). The objective of this study was to evaluate right heart size and function assessed by echocardiography during long term treatment with riociguat. METHODS: Patients who started riociguat treatment (1.0-2.5 mg tid) within the trials phase II, PATENT, PATENTplus, EAS, CHEST and continued treatment for 3-12 months were included in this study. Echocardiography was analysed off-line at baseline, after 3, 6 and 12 months by investigators who were blinded to clinical data. Last and baseline observation carried forward method (LOCF, BOCF) were performed as sensitivity analysis. RESULTS: Seventy-one patients (45% PAH, 55% CTEPH; 53.5% female; 60 ± 13 years, mean pulmonary arterial pressure 46 ± 10 mmHg, mean PVR 700 ± 282dynes·sec·cm-5) were included. After 6 months, RA and RV area, RV thickness tricuspid regurgitation velocity showed a significant reduction. After 12 months, patients receiving riociguat therapy showed a significant reduction in right atrial (- 2.6 ± 4.4 cm2, 95% CI -3.84, - 1.33; p < 0.001, n = 49) and right ventricular (RV) area (- 3.5 ± 5.2 cm2, 95% CI -5.1, - 1.9; p < 0.001; n = 44), RV thickness (- 0.76 ± 2.2 mm, 95% CI -1.55, 0.03; n = 32), and a significant increase in TAPSE (2.95 ± 4.78 mm, 95% CI 1.52, 4.39; n = 45) and RV fractional area change (8.12 ± 8.87 mm, 95% CI 4.61, 11.62; n = 27). Both LOCF and BOCF showed similar results but lower effect sizes. CONCLUSION: Patients under long-term treatment with riociguat show significantly reduced right heart size and improved RV function in PAH and CTEPH. Further controlled prospective studies are needed to confirm these results.

Echocardiographic parameters and vertebral heart size (VHS) in lambs during the neonatal period / Parâmetros ecocardiográficos e tamanho cardíaco vertebral (VHS) em cordeiros durante o período neonatal

Due to cardiac immaturity, newborns have a different morphology and cardiac output when compared with adults. The purpose of this study was to describe the cardiac changes in echocardiographic characteristics and vertebral heart size (VHS) in newborn lambs during the neonatal period. Twenty-eight healthy Ile de France lambs were evaluated from birth to 35 days old. With the assistance of echocardiography, this study evaluated, both in systole and diastole, indexes related to the right and left ventricles, the aorta (Ao), the left atrium (LA), the E point to septal separation (EPSS) and the thickness of the interventricular septum (VSd, VSs). The left atrium-to-aorta ratio (LA:Ao) was analyzed and both the shortening (SF%) and ejection fractions were calculated (EF%). The VHS was obtained by measuring the heart's long and short axes and comparing it to the thoracic vertebrae. Throughout the first 35 days, the results obtained demonstrated an increased LV:RV ratio when compared to adult lambs. The calculated indexes and the LA:Ao ratio did not present statistically significant differences. The VHS values were normally distributed, presenting a mean of 9.67 vertebrae (v) during the entire period. Both radiographic and echocardiographic parameters showed significant differences between the analyzed moments. The VHS values ranged from 8.4v at the minimum end to 11.2v at the maximum. In order to prevent these changes from being misdiagnosed as heart diseases, this study contributed to take note of neonatal physiological anatomy peculiarities and in addition, it describes the parameters for this age in Ilê de France lambs.(AU)

Devido à imaturidade cardíaca, os recém-nascidos apresentam uma morfologia e débito cardíacos diferenciados quando comparado aos adultos. O objetivo deste estudo foi descrever as alterações cardíacas ecocardiográficas e silhueta cardíaca ao exame radiográfico a partir do método VHS (vertebral heart size) em cordeiros recém-nascidos durante o período neonatal. Vinte e oito cordeiros saudáveis da raça Ile de France foram avaliados desde o nascimento até os 35 dias de idade. Ao exame ecocardiográfico avaliou-se em sístole e diástole, os índices relacionados aos ventrículos direito (VD) e esquerdo (VE), a parede livre do ventrículo esquerdo, aorta (Ao), átrio esquerdo (Ae), septo e ponto E, e diâmetros finais. Foi feita a relação entre o átrio esquerdo e aorta, além da fração de ejeção e de encurtamento. O VHS foi mensurado a partir do tamanho dos eixos longo e curto do coração em relação às vértebras torácicas. Os resultados obtidos demonstraram aumento do VE em relação ao VD no decorrer dos 35 dias (p<0,05). Os índices calculados e a relação AE:Ao não tiveram diferença. Os valores de VHS tiveram distribuição normal com média de 9,67 vértebras em todo o período. Os parâmetros radiográficos e ecocardiográficos mostraram diferenças significativas entre os momentos analisados. Os valores VHS variaram de 8.4 a 11.2 vertebras. Para evitar que essas alterações sejam erroneamente interpretadas como cardiopatias na espécie, este estudo demonstra às peculiaridades do desenvolvimento cardíaco neonatal em cordeiros, além de descrever parâmetros para esta faixa etária em cordeiros da raça Ilê de France.(AU)

Assessment of the vertebral heart scale and cardiothoracic ratio to standardize the heart size of collared peccaries (Tayassu tajacu Linnaeus, 1758) restrained with ketamine and midazolam / Avaliação do vertebral heart scale e índice cardiotorácico na padronização do tamanho cardíaco de cateto (Tayassu tajacu Linnaeus, 1758) contidos com cetamina e midazolam

Wild species, especially those threatened with extinction, are increasingly being investigated to obtain information that can be useful for their preservation. The objective of the present study was to standardize the vertebral heart scale (VHS) and cardiothoracic ratio (CTR) of the collared peccary (Tayassu tajacu Linnaeus, 1758) sedated with ketamine and midazolam. Fourteen clinically healthy collared peccaries were examined in the two-year age group weighing 15-22kg. The animals were submitted to digital radiography of the thorax in lateral and dorsal ventral projections to calculate the VHS and CTR. The VHS mean values for males and females was 8.88±0.51v for right recumbency and 8.84±0.39v for left decubitus, and there were no significant between-gender differences regarding recumbency (p>0.05). The CTR showed mean values of 0.50±0.05 (males) and 0.45±0.04 (females), but the gender-differences were not significant (p>0.05). A positive correlation was shown between VHS and CTR (r=0.98, right decubitus; r=0.96, left decubitus). Establishing reference values for heart measurements in collared peccaries using digital radiography of the thorax permitted standardization of the VHS and CTR values for this wild species. In the studied wild animal model, the VHS and CTR heart assessment indexes were shown to be essential diagnostic tools for investigations of alterations in the size of the cardiac silhouette.(AU)

Espécies silvestres têm sido cada vez mais exploradas como forma de obter informações que favoreçam sua conservação, especialmente aquelas ameaçadas de extinção. Este trabalho teve por objetivo a padronização dos valores de VHS (vertebral heart scale) e índice cardiotorácico (ICT) de catetos (Tayassu tajacu Linnaeus, 1758) contidos com Cetamina e Midazolam. Foram avaliados 14 catetos clinicamente saudáveis, com faixa etária de 2 anos e variação média de peso entre 15 a 22Kg. Os animais foram submetidos a radiografia digital de tórax em projeções laterolaterais e dorsoventrais para o cálculo do vertebral heart scale (VHS) e Índice Cardiotorácico (ICT). O VHS evidenciou valores médios entre machos e fêmeas de 8,88±0,51v para decúbito direito e 8,84±0,39v para decúbito esquerdo, não ocorrendo diferença estatística entre os decúbitos (p>0,05). O ICT revelou valores médios de 0,50±0,05 (machos) e de 0,45±0,04 (fêmeas), não sendo verificada diferença estatística significativa entre os sexos (p>0,05). Verificou-se correlação positiva entre VHS e o ICT (r=0,98, decúbito direito, r= 0,96, decúbito esquerdo). O estabelecimento dos valores de referência para mensurações cardíacas em catetos, a partir de radiografias digitais do tórax, permitiu a padronização do VHS e ICT para esta espécie silvestre. No modelo animal silvestre estudado, os índices de avaliação cardíaca VHS e ICT mostraram-se como uma ferramenta diagnóstica imprescindível para investigações sobre as alterações do tamanho da silhueta cardíaca.(AU)

Estudo ecodopplercardiográfico em caprinos da raça Moxotó / Doppler echocardiography in goats Moxotó

Objetivou-se com este estudo reportar descrições acerca dos cortes ecocardiográficos no modo bidimensional, das dimensões cardíacas pelo modo unidimensional e dos índices de fluxo Doppler em caprinos da raça Moxotó. Foram utilizados 32 caprinos da raça Moxotó, distribuídos em quatro grupos por categoria de peso corporal, de igual número (n=8), em: G1 (5-10kg), G2 (10-15kg), G3 (15-20kg) e G4 (>20kg). Todos foram submetidos a um registro ecocardiográfico pelos modos bidimensional, modo-M, Doppler pulsado (PW), contínuo (CW) e de fluxo de cores (CF). A formação espectral das imagens ecocardiográficas foi satisfatória, contudo algumas adaptações foram necessárias para obtenção adequada dos cortes nos caprinos acima de 20 kg. Os parâmetros ecocardiográficos em modo unidimensional (IVSd, IVSs, LVIDd, LVIDs, VPWd, LVPWs) e índices de função cardíaco (EF e FS) apresentaram uma correlação descritiva positiva com peso corporal enquadradas nas categorias estudadas. A separação septal do ponto E, mostrou-se constante dentre as categorias de peso investigadas, variando entre 0,1 a 0,41cm em caprinos da raça Moxotó. A relação Em/Am foi predominantemente " >1" em todos os caprinos estudados, com Emax > Amax em todas as categorias, não sendo sujeito a influência da frequência cardíaca dentre as categorias de peso estudados. O mesmo pode ser aplicado ao TRIV, que se mostrou uniforme dentre os intervalos de peso estudados. As velocidades de fluxo da valva aórtica individuais foram superiores a velocidade máxima do fluxo da valva pulmonar. Os tempos de ejeção dos fluxos aórtico e pulmonar apresentaram correlação positiva descritiva com o aumento do peso corporal. Condição também observada sobre o VTI dos espectros de fluxo, dada a relação direta desta variável com o volume sistólico inversamente à FC. O tempo de aceleração (TA) do fluxo pulmonar foi superior ao fluxo aórtico, sendo este relação direta com aumento do peso corporal por categoria estudada e inversamente à frequência cardíaca. Desta forma, a padronização das variáveis ecodopplercardiográficas na espécie caprina, deve sempre considerar particularidades relacionadas ao padrão racial, faixa etária e peso corporal, bem como estudos de repetibilidade e reprodutibilidade e adoção de elementos individuais referenciais para elaboração confiável de valores de normalidade.(AU)

This study describes the two-dimensional echocardiographic sections, M-mode cardiac dimensions, and Doppler flow indices in Moxotó goats. A total of 32 Moxotó goats were divided into four equal groups (n = 8) according to body weight class: G1 (5-10 kg), G2 (10-15kg), G3 (15-20kg) and G4 (>20kg). All animals underwent echocardiographic tests, two-dimensional and M-mode, and pulsed (PW), continuous (CW) and color flow (CF) Doppler. The spectral formation of echocardiographic images was satisfactory, although some adjustments were necessary to obtain adequate cuts/sections for goats above 20 kg. One-dimensional echocardiographic parameters (IVSD, IVSS, LVIDd, LVIDs, VPWd, LVPWs) and cardiac function index (EF and FS) showed a positive descriptive correlation with body weight in the categories studied. The septal separation of point E was constant among the weight categories investigated, ranging from 0.1 to 0.41cm. The Em/Am ratio was predominantly ">1", with Emax> Amax in all weight categories, and not affected by the heart rate among the studied weight classes. The IVRT was also uniform among the studied weight classes. The individual flow rates of the aortic valve were higher than the maximum flow rate of the pulmonary valve. The ejection times of the aortic and pulmonary flows were positively correlated with increasing body weight, something also observed on the VTI of flow spectra, given the direct relationship of this variable with the stroke volume inversely to FC. The acceleration time (AT) of pulmonary blood flow was greater than the aortic flow, and directly related to increasing body weight and inversely with heart rate. Thus, the standardization of Doppler echocardiographic variables in goats, should always consider breed, age and body weight as well as repeatability and reproducibility studies and adoption of individual reference elements for reliable development of normal values.(AU)