A loud right-apical systolic murmur is associated with the diagnosis of secondary pulmonary arterial hypertension: retrospective analysis of data from 201 consecutive client-owned dogs (2006-2007).

Abstract

Canine pulmonary arterial hypertension (PAH) remains under-recognized and under-treated despite being prevalent. This retrospective study investigated whether selected historical and physical examination findings were associated with the diagnosis of canine PAH, defined as tricuspid regurgitation (TR) with a confirmed systolic pressure gradient ≥ 35 mm Hg. Two hundred and one client-owned dogs (PAH group, n=96; control group, n=105) were studied. Dogs in the control group had TR with a confirmed systolic gradient <35 mm Hg. All dogs underwent a complete physical examination and a complete echocardiographic assessment. A loud systolic right-apical murmur (RAM) was significantly associated with TR ≥ 35 mm Hg. The proportion of dogs with PAH significantly increased as the RAM grade increased, with odds ratios of 4.4-37.6 for Grades 3/6-5/6 (P=0.004 to <0.001), respectively. A stronger right-than-left apical-murmur had a positive predictive value (PPV) of 83% and was 96% specific for TR ≥ 35 mm Hg, and when combined with syncope, it had a PPV of 92% and was 92% specific. A Grade ≥ 4/6 RAM had a PPV of 85% and was 93% specific. Syncope with a Grade ≥ 4/6 RAM had a PPV of 94% and was 92% specific. Ascites combined with a Grade ≥ 4 or ≥ 5/6 RAM had a PPV of 100% and was 100% specific for TR ≥ 35 mm Hg. For each of these three murmur categories (Grades ≥ 4/6, ≥ 5/6, and a louder-right-than-left murmur), when detected with no concurrent ascites or syncope, the positive likelihood ratio varied from 4.6 to 6.4. A loud systolic RAM in dogs with degenerative valve disease is highly suggestive of concurrent PAH.

• Authors: D G Ohad, I Lenchner, T Bdolah-Abram, G Segev
• Journal: Veterinary journal (London, England : 1997) (Vet J) Vol. 198 Issue 3 Pg. 690-5 (Dec 2013) ISSN: 1532-2971 [Electronic] England
• PMID: 24215779 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 Elsevier Ltd. All rights reserved.

Topics

• Animals
• Ascites (complications, epidemiology, veterinary)
• Dog Diseases (epidemiology, etiology)
• Dogs
• Echocardiography, Doppler (veterinary)
• Familial Primary Pulmonary Hypertension
• Female
• Hypertension, Pulmonary (complications, epidemiology, veterinary)
• Male
• Retrospective Studies
• Syncope (complications, epidemiology, veterinary)
• Systolic Murmurs (complications, epidemiology, veterinary)
• Tricuspid Valve Insufficiency (complications, epidemiology, veterinary)