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).
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.
Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Nutrition and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 76100, Israel. Electronic address: ohadan@agri.huji.ac.il.
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Ohad
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Lenchner
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Bdolah-Abram
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Segev
D000818:Animals; D001201:Ascites / Q000150:complications / Q000453:epidemiology / Q000662:veterinary*; D004283:Dog Diseases / Q000453:epidemiology* / Q000209:etiology; D004285:Dogs; D015150:Echocardiography, Doppler / Q000662:veterinary; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006976:Hypertension, Pulmonary / Q000150:complications / Q000453:epidemiology / Q000662:veterinary*; D008297:Male; D012189:Retrospective Studies; D013575:Syncope / Q000150:complications / Q000453:epidemiology / Q000662:veterinary*; D054160:Systolic Murmurs / Q000150:complications / Q000453:epidemiology / Q000662:veterinary*; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000453:epidemiology / Q000662:veterinary
Canine; Mitral murmur; Pulmonary hypertension; Thrill; Tricuspid