Doppler echocardiographic prediction of pulmonary hypertension in West Highland white terriers with chronic pulmonary disease.

Abstract

BACKGROUND: Pulmonary hypertension (PH) is commonly diagnosed by Doppler echocardiography (DE) of tricuspid regurgitation (TR). However, TR may be absent or difficult to measure. HYPOTHESIS: Doppler-derived systolic time intervals of pulmonary artery (PA) flow may be used to predict PH in dogs. ANIMALS: Seventy-three healthy dogs and 45 West Highland white terriers (WHWT) with interstitial pulmonary disease (IPD). METHODS: Echocardiographic studies, including determination of right ventricular acceleration time (AT), ejection time (ET), and AT : ET ratio; right ventricular shortening fraction (RV-SF); and TR velocity, were performed. Pulmonary hypertension was defined by TR >3.1 m/s. RESULTS: In healthy WHWT, AT (median, range) was 73 ms (53 to 104) and AT : ET was 0.40 (0.28 to 0.55). AT : ET was minimally affected by age (R2 = 0.04, 95% confidence interval [CI] 0.01-0.07, P < .001) but not by heart rate, body weight, or RV-SF. In all WHWT with TR, AT and AT : ET were inversely related to calculated systolic PA pressure (R2 = 0.52, 95% CI 0.42-0.62, P < .001 and R2 = 0.36, 95% CI 0.29-0.42, P = .001). Clinical cutoffs to predict systolic PH were defined for AT (58 ms; sensitivity [Se] 88% and specificity [Sp] 80%) and AT : ET (0.31; Se 73% and Sp 87%). CONCLUSION AND CLINICAL IMPORTANCE: PH is common in WHWT with IPD. Analysis of right ventricular AT and AT : ET may be predictive of PH and should be particularly useful if TR is absent.