Dataset Information

Diagnostic value of noninvasive pulse pressure measurements in Warmblood horses with aortic regurgitation.

ABSTRACT:

Background

Noninvasive blood pressures (NIBP) and pulse pressures (PP) have not been published in horses with aortic and mitral regurgitation (AR or MR).

Objectives

To investigate NIBP and PP in healthy Warmblood horses and horses with AR and MR and propose PP cutoffs to identify and stage AR severity.

Animals

Seventy-three Warmblood horses (healthy, 10; AR, 31; MR, 32).

Methods

Retrospective study. All horses had NIBP and an echocardiogram recorded. Cases were categorized based on severity of regurgitation. Pulse pressures were compared among healthy, MR, and AR groups and among AR severity groups. Cutoffs were determined by receiver operating characteristic curve analyses.

Results

Horses with AR had higher PP than horses with MR (mean difference [95% confidence interval (CI)], +17 [9-26] mm Hg, P < .001) and controls (+17 [5-30] mm Hg; P =.004). Horses with severe AR had higher PP compared those with mild (+38 [20-54] mm Hg; P < 0.001) and moderate AR (+33 [18-47] mm Hg; P < .001). The PP cutoffs to distinguish AR from MR and controls were 38 mm Hg (sensitivity [Sn], 100%; specificity [Sp], 19%) for maximal Sn and 61 mm Hg (Sn, 43%; Sp, 100%) for maximal Sp. The PP cutoffs to distinguish severe AR from mild and moderate AR were 57 mm Hg (Sn, 100%; Sp, 70%) for maximal Sn and 77 mm Hg (Sn, 75%; Sp, 100%) for maximal Sp.

Conclusions and clinical importance

Horses with AR have increased PP. Noninvasive PP measurements interpreted with provided cutoffs may aid clinicians in diagnosing and staging severity of AR in horses.

SUBMITTER: Boegli J

PROVIDER: S-EPMC6524107 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Publications

Diagnostic value of noninvasive pulse pressure measurements in Warmblood horses with aortic regurgitation.

Boegli Julia J Schwarzwald Colin C CC Mitchell Katharyn J KJ

Journal of veterinary internal medicine 20190402 3

<h4>Background</h4>Noninvasive blood pressures (NIBP) and pulse pressures (PP) have not been published in horses with aortic and mitral regurgitation (AR or MR).<h4>Objectives</h4>To investigate NIBP and PP in healthy Warmblood horses and horses with AR and MR and propose PP cutoffs to identify and stage AR severity.<h4>Animals</h4>Seventy-three Warmblood horses (healthy, 10; AR, 31; MR, 32).<h4>Methods</h4>Retrospective study. All horses had NIBP and an echocardiogram recorded. Cases were categ ...[more]

PMID: 30938891

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Project description:BackgroundEchocardiographic measurements are important prognostic indicators but might be influenced by heart rate and blood pressure. This is particularly important when comparing repeated examinations.HypothesisTo determine the effect of physiological stress at mildly increased heart rates and pharmacological challenge using IV administration of N-butylscopolammonium bromide and metamizol sodium on heart rate, blood pressure, and echocardiographic measurements.AnimalsTwenty healthy Warmblood horses.MethodsRandomized crossover study. Horses were examined echocardiographically by 2-dimensional, M-mode, pulsed wave (PW) Doppler, and PW tissue Doppler imaging with simultaneous ECG recording and noninvasive blood pressure measurements during rest, physiological stress, and pharmacological challenge. Cardiac dimensions and functions were measured by a blinded observer. Data were analyzed using repeated-measures analysis of variance.ResultsMean heart rate and arterial blood pressure were significantly higher during physiological stress (46 ± 2 bpm, 93 ± 16 mm Hg) and pharmacological challenge (62 ± 13 bpm, 107 ± 17 mm Hg) compared with rest (34 ± 3 bpm, 86 ± 12 mm Hg; P < .05). Compared with rest, physiological stress resulted in increased left atrial fractional area change (34.3 ± 7.5 vs 27.3 ± 5.1%; P = .01) and left ventricular late diastolic radial wall motion velocity (13 ± 3 vs 10 ± 2 cm/s; P = .01) but had no significant effect on most other echocardiographic variables. Compared with rest, pharmacological challenge led to significantly decreased left atrial and diastolic ventricular dimensions (left ventricular internal diameter: 10.3 ± 0.9 vs 10.7 ± 0.8 cm; P = .01), increased aortic and pulmonary diameters, and ventricular wall thickness.Conclusions and clinical importancePhysiological stress at mildly increased heart rates significantly enhanced atrial pump function. Larger heart rate and blood pressure increases during pharmacological challenge resulted in altered cardiac dimensions. This should be taken into account when evaluating echocardiographic measurements at increased heart rates.

Project description:Background Accurate assessment of the aortic annulus (AA) dimension and judgment of thoracic aorta aneurysm is crucial for patients with aortic regurgitation (AR) before surgery. The aim of this study was to evaluate the accuracy and reproducibility of three-dimensional transesophageal echocardiography (3D-TEE) methods for AA measurement and explore the predictive value of the AA dimensions obtained by 3D-TEE for high-risk thoracic aorta aneurysms using the gold standard of multi-slice computed tomography (MSCT). Methods 3D-TEE was performed on 111 patients with pure moderate-to-severe AR, and MSCT examination was conducted simultaneously. AA dimensions were obtained using reconstruction software for these two imaging techniques. Thoracic aortic diameters at standard anatomic landmarks were also measured by MSCT. All patients were divided into two groups depending on the presence of high-risk thoracic aorta aneurysms. Results Compared to MSCT, 3D-TEE overestimated all AA parameters. However, no statistically significant differences were found in the average bias between methods (minimum diameter: 26.07±3.57 vs. 25.88±3.68 mm, P=0.52; maximum diameter: 32.30±2.68 vs. 31.78±4.06 mm, P=0.11; area: 669.76±155.19 vs. 660.05±168.28 mm2, P=0.44; perimeter: 93.52±10.42 vs. 92.26±11.71 mm, P=0.12). 3D-TEE demonstrated good correlations with MSCT measurement for AA minimum diameter, maximum diameter, area, and perimeter (r=0.63, 0.64, 0.74, 0.69, P<0.05 for all). According to the multivariate logistic regression analysis, the AA minimum diameter obtained by 3D-TEE was the best predictor for the presence of high-risk thoracic aorta aneurysms. The sensitivity and specificity for prediction were 84.6% and 63.9%, respectively, for an AA minimum diameter ≥25.74 mm (AUC: 0.759, 95% CI: 0.668–0.850). Conclusions AA measurements obtained by the 3D-TEE method are feasible and reliable for patients with pure AR. The AA minimum diameter measured by 3D-TEE can effectively predict the presence of high-risk thoracic aorta aneurysms.

Dataset Information

Diagnostic value of noninvasive pulse pressure measurements in Warmblood horses with aortic regurgitation.

Background

Objectives

Animals

Methods

Results

Conclusions and clinical importance

Publications

Diagnostic value of noninvasive pulse pressure measurements in Warmblood horses with aortic regurgitation.

Similar Datasets

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