The predictive value of clinical, radiographic, echocardiographic variables and cardiac biomarkers for assessing risk of the onset of heart failure or cardiac death in dogs with preclinical myxomatous mitral valve disease enrolled in the DELAY study
The predictive value of clinical, radiographic, echocardiographic variables and cardiac biomarkers for assessing risk of the onset of heart failure or cardiac death in dogs with preclinical myxomatous mitral valve disease enrolled in the DELAY study
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DOI：
10.1016/j.jvc.2021.04.009
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发表时间：
2021-06-09
影响因子：
1.2
通讯作者：
Toaldo, M. Baron
中科院分区：
文献类型：
--
作者：
Borgarelli, M.;Ferasin, L.;Toaldo, M. Baron
目的：确定临床、影像学和超声心动图变量以及心脏生物标志物N-末端脑钠肽前体（NTproBNP）和心肌肌钙蛋白I在临床前粘液瘤性二尖瓣疾病（MMVD）犬中对至心力衰竭（HF）发作或心源性死亡时间的预测价值。动物：纳入了168只临床前MMVD和左心房与主动脉根比值>1.6（LA：Ao）且标准化左心室舒张末期直径>1.7的犬。方法：前瞻性、随机、多中心、单盲、安慰剂对照研究。比较不同时间点的临床、影像学、超声心动图变量和血浆心脏生物标志物浓度。使用接收工作曲线分析，确定选定变量的最佳截止值，并计算6个月间隔时发生研究终点的风险。结果如下：左心房与主动脉根部比值>2.1（风险比[HR] 3.2，95%置信区间[95% CI] 1.9-5.6），标准化左心室舒张末期直径> 1.9（HR：6.3; 95% CI：3.3-11.8），早期二尖瓣峰值流速（E峰）> 1 m/sec NT-proBNP > 1500 rmol/L（HR：5.7; 95%CI：3.3-9.5）与HF或心源性死亡风险增加相关。预测达到终点风险的最佳拟合模型由针对LA：Ao和E峰调整的血浆NT-proBNP浓度表示。结论：包括超声心动图变量和NT-proBNP在内的Logistic和生存模型可用于识别临床前MMVD犬，其发生HF或心源性死亡的风险较高。2021作者由爱思唯尔公司出版。这是一篇开放获取的文章，获得了CC BY-NC-ND许可证（http：//creativecommons.org/licenses/by-nc-nd/4.0/）。
Objectives: To identify the predictive value on time to onset of heart failure (HF) or cardiac death of clinical, radiographic, and echocardiographic variables, as well as cardiac biomarkers N-terminal pro brain natriuretic peptide (NTproBNP) and cardiac troponin I in dogs with preclinical myxomatous mitral valve disease (MMVD). Animals: One hundred sixty-eight dogs with preclinical MMVD and left atrium to aortic root ratio >1.6 (LA:Ao) and normalized left ventricular end-diastolic diameter >1.7 were included. Methods: Prospective, randomized, multicenter, single-blinded, placebo -controlled study. Clinical, radiographic, echocardiographic variables and plasma cardiac biomarkers concentrations were compared at different time points. Using receiving operating curves analysis, best cutoff for selected variables was identified and the risk to develop the study endpoint at six-month intervals was calculated. Results: Left atrial to aortic root ratio >2.1 (hazard ratio [HR] 3.2, 95% confidence interval [95% CI] 1.9-5.6), normalized left ventricular end-diastolic diameter > 1.9 (HR: 6.3; 95% CI: 3.3-11.8), early transmitral peak velocity (E peak) > 1 m/sec (HR: 3.9; 95% CI: 2.3-6.7), and NT-proBNP > 1500 rmol/L (HR: 5.7; 95% CI: 3.3-9.5) were associated with increased risk of HF or cardiac death. The best fit model to predict the risk to reach the endpoint was represented by the plasma NT-proBNP concentrations adjusted for LA:Ao and E peak. Conclusions: Logistic and survival models including echocardiographic variables and NT-proBNP can be used to identify dogs with preclinical MMVD at higher risk to develop HF or cardiac death. 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).