Prognostic Value of Left Atrial Function in Dogs with Chronic Mitral Valvular Heart Disease
Prognostic Value of Left Atrial Function in Dogs with Chronic Mitral Valvular Heart Disease
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DOI：
10.1111/jvim.12441
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发表时间：
2014-11-01
影响因子：
2.6
通讯作者：
Takiguchi, M.
中科院分区：
文献类型：
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作者：
Nakamura, K.;Osuga, T.;Takiguchi, M.
背景 在患有各种心脏病的人类患者中，左心房（LA）功能障碍与心脏病严重程度之间存在很强的相关性。 LA 功能障碍在患有慢性二尖瓣心脏病 (CMVHD) 的犬中的作用尚未得到解决。目的探讨 LA 功能与 CMVHD 犬预后的相关性。动物 38 只患有 CMVHD 的客户自养犬。方法前瞻性临床队列研究。根据一年内发生与心脏相关的死亡情况，将狗分为两组（幸存者和非幸存者）。比较各组之间的体格检查和超声心动图变量。为了评估识别心脏相关死亡患者的比较准确性，采用受试者工作特征（ROC）曲线和多变量逻辑分析。结果 LA活动面积变化分数（LA-FAC（act））的准确性最高，ROC曲线下面积（AUC）为0.95，其次是左心房与主动脉根比（LA/Ao），AUC为0.94；舒张早期二尖瓣流入速度峰值 (E)，AUC 为 0.85； LA 总面积变化分数 (LA-FAC(total))，AUC 为 0.85。在多变量 Logistic 回归分析中，LA-FAC(act) 成为 1 年内心脏相关死亡的唯一独立相关因素（比值比 = 1.401，P = 0.002）。结论和临床重要性就大小和功能而言，LA 与 CMVHD 犬的预后具有很强的相关性。本研究中最重要的死亡率独立预测因子是 LA-FAC(act)。
BackgroundA strong correlation between left atrial (LA) dysfunction and the severity of cardiac disease has been described in human patients with various cardiac diseases. The role of LA dysfunction in dogs with chronic mitral valvular heart disease (CMVHD) has not been addressed.ObjectivesTo investigate the correlation between LA function and the prognosis of dogs with CMVHD.AnimalsThirty-eight client-owned dogs with CMVHD.MethodsProspective clinical cohort study. Dogs were divided into 2 groups (survivors and nonsurvivors) based on the onset of cardiac-related death within 1year. Physical examination and echocardiographic variables were compared between the groups. For the assessment of the comparative accuracy in identifying patients with cardiac-related death, receiver operating characteristic (ROC) curves and multivariate logistic analysis were used.ResultsThe highest accuracy was obtained for the LA active fractional area change (LA-FAC(act)), with an area under the ROC curve (AUC) of 0.95, followed by the left atrial to aortic root ratio (LA/Ao), with an AUC of 0.94; peak early diastolic mitral inflow velocity (E), with an AUC of 0.85; and LA total fractional area change (LA-FAC(total)), with an AUC of 0.85. In the multivariate logistic regression analysis, LA-FAC(act) emerged as the only independent correlate of cardiac-related death within 1year (odds ratio=1.401, P=.002).Conclusions and Clinical ImportanceRegarding both the size and function, the LA has a strong correlation with the prognosis of dogs with CMVHD. The most significant independent predictor of mortality in this study was LA-FAC(act).