Radiographic quantification of left atrial size in dogs with myxomatous mitral valve disease

• Published in: Journal of veterinary internal medicine Vol. 35; no. 2; pp. 747 - 754
• Main Authors: Lam, Christopher, Gavaghan, Brad J., Meyers, Fiona E.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-03-2021; Wiley
• Subjects: Heart failure; Internal medicine; left atrial enlargement; modified‐vertebral left atrial size; pimobendan; radiographic left atrial dimension; Radiography; SMALL ANIMAL; Ultrasonic imaging; Vertebrae; vertebral heart size; vertebral left atrial size; left atrial enlargement; vertebral heart size; vertebral left atrial size; modified-vertebral left atrial size; radiographic left atrial dimension; pimobendan
• ISSN: 0891-6640; 1939-1676
• DOI: 10.1111/jvim.16073

Background
In the absence of echocardiography, identification of cardiomegaly via thoracic radiography is a necessary criterion for classification of disease severity in dogs with myxomatous mitral valve disease (MMVD).
Objective
Modified‐vertebral left atrial size (M‐VLAS) facilitates objective radiographic assessment of the left atrium (LA) in 2 dimensions and identifies LA enlargement more accurately than existing methods.
Animals
Sixty‐four dogs with various stages of MMVD and 6 control healthy dogs.
Methods
Retrospective case–control study. Medical records were searched for dogs with varying severity of MMVD. Modified‐vertebral left atrial size, vertebral left atrial size (VLAS), vertebral heart size (VHS), and radiographic left atrial dimension (RLAD) were measured from thoracic radiographs and compared with echocardiographically derived measurements.
Results
Positive correlation to LA/Ao was identified for M‐VLAS (r = 0.77, P < .001), VLAS (r = 0.76, P < .001), RLAD (r = 0.75, P < .001), and VHS (r = 0.67, P < .001). Receiver operating characteristic analyzes provided an area under the curve of 0.97 (95% CI, 0.94‐1.00) for M‐VLAS, which was superior to VHS (0.90, 95% CI, 0.94‐1.00, P = .03) in identifying dogs with LA/Ao ≥1.6. A cut‐off value of ≥3.4 vertebrae using M‐VLAS provided 92.7% sensitivity and 93.1% specificity in predicting LA enlargement.
Conclusions and clinical importance
M‐VLAS, which is superior to VHS, offers an accurate and repeatable way to radiographically identify LA enlargement in dogs with MMVD.