Diagnostic Accuracy of the Electrocardiogram for Detection of Atrial and Ventricular Overloads in Dogs

Monique Machado Louredo Machado Louredo Teles Bombardelli, Tatiana Champion, Julio Cezar Juk Fischborn, Ana Bianca Ferreira Gusso

Abstract


Background: Analysis of the electrocardiogram may suggest atrial and ventricular overloads. However, it has a low sensitivity and specificity for diagnosis of cardiac chamber overload. The accuracy of electrocardiographic interpretation can be improve using new cut-offs for the duration and amplitude of the electrocardiographic waves. Our objective was to evaluate the use of the electrocardiogram in the diagnosis of atrial and ventricular overload, using echocardiography as the gold standard test for the diagnosis of atrioventricular overload. We aimed to define new cut-off values that would increase the sensitivity and specificity of the electrocardiogram for diagnosis of chamber overload in dogs.


Materials, Methods & Results: Eletrocardiogram records were obtained in 81 dogs divided into 3 groups: Group 1A (healthy dogs 10 kg); Group 1B (dogs 10 kg with mitral or tricuspid valve disease); Group 2 (dogs weighing between 10.1 and 20 kg) and Group 3 (dogs > 20.1 kg). Duration in milliseconds (ms) and amplitude in millivolts (mV) of P waves and QRS complexes, PR and QT segment, T wave amplitude and ST segment were evaluated in lead DII. Using leads I and III, the mean cardiac electrical axis in the frontal plane, expressed in degrees, was determined as the mean of three consecutive measurements. For Group 1A and 1B the duration of P wave was < 45 ms and QRS duration < 55 ms. In Group 2 the duration of P wave was < 47 ms and QRS duration < 57 ms. In Group 3 the duration of P wave was < 50 ms and duration QRS < 64 ms. These values (duration of P wave and QRS duration) were compared with echocardiographic measurements of the left atrium, considering the reference value AE/Ao < 1.4 and measurements of the left ventricle in M-mode according to the body weight, respectively. A P wave amplitude < 0.4 mV suggested that the right atrium size was normal and this was compared with the area of the right atrium measured on the echocardiogram. The right ventricle was assessed using the amplitude of S wave and right axis deviation and compared with the right ventricular area obtained by echocardiography. The reference value of the right atrium and right ventricle is according to the body weight. For both the right and left atria, there was concordance between the diagnoses with electrocardiography and echocardiography. For the right and left ventricle was no agreement between the diagnoses. All criteria examined had low sensitivities, usually with high specificities. But it was not possible to determine a new cut-off that would improve the sensitivity of the electrocardiogram for diagnosis of atrial and ventricular overload in dogs.

Discussion: The electrocardiogram analysis produced false interpretations for the measures indicative of atrioventricular overloads and should not be used alone, for diagnosis of cardiac chamber overload. The standard electrocardiographic reference values, for P wave duration and amplitude, were excellent for identification of normal atrial size. However, QRS duration, R wave amplitude (dependent of the dog’s weight) and S wave amplitude, associated with cardiac electrical axis cannot be used for diagnosis of ventricle overload. Electrocardiographic analysis should not be used as a tool to assess cardiac chamber overload, which should be diagnosed by echocardiography and clinical investigation. Based on our findings echocardiogram is the gold standard test indicated to identify overload of cardiac chambers.


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References


Boon J.A. 2017. Measurement and Assesment of Two-Dimensional and M-mode Images. In: Two-Dimensional and M-Mode Echocardiography for the Small Animal Practitioner. 2nd edn. Ames: Willey Blackwell, pp.83-105.

Boon J.A. 2011. Evaluation of Size, Function and Hemodynamics. In: Veterinary Echocardiography. 2nd edn. Ames: Willey Blackwell, pp. 205-245.

Bonagura J.D. & Fuentes V.L. 2015. Echocardiography. In: Mattoon J.S. & Nyland T.G. (Eds). Small Animal Diagnostic Ultrasound. 3rd edn. Philadelphia: Saunders, pp.217-331.

Boswood A., Häggström J., Gordon S.G., Wess G., Stepien R.L., Oyama M.A., Keene B.W., Bonagura J., MacDonald K.A., Patteson M., Smith S., Fox P.R., Sanderson K., Woolley R., Szatmári V., Menaut P., Church W.M., O'Sullivan M.L., Jaudon J.P., Kresken J.G., Rush J., Barretts K.A., Rosenthal S.L., Saunders A.B., Ljungvall I., Deinert M., Bomassi E., Estrada A.H., Fernandez Del Palacio M.J., Moise N.S., Abbott J.A., Fujii Y., Spier A., Luethy M.W., Santilli R.A., Uechi M., Tidholm A. & Watson P. 2016. Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly: The EPIC Study - A Randomized Clinical Trial. Journal of Veterinary Internal Medicine. 30(6): 1765-1779. DOI: 10.1111/jvim.14586

Bouvard J., Thierry F., Culshaw G., Schwarz T., Handel I. & Pereira Y.M. 2019. Assessment of left atrial volume in dogs: comparisons of two-dimensional and realtime three-dimensional echocardiography with ECG-gated multidetector computed Q5 tomography angiography. Journal of Veterinary Cardiology. 24: 64-77. DOI: 10.1016/j.jvc.2019.06.004

Chapel E.H., Scansen B.A., Schober K.E. & Bonagura J.D. 2018. Echocardiographic Estimates of Right Ventricular Systolic Function in Dogs with Myxomatous Mitral Valve Disease. Journal of Veterinary Internal Medicine. 32(1): 64-71. DOI: 10.1111/jvim.14884

Filippi L.H. 2011. Sobrecargas atriais e ventriculares. In: O eletrocardiograma na medicina veterinária. São Paulo: Roca, pp.89-106.

Fries R.C., Gordon S.G., Saunders A.B., Miller M.W., Hariu C.D. & Schaeffer D.J. 2019. Quantitative assessment of two and three-dimensional transthoracic and two-dimensional transesophageal echocardiography, computed tomography, and magnetic resonance imaging in normal canine hearts. Journal of Veterinary Cardiology. 21: 79-92. DOI: 10.1016/j.jvc.2018.09.005

Fuentes V.L. 2008. Echocardiography and Doppler Ultrasound. In: Tilley L.P., Smith Jr. F.W.K., Oyama M.A. & Sleeper M.M. (Eds). Manual of Canine e Feline Cardiology. 4th edn. Toronto: Elsevier, pp.78-98.

Gentile-Solomon J.M. & Abbott J.A. 2016. Conventional Echocardiographic assessment of the canine right heart: reference intervals and repeatability. Journal of Veterinary Cardiology. 18(3): 234-247. DOI:10.1016/j.jvc.2016.05.002

Hsu P.C., Tsai W.C., Lin T.H., Su H.M., Voon W.C., Lai W.T. & Sheu S.H. 2012. Association of arterial stiffness and electrocardiography-determined left ventricular hypertrophy with left ventricular diastolic dysfunction. PLos One. 7(11): 1-7. DOI: 10.1371/journal.pone.0049100

Madron E. 2016. Normal Echocardiographic Examination. In: Clinical Echocardiography of the Dog and the Cat. St. Louis: Elsevier, pp.3-18.

Martin M. 2015. Changes in P-QRS-T morphology. In: Small Animal ECGs an introductory guide. 3rd edn. Ames: Wiley Blackwell, pp.63-70.

Matos D.I.A. 2010. Acuidade do Eletrocardiograma no Diagnóstico de Hipertrofia Ventricular esquerda. Revista Brasileira de Cardiologia. 23(6): 307-314.

Namdar M., Steffel J., Jetzer S., Schimied C., Hurlimann D., Camici G.G., Bayrak F., Ricciardi D., Rao J.Y., Asmundis C., Chierchia G.B., Sarkozy A., Luscher T.F., Jenni R., Duru F. & Brugada P. 2012. Value of electrocardiogram in the differentiation of hypertensive heart disease, hypertrophic cardiomyopathy, aortic stenosis, amyloidosis, and Fabry disease. The American Journal of Cardiology. 109(4): 587-593. DOI: 10.1016/j.amjcard.2011.09.052

Oyama M.A., Kraus M.S. & Gelzer A.R. 2014. Principles of Electrocardiography. In: Rapid Review off ECG Interpretation in Small Animal Practice. Boca Raton: Taylor & Francis Group, pp.9-16.

Pellegrino A., Daniel A.G.T., Pessoa R., Guerra J.M., Lucca G.G., Goissis M.D., Freitas M.F., Cogliat B. & Larsson M.H.M.A. 2016. Sensibilidade e especificidade do exame eletrocardiográfico na detecção de so-brecargas atriais e/ou ventriculares em gatos da raça Persa com cardiomiopatia hipertrófica. Pesquisa Veterinária Brasileira. 36(6): 187-196. DOI:10.1590/S0100-736X2016000300007

Schober K.E., Maerz I., Ludewig E. & Stern J.A. 2007. Diagnostic Accuracy of Electrocardiography and Thoracic Radiography in the Assessment of Left Atrial Size in Cats: Comparison with Transthoracic 2-Dimensional Echocardiograph. Journal of Veterinary Internal Medicine. 21(4): 709-718. DOI: 10.1892/0891-6640(2007)21[709:daoeat]2.0.co;2

Sieslack A.K., Dziallas P., Nolte I., Wefstaedt P. & Hungerbuhler S.O. 2014. Quantification of right ventricular volume in dogs: a comparative study between three dimensional echocardiography and computed tomography with the reference method magnetic resonance imaging. BMC Veterinary Research. 10(1): 242. DOI: 10.1186/s12917-014-0242-3

Tilley L.P. 1992. Analysis of canine P-QRS-T deflections. In: Essentials of canine and feline electrocardiography interpretation and treatment. 3rd edn. Philadelphia: Lea & Febiger, pp.59-99.

Thomas W.P., Gaber C.E., Jacobs G.J., Kaplan P.M., Lombard C.W., Moise N.S. & Moses B.L. 1993. Recommendations for standards in transthoracic two-dimensional echocardiography in the dog and cat. The echocardiography Committee of the Specialty of Cardiology, American College of Veterinary Internal Medicine. Journal of Veterinary Internal Medicine. 7(4): 247-252. DOI: 10.1111/j.1939-1676.1993.tb01015.x

Visser L.C., Scansen B.A., Schober K.E. & Bonagura J.D. 2015. Echocardiographic assessment of right ventricular systolic function in conscious healthy dogs: Repeatability and reference intervals. Journal of Veterinary Cardiology. 17(2): 83-96. DOI:10.1016/j.jvc.2014.10.003

Vessozi T., Domenech O., Iacona M., Marchesotti F., Zini E., Venco L. & Tognetti R. 2018. Echocardiographic Evaluation of the Right Atrial Area Index in Dogs with Pulmonary Hyper-tension. Journal of Veterinary Cardiology. 32(1): 42-47. DOI:10.1111/jvim.15035

Ware W.A. 2007. Overview of echocardiography. In: Cardiovascular Disease in Small Animal Medicine. Londres: Manson, pp.70-82.

Wolf R., Camacho A.A. & Souza R.C.A. 2000. Eletrocardiografia computadorizada em cães. Arquivo Brasileiro de Medicina Veterinária e Zootecnia. 52(6): 610-615. DOI:10.1590/S0102-09352000000600010.




DOI: https://doi.org/10.22456/1679-9216.105274

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