Echocardiography in Healthy Dogs - Comparison of Apical 5C and Subxiphoid Windows
DOI:
https://doi.org/10.22456/1679-9216.134503Keywords:
Doppler ultrasound., Endoscopy, Laringoscopy, Tumors, Image Diagnosis, cardiology, hemodynamic, dogAbstract
Background: Echocardiography is one of the most used diagnostic methods in Veterinary Cardiology for the investigation of heart diseases. This stands out for being a non-invasive technique, readily available and that generates satisfactory results in hemodynamic monitoring compared to other invasive techniques. However, some parameters are still not well
established in Veterinary Medicine. This work aims to perform a comparative echocardiographic study of the hemodynamic profile of the outflow tract of the left ventricle (LVOT) between the apical 5-chamber and subxiphoid windows in healthy dogs, in order to characterize the difference between their hemodynamic indices.
Materials, Methods & Results: An observational, prospective study was carried out in which 30 clinically healthy dogs
of both sexes of small to medium-sized breeds were examined. All animals underwent a complete screening echocardiographics examinations without sedation. After the complete examination, the left ventricular outflow tract (LVLVD) internal diameter was measured in the parasternal window on the long axis at the level of the aortic valve annulus during systole. The LVOT cross-sectional area was calculated using the formula πr2. The LVOT velocity-time integral (VTI) was measured by pulsed Doppler, with the cursor positioned before the aortic valve in the apical 5-chamber and subxiphoid window. Stroke volume (SV) was the result of the product of LVOT IVT measurements and LVOT crosssectional area. Cardiac output (CO) was estimated by the product of SV and heart rate (HR). VTI, SV and DC were comparable between the 2 groups and showed a statistically significant difference (P < 0.05). The values for the subxiphoid window were higher compared to the values found in the apical 5-chamber window.
Discussion: CO and SV can be underestimated when VTI is measured with the probe in an apical position. With the results of the present research, it is speculated that the measurement of the LVOT flow in a subxiphoid position is the method of choice for the acquisition of more accurate data on CO and SV. This difference in precision is justified by the dependence of the Doppler beam on alignment with blood flow. A Doppler signal with an intercept angle closer to 0° is preferable to obtain reliable values. The subxiphoid transducer provides more consistent alignment of the ultrasound beam with the aortic blood flow. Previous studies in humans have reported that vessel diameter has a greater relevance in the variation of cardiac output. In the present study, the variables that presented the highest correlation value were the LVSD and CO, in both acquisition methods. Studies performed in humans have suggested that cardiac output and VTI do not correlate with body index or weight, concluding that vessel diameter has a greater relevance in the variation of cardiac output. In line with previous human studies, the LVOT VTI allows for early identification of cardiogenic shock. In dogs, it has been used as a substitute for SV. This approach eliminates errors in the determination of the LVOT cross-sectional area defined by the formula πr2. In addition, the VTI has also been used in therapeutic guidance regarding fluid responsiveness. In these circumstances, the level of sensitivity and precision of the LVOT flow measurement becomes worrying, since the present research demonstrates a variability of hemodynamic profiles between 2 acquisition techniques in healthy dogs. Future studies are needed to investigate its application in Veterinary Medicine, in addition, studies involving reference data are needed.
Keywords: canines, Doppler, diagnostic imaging, cardiology, cardiovascular diseases, hemodynamics, LVLVD, LVOT.
Downloads
References
Abbott J.A. & MacLean H.N. 2003. Comparison of Doppler-derived peak aortic velocities obtained from subcostal and apical transducer sites in healthy dogs. Veterinary Radiology and Ultrasound. 44(6): 695-698. DOI: 10.1111/j.1740- DOI: https://doi.org/10.1111/j.1740-8261.2003.tb00533.x
2007.00299.x.
Aslan N., Yildizdas D., Horoz O.O., Coban Y., Demir F., Erdem S. & Sertdemir Y. 2020. Comparison of cardiac output and cardiac index values measured by critical care echocardiography with the values measured by pulse index continuous cardiac output (PiCCO) in the pediatric intensive care unit preliminary study. Italian Journal of Pediatrics. 46(1): 1-8. DOI: 10.1186/s13052-020-0803-y. DOI: https://doi.org/10.1186/s13052-020-0803-y
Baron S.B. & Comess K.A. 1990. Doppler echocardiography. Role in emergency diagnosis of cardiac valve disease. Postgraduate Medicine. 87(6): 85-98. DOI: 10.1080/00325481.1990.11716333. DOI: https://doi.org/10.1080/00325481.1990.11716333
Beigel R., Cercek B., Arsanjani R. & Siegel R.J. 2014. Echocardiography in the use of noninvasive hemodynamic monitoring. Journal Critical Care. 29(1): 1-8. DOI: 10.1016/j.jcrc.2013.09.003. DOI: https://doi.org/10.1016/j.jcrc.2013.09.003
Blanco P. 2020. Rationale for using the velocity–time integral and the minute distance for assessing the stroke volume
and cardiac output in point-of-care settings. The Ultrasound Journal. 12(21): 1-9. DOI: 10.1186/s13089-020-00170-x. DOI: https://doi.org/10.1186/s13089-020-00170-x
Boon J.A. 2011. Evaluation of size, function and hemodynamics. In: Boon J. (Ed). Veterinarian Echocardiography.
Chichester: Wiley-Blackwell, pp.153-267.
Brandfonbrener M., Landdowne M. & Shock N.W. 1955. Changes in cardiac output with age. Circulation. 12(4):
-566. DOI: 10.1161/01.cir.12.4.557. DOI: https://doi.org/10.1161/01.CIR.12.4.557
Bucci M., Rabozzi R., Guglielmini C. & Franci P. 2017. Respiratory variation in aortic blood peak velocity and caudal
vena cava diameter can predict fluid responsiveness in anesthetised and mechanically ventilated dogs. The Veterinary
Journal. 227(1): 30-35. DOI: 10.1016/j.tvjl.2017.08.004. DOI: https://doi.org/10.1016/j.tvjl.2017.08.004
Buchanan J.W. 2013. The history of veterinary cardiology. Journal of Veterinary Cardiology. 15(1): 65-85. DOI:10.1016/j.tvjl.2017.08.004. DOI: https://doi.org/10.1016/j.jvc.2012.12.002
Critchley L.A. & Critchley J.A. 1999. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. Journal of Clinical Monitoring and Computing. 15(2): 85-91. DOI:10.1023/a:1009982611386 DOI: https://doi.org/10.1023/A:1009982611386
Díaz A., Zócalo Y., Cabrera-Fischer E. & Bia D. 2018. Reference intervals and percentile curve for left ventricular outflow tract (LVOT), velocity time integral (VTI), and LVOT-VTI- derived hemodynamic parameters in healthy children and adolescents: Analysis of echocardiographic methods association and agreement. Echocardiography. 35(12): 2014-2034. DOI: 10.1111/echo.14176. DOI: https://doi.org/10.1111/echo.14176
Gaspar A., Azevedo P. & Roncon J.R. 2018. Non-invasive hemodynamic evaluation by Doppler echocardiography.
Brazilian Journal of Intensive Care. 30(3): 385-393. DOI: 10.5935/0103-507X.20180055. DOI: https://doi.org/10.5935/0103-507X.20180055
Irigoyen J.L., Corral J.M., Zelaya I.O., Muñoz G.M., Alcaide V.B., Saera M.B. & Lujan C.V. 2015. Accuracy of cardiac output estimations by transthoracic echocardiography compared with an accepted method of thermodilution, the pulmonary artery catheter, in the critically ill patients. Experimental Intensive Care Medicine. 3(1): 1-2. DOI: 10.1186/2197-425X-3-S1-A598. DOI: https://doi.org/10.1186/2197-425X-3-S1-A598
Jozwiak M., Mercado P., Teboul J.L., Benmalek A., Gimenez J., Dépret F., Richard C. & Monnet X. 2019. What is the lowest change in cardiac output that transthoracic echocardiography can detect? Critical Care. 23(1): 1-10. DOI: 10.1007/s10877-019-00330-y. DOI: https://doi.org/10.1186/s13054-019-2413-x
Lang R.M., Badano L.P., Mor-Avi V., Afilalo J., Armstrong A., Ernande L., Flachskampf F.A., Foster E., Goldstein S.A., Kuznetsova T., Lancellotti P., Muraru D., Picard M.H., Rietzschel E.R., Rudski L., Spencer K.T., Tsang W. & Voigt J.U. 2015. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society Echocardiography. 28(1): 1-39. DOI: 10.1093/ehjci/jev014. DOI: https://doi.org/10.1016/j.echo.2014.10.003
LeBlanc N.L., Scollan K.F. & Stieger-Vanegas S.M. 2017. Cardiac output measured by use of electrocardiogramgated 64-slice multidector computed tomography, echocardiography, and thermodilution in healthy dogs. American
Journal of Veterinary Research. 78(7): 818-827. DOI: 10.2460/ajvr.78.7.818 DOI: https://doi.org/10.2460/ajvr.78.7.818
Lopes P.C., Sousa M.G., Camacho A.A., Carareto R., Nishimori C.T., Santos P.S. & Nunes N. 2010. Comparison between two methods for cardiac output measurement in propofol -anesthetized dogs: thermodilution and Doppler. DOI: https://doi.org/10.1111/j.1467-2995.2010.00552.x
Veterinary Anaesthesia and Analgesia. 37(5): 401-408. DOI: 10.1186/s12917-017-1227-9. DOI: https://doi.org/10.1186/s12917-017-1227-9
Mercado P., Maizel J., Beyls C., Titeca- Beauport D., Joris M., Kontar L., Riviere A., Bonef O., Soupison T., Tribouilloy C., Cagny B. & Slama M. 2017. Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient. Critical Care. 21(1): 1-8. DOI: 10.1186/s13054-017-1737-7. DOI: https://doi.org/10.1186/s13054-017-1737-7
Mowat D.H., Haites N.E. & Rawles J.M. 1983. Aortic blood velocity measurement in healthy adults using a simple
ultrasound technique. Cardiovascular Research. 17(2): 75-80. DOI: 10.1093/cvr/17.2.75. DOI: https://doi.org/10.1093/cvr/17.2.75
Navaratnam M., Punn R., Ramamoorthy C. & Tacy T.A. 2017. LVOT-VTI is a Useful Indicator of Low Ventricular
Function in Young Patients. Pediatric Cardiology. 38(6): 1148-1154. DOI: 10.1007/s00246-017-1630-9. DOI: https://doi.org/10.1007/s00246-017-1630-9
Ortmeyer H.K. & Katzel L.I. 2020. Effects of Proximity between Companion Dogs and Their Caregivers on Heart Rate Variability Measures in Older Adults: A Pilot Study. International Journal of Environmental Research and Public Health. 17(8): 1-12. DOI: 10.3390/ijerph17082674. DOI: https://doi.org/10.3390/ijerph17082674
Pees C., Glagau E., Hauser J. & Michel- Behnke I. 2013. Reference values of aortic flow velocity integral in 1193 healthy infants, children, and adolescents to quickly estimate cardiac stroke volume. Pediatric Cardiology. 34(5): 1194-2000. DOI: 10.1007/s00246-012-0628-6. DOI: https://doi.org/10.1007/s00246-012-0628-6
Riesen S.C., Doherr M.G. & Lombard C.W. 2007. Comparison of Doppler-derived aortic velocities obtained from various transducer sites in healthy dogs and cats. Veterinary Radiology Ultrasound. 48(6): 570-573. DOI: 10.1111/j.1740-8261.2007.00299.x. DOI: https://doi.org/10.1111/j.1740-8261.2007.00299.x
Steeds R.P. 2011. Echocardiography: frontier imaging in cardiology. The British Journal of Radiology. 84(3): 237-245.
DOI: 10.1259/bjr/77730594. DOI: https://doi.org/10.1259/bjr/77730594
Tan C., Rubenson D., Srivastava A., Mohan R., Smith M.R, Billick K., Bardarian S. & Heywood J.T. 2017. Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort. Cardiovascular Ultrasound. 15(1): 18. DOI: 10.1186/s12947-017-0109-4. DOI: https://doi.org/10.1186/s12947-017-0109-4
Teixeira-Neto F.J. & Valverde A. 2021. Clinical Application of the Fluid Challenge Approach in Goal-Directed Fluid Therapy: What can we learn from human studies? Frontiers in Veterinary Science. 8(1): 1-24. DOI: 10.3389/fvets.2021.701377. DOI: https://doi.org/10.3389/fvets.2021.701377
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. Echocardiography Committee of the Specialty of Cardiology, American College of Veterinary Internal Medicine. Journal Veterinary Internal Medicine. 7(4): 247-252. DOI: 10.1111/j.1939-1676.1993.tb01015.x. DOI: https://doi.org/10.1111/j.1939-1676.1993.tb01015.x
Uehara Y., Koga M. & Takahashi M. 1995. Determination of cardiac output by echocardiography. The Journal of Veterinary Medical Science. 57(3): 401-407.
Uemura K., Kawada T., Inagaki M. & Sugimachi M. 2013. A minimally invasive monitoring system of cardiac output using aortic flow velocity and peripheral arterial pressure profile. Anesthesia & Analgesia. 116(5): 1006-1017. DOI: https://doi.org/10.1213/ANE.0b013e31828a75bd
DOI: 10.1292/jvms.57.401. DOI: https://doi.org/10.1292/jvms.57.401
Vinayagam D., Patey O., Thilaganathan B. & Khalil A. 2017. Cardiac output assessment in pregnancy: comparison
of two automated monitors with echocardiography. Ultrasound Obstetrics & Gynecology. 49(1): 32-38. DOI: 10.1002/
uog.15915.
Wetterslev M., Møller-Sørensen H., Johansen R.R. & Perner A. 2016. Systematic review of cardiac output measurements by echocardiography vs. thermodilution: the techniques are not interchangeable. Intensive Care Medicine. DOI: https://doi.org/10.1007/s00134-016-4258-y
(8): 1223-1233. DOI: 10.1007/s00134-016-4258.
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Daniele Clímaco Marques, Renan Paraguassu de Sá Rodrigues, Paulo Vitor Silva de Carvalho, Andrezza Braga Soares da Silva, Kelvin Ramon da Silva Leitão, Francisco das Chagas Araújo Sousa, Maria Angelica Parentes da Silva Barbosa, Jacyara de Jesus Rosa Pereira Alves, Amilton Paulo Raposo Costa, FLávio Ribeiro Alves
This work is licensed under a Creative Commons Attribution 4.0 International License.
This journal provides open access to all of its content on the principle that making research freely available to the public supports a greater global exchange of knowledge. Such access is associated with increased readership and increased citation of an author's work. For more information on this approach, see the Public Knowledge Project and Directory of Open Access Journals.
We define open access journals as journals that use a funding model that does not charge readers or their institutions for access. From the BOAI definition of "open access" we take the right of users to "read, download, copy, distribute, print, search, or link to the full texts of these articles" as mandatory for a journal to be included in the directory.
La Red y Portal Iberoamericano de Revistas Científicas de Veterinaria de Libre Acceso reúne a las principales publicaciones científicas editadas en España, Portugal, Latino América y otros países del ámbito latino
