Efficacy of a mitral regurgitation severity index to predict long‐term outcome in dogs with myxomatous mitral valve disease

Author:

Vereb Michelle1,Atkins Clarke E.2ORCID,Adin Darcy3ORCID,Blondel Thomas4,Coffman Melissa5ORCID,Lee Seunggon6ORCID,Guillot Emilie4ORCID,Ward Jessica L.1ORCID

Affiliation:

1. Department of Veterinary Clinical Sciences, College of Veterinary Medicine Iowa State University Ames Iowa USA

2. Department of Clinical Sciences, College of Veterinary Medicine North Carolina State University Raleigh North Carolina USA

3. Department of Large Animal Clinical Sciences, College of Veterinary Medicine University of Florida Gainesville Florida USA

4. Ceva Santé Animale Libourne France

5. Ceva Animal Health Lenexa Kansas USA

6. Seoul Animal Heart Hospital Seoul South Korea

Abstract

AbstractBackgroundPredicting progression of myxomatous mitral valve disease (MMVD) in dogs can be challenging.Hypothesis/ObjectivesThe mitral regurgitation severity index (MRSI) will predict time to congestive heart failure (CHF) and all‐cause death in dogs with MMVD.AnimalsEight hundred sixty‐nine client‐owned dogs.MethodsRetrospective study pooling data from 4 previous samples including dogs with MMVD stage B2 or C. MRSI was calculated as: (heart rate [HR]/120) × left atrium‐to‐aorta ratio (LA:Ao) × (age in years/10) × 100. Alternative MRSI formulas substituting radiographic measures of left atrial size were also calculated. Cox proportional hazard modeling and time‐dependent receiver‐operator characteristic curves quantified prognostic performance.ResultsFor Stage B2 pooled samples, MRSI > 156 was predictive of time to CHF (median 407 vs 1404 days; area under the curve [AUC] 0.68; hazard ratio 3.02 [95% CI 1.9‐4.9]; P < .001). MRSI > 173 was predictive of all‐cause death (median survival 868 vs 1843 days; AUC 0.64; hazard ratio 4.26 [95% CI 2.4‐7.5]; P < .001). MRSI showed superior predictive value compared to the individual variables of HR, LA:Ao, and age. Variations of the MRSI equation substituting radiographic vertebral left atrial size for LA:Ao were also significantly predictive of outcome in stage B2. MRSI was not consistently predictive of outcome in Stage C.Conclusions and Clinical ImportanceMRSI was predictive of outcome (onset of CHF and all‐cause death) in MMVD Stage B2, demonstrating utility as a useful prognostic tool. Echocardiographic LA:Ao can be effectively replaced by radiographically determined LA size in the MRSI formula.

Publisher

Wiley

Subject

General Veterinary

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