Outcome clinical audit: analyses of interventional closure of patent ductus arteriosus in dogs.

OBJECTIVES: The objectives of this study were to determine whether conducting a clinical audit was achievable in a group of centres that perform interventional cardiac procedures and to report the success and complications rates in dogs diagnosed with patent ductus arteriosus. METHODS: This was a multicentre, European-wide, prospective study. Patient data were entered into a bespoke database prior to commencing interventional closure of patent ductus arteriosus in all animals undergoing this procedure during the study period. The database was designed to gather clinical audit information, after completion of the procedure, such as discharge outcome, complication rate, and medium-term outcome. RESULTS: A total of 339 cases were included from five participating centres. The process of performing clinical audit was achieved in all centres. Successful discharge outcome was 95.9% with a complication rate of 4.1%. The procedure-related mortality was 0.6%. 149 cases (43.9%) were either lost to follow-up or had not yet had a follow-up within the time period. Of the remaining 169 cases in which follow-up was available, 157 (92.9%) cases had a successful medium-term outcome CONCLUSIONS: This study demonstrates that the process of performing a clinical audit is achievable in veterinary clinical interventions across different centres. These results provide a benchmark for future comparison in our ongoing clinical audit and validate the process of clinical audit for other centres performing cardiac interventions. The use of clinical audit should be considered in other aspects of veterinary medicine.

The effects of activity, body weight, sex and age on echocardiographic values in English setter dogs.

BACKGROUND: Breed-specific reference intervals improve echocardiographic interpretation and thereby reduce misdiagnoses, especially in athletic breeds. OBJECTIVES: The objectives of the study were to examine transthoracic echocardiographic values in healthy adult English setter dogs and determine the effects of activity, body weight, sex and age on these values. ANIMALS, MATERIALS AND METHODS: One hundred and one adult English setter dogs, recruited from local veterinary clinics and from the Norwegian English setter club, underwent routine transthoracic echocardiography. The population was stratified into two groups based on the reported level of activity. The effects of activity level, body weight, sex and age on echocardiographic variables were examined. Results were compared with published data from other breeds and from a pre-existing species-wide allometric model. RESULTS: Of the 100 dogs between 19 months and 10 years of age included in the study, 72 were reported as very active and 28 as less active. Echocardiographic intervals were calculated for body size-independent echocardiographic variables. The upper limits of the intervals for left-atrial-to-aortic ratios and normalised left ventricular volumes exceeded those of various, previously published studies of other breeds. Normalised left ventricular dimensions exceeded published allometric 95th percentile upper reference values in 13% of dogs in diastole and 32% of dogs in systole. More active dogs had larger cardiac dimensions than less active dogs; however, the activity level did not predict echocardiographic variables when included in a multiple regression model. CONCLUSIONS: The study provides breed specific transthoracic echocardiographic values for English setter dogs, thereby contributing to improve diagnostic assessment of cardiac health in this breed.

Two-dimensional echocardiographic estimates of left ventricular volumes obtained in different views in dogs provide similar measurements but are not interchangeable.

INTRODUCTION: Little information exists regarding the interchangeability of left ventricular volume estimates using a monoplane Simpson's Method of Discs on images obtained from the left apical four-chamber and right parasternal long axis four-chamber views. We examined if volume estimates obtained from these views were interchangeable. ANIMALS: A total of 224 dogs: 86 healthy, 96 with mitral valve disease, 42 with various cardiac pathologies. MATERIALS AND METHODS: Investigators obtained right parasternal long-axis and left apical four-chamber views from each dog and used manufacturer-supplied software to estimate left ventricular volumes in diastole and systole using Simpson's Method of Discs. Estimates based on linear measurements (diameter cubed, 0.67∗diameter cubed, and Teichholz) were also calculated. Reproducibility for each view, and agreement between the estimates obtained with each view, and those calculated from linear dimensions, were examined using Limits of Agreement. Reference intervals for volumes indexed to bodyweight and body surface area were calculated. RESULTS: Neither method proved very reproducible. Although no bias was detected, the agreement between volumes indexed to bodyweight and body surface area was insufficient to recommend interchangeability. Estimates based on Teichholz and diameter cubed methods overestimated volumes; however, those based on 0.67∗diameter cubed performed reasonably. CONCLUSIONS: Monoplane volume estimates from the left apical and right parasternal long axis four-chamber views are similar but not interchangeable. Clinicians can perform crude estimates of left ventricular volume using the equation 0.67∗diameter cubed.

Two-dimensional echocardiographic left- atrial-to-aortic ratio in healthy adult dogs: a reexamination of reference intervals.

INTRODUCTION: Left atrial-to-aortic ratios (LA:Ao) provide a body weight independent estimate of left atrial size. However, reference intervals were established with small sample populations and for only single points in the cardiac cycle. More robust reference intervals are warranted. ANIMALS: Two hundred and thirty eight apparently healthy adult dogs. MATERIALS AND METHODS: LA:Ao measurements were obtained at 3 points in the cardiac cycle - maximal dimension, at the closing of the aortic valve (or just before opening of the mitral valve) (LA:AoMAX); minimal dimension, at the onset of the QRS complex (LA:AoMIN) and at the onset of atrial systole (LA:AoP). LA:AoMAX was obtained from right parasternal short and long-axis views, and LA:AoMIN and LA:AoP were obtained from the right parasternal short-axis view. Dogs were excluded from analyses of reference intervals if weight-based left atrial and left ventricular diastolic dimensions exceeded reference interval limits. Effects of breed and body weight on LA:Ao measurements were examined. RESULTS: Upper LA:Ao reference limits mostly agreed with previously published limits, although 10% of dogs had LA:AoMAX in the short-axis view exceeding 1.6. These dogs had smaller aortae than expected for their body weight, and included mostly boxers and English setters. Reference limits for LA:AoMIN and LA:AoP were smaller than those for LA:AoMAX in either view. No LA:Ao measurements were associated with body weight. CONCLUSIONS: Reference limits were either confirmed or established for the common two-dimensional methods of assessing relative left atrial size in healthy dogs. Clinicians should use caution when diagnosing mild left atrial enlargement in certain dog breeds and should examine the weight-based aortic dimensions in such cases.