Objectives

To identify the predictive value on time to onset of heart failure (HF) or cardiac death of clinical, radiographic, and echocardiographic variables, as well as cardiac biomarkers N-terminal pro brain natriuretic peptide (NT-proBNP) and cardiac troponin I in dogs with preclinical myxomatous mitral valve disease (MMVD).

Animals

One hundred sixty-eight dogs with preclinical MMVD and left atrium to aortic root ratio ≥1.6 (LA:Ao) and normalized left ventricular end-diastolic diameter ≥1.7 were included.

Methods

Prospective, randomized, multicenter, single-blinded, placebo-controlled study. Clinical, radiographic, echocardiographic variables and plasma cardiac biomarkers concentrations were compared at different time points. Using receiving operating curves analysis, best cutoff for selected variables was identified and the risk to develop the study endpoint at six-month intervals was calculated.

Results

Left atrial to aortic root ratio >2.1 (hazard ratio [HR] 3.2, 95% confidence interval [95% CI] 1.9–5.6), normalized left ventricular end-diastolic diameter > 1.9 (HR: 6.3; 95% CI: 3.3–11.8), early transmitral peak velocity (E peak) > 1 m/sec (HR: 3.9; 95% CI: 2.3–6.7), and NT-proBNP > 1500 ρmol/L (HR: 5.7; 95% CI: 3.3–9.5) were associated with increased risk of HF or cardiac death. The best fit model to predict the risk to reach the endpoint was represented by the plasma NT-proBNP concentrations adjusted for LA:Ao and E peak.

Conclusions

Logistic and survival models including echocardiographic variables and NT-proBNP can be used to identify dogs with preclinical MMVD at higher risk to develop HF or cardiac death.

中文翻译：

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临床、放射学、超声心动图变量和心脏生物标志物对评估参与 DELAY 研究的临床前粘液瘤性二尖瓣疾病犬发生心力衰竭或心脏死亡风险的预测价值

目标

确定犬的临床、放射学和超声心动图变量以及心脏生物标志物 N 端脑钠肽原 (NT-proBNP) 和心肌肌钙蛋白 I 对心力衰竭 (HF) 或心脏死亡发生时间的预测价值临床前粘液瘤性二尖瓣疾病 (MMVD)。

动物

包括临床前 MMVD 和左心房与主动脉根比≥1.6 (LA:Ao) 和标准化左心室舒张末期直径≥1.7 的 168 只狗。

方法

前瞻性、随机、多中心、单盲、安慰剂对照研究。在不同时间点比较临床、放射学、超声心动图变量和血浆心脏生物标志物浓度。使用接收操作曲线分析，确定了选定变量的最佳截止值，并计算了每六个月出现研究终点的风险。

结果

左心房与主动脉根部之比 >2.1（风险比 [HR] 3.2，95% 置信区间 [95% CI] 1.9–5.6），标准化左心室舒张末期直径 > 1.9（HR：6.3；95% CI：3.3– 11.8），早期二尖瓣峰值速度（E 峰）> 1 m/sec（HR：3.9；95% CI：2.3–6.7），NT-proBNP > 1500 ρmol/L（HR：5.7；95% CI：3.3– 9.5) 与 HF 或心脏死亡风险增加有关。预测达到终点的风险的最佳拟合模型由针对 LA:Ao 和 E 峰调整的血浆 NT-proBNP 浓度表示。

结论

包括超声心动图变量和 NT-proBNP 在内的逻辑和生存模型可用于识别具有较高风险发生 HF 或心脏死亡的临床前 MMVD 犬。