Key result
Elevated Ea/Ees is linked to ~2.7-fold higher cardiac-related death risk in myxomatous mitral valve disease.
Why the study?
Inappropriate left ventricular-arterial coupling is associated with advanced disease severity in dogs with myxomatous mitral valve disease, but its prognostic value remained to be evaluated.
Does inappropriate left ventricular-arterial coupling (Ea/Ees >0.34) predict cardiac-related death in dogs with myxomatous mitral valve disease?
Cohort (n=89)
Single-blind
No
Does inappropriate left ventricular-arterial coupling (Ea/Ees >0.34) predict cardiac-related death in dogs with myxomatous mitral valve disease?
Inappropriate left ventricular-arterial coupling assessed by echocardiography is an independent predictor of cardiac-related death in dogs with myxomatous mitral valve disease.
Answers are grounded in this paper and cite their sources.
Supports Ea/Ees >0.34 as prognostic marker in canine MMVD; hypothesis-generating and should not yet change practice.
BACKGROUND: The interaction between the left ventricle (LV) and systemic arterial systems, known as left ventricular-arterial coupling (VAC), has been evaluated based on the effective arterial elastance (Ea) to LV end-systolic elastance (Ees) ratio (Ea/Ees). The Ea reflects the total arterial load of LV, whereas Ees reflects the LV systolic function. A recent study found that inappropriate VAC based on increased Ea/Ees estimated by echocardiography is associated with advanced disease severity in dogs with myxomatous mitral valve disease (MMVD). HYPOTHESIS: Inappropriate VAC assessed by echocardiographic estimation of Ea/Ees is associated with a worse prognosis in dogs with MMVD. ANIMALS: Eighty-nine dogs with MMVD. METHODS: Prospective cohort study. Dogs underwent echocardiographic examinations at enrollment. The Ea was estimated using the formula: mean blood pressure/(forward stroke volume/body weight). The Ees was estimated using the formula: mean blood pressure/(LV end-systolic volume/body weight). The Ea/Ees was calculated. RESULTS: By end of study, 22 dogs died of cardiac-related causes with 67 dogs censored. Dogs with increased Ea/Ees (Ea/Ees >0.34; median survival time, 527 days; 95% confidence interval [CI], 322 days-not determinable) had a shorter survival time (P < .0001) than those without increased Ea/Ees (Ea/Ees ≤0.34; median survival time, >1112 days; 95% CI, not determinable). Multivariate Cox proportional hazard analysis showed that Ea/Ees, body weight, peak systolic mitral annular velocity, and the peak early diastolic transmitral velocity-to-peak early diastolic mitral annular velocity ratio were independent predictors of cardiac-related death among echocardiographic indices. CONCLUSIONS AND CLINICAL IMPORTANCE: Inappropriate VAC assessed based on echocardiographically-estimated Ea/Ees is associated with a worse prognosis in dogs with MMVD.
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Osuga et al. (2021) conducted a cohort in Myxomatous mitral valve disease (MMVD) (n=89). Increased Ea/Ees ratio (>0.34) indicating inappropriate left ventricular-arterial coupling vs. Ea/Ees ratio ≤0.34 was evaluated on Cardiac-related death (HR 2.67, 95% CI 1.48-5.68, p=0.0006). In dogs with myxomatous mitral valve disease, inappropriate left ventricular-arterial coupling indicated by an increased Ea/Ees (>0.34) was independently associated with a 2.67-fold higher risk of cardiac-related death.
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