Use of the vertebral heart scale for differentiation of cardiac and noncardiac causes of respiratory distress in cats: 67 cases (2002–2003)
Meg M. Sleeper, VMD, DACVIM; Risa Roland, DVM, DACVIM; Kenneth J. Drobatz, DVM, MSCE, DACVECC, DACVIM
Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104. (Sleeper, Roland, Drobatz)
Objective—To assess the effectiveness of the vertebral heart scale (VHS) system to differentiate congestive heart failure from other causes of dyspnea in cats.
Design—Retrospective case series.
Animals—67 cats with acute respiratory distress.
Procedures—Medical records of client-owned cats evaluated on an emergency basis because of acute respiratory distress during a 1-year period were reviewed. For study inclusion, cats must have undergone evaluation with echocardiography and thoracic radiography within 12 hours after hospital admission. The VHS was calculated for each cat by 2 investigators. Signalment, physical examination, and echocardiographic findings were reviewed for each patient.
Results—There was 83% agreement overall between the 2 investigators in assessment of cardiomegaly in cats with dyspnea (κ = 0.49). The VHS cutpoints were the same for both observers in terms of optimizing sensitivity and specificity. A VHS of > 8.0 vertebrae was the best cutpoint when screening for heart disease, whereas a VHS of > 9.3 vertebrae was very specific for the presence of heart disease. Measurements between 8.0 and 9.3 vertebrae suggested the cause of dyspnea was equivocal (ie, secondary to congestive heart failure or respiratory disease), in which case echocardiography would be most useful in providing additional diagnostic information.
Conclusions and Clinical Relevance—Results suggested that the VHS system may be a useful tool to help differentiate cardiac from noncardiac causes of respiratory distress in cats in an emergency situation when an echocardiogram is not available or is not plausible in an unstable patient.
February 1, 2013, Vol. 242, No. 3, Pages 366-371