Prognóstico da instalação da insuficiência cardíaca congestiva em cães com degeneração de valva mitral: O estudo PREDICT / Prediction of first onset of congestive heart failure in dogs with degenerative mitral valve disease: The PREDICT cohort study

Journal of Veterinary Cardiology

Volume 14, Issue 1, March 2012, Pages 193–202

The Mitral Valve

Prediction of first onset of congestive heart failure in dogs with degenerative mitral valve disease: The PREDICT cohort study

• Caryn A. Reynolds, DVM^a, 
• Dorothy Cimino Brown, DVM, MSCE^a, 
• John E. Rush, DVM, MS^b, 
• Philip R. Fox, DVM, MS^c, 
• Thaibihn P. Nguyenba, DVM^d, 
• Linda B. Lehmkuhl, DVM^d, 
• Sonya G. Gordon, DVM, DVSc^e, 
• Heidi B. Kellihan, DVM^f, 
• Rebecca L. Stepien, DVM, MS^f, 
• Bonnie K. Lefbom, DVM^g, 
• C. Kate Meier, DVM^h, 
• Mark A. Oyama, DVM^a, , 

Abstract

Objective

To identify risk factors for first-onset congestive heart failure (CHF) in dogs with degenerative mitral valve disease (DMVD).

Animals

Eighty-two dogs with and without CHF secondary to DMVD were retrospectively assigned to a derivation cohort. Sixty-five dogs with asymptomatic DMVD were recruited into a prospective validation cohort.

Methods

Variables associated with risk of CHF in dogs were identified in a derivation cohort and used to construct a predictive model, which was then prospectively tested through longitudinal examination of a validation cohort.

Results

Logistic regression analysis of the derivation cohort yielded a predictive model that included the left atrial to aortic root dimension ratio (LA:Ao) and plasma concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP). When this model was prospectively applied to the validation cohort, it correctly predicted first-onset of CHF in 69.2% of cases. Analysis of the validation cohort revealed that plasma NT-proBNP concentration and indexed left ventricular end-diastolic diameter (LVIDd:Ao) were independent risk factors for development of first-onset CHF in dogs with DMVD (NT-proBNP ≥1500 pmol/L, odds ratio (OR), 5.76, 95% confidence interval (CI), 1.37–24.28, P = 0.017; LVIDd:Ao ≥3, OR, 6.11, 95% CI, 1.09–34.05,P = 0.039).

Conclusions

Measures of left heart size and plasma NT-proBNP concentration independently estimate risk of first-onset of CHF in dogs with DMVD. These parameters can contribute to the management of dogs with DMVD.

Keywords

• Natriuretic peptide; 
• Mitral regurgitation; 
• BNP