TRICUSPID ANNULAR PLAN SYSTOLIC EXCURSION (TAPSE) EVALUATION IN DOGS WITH CHRONIC DEGENERATIVE VALVULAR DISEASE WITH AND WITHOUT PULMONARY HYPERTENSION

AIM OF THE STUDY: The aim of the study was to investigate the TAPSE in dogs with chronic degenerative valvular disease (CDVD) at different stages of heart failure (HF) and pulmonary hypertension (PH). MATERIAL & METHODS: Dogs were prospectively enrolled and underwent a complete cardiologic evaluation, including physical examination, thoracic radiography, EKG, and trans-thoracic echocardiographic examination (TTE). The TTE included 2D and M-mode evaluation of the left ventricle, Doppler interrogation of trans-valvular blood flows and Tissue Doppler Interrogation (TDI) of the lateral and septal mitral annulus and the tricuspid annulus. Healthy (control) dogs and dogs with CDVD with combined mitral and tricuspid regurgitation (TR) but without other cardiovascular disorders were selected. Evidence of PH was based on TR jet Peak velocity (TRVMax) >2.8 m/s. In dogs with CDVD, HF severity was classified according to proposed guidelines (Atkins C., 2009). Dogs with CDVD were also subdivided in: No PH, if TRVMax ≤2.8 m/s; Mild PH, if TRVmax >2.8 m/s and ≤3.5 m/s; Moderate PH, if TRVMax >3.5 m/s and ≤4.5 m/s; and Severe PH, if TRVMax >4.5 m/s. To obtain TAPSE, a 4-chamber apical view, optimized for right ventricular inflow was used, and an M-mode cursor was placed through the lateral tricuspid annulus. TAPSE was measured on M-mode images as the total displacement of the tricuspid annulus from the deepest point in diastole to the highest point on systole. The parameter was measured three times and the average value was used for statistical analysis. Correlations between TAPSE and body weight (BW), body surface area (BSA), heart rate and other echocardiographic parameters were investigated using Pearson coefficient and those normally distributed, were analyzed using an analysis of covariance (ANCOVA) to assess the differences among PH groups and HF groups, corrected for BSA. P values < 0.05 were considered significant. RESULTS: 103 dogs were recruited: 8 were free from heart disease, 56 had CDVD but No-PH, 25 had CDVD and Mild-PH, 11 had CDVD and Moderate-PH and 3 CDVD and had Severe-PH. According to the ACVIM classification of HF, 8 dogs were in class A, 53 in class B1, 22 in class B2, 17 in class C and 3 in class D. Average BW was 14.5 Kg (Range 2.6 – 72 kg); the average age was 9.5 years (range 0.7- 16.1 years). TAPSE values were significantly correlated with BW and BSA, (Pearson correlation coefficient 0.49 and 0.52, respectively). TAPSE values were also correlated with some echocardiographic indices of left and right ventricular systolic and diastolic function. ANCOVA analysis did not evidence any significant difference in TAPSE values among dogs of different PH and HF groups. CONCLUSIONS: Although TAPSE is significantly correlated with some right ventricular parameters it does not seem to play an important role in dogs with CDVD and PH