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Prognostic factors in dogs with presumed degenerative mitral valve disease attending primary‐care veterinary practices in the United Kingdom

Mattin, M. J., Boswood, A., Church, D. B., Brodbelt, D. C.
Journal of veterinary internal medicine 2019 v.33 no.2 pp. 432-444
biomarkers, clinical examination, cohort studies, comorbidity, death, diuretics, dogs, exercise, females, heart, heart rate, heart valve diseases, models, mortality, natriuretic peptides, regression analysis, risk factors, troponin I, veterinarians, veterinary clinics, United Kingdom
BACKGROUND: Prognostic risk factors were identified for dogs with degenerative mitral valve disease (DMVD) monitored by veterinary cardiologists. The value of these measurements has not been determined in the wider primary care setting. OBJECTIVES: To evaluate whether plasma cardiac biomarkers and data obtained from routine history‐taking and physical examination are predictive of survival in dogs with DMVD attending primary care practice. ANIMALS: Eight‐hundred and ninety‐three dogs with a presumptive diagnosis of DMVD recruited from 79 primary care veterinary practices in the United Kingdom. METHODS: Prospective cohort study. Primary care veterinary practitioners recorded clinical data. Plasma N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) and cardiac troponin I (cTnI) were measured at presentation. Cox regression models evaluated associations between risk factor variables and hazard of death (all‐cause mortality and cardiac‐related death). Flexible parametric models generated predicted survival probabilities for dogs with different combinations of prognostic risk factor variable values. RESULTS: Dogs with higher NT‐proBNP and cTnI concentrations, higher heart rates, older dogs, females, and those reported to be exercise intolerant, dyspneic, and diagnosed with selected comorbidities had an increased hazard of death due to any cause. Dogs with higher concentrations of plasma biomarkers, higher heart rates, and heart murmur intensities, those with exercise intolerance and those receiving potent diuretics had a higher hazard of cardiac‐related death. CONCLUSIONS AND CLINICAL IMPORTANCE: Cardiac biomarkers and key clinical findings identified in this study can help primary care veterinary practitioners identify dogs with DMVD that are at highest risk of death.