Utility of Computed Tomographic Angiography for Pulmonary Hypertension Assessment in a Cohort of West Highland White Terriers With or Without Canine Idiopathic Pulmonary Fibrosis.

Eugénie Soliveres,Aline Fastrès,Alexandru-Cosmin Tutunaru,Anne-Christine Merveille,Cécile Clercx,Thierry Couvreur,Elodie Roels,Géraldine Bolen,Kathleen Mc Entee

doi:10.3389/fvets.2021.732133

Abstract

West Highland white terriers (WHWTs) affected with canine idiopathic pulmonary fibrosis (CIPF) are at risk of developing precapillary pulmonary hypertension (PH). In humans, thoracic computed tomography angiography (CTA) is commonly used to diagnose and monitor patients with lower airway diseases. In such patients, CTA helps to identify comorbidities, such as PH, that could negatively impact prognosis. Diameter of the pulmonary trunk (PT), pulmonary trunk-to-aorta ratio (PT/Ao), and right ventricle-to-left ventricle ratio (RV/LV) are CTA parameters commonly used to assess the presence of PH. Pulmonary vein-to-right pulmonary artery ratio (PV/PA) is a new echocardiographic parameter that can be used in dogs to diagnose PH. The primary aim of this study was to evaluate the use of various CTA parameters to diagnose PH. An additional aim was to evaluate the correlation of RV/LV measurements between different CTA planes. CTA and echocardiography were prospectively performed on a total of 47 WHWTs; 22 affected with CIPF and 25 presumed healthy control dogs. Dogs were considered to have PH if pulmonary vein-to-right pulmonary artery ratio (PV/PA) measured on 2D-mode echocardiography was less than to 0.7. WHWTs affected with CIPF had higher PT/Ao compared with control patients. In WHWTs affected with CIPF, PT size was larger in dogs with PH (15.4 mm) compared with dogs without PH (13 mm, p = 0.003). A cutoff value of 13.8 mm predicted PH in WHWTs affected with CIPF with a sensitivity of 90% and a specificity of 87% (AUC = 0.93). High correlations were observed between the different CTA planes of RV/LV. Results suggest that diameter of the PT measured by CTA can be used to diagnose PH in WHWTs with CIPF.

Highlights

Canine idiopathic pulmonary fibrosis (CIPF) of the West Highland white terrier (WHWT) is a progressive and fatal interstitial pulmonary disease [1, 2]
The primary aim of the study was to evaluate the diagnostic accuracy of pulmonary trunk (PT), pulmonary trunk-to-aorta ratio (PT/Ao), right ventricle-to-left ventricle ratio on CTA (RV/LV), and pulmonary vein-to-right pulmonary artery ratio (PV/PA) measured by computed tomography angiography (CTA) to predict pulmonary hypertension (PH) in a population of middle-aged to old WHWTs affected or not with CIPF with PH defined as PV/PA
No statistical difference in sex was observed between the groups (p = 0.210), 11 of the 19 females were classified as having CIPF, and 11 of the 28 males were classified as having CIPF

Summary

Introduction

Canine idiopathic pulmonary fibrosis (CIPF) of the West Highland white terrier (WHWT) is a progressive and fatal interstitial pulmonary disease [1, 2]. CIPF shares clinical and pathologic features with human idiopathic pulmonary fibrosis (IPF) and other interstitial pulmonary diseases [1, 3]. Affected WHWTs are middle aged to old with no sex predisposition [1, 2, 4]. Most common clinical signs include exercise intolerance and cough [1, 2, 4]. Dogs can present dyspnea, tachypnea, cyanosis, and collapse [1, 3]. The diagnosis is based on signalment, duration and evolution of symptoms, clinical examination, results of diagnostic imaging especially high-resolution computed tomography (HRCT) and, because pulmonary biopsies are not routinely performed, exclusion of other respiratory diseases [1, 4]

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