Use of computed radiology as a screening test for the identification of congenital heart disease in dogs
DOI:
https://doi.org/10.5433/1679-0359.2020v41n4p1213Keywords:
Cardiac Malformations, Cardiology, Diagnostic Imaging, Thorax X-ray.Abstract
The objectives of this study were to evaluate the accuracy of thoracic radiology as a screening test for congenital heart diseases in dogs, to identify the main contributions and limitations of this modality, and to verify the reproducibility of the evaluations by three observers with different levels of training. An interobserver, observational, retrospective and prospective study was carried out, including ninety dogs: thirty healthy animals, thirty with acquired heart diseases and thirty with congenital heart diseases, which all had thoracic radiographs and a confirmed echocardiographic diagnosis. The cases were separated and randomized by a mediator who did not participate in the reading of the radiographic examinations, and no evaluator had access to the patients' data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of each observer were calculated in relation to the correct classification of dogs to groups of normal or acquired and congenital heart diseases, as well as identification of enlargement of the cardiac silhouette and large vessels of dogs with congenital heart diseases. Finally, the Kappa coefficient was obtained between the observers to verify the reproducibility of the radiological evaluations performed. In general, sensitivity, PPV and accuracy were unsatisfactory ( 70%), and the agreement ranged from poor to reasonable (between 0 and 0.39). Although greater accuracy was achieved in the differentiation of healthy dogs from those with acquired and congenital heart diseases by thoracic radiography, when compared to the other studies, the modality was able only to identify healthy patients, and could not differentiate the individuals with different forms of heart disease or define the cardiac malformations. In addition, there was low reproducibility between observers, therefore, this technique should not be used as a sole screening method in dogs with suspected congenital heart diseases.Metrics
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References
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Nunes, A. A., Martinez, E. Z., Ana, L. W., Pazin, A., Fº., Coelho, E. B., & Mello, L. M. (2015). Testes diagnósticos no contexto da avaliação de tecnologias em saúde: abordagens, métodos e interpretação. Medicina (Ribeirão Preto), 48(1), 1-18. doi: 10.11606/issn.2176-7262.v48i1p8-18
O’Grady, M. R., Holmberg, D. L., Miller, C. W., & Cockshutt, J. R. (1989). Canine congenital aortic stenosis: a review of the literature and commentary. Canadian Veterinary Journal, 30(10), 811-815. PMID: 17423439
Oliveira, P., Domenech, O., Silva, J., Vannini, S., Bussadori, R., & Bussadori, C. (2011). Retrospective review of congenital heart disease in 976 dogs. Journal of Veterinary Internal Medicine, 25(3), 477-483. doi: 10.1111/j.1939-1676.2011.0711.x
Ringwald, R. J., & Bonagura, A. D. (1988). Tetralogy of Fallot in the dog: clinical findings in 13 cases. Journal of the American Animal Hospital Association, 24(1), 33-43. RN:45110331
Satou, G. M., Lacro, R. V., Chung, T., Gauvreau, K., & Jenkins, K. J. (2001). Heart size on chest X-ray as a predictor of cardiac enlargement by echocardiography in children. Pediatric Cardiology, 22(3), 218-222. doi: 10.1007/s002460010207
Schweigmann, G., Gassner, I., & Maurer, K. (2006). Imaging the neonatal heart - essentials for the radiologist. European Journal of Radiology, 60(2), 159-170. doi: 10.1016/j.ejrad.2006.07.017
Sisson, D., Luethy, M., & Thomas, W. P. (1991). Ventricular septal defect accompanied by aortic regurgitation in five dogs. Journal of the American Animal Hospital Association, 27(4), 441-448.
Strickland, K. N., & Oyama, M. A. (2016). Congenital heart disease. In F. W. K. Smith, Jr., L. P. Tilley, M. A. Oyama, Manual of canine and feline cardiology (5nd ed., cap. 13, pp. 218-238). St. Louis: Saunders Elsevier.
Temmerman, A. M., Mooyaart, E. L., & Taverne, P. P. (1991). The value of routine chest roentgenogram in the cardiological evaluation of infants and children. A prospective study. European Journal of Pediatrics, 150(9), 623-626.
Thomas, W. P., Gaber, C. E., Jacobs, G. J., Kaplan, P. M., Lombard, C. W., Moise, N. S., & Moses, B. L. (1993). Recommendations for standards in transthoracic two-dimensional echocardiography in the dog and cat. Echocardiography Committee of the Specialty of Cardiology, American College of Veterinary Internal Medicine. Journal of Veterinary Internal Medicine, 7(4), 247-252. doi: 10.1111/j.1939-1676.1993.tb01015.x
Thrall, D. E., & Robertson, I. D. (2016). Atlas of normal radiographic anatomy and anatomic variants in the dog and the cat. (2nd ed.). St. Louis: Saunders Elsevier.
Tumkosit, M., Yingyong, N., Mahayosnond, A., Choo, K. S., & Goo, H. W. (2012). Accuracy of chest radiography for evaluating significantly abnormal pulmonary vascularity in children with congenital heart disease. The International Journal of Cardiovascular Imaging, 28(1), 69-75. doi: 10.1007/s10554-012-0073-x
Bahr, R. (2018). Canine and feline cardiovascular system. In D. E. Thrall, Textbook of veterinary diagnostic radiology (7nd ed., cap. 35, pp. 684-709). St. Louis: Saunders Elsevier.
Beijerink, N. J., Oyama, M. A., & Bonagura, J. D. (2017). Congenital heart disease. In S. J. Ettinger, E. C. Feldman, & E. Côté, Textbook of veterinary internal medicine: disease of the dog and the cat (8nd ed., cap. 250, pp. 2952-3032). St. Louis: Saunders Elsevier.
Birkebaek, N. H., Hansen, L. K., Elle, B., Andersen, P. E., Friis, M., Egeblad, M., Damgaard-Pedersen, K., Nielsen, N. T., Oxhoj, H. (1999). Chest roentgenogram in the evaluation of heart defects in asymptomatic infants and children with a cardiac murmur: reproducibility and accuracy. Pediatrics, 103(2), 1-4. doi: 10.1542/peds.103.2.e15
Birkebaek, N. H., Hansen, L. K., & Oxhoj, H. (1995). Diagnostic value of chest radiography and alectrocardiography in the evaluation of asymptomatic children with cardiac murmur. Acta Pediatrica, 84(12), 1379-1381. doi: 10.1111/j.1651-2227.1995.tb13573.x
Buchanan, J. W. (1999). Prevalence of cardiovascular disease. In P. R. Fox, D. D. Sisson, & N. S. Moise, Textbook of canine and feline cardiology: principles and clinical practice (2nd ed., pp. 457-470). Philadelphia: WB Saunders.
Côté, E., Edwards, N. J., Ettinger, S. J., Fuentes, V. L., MacDonald, K. A., Scansen, B. A., Sisson, D. D., Abbott, J. A. (2015). Management of incidentally detected heart murmurs in dogs and cats. Journal of the American Veterinary Medical Association, 246(10), 1076-1088. doi: 10.2460/javma.246.10.1076
Fingland, R. B., Bonagura, A. D., & Myerc, W. (1986). Pulmonic stenosis in the dog: 29 cases (1975-1984). Journal of the American Veterinary Medical Association, 189(2), 218-226. PMID: 3744983
Fonseca, B., Chang, R.-K., Senac, M., Knight, G., & Sklansky, M. S. (2005). Chest radiography and the evaluation of the neonate for congenital heart disease. Pediatric Cardiology, 26(4), 367-372. doi: 10.1007/s00246-005-8649-z
Lamb, C. R., Boswood, A., Volkman, A., & Connolly, D. J. (2001). Assessment of survey radiography as a method for diagnosis of congenital cardiac disease in dogs. Journal of Small Animal Practice, 42(11), 541-545. doi: 10.1111/j.1748-5827.2001.tb06024.x
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 3(1), 159-174. PMID: 843571
Lehmkuhl, B., Warew, A., & Bonagura, A. D. (1994). Mitral stenosis in 15 dogs. Journal of Veterinary Internal Medicine, 8(1), 2-17. doi: 10.1111/j.1939-1676.1994.tb03190.x
Levitt, L., Fowler, J. D., & Schuh, J. C. L. (1989). Aortic stenosis in the dog: a review of 12 cases. Journal of the American Animal Hospital Association, 25(4), 357-362. RN:45061054
Lombard, C. W., & Ackerman, N. (1984). Right heart enlargement in heartworm-infected dogs: a radiographic, electrocardiographic and echocardiographic correlation. Veterinary Radiology, 25(5), 210-217. doi: 10.1111/j.1740-8261.1984.tb01929.x
Lombard, C. W., & Spencer, C. P. (1985). Correlation between radiographic, echocardiographic, and electrocardiographic signs of left heart enlargement in dogs with mitral regurgitation. Veterinary Radiology, 26(3), 89-97. doi: 10.1111/j.1740-8261.1985.tb01389.x
MacDonald, K. A. (2006). Congenital heart disease of puppies and kittens. Veterinary Clinics of North America: Small Animal Practice, 36(3), 503-531. doi: 10.1016/j.cvsm.2005.12.006
Newburger, J. W., Rosenthal, A., Williams, R. G., Fellows, K., & Miettinen, O. S. (1983). Noninvasive tests in the initial evaluation of heart murmurs in children. The New England Journal of Medicine, 308(2), 61-64. doi: 10.1056/NEJM198301133080201
Nunes, A. A., Martinez, E. Z., Ana, L. W., Pazin, A., Fº., Coelho, E. B., & Mello, L. M. (2015). Testes diagnósticos no contexto da avaliação de tecnologias em saúde: abordagens, métodos e interpretação. Medicina (Ribeirão Preto), 48(1), 1-18. doi: 10.11606/issn.2176-7262.v48i1p8-18
O’Grady, M. R., Holmberg, D. L., Miller, C. W., & Cockshutt, J. R. (1989). Canine congenital aortic stenosis: a review of the literature and commentary. Canadian Veterinary Journal, 30(10), 811-815. PMID: 17423439
Oliveira, P., Domenech, O., Silva, J., Vannini, S., Bussadori, R., & Bussadori, C. (2011). Retrospective review of congenital heart disease in 976 dogs. Journal of Veterinary Internal Medicine, 25(3), 477-483. doi: 10.1111/j.1939-1676.2011.0711.x
Ringwald, R. J., & Bonagura, A. D. (1988). Tetralogy of Fallot in the dog: clinical findings in 13 cases. Journal of the American Animal Hospital Association, 24(1), 33-43. RN:45110331
Satou, G. M., Lacro, R. V., Chung, T., Gauvreau, K., & Jenkins, K. J. (2001). Heart size on chest X-ray as a predictor of cardiac enlargement by echocardiography in children. Pediatric Cardiology, 22(3), 218-222. doi: 10.1007/s002460010207
Schweigmann, G., Gassner, I., & Maurer, K. (2006). Imaging the neonatal heart - essentials for the radiologist. European Journal of Radiology, 60(2), 159-170. doi: 10.1016/j.ejrad.2006.07.017
Sisson, D., Luethy, M., & Thomas, W. P. (1991). Ventricular septal defect accompanied by aortic regurgitation in five dogs. Journal of the American Animal Hospital Association, 27(4), 441-448.
Strickland, K. N., & Oyama, M. A. (2016). Congenital heart disease. In F. W. K. Smith, Jr., L. P. Tilley, M. A. Oyama, Manual of canine and feline cardiology (5nd ed., cap. 13, pp. 218-238). St. Louis: Saunders Elsevier.
Temmerman, A. M., Mooyaart, E. L., & Taverne, P. P. (1991). The value of routine chest roentgenogram in the cardiological evaluation of infants and children. A prospective study. European Journal of Pediatrics, 150(9), 623-626.
Thomas, W. P., Gaber, C. E., Jacobs, G. J., Kaplan, P. M., Lombard, C. W., Moise, N. S., & Moses, B. L. (1993). Recommendations for standards in transthoracic two-dimensional echocardiography in the dog and cat. Echocardiography Committee of the Specialty of Cardiology, American College of Veterinary Internal Medicine. Journal of Veterinary Internal Medicine, 7(4), 247-252. doi: 10.1111/j.1939-1676.1993.tb01015.x
Thrall, D. E., & Robertson, I. D. (2016). Atlas of normal radiographic anatomy and anatomic variants in the dog and the cat. (2nd ed.). St. Louis: Saunders Elsevier.
Tumkosit, M., Yingyong, N., Mahayosnond, A., Choo, K. S., & Goo, H. W. (2012). Accuracy of chest radiography for evaluating significantly abnormal pulmonary vascularity in children with congenital heart disease. The International Journal of Cardiovascular Imaging, 28(1), 69-75. doi: 10.1007/s10554-012-0073-x
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2020-05-13
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Lucina, S. B., Silva, M. A. F. da, Giannico, A. T., Sousa, M. G., & Froes, T. R. (2020). Use of computed radiology as a screening test for the identification of congenital heart disease in dogs. Semina: Ciências Agrárias, 41(4), 1213–1226. https://doi.org/10.5433/1679-0359.2020v41n4p1213
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