Prevalence and Prognostic Role of L Wave and Selected Clinical and Echocardiographic Variables in Dogs with Atrial Fibrillation

Overview

Journal J Vet Intern Med

Specialties General Medicine
Veterinary Medicine

Date 2022 Dec 8

PMID 36480559

Authors

Giovanni Romito

Stefana Darida

Carlotta Valente

Helen Poser

Barbara Contiero

Mario Cipone

Carlo Guglielmini

Affiliations

Soon will be listed here.

Abstract

Background: Information regarding the frequency of L waves and their prognostic relevance in dogs with secondary atrial fibrillation (AF) is limited.

Hypothesis/objectives: To determine whether L waves occur and ascertain their prognostic role, as well as the role of other clinical and echocardiographic variables in dogs with AF.

Animals: Fifty-five dogs with AF associated with myxomatous mitral valve disease or dilated cardiomyopathy.

Methods: Retrospective, multicenter observational study. In addition to L waves analysis, other clinical and echocardiographic variables, including type of antiarrhythmic treatment, were evaluated. A survival analysis was performed to test for predictors of cardiac death and all-cause mortality using Cox proportional hazards regression models.

Results: L waves were evident in 33/55 dogs (60%, 95% confidence interval [CI] = 47%-72%) but their presence did not influence outcome. Increased left ventricular end-systolic diameter normalized for body weight (LVSDn) was a significant predictor of both cardiac death (hazard ratio [HR] = 4.41, 95% CI = 1.18-16.54; P = .03) and all-cause mortality (HR = 9.39, 95% CI = 2.49-35.32; P < .001). Heart rate assessed during echocardiography (Echo-HR) represented an additional significant predictor of cardiac death (HR = 1.01, 95% CI = 1.00-1.01; P = .04) and all-cause mortality (HR = 1.01, 95% CI = 1.00-1.01; P = .04).

Conclusions And Clinical Importance: L waves occurred frequently in dogs with AF, but held no prognostic relevance. Conversely, LVSDn and Echo-HR represented independent predictors of negative outcome in these animals.

Citing Articles

Management of two dogs with post-operative new-onset persistent atrial fibrillation following mitral valve repair.

Kurogochi K, Nishiyama M, Masaki H, Asakawa M, Uechi M Vet Med Sci. 2025; 11(1):e70029.

PMID: 39812505 PMC: 11734185. DOI: 10.1002/vms3.70029.

Evaluation of Galectin-3 in Dogs with Atrial Fibrillation.

Arcuri G, Valente C, Romito G, Bonsembiante F, Mazzoldi C, Contiero B Animals (Basel). 2024; 14(17).

PMID: 39272333 PMC: 11394297. DOI: 10.3390/ani14172547.

Longitudinal analysis of echocardiographic and cardiac biomarker variables in dogs with atrial fibrillation: The optimal rate control in dogs with atrial fibrillation II study.

Pedro B, Mavropoulou A, Oyama M, Linney C, Neves J, Dukes-McEwan J J Vet Intern Med. 2024; 38(4):2076-2088.

PMID: 38877661 PMC: 11256134. DOI: 10.1111/jvim.17120.

Risk Factors for Atrial Fibrillation in the Dog: A Systematic Review.

Arcuri G, Valente C, Perini C, Guglielmini C Vet Sci. 2024; 11(1).

PMID: 38275929 PMC: 10818451. DOI: 10.3390/vetsci11010047.

Risk factors for atrial fibrillation in dogs with dilated cardiomyopathy.

Guglielmini C, Valente C, Romito G, Mazzoldi C, Baron Toaldo M, Goncalves Sousa M Front Vet Sci. 2023; 10:1183689.

PMID: 37228845 PMC: 10203468. DOI: 10.3389/fvets.2023.1183689.

References

Cornell C, Kittleson M, Della Torre P, Haggstrom J, Lombard C, Pedersen H . Allometric scaling of M-mode cardiac measurements in normal adult dogs. J Vet Intern Med. 2004; 18(3):311-21. DOI: 10.1892/0891-6640(2004)18<311:asomcm>2.0.co;2. View

Gelzer A, Kraus M, Rishniw M . Evaluation of in-hospital electrocardiography versus 24-hour Holter for rate control in dogs with atrial fibrillation. J Small Anim Pract. 2015; 56(7):456-62. DOI: 10.1111/jsap.12363. View

Neves J, Pedro B, Christley R, Dukes-McEwan J . Usefulness of pulsed-wave tissue Doppler imaging at the mitral annulus for prediction of new-onset atrial fibrillation in dogs. J Vet Cardiol. 2018; 20(6):425-437. DOI: 10.1016/j.jvc.2018.10.002. View

Keren G, Meisner J, Sherez J, Yellin E, Laniado S . Interrelationship of mid-diastolic mitral valve motion, pulmonary venous flow, and transmitral flow. Circulation. 1986; 74(1):36-44. DOI: 10.1161/01.cir.74.1.36. View

Pastore M, De Carli G, Mandoli G, DAscenzi F, Focardi M, Contorni F . The prognostic role of speckle tracking echocardiography in clinical practice: evidence and reference values from the literature. Heart Fail Rev. 2020; 26(6):1371-1381. DOI: 10.1007/s10741-020-09945-9. View

Masai K, Mano T, Goda A, Sugahara M, Daimon A, Asakura M . Correlates and Prognostic Values of Appearance of L Wave in Heart Failure Patients With Preserved vs. Reduced Ejection Fraction. Circ J. 2018; 82(9):2311-2316. DOI: 10.1253/circj.CJ-18-0417. View

Ward J, Ware W, Viall A . Association between atrial fibrillation and right-sided manifestations of congestive heart failure in dogs with degenerative mitral valve disease or dilated cardiomyopathy. J Vet Cardiol. 2019; 21:18-27. DOI: 10.1016/j.jvc.2018.10.006. View

Nakamura K, Kawamoto S, Osuga T, Morita T, Sasaki N, Morishita K . Left Atrial Strain at Different Stages of Myxomatous Mitral Valve Disease in Dogs. J Vet Intern Med. 2017; 31(2):316-325. PMC: 5354021. DOI: 10.1111/jvim.14660. View

Vollmar C, Vollmar A, Keene B, Fox P, Reese S, Kohn B . Dilated cardiomyopathy in 151 Irish Wolfhounds: Characteristic clinical findings, life expectancy and causes of death. Vet J. 2019; 245:15-21. DOI: 10.1016/j.tvjl.2018.12.018. View

10.

Tidholm A, Haggstrom J . Prognostic value of selected one-, two- and three-dimensional and Doppler echocardiographic methods to assess severity in dogs with myxomatous mitral valve disease. J Vet Cardiol. 2022; 39:89-101. DOI: 10.1016/j.jvc.2021.12.005. View

11.

Rishniw M, Erb H . Evaluation of four 2-dimensional echocardiographic methods of assessing left atrial size in dogs. J Vet Intern Med. 2000; 14(4):429-35. DOI: 10.1892/0891-6640(2000)014<0429:eofemo>2.3.co;2. View

12.

Su H, Lin T, Hsu P, Lee W, Chu C, Lee C . Incremental prognostic value of identifying mitral L wave in patients with atrial fibrillation. Int J Cardiol. 2013; 168(4):4501-3. DOI: 10.1016/j.ijcard.2013.06.118. View

13.

Ito K, Li S, Homma S, Thompson J, Buchsbaum R, Matsumoto K . Left ventricular dimensions and cardiovascular outcomes in systolic heart failure: the WARCEF trial. ESC Heart Fail. 2021; 8(6):4997-5009. PMC: 8712869. DOI: 10.1002/ehf2.13560. View

14.

Reinero C, Visser L, Kellihan H, Masseau I, Rozanski E, Clercx C . ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs. J Vet Intern Med. 2020; 34(2):549-573. PMC: 7097566. DOI: 10.1111/jvim.15725. View

15.

Bhasin D, Arora G, Gupta A, Isser H, Bansal S . L-wave in severe mitral stenosis. Acta Cardiol. 2021; 76(6):678-679. DOI: 10.1080/00015385.2021.1886407. View

16.

Jung S, Sun W, Griffiths L, Kittleson M . Atrial Fibrillation as a Prognostic Indicator in Medium to Large-Sized Dogs with Myxomatous Mitral Valvular Degeneration and Congestive Heart Failure. J Vet Intern Med. 2015; 30(1):51-7. PMC: 4913664. DOI: 10.1111/jvim.13800. View

17.

Meurs K, Stern J, Sisson D, Kittleson M, Cunningham S, Ames M . Association of dilated cardiomyopathy with the striatin mutation genotype in boxer dogs. J Vet Intern Med. 2013; 27(6):1437-40. DOI: 10.1111/jvim.12163. View

18.

Summerfield N, Boswood A, OGrady M, Gordon S, Dukes-McEwan J, Oyama M . Efficacy of pimobendan in the prevention of congestive heart failure or sudden death in Doberman Pinschers with preclinical dilated cardiomyopathy (the PROTECT Study). J Vet Intern Med. 2012; 26(6):1337-49. PMC: 3546380. DOI: 10.1111/j.1939-1676.2012.01026.x. View

19.

Ari H, Ari S, Akkaya M, Sarigul O, Emlek N, Aydin C . A novel echocardiographic predictor of atrial fibrillation recurrence: L-wave. Echocardiography. 2013; 30(10):1180-6. DOI: 10.1111/echo.12254. View

20.

Ha J, Ahn J, Moon J, Suh H, Kang S, Rim S . Triphasic mitral inflow velocity with mid-diastolic flow: the presence of mid-diastolic mitral annular velocity indicates advanced diastolic dysfunction. Eur J Echocardiogr. 2005; 7(1):16-21. DOI: 10.1016/j.euje.2005.03.007. View