STANDARD ECHOCARDIOGRAPHY FOR EVALUATING DOGS WITH

MITRAL VALVE DISEASE

Dr. Michele Borgarelli
DVM, PhD, Dipl ECVIM-Cardiology, Kansas State University (USA)

Although the presence of a systolic left apical murmur in a typical breed is strongly
suggestive of the presence of chronic degenerative mitral valve disease (CDVD), the diagnosis
needs to be confirmed by echocardiography in order to exclude the presence of other cardiovascular
diseases leading to mitral regurgitation, such as mitral valve dysplasia. The recently published
ACVIM consensus statement recommends that echocardiography should be performed to answer
specific questions regarding the cause of the murmur of mitral regurgitation and the presence of
cardiac chamber enlargement in dogs with suspected CDVD. The echocardiographic characteristics
of CDVD include prolapse and/or thickening of one or both mitral valve leaflets. Mitral valve
prolapse is characterized by an abnormal displacement of the mitral valve leaflets superiorly and
posteriorly from the left ventricle in the left atrium. In dogs, some studies suggest that the right
parasternal 4 chambers long axis view is the gold standard view to identify the presence of MVP.
In people, the gold standard view to recognize the MVP is the right parasternal long axis view. This
is due to the fact that in people the mitral valve has a saddle shape. Using other views, such as the
apical view, can provide an overestimation of the prevalence of MVP. In dogs, the mitral valve can
present two different annular geometries, circular and elliptical. This could influence the
echocardiographic estimation of the mitral valve prolapse. According to this data, we suggest that
the presence of MVP in dogs should be confirmed in at least 2 echocardiographic views.
Echocardiography can also provide some important information concerning the severity of
the disease and ventricular function. The severity of the disease should be based on a multi-faceted
approach including assessment of left atrial and left ventricular enlargement, characteristics of the
transmitral flow, and qualitative and quantitative assessments of mitral regurgitation using spectral
and color Doppler. Left atrial enlargement not only represents a reliable indicator of the severity of
mitral regurgitation in dogs with CDVD, but it is also the most reliable independent prognostic
indicator. Evaluation of systolic and diastolic left ventricular function in dogs with CDVD is
particularly challenging. CDVD with moderate to severe mitral regurgitation is a condition
characterized by pure volume overload and relatively decreased afterload and by increased
sympathetic activation. Both these factors are responsible for the apparent increased contractility
observed in these patients. Accordingly, in dogs with moderate to severe CDVD, fractional
shortening (FS%) and ejection fraction (EF%) should be expected to be above the normal expected
references. Consequently, a normal FS% or EF% in dogs with moderate to severe CDVD should be
considered suggestive of systolic dysfunction. It has been suggested that other parameters, such the

end systolic volume index or the end systolic diameter corrected (accordingly to the Cornell
method), may represent a better indicator of systolic function, because they are less dependent from
the pre-load. We have demonstrated that dogs with moderate CDVD present some degree of
systolic dysfunction and that this is more pronounced in affected large breed dogs. Also, the study
of diastolic function using standard echo-Doppler technique is particularly challenging in dogs with
CDVD. Echocardiographic parameters suggestive of the presence of diastolic dysfunction are
represented by the left ventricular enlargement, changes of the transmitral flow and pulmonary
venous flow. It is important to remember that because particular loading conditions of patients with
CDVD, interpretation of the transmitral flow and pulmonary venous flow needs particular attention.
For example a restrictive pattern of the TMF can simply reflect left atrial volume overload and not
an increased left ventricular filling pressure. Nevertheless the TMF study can provide some useful
information in affected dogs. We have found that a peak velocity of E wave is associated to an
increased risk of death for both pre-clinical dogs and dogs with heart failure.
Finally echocardiography is a reliable method to demonstrate the presence of pulmonary
hypertension in dogs with CDVD.