It was great to meet so many enthusiastic people at September’s hands-on echocardiography day in Bromley, southeast London. We kicked off the session with a look at what normal looks like, scanning Virginia’s dog, Bloss, and some volunteer Shetland Sheepdogs on a range of ultrasound systems.
Logan the spaniel arrived mid-morning, and we discussed how to grade his mitral regurgitation, including looking at signs of cardiac remodelling.
One of the things people particularly enjoy about our courses are the number of cats we have on hand, and during our September course we had Bengals (well behaved ones; yes, really!), Maine Coons and British Shorthairs all attending for scans.
We also had two little female Maine Coon kittens, both from the same litter, and both with interesting hearts for different reasons. You can see their echocardiograms below.
The struggles of the LA:Ao ratio from the short axis view are a topic which comes up on every course, and Professor Luis Fuentes demonstrated a more reproducible alternative to our delegates, which they could index to the aortic diameter if they wanted to. You can also see this demonstrated below:
Tricuspid Annular Plane Systolic Excursion (TAPSE) came up on the course as a relatively easy trace to acquire, with good reproducibility. The best source for reference values in dogs is the Visser et al. (2015) paper, from which this table has been adapted:
| Bodyweight in kg | TAPSE in mm |
| 3 | 6.6–10.6 |
| 4 | 7.2–11.5 |
| 5 | 7.7–12.3 |
| 7 | 8.5–13.6 |
| 9 | 9.2–14.7 |
| 12 | 10.0–16.0 |
| 15 | 10.7–17.1 |
| 20 | 11.6–18.6 |
| 25 | 12.4–19.9 |
| 30 | 13.1–21.0 |
| 35 | 13.7–22.0 |
| 40 | 14.3–22.8 |
Pulmonary vein flow is useful parameter for diastolic function assessment, and traces can be taken from many different views. Those of you enrolled in the Confidence in Echocardiography online training programme can, from next month, access a step-by-step walkthrough of how to obtain and interpret pulmonary vein flow from each view, and send in your own traces for help on optimising and interpreting your results.
Above: This cat has a reversed S:D ratio, but the lack of a dominant Ar wave means this is likely supernormal, the high velocity D wave owing to strong ‘suction’ of the left ventricle in a young, healthy cat.
We also briefly looked at isovolumic relaxation time, how to obtain the best possible trace, and how to measure from it. A lot of the more ‘advanced’ measurements like this can tie your brain in knots when you’re learning, and IVRT is definitely one of these things as it goes along the lines of “if IVRT is greater than x, then your patient has diastolic dysfunction, but if it’s less than x, then if y is present, they also have diastolic dysfunction. Except in this other situation where IVRT will be normal, but your patient most definitely does still have diastolic dysfunction!”
Therefore, if you’re just getting started with diastolic function assessment, I would start with getting an impression from 2D imaging, mitral inflow and possibly tissue Doppler, and once you’ve really mastered these things and the driving forces behind them, start to add pulmonary vein flow profiles and IVRT into your examination. Otherwise, these extra traces will not be giving you additional information – they will be giving you confusing information.
Whether you’ve been on one of our courses before or you are thinking about your first time training with us, we would love to welcome you to Bromley for our next training course. Please visit our events page to see when our next hands-on veterinary echocardiography training day will be held, or send us an email.
If you are thinking about joining our programme for access to long-term support and mentoring, we encourage you to arrange a free call to check that this is the right programme for you. If it isn’t, me or Matthew (both echocardiographers who have been through the same learning journey you’re on, albeit a good few years ago!) will be glad to suggest alternatives for you.
References
Visser et al. (2015). Echocardiographic assessment of right ventricular systolic function in conscious healthy dogs: Repeatability and reference intervals.
Strohm et al (2018). Two-dimensional, long-axis echocardiographic ratios for assessment of left atrial and ventricular size in dogs.
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