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研究生:翁敏捷
研究生(外文):Min-Chieh Weng
論文名稱:右肺動脈延展性指數和其他心臟超音波參數於肺高壓犬隻之臨床應用
論文名稱(外文):Diagnostic Value of Right Pulmonary Artery Distensibility Index and Selected Echocardiographic Indices in Dogs with Pulmonary Hypertension: Comparing with Doppler Echocardiographic Estimates of Systolic Pulmonary Artery Pressure and Clinical Assessments
指導教授:林永昌林永昌引用關係
指導教授(外文):Yun-Chang Lin
口試委員:林荀龍傅雲慶
口試委員(外文):Shiun-Long LinYun-Ching Fu
口試日期:2016-07-21
學位類別:碩士
校院名稱:國立中興大學
系所名稱:獸醫學系暨研究所
學門:獸醫學門
學類:獸醫學類
論文種類:學術論文
論文出版年:2016
畢業學年度:104
語文別:英文
論文頁數:86
中文關鍵詞:肺高壓肺動脈硬度肺動脈延展性心絲蟲
外文關鍵詞:Pulmonary hypertensionpulmonary artery stiffnesspulmonary artery distensibilityheartworm disease
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Pulmonary hypertension (PH) can cause severe clinical signs and Doppler echocardiography-derived tricuspid regurgitation pressure gradient (TRPG) is the most used variable to evaluate the severity of PH in veterinary medicine. But if the Tricuspid regurgitant (TR) jet is absent or difficult to measure, evaluation of PH is limited. Right pulmonary artery distensibility (RPAD) index is a novel method to evaluate the distensibility of pulmonary artery (PA) and it has been proved good correlation with TRPG. There are also some indices of right ventricular function and PA stiffness (PAS). The aim of the study is to evaluate the diagnostic values of RPAD index, PAS and other indices comparing with clinical signs, radiographic evidences and TRPG in dogs with various degrees and primary disease of PH. Two hundred dogs were retrospectively included on the basis of underwent echocardiography examination which consisted of dogs with myxomatous mitral valve disease (MMVD), heartworm disease (HW), PH associated with pulmonary disease and healthy dogs. Dogs were allocated into groups by diagnosis, TRPG and heart failure, and survival analysis were also done. The results showed moderate correlation of RPAD index to TRPG (r = -0.601), and normalized dimensions of right PA (RPA) during end-systole (RPAsn) and end-diastole (RPAdn) also correlared with TRPG (r = 0.549 and 0.634, respectively). RPAD index, RPAdn and PAS were significantly different in dogs with severe PH, HWD, MMVD and right heart failure. RPAD index, RPAsn, RPAdn and PAS were related to cardiac-related death both within 3 months or 1 year. The result confirmed the usefulness of RPAD index, RPAdn and PAS to evaluate the severity of PH even without measureable TR and to predict the prognosis.

Abstract i
Table of Contents ii
List of Tables and Figures iv
1. Introduction 1
2. Literature Review 4
2.1. Pulmonary Hypertension 4
2.1.1 Definition of Pulmonary Hypertension 4
2.1.2 Causes of Pulmonary Hypertension 4
2.1.3 Classification of Pulmonary Hypertension 5
2.1.4 Pathophysiology of Pulmonary Hypertension 6
2.1.5 Evaluation of Pulmonary Hypertension 7
2.1.6 Relationship Between Pulmonary Hypertension and Congestive Right Heart Failure 8
2.2 Diagnosis of Pulmonary Hypertension 9
2.2.1 Clinical Signs and Physical Examination Evidences of Pulmonary Hypertension 9
2.2.2 Clinical Biological Evidences of Pulmonary Hypertension 10
2.2.3 Radiographic Evidences of Pulmonary Hypertension 10
2.2.4 Echocardiographic Evidences of Pulmonary Hypertension 11
2.3 Diagnosis of Pulmonary Hypertension using Echocardiography 11
2.3.1 Pulmonary Artery Systolic and Diastolic Pressure 11
2.3.2 Right Pulmonary Artery Distensibility 12
2.3.3 Pulmonary Artery Stiffness 13
2.3.4 Right Ventricular Tei Index 13
2.3.5 Other Indices of Right Heart Function 14
3. Material and Methods 16
3.1. Animals 16
3.2. Equipment and Instruments 19
3.3. Echocardiography 20
3.4. Echocardiographic Indices Measurement Variability 25
3.5. Statistical Analysis 26
4. Results 28
4.1. Descriptive statistics 28
4.2. Correlation Analyses 31
4.3. Differences between groups 36
4.4. Diagnostic accuracy and optimal cutoffs for predicting pulmonary hypertension 45
4.5. Survival analyses 49
4.6. Intra-observer and inter-observer variability of echocardiographic measurements 57
5. Discussion 58
6. Reference 71



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Wang, Z., & Chesler, N. C. (2011). Pulmonary vascular wall stiffness: An important contributor to the increased right ventricular afterload with pulmonary hypertension. Pulm Circ, 1(2), 212-223. doi:10.4103/2045-8932.83453
Weir-McCall, J. R., Struthers, A. D., Lipworth, B. J., & Houston, J. G. (2015). The role of pulmonary arterial stiffness in COPD. Respiratory Medicine, 109(11), 1381-1390. doi:10.1016/j.rmed.2015.06.005
Wu, C. C., & Fan, P. C. (2003). Prevalence of canine dirofilariasis in Taiwan. Journal of Helminthology, 77(1), 83-88. doi:10.1079/joh2002150
6.3.Electronic Resources
American-Heartworm-Society. (2014). Current canine guidelines for the prevention, diagnosis, and management of heartworm (Dirofilaria immitis) infection in dogs (Guideline). Retrieved 2014



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