한국에서 진단된 개의 점액종성 승모판 질환에서 교정 혈청 염소 농도와 질병 중증도 간의 연관성에 관한 연구 = Analysis of the Association Between Corrected Serum Chloride and Disease Severity in Dogs With Myxomatous Mitral Valve Disease in Korea

다국어 초록 (Multilingual Abstract)

Background: Myxomatous mitral valve disease (MMVD) in dogs is accompanied by neurohormonal activation and diuretic exposure that can alter chloride handling, but the clinical behavior of chloride indices across disease stages and during acute CHF has not been well defined in Korean canine populations.
Objectives: To characterize chloride-related electrolyte variables across ACVIM MMVD stages, to compare these indices between non-remodeling vs remodeling and non-CHF vs CHF groups, and to explore associations between chloride variables and echocardiographic/radiographic indices of acute CHF severity.
Animals: One hundred eighty-eight client-owned dogs: 147 dogs with MMVD (ACVIM stages B1, B2, C, D) and 41 control dogs without structural heart disease. A subset of 41 dogs with acute CHF was used for correlation analyses.
Methods: This was a retrospective, single-center observational study (2020–2025). Serum sodium and chloride were measured using validated analyzers. Measured chloride (mCl), corrected chloride (cCl, using a published sodium-adjusted formula), chloride deviation (dCl = cCl −mCl), measured sodium (mNa) and sodium-to-chloride ratio (Na:Cl) were calculated. Dogs were classified as Control, B1, B2, C, or D; and regrouped as non-remodeling (Control+B1) vs remodeling (B2+C+D), and non-CHF (B1+B2) vs CHF (C+D). Stage-based comparisons used Kruskal–Wallis tests; group comparisons used Mann–Whitney U tests. In dogs with acute CHF, associations between electrolyte variables and LA/Ao, LVIDDn, and VHS were assessed using Spearman correlation (P < 0.05).
Results: With advancing ACVIM stage, mCl and cCl decreased significantly, whereas mNa and dCl did not differ across stages; Na:Cl showed a smaller but significant stage-associated change. Remodeling dogs (B2–D) had lower mCl and cCl than non-remodeling dogs (Control+B1), whereas mNa, dCl, and Na:Cl did not differ between groups. CHF dogs (C+D) had significantly lower mCl than non-CHF dogs (B1+B2), whereas cCl, dCl, and sodium indices did not differ. Comparisons between B2 and CHF (C+D) showed similar trendsbut did not reach statistical significance. In dogs with acute CHF, none of the chloride-related variables correlated significantly with LA/Ao, LVIDDn, or VHS.
Conclusions and Clinical Importance: In this Korean MMVD cohort, absolute chloride concentrations (mCl and cCl), rather than sodium-based indices or dCl, were most closely associated with ACVIM stage and structural remodeling, and mCl alone was significantly associated with CHF status. Serum chloride behaved as a marker of chronic fluid and neurohormonal burden rather than as a surrogate for instantaneous structural severity, and may provide a simple, accessible tool to aid risk stratification and longitudinal monitoring, particularly in B2 and remodeling-stage dogs.

국문 초록 (Abstract)

개의 점액종성 승모판 질환(Myxomatous Mitral Valve Disease, MMVD)은 신경호르몬계 활성화와 이뇨제 사용과 동반되며 염화물 대사 이상이 발생할 수 있으나, 국내 개 집단에서 질환 단계 및 울혈성 심부전(congestive heart failure, CHF)과의 연관성은 충분히 규명되지 않았다. 본 연구는 ACVIM 분류에 따른 MMVD 단계별 염화물 관련 전해질 지표의 변화를 평가하고, 심장 리모델링 및 CHF 상태와의 관련성을 분석하고자 수행된 후향적 단일기관 관찰 연구이다. 2020년부터 2025년까지 구조적 심장 질환이 없는 대조군 41두와 MMVD 개 147두(B1–D), 총 188두를 대상으로 하였으며, 급성 CHF 개체 41두를 별도로 분석하였다. 측정 염화물(mCl), 교정 염화물(cCl), 염화물 편차(dCl), 측정 나트륨(mNa) 및 나트륨-염화물 비(Na:Cl)를 산출하여 단계별 및 군 간 비교를 시행하고, 급성 CHF 개체에서는 심초음파 및 방사선학적 중증도 지표와의 상관성을 평가하였다. 그 결과, ACVIM 단계가 진행됨에 따라 mCl과 cCl은 유의하게 감소하였으나 mNa와 dCl은 차이를 보이지 않았으며, 리모델링군은 비리모델링군에 비해 mCl과 cCl이 유의하게 낮았다. CHF군은 비 CHF군에 비해 mCl만 유의하게 감소하였다. 급성 CHF 개체에서 염화물 지표는 구조적 중증도 지표와 유의한 상관관계를 보이지 않았다. 본 연구 결과, MMVD 개에서 염화물은 나트륨 기반 지표보다 질환 단계와 리모델링 상태를 더 잘 반영하였으며, 혈청 염화물은 급성 구조적 중증도보다는 만성 체액 및 신경호르몬 부담을 반영하는 지표로서 임상적 활용 가치가 있을 것으로 판단된다.

목차 (Table of Contents)

• Contents i
• List of Tables ii
• Abstract iii
• Introduction 1
• Materials and Methods 3
• Results 7
• Discussion 16
• Conclusion 21
• References 22
• Abstract in Korean 24