The heart to single vertebra ratio: A new objective method for radiographic assessment of cardiac silhouette size in dogs

Vertebral heart size (VHS) is widely determined in clinical practice as an objective method to assess the cardiac silhouette dimensions. However, a key limitation is that it is difficult to determine VHS in dogs with vertebral alterations. This retrospective, method comparison, observer agreement study sought to overcome this limitation by using the heart-to-single vertebra ratio (HSVR), by evaluating the level of agreement between VHS and HSVR, as well as the intra- and inter-observer agreement for HSVR. Three independent observers retrospectively evaluated thoracic radiographs obtained over a set time period. Exclusion criteria were the presence of alterations of the tho- racic spine and the inability to clearly outline the cardiac silhouette. The lengths of the vertebral bodies, from the fourth to eighth thoracic vertebra, and VHS were measured on each radiograph. The HSVR was calculated by dividing the sum of the cardiac long and short axes by the length of each vertebral body. Eighty dogs of different breeds were included in the final analysis. Lin’s concordance correlation coefficients revealed strong correlations between VHS and HSVR (0.91–0.96), and the Bland–Altman plots showed low bias (0.01–0.2) between the methods. The mean absolute errors indicated low average magnitudes of error (0.11–0.28). The intraclass correlation coefficients showed good to excellent inter-observer (0.87–0.92; P = 0.000) and intra-observer (0.87–0.99; P < .001) agreement. In the authors’ opinion, this new method, which is less time consuming and more objective, could offer a valuable alternative to VHS.