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Vereb M, Atkins CE, Adin D, Blondel T, Coffman M, Lee S, Guillot E, Ward JL. Efficacy of a mitral regurgitation severity index to predict long-term outcome in dogs with myxomatous mitral valve disease. J Vet Intern Med 2024; 38:51-60. [PMID: 37909399 PMCID: PMC10800232 DOI: 10.1111/jvim.16923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Predicting progression of myxomatous mitral valve disease (MMVD) in dogs can be challenging. HYPOTHESIS/OBJECTIVES The mitral regurgitation severity index (MRSI) will predict time to congestive heart failure (CHF) and all-cause death in dogs with MMVD. ANIMALS Eight hundred sixty-nine client-owned dogs. METHODS Retrospective study pooling data from 4 previous samples including dogs with MMVD stage B2 or C. MRSI was calculated as: (heart rate [HR]/120) × left atrium-to-aorta ratio (LA:Ao) × (age in years/10) × 100. Alternative MRSI formulas substituting radiographic measures of left atrial size were also calculated. Cox proportional hazard modeling and time-dependent receiver-operator characteristic curves quantified prognostic performance. RESULTS For Stage B2 pooled samples, MRSI > 156 was predictive of time to CHF (median 407 vs 1404 days; area under the curve [AUC] 0.68; hazard ratio 3.02 [95% CI 1.9-4.9]; P < .001). MRSI > 173 was predictive of all-cause death (median survival 868 vs 1843 days; AUC 0.64; hazard ratio 4.26 [95% CI 2.4-7.5]; P < .001). MRSI showed superior predictive value compared to the individual variables of HR, LA:Ao, and age. Variations of the MRSI equation substituting radiographic vertebral left atrial size for LA:Ao were also significantly predictive of outcome in stage B2. MRSI was not consistently predictive of outcome in Stage C. CONCLUSIONS AND CLINICAL IMPORTANCE MRSI was predictive of outcome (onset of CHF and all-cause death) in MMVD Stage B2, demonstrating utility as a useful prognostic tool. Echocardiographic LA:Ao can be effectively replaced by radiographically determined LA size in the MRSI formula.
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Affiliation(s)
- Michelle Vereb
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineIowa State UniversityAmesIowaUSA
| | - Clarke E. Atkins
- Department of Clinical Sciences, College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Darcy Adin
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | | | | | | | | | - Jessica L. Ward
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineIowa State UniversityAmesIowaUSA
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Wesselowski S, Gordon SG, Fries R, Saunders AB, Sykes KT, Vitt J, Boutet B, Häggström J, Kadotani S, Stack J, Barnett BG. Use of physical examination, electrocardiography, radiography, and biomarkers to predict echocardiographic stage B2 myxomatous mitral valve disease in preclinical Cavalier King Charles Spaniels. J Vet Cardiol 2023; 50:1-16. [PMID: 37913604 DOI: 10.1016/j.jvc.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Cavalier King Charles Spaniels (CKCS) are predisposed to developing myxomatous mitral valve disease (MMVD). Dogs with stage B2 MMVD benefit from medication. OBJECTIVES To develop (1) breed-specific cut-offs for individual screening tests and (2) predictive models utilizing physical examination (PE), ECG, radiograph, and blood-based biomarker variables in combination for identification of echocardiographic stage B2 MMVD in preclinical CKCS. ANIMALS Adult, preclinical CKCS not receiving cardiac medications (N = 226). MATERIALS AND METHODS Prospective, cross-sectional study. Enrolled CKCS underwent PE, ECG, radiography, Doppler blood pressure measurement, echocardiography, and biomarker testing. Dogs were grouped by MMVD stage using echocardiography only. The discriminatory ability of individual tests to identify stage B2 was assessed, and prediction models were developed using variables derived from four 'tests' (PE, ECG, radiography, and biomarkers). RESULTS N-terminal pro-B-type natriuretic peptide (NT-proBNP) and radiographic vertebral heart size (VHS) had the best discriminatory ability of individual diagnostic tests to differentiate stage A/B1 CKCS from stage B2, with an area under the curve (AUC) of 0.855 and 0.843, respectively. An NT-proBNP ≥1138 pmol/L or a VHS ≥11.5 had high specificity for predicting stage B2 (90.1% and 90.6%, respectively). Prediction models incorporating variables from multiple tests had better discriminatory ability than single tests. The four-test prediction model had an AUC of 0.971. Three and two-test models had AUCs ranging between 0.925-0.959 and 0.895-0.949, respectively. CONCLUSIONS Both NT-proBNP and VHS have good utility for predicting echocardiographic stage B2 MMVD in CKCS as individual tests. Prediction models incorporating multiple test variables have superior discriminatory ability.
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Affiliation(s)
- S Wesselowski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA.
| | - S G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - R Fries
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, 1008 Hazelwood Drive, Urbana, IL, USA
| | - A B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - K T Sykes
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - J Vitt
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, 1008 Hazelwood Drive, Urbana, IL, USA
| | - B Boutet
- VETMED emergency and specialty veterinary hospital, 20610 N Cave Creek Rd, Phoenix, AZ, USA
| | - J Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Box 7045, 7507 Uppsala, Sweden
| | - S Kadotani
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, 1008 Hazelwood Drive, Urbana, IL, USA
| | - J Stack
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, 1008 Hazelwood Drive, Urbana, IL, USA
| | - B G Barnett
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
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Pedro B, Mavropoulou A, Oyama MA, Linney C, Neves J, Dukes-McEwan J, Fontes-Sousa AP, Gelzer AR. Optimal rate control in dogs with atrial fibrillation-ORCA study-Multicenter prospective observational study: Prognostic impact and predictors of rate control. J Vet Intern Med 2023; 37:887-899. [PMID: 37128174 DOI: 10.1111/jvim.16666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/06/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The optimal heart rate (HR) in dogs with atrial fibrillation (AF) is unknown. Impact of HR on survival needs elucidation. HYPOTHESIS/OBJECTIVES Dogs with a 24 hours Holter-derived meanHR ≤125 beats per minute (bpm; rate controlled) survive longer than dogs with higher meanHR. We further aimed to determine which variables predict ability to achieving rate control. ANIMALS Sixty dogs with AF. METHODS Holter-derived meanHR, clinical, echocardiographic, and biomarker variables were analyzed prospectively. Survival was recorded from time of rate control, with all-cause mortality as primary endpoint. Cox proportional hazards analysis identified variables independently associated with survival; Kaplan-Meier survival analysis estimated the median survival time of dogs with meanHR ≤125 bpm vs >125 bpm. Logistic regression explored baseline variables associated with inability to achieve rate control. RESULTS Structural heart disease was present in 56/60 dogs, 50/60 had congestive heart failure, and 45/60 died. Median time to all-cause death was 160 days (range, 88-303 days), dogs with meanHR >125 bpm (n = 27) lived 33 days (95% confidence interval [CI], 15-141 days), dogs with meanHR ≤125 bpm (n = 33) lived 608 days (95% CI, 155-880 days; P < .0001). Congenital heart disease and N-terminal pro-B-type natriuretic peptide were independently associated with higher risk of death (P < .01 and <.0001, respectively) whereas meanHR ≤125 bpm decreased the risk of death (P < .001). Increased left atrial size, increased C-reactive protein concentration and lower blood pressure at admission were associated with failure to achieve rate control. CONCLUSIONS AND CLINICAL IMPORTANCE Rate control affects survival; an optimal target meanHR <125 bpm should be sought in dogs with AF. Baseline patient variables can help predict if rate control is achievable.
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Affiliation(s)
- Brigite Pedro
- Willows Veterinary Centre and Referral Service, West Midlands, United Kingdom
- Centro de Cardiologia Veterinária do Porto, Porto, Portugal
- Centro de Cardiologia Veterinária do Atlântico, Mafra, Portugal
- Virtual Veterinary Specialists Ltd, Middlesex, United Kingdom
- ICBAS-UP, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | | | - Mark A Oyama
- Department of Clinical Studies and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Linney
- Willows Veterinary Centre and Referral Service, West Midlands, United Kingdom
- Paragon Veterinary Referrals, Wakefield, United Kingdom
| | - João Neves
- Willows Veterinary Centre and Referral Service, West Midlands, United Kingdom
- Centro de Cardiologia Veterinária do Porto, Porto, Portugal
- Centro de Cardiologia Veterinária do Atlântico, Mafra, Portugal
- Virtual Veterinary Specialists Ltd, Middlesex, United Kingdom
| | - Joanna Dukes-McEwan
- Small Animal Teaching Hospital, Department of Small Animal Clinical Science, University of Liverpool Leahurst Campus, Neston, United Kingdom
| | - Ana P Fontes-Sousa
- ICBAS-UP, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Departamento de Imuno-Fisiologia e Farmacologia, Centro de Investigação Farmacológica e Inovação Medicamentosa (MedInUP), Universidade do Porto, Porto, Portugal
- UPVET, Hospital Veterinário da Universidade do Porto, Porto, Portugal
| | - Anna R Gelzer
- Department of Clinical Studies and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Grosso G, Vezzosi T, Domenech O, Tognetti R. Prognostic relevance of left cardiac enlargement in dogs with preclinical myxomatous mitral valve disease. J Vet Cardiol 2023; 45:50-58. [PMID: 36702085 DOI: 10.1016/j.jvc.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/15/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION According to the most recent consensus guidelines on canine myxomatous mitral valve disease (MMVD), dogs with only left atrial enlargement (LAE) or left ventricular enlargement are classified as stage B1. The concomitant presence of LAE and left ventricular enlargement is needed to be classified as stage B2. The primary aim of the study was to evaluate the prognosis in stage B1 and stage B2 according to the revised definition. The secondary aim was to assess the prognostic relevance of LAE in stage B1. ANIMALS A total of 440 dogs with MMVD, 276 in stage B1 and 164 in stage B2. MATERIALS AND METHODS Retrospective and observational study. The left atrium-to-aorta ratio and the left ventricular end-diastolic diameter normalized were used to define cardiac dimensions. The long-term outcome was assessed by telephone interviews with owners and referring vets. Both cardiac-related and all-cause mortality were evaluated. RESULTS Stage B1 dogs had a longer median survival time than stage B2, considering both cardiac-related death (2344 vs. 1341 days; P<0.001) and all-cause mortality (1832 vs. 855 days; P<0.001). Age, left atrium-to-aorta ratio, and the left ventricular end-diastolic diameter normalized were independent predictors of cardiac-related death and all-cause mortality. Among stage B1, dogs with LAE lived shorter than those without LAE (1183 vs. 1882 days; P=0.005) considering all-cause mortality. DISCUSSION AND CONCLUSIONS Stage B1 dogs lived longer than stage B2 dogs. Among stage B1, LAE had prognostic relevance considering all-cause mortality. This finding could add useful prognostic information in the management of preclinical MMVD.
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Affiliation(s)
- G Grosso
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122 San Piero a Grado, Pisa, Italy
| | - T Vezzosi
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122 San Piero a Grado, Pisa, Italy.
| | - O Domenech
- Department of Cardiology, Anicura Istituto Veterinario Novara, Strada Provinciale 9, 28060 Granozzo con Monticello, Novara, Italy
| | - R Tognetti
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122 San Piero a Grado, Pisa, Italy
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Comparison of different radiographic scores with associated echocardiographic measurements and prediction of heart enlargement in dogs with and without myxomatous mitral valve disease. J Vet Cardiol 2022; 44:1-12. [PMID: 36174296 DOI: 10.1016/j.jvc.2022.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Staging of myxomatous mitral valve disease (MMVD) requires an echocardiographic examination along with thoracic radiographs. The aims of this study were to calculate mean values for radiographic scores vertebral heart size (VHS), left atrial width (LAWidth), radiographic left atrial dimension (RLAD), and vertebral left atrial size (VLAS) in conventional and grayscale inverted images in healthy dogs and dogs with different stages of MMVD, and to find cutoff values for a stage assignment. ANIMALS One hundred fifty dogs in different stages of MMVD and 50 unaffected dogs were evaluated. METHODS Radiographic scores, echocardiographic left atrium-to-aorta ratio and normalized left ventricular internal dimension at end-diastole, and results of a clinical examination were obtained. Analyses were performed to evaluate the correlation between radiographic scores and echocardiographic values, to determine cutoff values for a radiographic stage assignment, and to compare measurements in conventional and inverted radiographs. RESULTS After excluding breed-specific higher VHS, the means of VHS, LAWidth, RLAD, and VLAS were similar in the control group and stage B1. All radiographic scores increased in stages B2 and C. The cutoff values identifying heart enlargement, and therefore differentiating stages B1 and B2, were 11.0 for VHS, 1.8 for LAWidth, 2.0 for RLAD, and 2.3 for VLAS. Besides RLAD, scores were similar in conventional and inverted radiographs. CONCLUSION Cutoff values for the different radiographic scores for stage assignment were calculated. Radiographic cardiac scores using either conventional or inverted grayscale could be a tool to differentiate between different stages of MMVD when echocardiography is unavailable.
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Effectiveness of therapy with low-dosage masitinib on pulmonary hypertension in dogs: a pilot study. ACTA VET BRNO 2022. [DOI: 10.2754/avb202291040363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this pilot study was to assess the efficacy of long-term masitinib therapy at low doses on echocardiographic, cardiovascular, haematological, and blood biochemical indicators, as well as clinical symptoms in dogs with pulmonary hypertension (PH) caused by advanced chronic degenerative mitral valve disease or heartworm disease. Seven client-owned dogs with severe PH were recruited prospectively and given low-dose masitinib orally, 3 mg/kg body weight (approximately one-fourth of the recommended antineoplastic dosage), q24h, for 123–928 days. Examinations were performed prior to masitinib administration, as well as 1, 2, 3, 6, and 12 months later. At 1–12 months, low-dose masitinib significantly reduced systolic pulmonary arterial pressure (P < 0.05 or 0.01) and dramatically improved clinical symptoms. Low-dose masitinib treatment improved right ventricular function indicators such as right atrium/aorta ratio, maximum tricuspid regurgitation velocity, right ventricular Tei index, and tricuspid annular plane systolic excursion, without worsening left ventricular function indicators. These findings suggest that low-dose masitinib may be effective as an adjunctive therapeutic for chronic heart failure in dogs with PH and may increase the survival of PH dogs.
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Morita T, Nakamura K, Osuga T, Takiguchi M. Incremental predictive value of echocardiographic indices of right ventricular function in the assessment of long-term prognosis in dogs with myxomatous mitral valve disease. J Vet Cardiol 2021; 39:51-62. [PMID: 34979482 DOI: 10.1016/j.jvc.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Few studies have evaluated the utility of echocardiographic indices of right ventricular (RV) function in predicting prognosis in dogs with myxomatous mitral valve disease (MMVD). ANIMALS Sixty-seven client-owned dogs were diagnosed with MMVD. MATERIALS AND METHODS clinical cohort study. Dogs diagnosed with American college of veterinary internal medicine (ACVIM) stage B2, C or D between April 2014 and March 2017 were enrolled. Long-term outcomes were assessed by telephone or from the medical record. The primary end-point was defined as cardiac-related death. Echocardiographic indices of RV function, including the RV Tei index, free wall and septal RV longitudinal strain, were obtained. Univariable and multivariable Cox proportional hazard analyses were used to identify variables predictive of cardiac-related death. RESULTS Twenty-four dogs died during the follow-up period. The median follow-up time was 482 days, and the median survival time for dogs with cardiac-related death was 230 days. For cardiac-related death, peak early diastolic mitral inflow velocity, ACVIM stage C or D, tricuspid regurgitation velocity, RV Tei index and RV end-diastolic area were predictors in univariable Cox proportional hazard analysis. In multivariable Cox proportional analysis adjusted for the left atrial to aorta ratio, peak early diastolic mitral inflow velocity and ACVIM stage, an increase in the Tei index by 0.1 increased the hazard ratio of cardiac-related death by 33% (95% confidence interval, 16-70%; P = 0.002). CONCLUSIONS In dogs with MMVD, RV dysfunction assessed by the Tei index is an independent predictor of cardiac-related death.
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Affiliation(s)
- T Morita
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido, 060-0818, Japan
| | - K Nakamura
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido, 060-0818, Japan.
| | - T Osuga
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, 1-1 Gakuenkibanadai-nishi, Miyazaki, 889-2192, Japan
| | - M Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido, 060-0818, Japan
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Klein S, Nolte I, Rumstedt K, Sehn M, Raue JF, Weiner F, Treese JS, Beyerbach M, Bach JP. The effect of treatment with pimobendan in dogs with preclinical mitral valve disease - a placebo-controlled double-blinded crossover study. BMC Vet Res 2021; 17:310. [PMID: 34563187 PMCID: PMC8467240 DOI: 10.1186/s12917-021-03014-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background Pimobendan is a widely used medication for the treatment of dogs with congestive heart failure (CHF) and preclinical degenerative mitral valve disease (DMVD) with cardiomegaly. The benefit of a treatment in dogs with preclinical DMVD but without cardiomegaly has not yet been elucidated. Some positive effects concerning life quality and a decrease in cardiac biomarkers could be verified. This study aimed to further investigate these results using a placebo-controlled double-blinded crossover design. Out of a total of 15 dogs, eight were allocated to sequence-group AB, in which dogs received pimobendan (A) during the first treatment period and placebo (B) during the second period. Accordingly, sequence-group BA was treated first with placebo followed by pimobendan. Each treatment period lasted six months and included a baseline investigation and follow-ups after 90 and 180 days. The investigations included a questionnaire completed by the owners, echocardiographic examination, and measurements of NT-proBNP, cTnI and lactate before and after a standardised submaximal exercise test. Results NT-proBNP values decreased significantly during the treatment period with pimobendan, and the post-exercise increase was attenuated at day 180. No significant treatment effects could be verified for cTnI and lactate, neither pre- nor post-exercise. Left ventricular size decreased under treatment, whereas no significant changes in left atrial size were detected. The owners described their dogs under treatment with pimobendan as being more active at day 90 (11/15) and day 180 (12/15). Those animals treated with placebo were described as being more active at day 90 (2/15) and day 180 (5/15). Conclusions Pimobendan had reducing effects on the concentrations of pre- and post-exercise cardiac biomarkers and the size of the left ventricle in dogs with DMVD ACVIM B1. Exercise testing in addition to an assessment of cardiac biomarkers might improve the decision when to initiate pimobendan treatment in dogs with DMVD. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-021-03014-5.
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Affiliation(s)
- Stephanie Klein
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Ingo Nolte
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany.
| | - Katja Rumstedt
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Maximiliane Sehn
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | | | - Franziska Weiner
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Julia Sophie Treese
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Martin Beyerbach
- Institute for Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health at the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Jan-Peter Bach
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
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Effect of Pravastatin as an Adjunctive Therapeutic for Mitral Insufficiency with Hyperlipidemia in a Dog. Case Rep Vet Med 2021; 2021:6054125. [PMID: 34532150 PMCID: PMC8440077 DOI: 10.1155/2021/6054125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022] Open
Abstract
Pravastatin (PS) has been found to increase left ventricle (LV) expansion capacity and decrease LV constriction and left atrial pressure in healthy dogs. To date, there are no available reports on the effects of PS in dogs with hypercholesterolemia with chronic heart failure (CHF). This case report demonstrates a successful long-term treatment plan using PS in a dog suffering from mitral insufficiency with hyperlipidemia. A 12-year-old, castrated male Chihuahua dog had mitral insufficiency with hyperlipidemia. The dog presented with symptoms of chronic coughing. PS was orally administered (1 mg/kg, SID) in addition to general treatment for mitral insufficiency. The follow-up period was 375 days. PS administration decreased the heart rate (HR), vertebral heart size (VHS), and N-terminal probrain natriuretic peptide (NT-proBNP) concentration of the dog. In addition, PS administration also improved chronic cardiac failure induced by mitral insufficiency and hyperlipidemia. This report suggests that PS can be useful as an adjunctive therapeutic for dogs with hypercholesterolemia with mitral insufficiency.
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Riengvirodkij N, Roytrakul S, Jaresitthikunchai J, Phaonakrop N, Charoenlappanich S, Sakcamduang W. Peptide barcodes in dogs affected by mitral valve disease with and without pulmonary hypertension using MALDI-TOF MS and LC-MS/MS. PLoS One 2021; 16:e0255611. [PMID: 34383793 PMCID: PMC8360550 DOI: 10.1371/journal.pone.0255611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/19/2021] [Indexed: 11/20/2022] Open
Abstract
Mitral valve disease (MVD) is an important and most frequently acquired heart disease found in dogs. MVD is classified into different stages according to its severity. There is a challenge in differentiation between asymptomatic and symptomatic stages of the MVD. Moreover, pulmonary hypertension (PH) is a common complication in dogs affected by MVD. In clinical practice, there are also some limitations to identify PH. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is a technique that can characterize specific patterns of peptide mass called peptide barcodes from various samples. Besides, in combination with liquid chromatography-tandem mass spectrometry (LC-MS/MS), potential peptide sequences associated with specific conditions could be identified. The present study aimed to use MALDI-TOF coupled with LC-MS/MS to characterize specific peptide barcodes and potential peptide candidates in serum samples from healthy dogs, dogs with MVD stage B (MVD B, asymptomatic stage), MVD stage C (MVD C, symptomatic stage), MVD stage B with PH (MVD B PH), and MVD stage C with PH (MVD C PH). Discrete clusters of the 5 sample groups were identified by 3D plot analysis. Peptide barcodes also revealed differences in peptide patterns among the 5 groups. Six amino acid sequences of peptide candidates at 1,225.60, 1,363.85, 1,688.71, 1789.52, 2020.21, and 2156.42 Da were identified as part of the proteins CLCN1, CLUL1, EDNRA, PTEN, SLC39A7, and CLN6, respectively. The network interactions between these discovered proteins and common cardiovascular drugs were also investigated. These results demonstrate that MALDI-TOF MS has promise as an optional technique for diagnosing dogs affected by asymptomatic and symptomatic stages of MVD with and without PH. Further studies are required to identify peptide barcodes in dogs with other diseases to create peptide barcode databases in veterinary medicine before using this method as a novel diagnostic tool in the future.
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Affiliation(s)
- Nattapon Riengvirodkij
- Prasu-Arthorn Animal Hospital, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | - Sittiruk Roytrakul
- Functional Proteomics Technology Laboratory, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Janthima Jaresitthikunchai
- Functional Proteomics Technology Laboratory, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Narumon Phaonakrop
- Functional Proteomics Technology Laboratory, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Sawanya Charoenlappanich
- Functional Proteomics Technology Laboratory, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Walasinee Sakcamduang
- Department of Clinical Sciences and Public Health, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
- * E-mail:
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O'Brien MJ, Beijerink NJ, Wade CM. Genetics of canine myxomatous mitral valve disease. Anim Genet 2021; 52:409-421. [PMID: 34028063 DOI: 10.1111/age.13082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 12/26/2022]
Abstract
Myxomatous mitral valve disease (MMVD) is the most common heart disease and cause of cardiac death in domestic dogs. MMVD is characterised by slow progressive myxomatous degeneration from the tips of the mitral valves onwards with subsequent mitral valve regurgitation, and left atrial and ventricular dilatation. Although the disease usually has a long asymptomatic period, in dogs with severe disease, mortality is typically secondary to left-sided congestive heart failure. Although it is not uncommon for dogs to survive long enough in the asymptomatic period to die from unrelated causes; a proportion of dogs rapidly advance into congestive heart failure. Heightened prevalence in certain breeds, such as the Cavalier King Charles Spaniel, has indicated that MMVD is under a genetic influence. The genetic characterisation of the factors that underlie the difference in progression of disease is of strong interest to those concerned with dog longevity and welfare. Advanced genomic technologies have the potential to provide information that may impact treatment, prevalence, or severity of MMVD through the elucidation of pathogenic mechanisms and the detection of predisposing genetic loci of major effect. Here we describe briefly the clinical nature of the disorder and consider the physiological mechanisms that might impact its occurrence in the domestic dog. Using results from comparative genomics we suggest possible genetic approaches for identifying genetic risk factors within breeds. The Cavalier King Charles Spaniel breed represents a robust resource for uncovering the genetic basis of MMVD.
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Affiliation(s)
- M J O'Brien
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
| | - N J Beijerink
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, NSW, 2006, Australia.,Veterinaire Specialisten Vught, Reutsedijk 8a, Vught, 5264 PC, The Netherlands
| | - C M Wade
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
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Borgarelli M, Ferasin L, Lamb K, Chiavegato D, Bussadori C, D'Agnolo G, Migliorini F, Poggi M, Santilli RA, Guillot E, Garelli-Paar C, Toschi Corneliani R, Farina F, Zani A, Dirven M, Smets P, Guglielmini C, Oliveira P, Di Marcello M, Porciello F, Crosara S, Ciaramella P, Piantedosi D, Smith S, Vannini S, Dall'Aglio E, Savarino P, Quintavalla C, Patteson M, Silva J, Locatelli C, Baron Toaldo M. The predictive value of clinical, radiographic, echocardiographic variables and cardiac biomarkers for assessing risk of the onset of heart failure or cardiac death in dogs with preclinical myxomatous mitral valve disease enrolled in the DELAY study. J Vet Cardiol 2021; 36:77-88. [PMID: 34118562 DOI: 10.1016/j.jvc.2021.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify the predictive value on time to onset of heart failure (HF) or cardiac death of clinical, radiographic, and echocardiographic variables, as well as cardiac biomarkers N-terminal pro brain natriuretic peptide (NT-proBNP) and cardiac troponin I in dogs with preclinical myxomatous mitral valve disease (MMVD). ANIMALS One hundred sixty-eight dogs with preclinical MMVD and left atrium to aortic root ratio ≥1.6 (LA:Ao) and normalized left ventricular end-diastolic diameter ≥1.7 were included. METHODS Prospective, randomized, multicenter, single-blinded, placebo-controlled study. Clinical, radiographic, echocardiographic variables and plasma cardiac biomarkers concentrations were compared at different time points. Using receiving operating curves analysis, best cutoff for selected variables was identified and the risk to develop the study endpoint at six-month intervals was calculated. RESULTS Left atrial to aortic root ratio >2.1 (hazard ratio [HR] 3.2, 95% confidence interval [95% CI] 1.9-5.6), normalized left ventricular end-diastolic diameter > 1.9 (HR: 6.3; 95% CI: 3.3-11.8), early transmitral peak velocity (E peak) > 1 m/sec (HR: 3.9; 95% CI: 2.3-6.7), and NT-proBNP > 1500 ρmol/L (HR: 5.7; 95% CI: 3.3-9.5) were associated with increased risk of HF or cardiac death. The best fit model to predict the risk to reach the endpoint was represented by the plasma NT-proBNP concentrations adjusted for LA:Ao and E peak. CONCLUSIONS Logistic and survival models including echocardiographic variables and NT-proBNP can be used to identify dogs with preclinical MMVD at higher risk to develop HF or cardiac death.
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Affiliation(s)
- M Borgarelli
- Department Small Animal Clinical Science, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA, USA.
| | - L Ferasin
- Specialist Veterinary Cardiology Consultancy Ltd, Alton, Hampshire, UK
| | - K Lamb
- Lamb Statiscal Consulting and Scientific Writing LLC, West St. Paul, MN, USA
| | | | - C Bussadori
- Clinica Veterinaria Gran Sasso, Milan, Italy
| | | | | | - M Poggi
- Centro Veterinario Imperiese, Imperia, Italy
| | - R A Santilli
- Clinica Veterinaria Malpensa, Samarate Varese, Italy
| | - E Guillot
- Ceva Santé Animale, Libourne, France
| | | | | | - F Farina
- Ambulatorio Veterinario del Parco Margherita, Naples, Italy
| | - A Zani
- Clinica Cardiovet, Livorno, Italy
| | - M Dirven
- Dierenkliniek Rijen, Rijen, the Netherlands
| | - P Smets
- Dierenkliniek Rijen, Rijen, the Netherlands
| | - C Guglielmini
- Dipartimento di Medicina Animale, Produzione e Salute, Università di Padova, Legnaro, Padova, Italy
| | - P Oliveira
- Davies Veterinary Specialists Ltd, Higham Gobion, Hertfordshire, UK
| | - M Di Marcello
- Centro Veterinario Cellatica, Cellatica, Brescia, Italy
| | - F Porciello
- Dipartimento di Medicina Veterinaria, Università degli Studi di Perugia, Perugia, Italy
| | - S Crosara
- Clinica Veterinaria CMV, Varese, Italy
| | - P Ciaramella
- Dipartimento di Medicina Veterinaria e Produzioni Animali, Università degli Studi di Napoli Federico II, Naples, Italy
| | - D Piantedosi
- Dipartimento di Medicina Veterinaria e Produzioni Animali, Università degli Studi di Napoli Federico II, Naples, Italy
| | - S Smith
- Sarah Smith Cardiology Ivy Court, Willington, UK
| | - S Vannini
- Clinica Veterinaria Gran Sasso, Milan, Italy
| | - E Dall'Aglio
- Clinica Veterinaria Milano Sud, Peschiera Borromeo, Milano, Italy
| | - P Savarino
- Facoltà di Medicina Veterinaria di Torino, Ospedale Didattico Veterinario della Facoltà, Sezione Clinica Medica, Grugliasco, Turin, Italy
| | - C Quintavalla
- Dipartimento di Scienze Mediche Veterinarie, Università di Parma, Parma, Italy
| | - M Patteson
- Heartvets, The Animal Hospital Stinchcombe, Dursley, UK
| | - J Silva
- Clinica Veterinaria Gran Sasso, Milan, Italy
| | - C Locatelli
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - M Baron Toaldo
- Dipartimento di Scienze Mediche Veterinarie, Alma Mayor Studiorum, Università di Bologna, Ozzano Emilia, Italy
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Vezzosi T, Grosso G, Tognetti R, Meucci V, Patata V, Marchesotti F, Domenech O. The Mitral INsufficiency Echocardiographic score: A severity classification of myxomatous mitral valve disease in dogs. J Vet Intern Med 2021; 35:1238-1244. [PMID: 33951235 PMCID: PMC8163114 DOI: 10.1111/jvim.16131] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 11/27/2022] Open
Abstract
Background There is no commonly shared severity score for myxomatous mitral valve disease (MMVD) based on routinely acquired echocardiographic variables. Hypothesis/Objectives To propose an easy‐to‐use echocardiographic classification of severity of MMVD in dogs. Animals Five hundred and sixty dogs with MMVD. Methods This was a retrospective, multicenter, observational study. The proposed Mitral INsufficiency Echocardiographic (MINE) score was based on 4 echocardiographic variables: left atrium‐to‐aorta ratio, left ventricular end‐diastolic diameter normalized for body weight, fractional shortening, and E‐wave transmitral peak velocity. Specific echocardiographic cutoffs were defined based on previous prognostic studies on MMVD, and severity scores were assigned as follows: mild (score: 4‐5), moderate (score: 6‐7), severe (score: 8‐12), late stage (score: 13‐14). Results Median survival time was significantly different (P < .05) between the proposed severity classes: mild (2344 days, 95% confidence interval [CI] 1877‐2810 days), moderate (1882 days, 95% CI 1341‐2434 days), severe (623 days, 95% CI 432‐710 days), and late stage (157 days, 95% CI 53‐257 days). A MINE score >8 was predictive of cardiac death (area under the curve = 0.85; P < .0001; sensitivity 87%, specificity 73%). In the multivariable analysis, all the echocardiographic variables of the MINE score were independent predictors of death because of heart disease (P < .001). Conclusions and Clinical Importance The MINE score is a new easy‐to‐use echocardiographic classification of severity of MMVD, which has been proven to be clinically effective as it is associated with survival. This classification provides prognostic information and could be useful for an objective echocardiographic assessment of MMVD.
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Affiliation(s)
- Tommaso Vezzosi
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Giovanni Grosso
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Rosalba Tognetti
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Valentina Meucci
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Valentina Patata
- Department of Cardiology, Anicura Istituto Veterinario Novara, Granozzo con Monticello, Italy
| | - Federica Marchesotti
- Department of Cardiology, Anicura Istituto Veterinario Novara, Granozzo con Monticello, Italy
| | - Oriol Domenech
- Department of Cardiology, Anicura Istituto Veterinario Novara, Granozzo con Monticello, Italy
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Red Cell Distribution Width Has a Negative Prognostic Role in Dogs with Myxomatous Mitral Valve Disease. Animals (Basel) 2021; 11:ani11030778. [PMID: 33799710 PMCID: PMC7998152 DOI: 10.3390/ani11030778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 12/05/2022] Open
Abstract
Simple Summary The red cell distribution width (RDW) is a simple and inexpensive laboratory parameter that reflects the difference in size of the red blood cells (also known as anisocytosis) and is conventionally used in a clinical setting for the differential diagnosis of anemias. Nonetheless, recent studies have demonstrated that anisocytosis is commonplace in many non-hematological human disorders and an increased RDW has been associated with a negative prognosis in patients with different cardiovascular diseases. In dogs, no studies have evaluated the prognostic role of RDW with myxomatous mitral valve disease (MMVD). The present study evaluates clinical, echocardiographic, and laboratory parameters, including RDW, with a cohort of dogs with MMVD and followed up on for more than one year. We sought to evaluate if RDW acts as an independent prognostic marker for negative outcomes in dogs with MMVD with or without concurrent non-cardiac diseases. Abstract Red cell distribution width (RDW) is a quantitative measurement of anisocytosis. This hematological parameter is an important prognostic biomarker for different cardiovascular disorders in humans but its influence on survival has been poorly investigated in dogs with cardiovascular disease. The RDW and various clinical, complete blood count, serum biochemical and echocardiographic variables were retrospectively investigated in 146 client-owned dogs with myxomatous mitral valve disease (MMVD) at various disease stages, with or without concurrent diseases and treatment. Laboratory variables, including RDW, urea, and white blood cell (WBC), in addition to the echocardiographic variable left atrium to aorta ratio were found to be independent predictors of all-cause mortality at six months in a multivariable Cox proportional hazards regression model. In particular, the hazard ratio of RDW was 1.203 (95% confidence interval = 1.045–1.384; p = 0.010). The negative effect of increased RDW on outcome was confirmed using Kaplan–Meier curve analysis. The results of this study indicate that RDW acted as an independent predictor of negative outcome in dogs with MMVD.
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Wilshaw J, Rosenthal SL, Wess G, Dickson D, Bevilacqua L, Dutton E, Deinert M, Abrantes R, Schneider I, Oyama MA, Gordon SG, Elliott J, Xia D, Boswood A. Accuracy of history, physical examination, cardiac biomarkers, and biochemical variables in identifying dogs with stage B2 degenerative mitral valve disease. J Vet Intern Med 2021; 35:755-770. [PMID: 33645846 PMCID: PMC7995403 DOI: 10.1111/jvim.16083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/26/2021] [Accepted: 02/11/2021] [Indexed: 01/26/2023] Open
Abstract
Background Treatment is indicated in dogs with preclinical degenerative mitral valve disease (DMVD) and cardiomegaly (stage B2). This is best diagnosed using echocardiography; however, relying upon this limits access to accurate diagnosis. Objectives To evaluate whether cardiac biomarker concentrations can be used alongside other clinical data to identify stage B2 dogs. Animals Client‐owned dogs (n = 1887) with preclinical DMVD prospectively sampled in Germany, the United Kingdom, and the United States. Methods Dogs that met inclusion criteria and were not receiving pimobendan (n = 1245) were used for model development. Explanatory (multivariable logistic regression) and predictive models were developed using clinical observations, biochemistry, and cardiac biomarker concentrations, with echocardiographically confirmed stage B2 disease as the outcome. Receiver operating characteristic curves assessed the ability to identify stage B2 dogs. Results Age, appetite, serum alanine aminotransferase activity, body condition, serum creatinine concentration, murmur intensity, and plasma N‐terminal propeptide of B‐type natriuretic peptide (NT‐proBNP) concentration were independently associated with the likelihood of being stage B2. The discriminatory ability of this explanatory model (area under curve [AUC], 0.84; 95% confidence interval [CI], 0.82‐0.87) was superior to NT‐proBNP (AUC, 0.77; 95% CI, 0.74‐0.80) or the vertebral heart score alone (AUC, 0.76; 95% CI, 0.69‐0.83). A predictive logistic regression model could identify the probability of being stage B2 (AUC test set, 0.86; 95% CI, 0.81‐0.91). Conclusion and Clinical Importance Our findings indicate accessible measurements could be used to screen dogs with preclinical DMVD. Encouraging at‐risk dogs to seek further evaluation could result in a greater proportion of cases being appropriately managed.
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Affiliation(s)
- Jenny Wilshaw
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK
| | | | - Gerhard Wess
- Clinic of Small Animal Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | | | | | | | | | | | - Mark A Oyama
- Department of Veterinary Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sonya G Gordon
- College of Veterinary Medicine, Texas A&M University, College Station, Texas, USA
| | - Jonathan Elliott
- Department of Comparative Biomedical Science, Royal Veterinary College, University of London, London, UK
| | - Dong Xia
- Research Support Office, Royal Veterinary College, University of London, London, UK
| | - Adrian Boswood
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK
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16
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Wilshaw J, Stein M, Lotter N, Elliott J, Boswood A. The effect of myxomatous mitral valve disease severity on packed cell volume in dogs. J Small Anim Pract 2021; 62:428-436. [PMID: 33599987 DOI: 10.1111/jsap.13308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/16/2020] [Accepted: 01/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to examine whether associations between disease severity and packed cell volume exist in dogs with myxomatous mitral valve disease. MATERIALS AND METHODS Data were selected from 289 dogs that had been examined at a research clinic (2004-2017) on multiple occasions (n=1465). American College of Veterinary Internal Medicine stage and echocardiographic measurements were entered in separate multivariable linear mixed effects models with packed cell volume as the dependent variable. Age, breed, sex, weight and blood urea nitrogen concentrations were additionally tested in these analyses to control for patient characteristics. RESULTS Packed cell volume (% whole blood) in stages B1 and B2 (B1: 42.62 ±0.27, P=0.001; B2: 41.77± 0.42, P < 0.001) was lower than stage A (44.57 ±0.53). In stage C, packed cell volume was greater than both preclinical stages (C: 43.84 ±0.46). When the administration of loop diuretics was included in statistical models, packed cell volume was inversely related to normalised left ventricular internal diameters (β: -2.37; 95% confidence intervals: -3.49, -1.25; P < 0.001). CLINICAL SIGNIFICANCE Dogs with myxomatous mitral valve disease may develop reductions in packed cell volume as their disease progresses. Although this finding was statistically significant at a population level, it should be noted that the differences described are relatively small. This, along with other causes of variation in packed cell volume, means that changes would be challenging to appreciate within individual patients. Plasma volume depletion following diuretic administration may explain why findings differed in stage C.
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Affiliation(s)
- J Wilshaw
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Herts, AL9 7TA, UK
| | - M Stein
- Department of Companion Animals, Atlantic Veterinary College, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - N Lotter
- Department of Comparative Biomedical Science, Royal Veterinary College, Royal College Street, London, NW1 OTU, UK
| | - J Elliott
- Department of Comparative Biomedical Science, Royal Veterinary College, Royal College Street, London, NW1 OTU, UK
| | - A Boswood
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Herts, AL9 7TA, UK
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Franchini A, Abbott JA, Tyrrell W, Rosenthal S, Lahmers S, Menciotti G, Crosara S, Häggström J, Borgarelli M. Predictors of reoccurrence of congestive signs within 180 days after successful treatment of the first episode of congestive heart failure in dogs with myxomatous mitral valve disease. J Vet Cardiol 2021; 34:112-119. [PMID: 33706221 DOI: 10.1016/j.jvc.2020.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Myxomatous mitral valve disease (MMVD) is the most common cause of left-sided congestive heart failure in dogs. We sought to identify predictors of first reoccurrence of congestive signs (CS) within 180 days in dogs with MMVD and clinically stable heart failure. ANIMALS A total of 445 dogs affected by stable American College of Veterinary Internal Medicine (ACVIM)-Stage-C MMVD were included, 106 in the reoccurrence group (RG) and 339 in no reoccurrence group (NRG). Patients were considered "stable" if medical treatment had been unchanged for at least 4 weeks since the first identification of CS. METHODS Medical records of dogs with stable ACVIM-Stage-C MMVD included in a registry of dogs affected by MMVD were reviewed. Follow-up was required for inclusion in this investigation. Logistic regression was used to identify clinical and echocardiographic variables that independently predict first reoccurrence of CS. RESULTS Baseline left atrial-aortic ratio (p=0.022, OR: 1.89, 90% CI: 1.20-2.98), left ventricular internal diameter at end-diastole (LVIDd_N) (p=0.014, OR: 2.84, 90% CI: 1.41-5.77), peak velocity of early diastolic transmitral flow (p=0.049, OR: 1.81, 90% CI: 1.10-3.00) and furosemide daily dosage (p=0.039, OR: 1.19, 90% CI: 1.04-1.37) were associated with reoccurrence of CS in univariable analyses. The LVIDd_N (p=0.014) remained significant in the multivariable analysis, but the area under the receiver operator characteristic curve was 0.57. CONCLUSION This study failed to identify accurate predictors of reoccurrence of CS. However, dogs with larger value of LVIDd_N are more likely to have reoccurrence of CS within 180 days.
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Affiliation(s)
- A Franchini
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytech Institute and State University, 204 Duck Pond Drive, Blacksburg, VA, 24061-0442, USA.
| | - J A Abbott
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytech Institute and State University, 204 Duck Pond Drive, Blacksburg, VA, 24061-0442, USA
| | - W Tyrrell
- CVCA Cardiac Care for Pets, 165 Fort Evans Road NE, Leesburg, VA, 20176, USA
| | - S Rosenthal
- CVCA Cardiac Care for Pets, 1209 Cromwell Bridge Road, Towson, MD, 21286, USA
| | - S Lahmers
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytech Institute and State University, 204 Duck Pond Drive, Blacksburg, VA, 24061-0442, USA
| | - G Menciotti
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytech Institute and State University, 204 Duck Pond Drive, Blacksburg, VA, 24061-0442, USA
| | - S Crosara
- Department of Veterinary Sciences, University of Parma, Strada Del Taglio 10, 43126, PR, Italy
| | - J Häggström
- Department of Clinical Science, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Science, Box 7054, Uppsala, Sweden
| | - M Borgarelli
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytech Institute and State University, 204 Duck Pond Drive, Blacksburg, VA, 24061-0442, USA
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Gavazza A, Fruganti A, Turinelli V, Marchegiani A, Spaterna A, Tesei B, Rossi G, Cerquetella M. Canine Traditional Laboratory Tests and Cardiac Biomarkers. Front Vet Sci 2020; 7:320. [PMID: 32676505 PMCID: PMC7333565 DOI: 10.3389/fvets.2020.00320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
In small animals, cardiac disease evaluation through laboratory tests can be a challenge. This review will present both historical and updated perspectives on the clinical pathology of cardiac diseases in dogs and demonstrate that laboratory tests are useful tools for the management of patients with cardiac diseases.
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Affiliation(s)
- Alessandra Gavazza
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Alessandro Fruganti
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | | | - Andrea Marchegiani
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Andrea Spaterna
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Beniamino Tesei
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Giacomo Rossi
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Matteo Cerquetella
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
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Hezzell MJ. What can changes in serial measurements tell us about prognosis in myxomatous mitral valve disease? Vet Rec 2020; 185:340-342. [PMID: 31541051 DOI: 10.1136/vr.l5651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Effect of temperature variation on hospital admissions and outcomes in dogs with myxomatous mitral valve disease and new onset pulmonary edema. PLoS One 2020; 15:e0227807. [PMID: 31935277 PMCID: PMC6959981 DOI: 10.1371/journal.pone.0227807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/31/2019] [Indexed: 01/26/2023] Open
Abstract
The effect of seasonal variation on hospital admissions and outcomes in humans with cardiovascular disease and congestive heart failure (CHF) has been described. This study evaluates the effect of temperature variation on admissions and outcomes in dogs with myxomatous mitral valve disease (MMVD) and first onset CHF. Ninety-three client-owned dogs with MMVD and a first occurrence of pulmonary edema were included in this retrospective clinical cohort study. Recorded clinical and echocardiographic variables were accumulated and analyzed with dogs allocated into groups in a temperature-wise manner that considered the mean of the average (Tave) and maximum ambient temperature (Tmax) of the 14 days preceding hospital admission. A survival analysis was also performed. No difference was found in the percentage of dogs decompensating in three different temperature periods (i.e., cold, intermediate, and hot temperature) according to both Tave and Tmax. Dogs developing CHF during the intermediate temperatures according to Tmax died earlier from cardiac-related causes (median survival time 280 days, 95% CI = 147–486 days) compared to those decompensating during hot temperatures (median survival time 518 days, 95% CI = 344–819 days, P = 0.039). However, an effect of the ambient temperature on survival was not confirmed by Cox proportional hazard analysis. In conclusion, this study failed to show that ambient temperature has an effect on the first occurrence of CHF and outcomes in dogs with MMVD.
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Nemec Svete A, Verk B, Jazbec Križman P, Druzhaeva N, Bohanec N, Domanjko Petrič A. Blood variables associated with survival in canine congestive heart failure patients. BULGARIAN JOURNAL OF VETERINARY MEDICINE 2020. [DOI: 10.15547/bjvm.2019-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Our study aimed to investigate the blood variables: coenzyme Q10, N-terminal pro-B-type natriuretic peptide (NT-proBNP), electrolytes, cholesterol, triglyceride, glutathione peroxidase, white blood cell, neutrophil, lymphocyte and monocyte counts and relative numbers of neutrophils, lymphocytes and monocytes that may be associated with survival of dogs in congestive heart failure (CHF). Twenty-one client-owned dogs in CHF were included in the study. Cox regression analysis showed significant association only between NT-proBNP blood concentration and survival.
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22
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Park JS, Park JH, Seo KW, Song KH. Correlation between NT-proBNP and lipase levels according to the severity of chronic mitral valve disease in dogs. J Vet Sci 2019; 20:e43. [PMID: 31364327 PMCID: PMC6669210 DOI: 10.4142/jvs.2019.20.e43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/17/2019] [Accepted: 06/24/2019] [Indexed: 11/20/2022] Open
Abstract
Chronic mitral valve disease (CMVD) is the most common cardiovascular disease in dogs, causing decreased cardiac output that results in poor tissue perfusion and tissue damage to kidneys, pancreas, and other organs. The purpose of this study was to evaluate the relationships between heart disease severity and N-terminal pro B-type natriuretic peptide (NT-proBNP) and lipase in dogs with CMVD, as well as to evaluate longitudinal changes in these values. A total of 84 dogs participated in this 2015 to 2017 study. Serum values of NT-proBNP and lipase were analyzed; radiography was used to measure the vertebral heart score and assess various echocardiographic values. NT-proBNP showed a strong positive correlation with increasing stage of heart disease; lipase showed a mild positive correlation with heart disease stage. When the three values (NT-proBNP, lipase and month) were continuously measured at 6-month intervals, all showed a correlation with the increasing length of the disease.
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Affiliation(s)
- Jun Seok Park
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Jae Hong Park
- Department of Animal Resources Science, Dankook University, Cheonan 31116, Korea
| | - Kyoung Won Seo
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Kun Ho Song
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea.
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23
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Chan IP, Wu SY, Chang CC, Chen WY. Serial measurements of cardiac troponin I in heart failure secondary to canine mitral valve disease. Vet Rec 2019; 185:343. [PMID: 31439824 DOI: 10.1136/vr.105265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 07/05/2019] [Accepted: 07/19/2019] [Indexed: 11/03/2022]
Abstract
Serial measurements of cardiac troponin I (cTnI) levels are considered to be better predictors of cardiac death than single-time-point analyses in human medicine. We hypothesised that cTnI levels could reflect the severity of myxomatous mitral valve disease (MMVD), and that serial changes in the cTnI level had a prognostic value in dogs with congestive heart failure (CHF) secondary to MMVD. Seventy-six dogs were initially enrolled and classified by the American College of Veterinary Internal Medicine (ACVIM) staging system. The single-timepoint cTnI concentration in these dogs significantly increased with the ACVIM stage. Twenty-seven dogs with CHF subsequently underwent serial measurement of cTnI levels, and the results showed that those who demonstrated a decrease in cTnI levels from the first to the third visit exhibited a higher risk of cardiac death than did those without such changes (P=0.012). We suspect that the downward trend in cTnI levels may be affected by medical treatment for CHF. In conclusion, although cTnI levels could reflect the severity of MMVD to a certain extent, the serial changes may be affected by medical treatment. Therefore, caution should be exercised when cTnI is used for assessment of the prognosis of CHF secondary to MMVD in dogs.
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Affiliation(s)
- I-Ping Chan
- Veterinary Medical Teaching Hospital, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan.,Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - San-Yu Wu
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chao-Chin Chang
- Graduate Institute of Microbiology and Public Health, National Chung Hsing University, Taichung, Taiwan
| | - Wen-Ying Chen
- Veterinary Medical Teaching Hospital, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan .,Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
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24
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Visser LC, Ciccozzi MM, Sintov DJ, Sharpe AN. Echocardiographic quantitation of left heart size and function in 122 healthy dogs: A prospective study proposing reference intervals and assessing repeatability. J Vet Intern Med 2019; 33:1909-1920. [PMID: 31313382 PMCID: PMC6766555 DOI: 10.1111/jvim.15562] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/01/2019] [Indexed: 12/21/2022] Open
Abstract
Background Broadly applicable reference intervals (RIs) for measurements of left atrial (LA) and left ventricular (LV) size and function generated prospectively using statistically appropriate methods are limited. Objectives To generate body size‐independent RIs for linear, area, and volume measurements of LA size and LV size and function. Animals Healthy adult dogs (n = 122) of variable size and somatotype. Methods Prospective study. All dogs underwent an echocardiogram performed by the same examiner. Effects of body weight, sex, age, and heart rate were evaluated by regression and correlation analyses. Scaling exponents and prediction intervals were generated for linear measurements using the allometric equation. After normalization to body weight, 95% RIs were determined using nonparametric methods with 2.5 and 97.5 percentiles serving as the lower and upper limits (each with 90% confidence intervals), respectively. Results Linear LA and LV measurements were strongly correlated (R2 ≥ 0.79) with body weight. Scaling exponents were close to the expected 1/3 (0.299‐0.392). Prediction intervals for linear measurements of LV chamber size were considerably narrower than previously reported. Weak correlations (r = −0.42 to −0.50) among LV fractional shortening, fractional area change, and ejection fraction and body weight were identified. No other meaningful relationships were identified between the measurements and sex, age, and heart rate. Conclusions and Clinical Importance Body size‐independent RIs for several linear, area, and volume measurements of LA and LV size and function were generated prospectively from a large and diverse reference population and are available for clinical use.
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Affiliation(s)
- Lance C Visser
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Marisa M Ciccozzi
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Daniel J Sintov
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Ashley N Sharpe
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California
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25
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Thassakorn P, Patchanee P, Pongkan W, Chattipakorn N, Boonyapakorn C. Effect of atorvastatin on oxidative stress and inflammation markers in myxomatous mitral valve disease in dogs: A comparison of subclinical and clinical stages. J Vet Pharmacol Ther 2019; 42:258-267. [PMID: 30666669 DOI: 10.1111/jvp.12746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 11/08/2018] [Accepted: 11/19/2018] [Indexed: 02/02/2023]
Abstract
Myxomatous mitral valve disease (MMVD) is the most common acquired cardiac disorder found in dogs. The disease process can lead to heart failure (HF) and has been found to be associated with oxidative stress and inflammation. Statins exert antioxidant and anti-inflammatory effects in human HF patients. However, the beneficial effects of statins in MMVD dogs are still unclear. Thirty MMVD dogs were enrolled in the study and were divided into two groups: MMVD without HF dogs (n = 15) and MMVD with HF dogs (n = 15). Atorvastatin (8 mg kg-1 day-1 ) was administered orally to all dogs for 4 weeks. All dogs underwent physical examination and cardiac examination at the beginning and end of the experiment, including baseline values for hematology, blood chemistry profile, lipid profile, N-terminal pro B-type natriuretic peptide, oxidative stress marker (8-isoprostane), and inflammatory marker (tumor necrosis factor alpha). The results showed that atorvastatin reduced plasma cholesterol levels in both groups. In addition, plasma concentrations of 8-isoprostane, tumor necrosis factor alpha, and N-terminal pro B-type natriuretic peptide were significantly lower after atorvastatin administration, but only in MMVD dogs in the HF group. Atorvastatin found to be associated with possible antioxidant and inflammatory effects in dogs with HF secondary to MMVD. The potential benefits of statins in dogs with HF merits further investigation in larger, placebo-controlled studies.
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Affiliation(s)
| | - Papras Patchanee
- Faculty of Veterinary Medicine, Integrative Research Center for Veterinary Preventive Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wanpitak Pongkan
- Faculty of Veterinary Medicine, Department of Veterinary Biosciences and Veterinary Public Health, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chavalit Boonyapakorn
- Faculty of Veterinary Medicine, Department of Companion Animal and Wildlife Clinic, Chiang Mai University, Chiang Mai, Thailand
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26
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Mattin MJ, Brodbelt DC, Church DB, Boswood A. Factors associated with disease progression in dogs with presumed preclinical degenerative mitral valve disease attending primary care veterinary practices in the United Kingdom. J Vet Intern Med 2018; 33:445-454. [PMID: 30565334 PMCID: PMC6430875 DOI: 10.1111/jvim.15390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 11/15/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Factors associated with disease progression in dogs with preclinical (stage B) degenerative mitral valve disease (DMVD) have not been evaluated previously in primary care veterinary practice. OBJECTIVES To evaluate whether plasma cardiac biomarkers, clinical signs, and physical examination findings are associated with clinical progression (reaching the composite endpoint of initiation of treatment with a potent diuretic or cardiac death) in dogs presumed to have stage B DMVD. ANIMALS Six-hundred and eighty-four dogs diagnosed with DMVD recruited from 73 primary care practices in the United Kingdom. Dogs were not receiving potent diuretics at recruitment. METHODS Prospective cohort study design. Primary care veterinarians recorded the presence or absence of clinical signs and physical examination findings. Baseline plasma N-terminal pro B-type natriuretic peptide (NT-proBNP) and cardiac troponin I were measured. Cox regression models measured associations between risk factor variables and clinical progression. Flexible parametric models generated predicted probabilities of reaching the composite endpoint for dogs with different combinations of prognostic risk factor variables. RESULTS Plasma NT-proBNP, heart rate, heart murmur intensity, presence of a cough, being a Cavalier King Charles Spaniel, and being prescribed pimobendan were associated with clinical progression to initiation of treatment with a potent diuretic or cardiac-related death. CONCLUSIONS AND CLINICAL IMPORTANCE Dogs with stage B DMVD identified as having a high risk of disease progression might benefit from more frequent monitoring or further diagnostic evaluation. The prognostic factors identified could facilitate risk stratification of dogs presenting with preclinical DMVD.
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Affiliation(s)
| | - David C Brodbelt
- Royal Veterinary College, University of London, London, United Kingdom
| | - David B Church
- Royal Veterinary College, University of London, London, United Kingdom
| | - Adrian Boswood
- Royal Veterinary College, University of London, London, United Kingdom
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27
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Mattin MJ, Boswood A, Church DB, Brodbelt DC. Prognostic factors in dogs with presumed degenerative mitral valve disease attending primary-care veterinary practices in the United Kingdom. J Vet Intern Med 2018; 33:432-444. [PMID: 30357909 PMCID: PMC6430873 DOI: 10.1111/jvim.15251] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/19/2018] [Accepted: 05/31/2018] [Indexed: 11/28/2022] Open
Abstract
Background Prognostic risk factors were identified for dogs with degenerative mitral valve disease (DMVD) monitored by veterinary cardiologists. The value of these measurements has not been determined in the wider primary care setting. Objectives To evaluate whether plasma cardiac biomarkers and data obtained from routine history‐taking and physical examination are predictive of survival in dogs with DMVD attending primary care practice. Animals Eight‐hundred and ninety‐three dogs with a presumptive diagnosis of DMVD recruited from 79 primary care veterinary practices in the United Kingdom. Methods Prospective cohort study. Primary care veterinary practitioners recorded clinical data. Plasma N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) and cardiac troponin I (cTnI) were measured at presentation. Cox regression models evaluated associations between risk factor variables and hazard of death (all‐cause mortality and cardiac‐related death). Flexible parametric models generated predicted survival probabilities for dogs with different combinations of prognostic risk factor variable values. Results Dogs with higher NT‐proBNP and cTnI concentrations, higher heart rates, older dogs, females, and those reported to be exercise intolerant, dyspneic, and diagnosed with selected comorbidities had an increased hazard of death due to any cause. Dogs with higher concentrations of plasma biomarkers, higher heart rates, and heart murmur intensities, those with exercise intolerance and those receiving potent diuretics had a higher hazard of cardiac‐related death. Conclusions and Clinical Importance Cardiac biomarkers and key clinical findings identified in this study can help primary care veterinary practitioners identify dogs with DMVD that are at highest risk of death.
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Affiliation(s)
- M J Mattin
- Royal Veterinary College, University of London, London, The United Kingdom
| | - A Boswood
- Royal Veterinary College, University of London, London, The United Kingdom
| | - D B Church
- Royal Veterinary College, University of London, London, The United Kingdom
| | - D C Brodbelt
- Royal Veterinary College, University of London, London, The United Kingdom
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28
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Two-dimensional, long-axis echocardiographic ratios for assessment of left atrial and ventricular size in dogs. J Vet Cardiol 2018; 20:330-342. [DOI: 10.1016/j.jvc.2018.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 11/18/2022]
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29
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Hori Y, Nakamura K, Kanno N, Hitomi M, Yamashita Y, Hosaka S, Isayama N, Mimura T. Effects of the angiotensin-converting enzyme inhibitor alacepril in dogs with mitral valve disease. J Vet Med Sci 2018; 80:1212-1218. [PMID: 29937457 PMCID: PMC6115264 DOI: 10.1292/jvms.17-0557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Alacepril is a relatively novel angiotensin-converting enzyme inhibitor; however, the safety, tolerance, and efficacy of alacepril in terms of cough suppression in dogs with mitral valve disease (MVD) remain unknown. The aim of this study was to investigate the safety, tolerance, and cough suppression efficacy of alacepril in dogs with MVD. This was a multi-center, prospective study. Forty-two dogs with echocardiographic or radiographic evidence of cardiac enlargement in addition to cough were enrolled. Dogs were treated with alacepril (1.0-3.0 mg/kg/day) for at least 4 weeks. One dog (2.4%) developed complications, including appetite loss, lethargy, and vomiting. Thirty-six dogs were re-evaluated after 4 weeks of treatment. Cough resolved or improved in 20 dogs (55.6%) after treatment. Based on the efficacy of alacepril, the dogs were divided into an effective group (n=20) and an ineffective group (n=16). After treatment, the left ventricular end-diastolic internal diameter corrected for body weight was significantly increased from baseline in the ineffective group but was significantly decreased in the effective group. Univariate binomial logistic regression analyses showed that high atrial natriuretic peptide level, N-terminal pro-B-type natriuretic peptide level, and E wave velocity at baseline were significantly correlated with alacepril inefficacy. Alacepril as treatment for MVD is well tolerated in most dogs, and different conditions of cardiac loading may influence the effect of the drug. Alacepril is expected to improve the quality of life of dogs with early stage MVD.
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Affiliation(s)
- Yasutomo Hori
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midori-machi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan
| | - Kensuke Nakamura
- University of Miyazaki, 1-1 Gakuenkibanadai-nishi, Miyazaki 889-2192 Japan
| | - Nobuyuki Kanno
- Veterinary Internal Medicine, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa 252-8510, Japan
| | - Makoto Hitomi
- Hitomi Animal Hospital, 37-7 Yoshidakamiadachicho, Sakyo, Kyoto 606-8307, Japan
| | - Yohei Yamashita
- Ebisu Animal Hospital, 3-3-43 Nishitaga, Taihaku, Sendai, Miyagi 982-0034, Japan.,Laboratory of Small Animal Internal Medicine II, School of Veterinary Medicine, Kitasato University, 23-35-1 Higashi, Towada, Aomori 034-8628, Japan
| | - Satoshi Hosaka
- Hosaka Animal Hospital, 4-17-1 Nihonmatsu Midori, Sagamihara, Kanagawa 252-0137, Japan
| | - Noriko Isayama
- Uenonomori Animal Clinic, 1-5-11 Yanaka Taito, Tokyo 110-0001, Japan
| | - Takahiro Mimura
- Olieve Animal Medical Center, 12-5 Shinomiyakandacho, Yamashina, Kyoto 607-8035, Japan
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30
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Baron Toaldo M, Romito G, Guglielmini C, Diana A, Pelle NG, Contiero B, Cipone M. Prognostic value of echocardiographic indices of left atrial morphology and function in dogs with myxomatous mitral valve disease. J Vet Intern Med 2018; 32:914-921. [PMID: 29572938 PMCID: PMC5980607 DOI: 10.1111/jvim.15093] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 11/28/2017] [Accepted: 02/08/2018] [Indexed: 11/28/2022] Open
Abstract
Background The prognostic relevance of left atrial (LA) morphological and functional variables, including those derived from speckle tracking echocardiography (STE), has been little investigated in veterinary medicine. Objectives To assess the prognostic value of several echocardiographic variables, with a focus on LA morphological and functional variables in dogs with myxomatous mitral valve disease (MMVD). Animals One‐hundred and fifteen dogs of different breeds with MMVD. Methods Prospective cohort study. Conventional morphologic and echo‐Doppler variables, LA areas and volumes, and STE‐based LA strain analysis were performed in all dogs. A survival analysis was performed to test for the best echocardiographic predictors of cardiac‐related death. Results Most of the tested variables, including all LA STE‐derived variables were univariate predictors of cardiac death in Cox proportional hazard analysis. Because of strong correlation between many variables, only left atrium to aorta ratio (LA/Ao > 1.7), mitral valve E wave velocity (MV E vel > 1.3 m/s), LA maximal volume (LAVmax > 3.53 mL/kg), peak atrial longitudinal strain (PALS < 30%), and contraction strain index (CSI per 1% increase) were entered in the univariate analysis, and all were predictors of cardiac death. However, only the MV E vel (hazard ratio [HR], 4.45; confidence interval [CI], 1.76‐11.24; P < .001) and LAVmax (HR, 2.32; CI, 1.10‐4.89; P = .024) remained statistically significant in the multivariable analysis. Conclusions and Clinical Importance The assessment of LA dimension and function provides useful prognostic information in dogs with MMVD. Considering all the LA variables, LAVmax appears the strongest predictor of cardiac death, being superior to LA/Ao and STE‐derived variables.
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Affiliation(s)
- Marco Baron Toaldo
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giovanni Romito
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Carlo Guglielmini
- Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
| | - Alessia Diana
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Nazzareno G Pelle
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Barbara Contiero
- Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
| | - Mario Cipone
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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31
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Affiliation(s)
- Melanie Hezzell
- University of BristolLangford HouseLangfordBristolBS40 5DUUK
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32
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Wurtinger G, Henrich E, Hildebrandt N, Wiedemann N, Schneider M, Hassdenteufel E. Assessment of a bedside test for N-terminal pro B-type natriuretic peptide (NT-proBNP) to differentiate cardiac from non-cardiac causes of pleural effusion in cats. BMC Vet Res 2017; 13:394. [PMID: 29262821 PMCID: PMC5738779 DOI: 10.1186/s12917-017-1319-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/12/2017] [Indexed: 12/20/2022] Open
Abstract
Background Cats with pleural effusion represent common emergencies in small animal practice. The aim of this prospective study was to investigate the diagnostic ability of a point-of-care ELISA (POC-ELISA) for the measurement of N-terminal pro B-type natriuretic peptide (NT-proBNP) to differentiate cardiac from non-cardiac disease in cats with pleural effusion. The sample material for use of this rapid test was either plasma or diluted pleural effusion. Twenty cats with moderate to severe pleural effusion were prospectively recruited. The cats were grouped into two groups, with or without congestive heart failure (CHF; N-CHF), after complete work-up. Blood and effusion were collected in EDTA tubes. Plasma and pleural effusion supernatants were transferred into stabilizer tubes and frozen. POC-ELISA for NT-proBNP was performed with plasma and diluted effusion (1:1). Quantitative NT-proBNP measurement was performed in plasma and diluted and undiluted effusions. Results Six cats were assigned to the CHF group. Of the 14 cats in the N-CHF group, 6 had concurrent cardiac abnormalities that were not responsible for the effusion. For the detection of CHF, the test displayed respective sensitivities and specificities of 100% and 79% in plasma and 100% and 86% in diluted pleural fluid. Receiver operating characteristic (ROC) analysis for quantitative NT-proBNP measurement of plasma and diluted and undiluted pleural effusions displayed areas under the curve of 0.98, sensitivities of 100% and specificities of 86%. The optimum cut-off was calculated at 399 pmol/l in plasma and 229 pmol/l in the diluted effusion and 467 pmol/l in the undiluted effusion. Conclusions POC-ELISA for NT-proBNP in both plasma and diluted pleural effusion was suitable to differentiate cardiac from non-cardiac causes of feline pleural effusion. According to our results, use of pleural effusion is feasible, but dilution of the effusion before measurement seems to improve specificity. Electronic supplementary material The online version of this article (10.1186/s12917-017-1319-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gabriel Wurtinger
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany.
| | - Estelle Henrich
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Nicolai Hildebrandt
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Nicola Wiedemann
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Matthias Schneider
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Esther Hassdenteufel
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
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33
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Wurtinger G, Henrich E, Hildebrandt N, Wiedemann N, Schneider M, Hassdenteufel E. Assessment of a bedside test for N-terminal pro B-type natriuretic peptide (NT-proBNP) to differentiate cardiac from non-cardiac causes of pleural effusion in cats. BMC Vet Res 2017. [PMID: 29262821 DOI: 10.1186/s12917-017-1319-6.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cats with pleural effusion represent common emergencies in small animal practice. The aim of this prospective study was to investigate the diagnostic ability of a point-of-care ELISA (POC-ELISA) for the measurement of N-terminal pro B-type natriuretic peptide (NT-proBNP) to differentiate cardiac from non-cardiac disease in cats with pleural effusion. The sample material for use of this rapid test was either plasma or diluted pleural effusion. Twenty cats with moderate to severe pleural effusion were prospectively recruited. The cats were grouped into two groups, with or without congestive heart failure (CHF; N-CHF), after complete work-up. Blood and effusion were collected in EDTA tubes. Plasma and pleural effusion supernatants were transferred into stabilizer tubes and frozen. POC-ELISA for NT-proBNP was performed with plasma and diluted effusion (1:1). Quantitative NT-proBNP measurement was performed in plasma and diluted and undiluted effusions. RESULTS Six cats were assigned to the CHF group. Of the 14 cats in the N-CHF group, 6 had concurrent cardiac abnormalities that were not responsible for the effusion. For the detection of CHF, the test displayed respective sensitivities and specificities of 100% and 79% in plasma and 100% and 86% in diluted pleural fluid. Receiver operating characteristic (ROC) analysis for quantitative NT-proBNP measurement of plasma and diluted and undiluted pleural effusions displayed areas under the curve of 0.98, sensitivities of 100% and specificities of 86%. The optimum cut-off was calculated at 399 pmol/l in plasma and 229 pmol/l in the diluted effusion and 467 pmol/l in the undiluted effusion. CONCLUSIONS POC-ELISA for NT-proBNP in both plasma and diluted pleural effusion was suitable to differentiate cardiac from non-cardiac causes of feline pleural effusion. According to our results, use of pleural effusion is feasible, but dilution of the effusion before measurement seems to improve specificity.
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Affiliation(s)
- Gabriel Wurtinger
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany.
| | - Estelle Henrich
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Nicolai Hildebrandt
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Nicola Wiedemann
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Matthias Schneider
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Esther Hassdenteufel
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
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34
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Boswood A, Gordon SG, Häggström J, Wess G, Stepien RL, Oyama MA, Keene BW, Bonagura J, MacDonald KA, Patteson M, Smith S, Fox PR, Sanderson K, Woolley R, Szatmári V, Menaut P, Church WM, O'Sullivan ML, Jaudon JP, Kresken JG, Rush J, Barrett KA, Rosenthal SL, Saunders AB, Ljungvall I, Deinert M, Bomassi E, Estrada AH, Fernandez Del Palacio MJ, Moise NS, Abbott JA, Fujii Y, Spier A, Luethy MW, Santilli RA, Uechi M, Tidholm A, Schummer C, Watson P. Longitudinal Analysis of Quality of Life, Clinical, Radiographic, Echocardiographic, and Laboratory Variables in Dogs with Preclinical Myxomatous Mitral Valve Disease Receiving Pimobendan or Placebo: The EPIC Study. J Vet Intern Med 2017; 32:72-85. [PMID: 29214723 PMCID: PMC5787203 DOI: 10.1111/jvim.14885] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/21/2017] [Accepted: 10/23/2017] [Indexed: 11/30/2022] Open
Abstract
Background Changes in clinical variables associated with the administration of pimobendan to dogs with preclinical myxomatous mitral valve disease (MMVD) and cardiomegaly have not been described. Objectives To investigate the effect of pimobendan on clinical variables and the relationship between a change in heart size and the time to congestive heart failure (CHF) or cardiac‐related death (CRD) in dogs with MMVD and cardiomegaly. To determine whether pimobendan‐treated dogs differ from dogs receiving placebo at onset of CHF. Animals Three hundred and fifty‐four dogs with MMVD and cardiomegaly. Materials and Methods Prospective, blinded study with dogs randomized (ratio 1:1) to pimobendan (0.4–0.6 mg/kg/d) or placebo. Clinical, laboratory, and heart‐size variables in both groups were measured and compared at different time points (day 35 and onset of CHF) and over the study duration. Relationships between short‐term changes in echocardiographic variables and time to CHF or CRD were explored. Results At day 35, heart size had reduced in the pimobendan group: median change in (Δ) LVIDDN −0.06 (IQR: −0.15 to +0.02), P < 0.0001, and LA:Ao −0.08 (IQR: −0.23 to +0.03), P < 0.0001. Reduction in heart size was associated with increased time to CHF or CRD. Hazard ratio for a 0.1 increase in ΔLVIDDN was 1.26, P = 0.0003. Hazard ratio for a 0.1 increase in ΔLA:Ao was 1.14, P = 0.0002. At onset of CHF, groups were similar. Conclusions and Clinical Importance Pimobendan treatment reduces heart size. Reduced heart size is associated with improved outcome. At the onset of CHF, dogs treated with pimobendan were indistinguishable from those receiving placebo.
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Affiliation(s)
- A Boswood
- department of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - S G Gordon
- Small Animal Clinical Science, Texas A&M University, College Station, TX
| | - J Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - G Wess
- Clinic of Small Animal Medicine, University of Munich, Munich, Germany
| | - R L Stepien
- Medical Sciences, University of Wisconsin Madison School of Veterinary Medicine, Madison, WI
| | - M A Oyama
- Clinical Studies-Philadelphia, MJR-VHUP-Cardiology, University of Pennsylvania, Philadelphia, PA
| | - B W Keene
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - J Bonagura
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH
| | | | - M Patteson
- HeartVets @ Vale Referrals, The Animal Hospital, Dursley, Gloucestershire, UK
| | - S Smith
- Sarah Smith Cardiology, Derby, UK
| | - P R Fox
- Animal Medical Center, New York, NY
| | - K Sanderson
- Rocky Mountain Veterinary Cardiology, Boulder, CO
| | - R Woolley
- Cardio Respiratory Pet Referrals Victoria, Mordialloc, Vic., Australia
| | - V Szatmári
- Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - P Menaut
- Internal Medicine and Cardiology, Clinique Vétérinaire Aquivet, Eysines, France
| | - W M Church
- Desert Veterinary Medical Specialists, Phoenix, AZ
| | - M L O'Sullivan
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - J-P Jaudon
- Clinique Veterinaire Des Etangs, Villars Les Dombes, France
| | - J-G Kresken
- Clinic for Small Animals Kaiserberg, Duisburg, Germany
| | - J Rush
- Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA
| | - K A Barrett
- Cardiology, VCA West Los Angeles, Los Angeles, CA
| | | | - A B Saunders
- Small Animal Clinical Science, Texas A&M University, College Station, TX
| | - I Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - M Deinert
- Tierklinik am Sandpfad, Wiesloch, Germany
| | - E Bomassi
- Cardiology, Centre Hospitalier Vétérinaire des Cordeliers, Meaux, France
| | - A H Estrada
- Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL
| | | | - N S Moise
- Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - J A Abbott
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
| | - Y Fujii
- Surgery 1, Azabu University, Sagamihara, Kanagawa, Japan
| | - A Spier
- Blue Pearl Veterinary Partners, Tampa, FL
| | - M W Luethy
- Chicago Veterinary Emergency and Specialty Center, Chicago, IL
| | - R A Santilli
- Cardiology, Clinica Veterinaria Malpensa, Gallarate, Varese, Italy
| | - M Uechi
- Japan Animal Specialty Medical Institute Inc., JASMINE Veterinary Cardiovascular Medical Center, Yokohama, Japan
| | - A Tidholm
- Djursjukhuset Albano, Danderyd, Sweden
| | - C Schummer
- Animal Health, Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - P Watson
- Animal Health, Boehringer Ingelheim, Ingelheim am Rhein, Germany
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Carretón E, Morchón R, Montoya-Alonso JA. Cardiopulmonary and inflammatory biomarkers in heartworm disease. Parasit Vectors 2017; 10:534. [PMID: 29143665 PMCID: PMC5688449 DOI: 10.1186/s13071-017-2448-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In heartworm disease, several biomarkers of cardiopulmonary injury and inflammatory activity have been studied during the recent years. D-dimer is a fibrin degradation product present after a clot is degraded, which has been reported to provide support for the diagnosis of pulmonary thromboembolism in heartworm disease. Furthermore, concentrations increment with increased disease severity and during the adulticide treatment. This increase in concentration has proved to be valuable. Cardiac biomarkers troponin I, myoglobin and NT-proBNP demonstrated presence of myocardial injury and heart failure, especially in chronic infections, which in some cases, slightly improve after the adulticide treatment. An acute phase response in dogs with Dirofilaria immitis, characterized by variations of acute phase proteins (APP), has been reported, indicating inflammatory processes that could contribute to disease progression. Among them, C-reactive protein (CRP) increases according to the severity of the disease; and a strong correlation between pulmonary hypertension and CRP has been observed. In cats, little work has been done to ascertain the utility of these biomarkers in feline heartworm; the only published study in D. immitis–seropositive cats reported significantly higher concentrations in positive APP serum amyloid A, haptoglobin and ceruloplasmin.
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Affiliation(s)
- Elena Carretón
- Faculty of Veterinary Medicine, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Trasmontaña s/n, 35413-Arucas, Las Palmas, Spain.
| | - Rodrigo Morchón
- Laboratory of Parasitology, Faculty of Pharmacy, Institute of Biomedical Research of Salamanca(IBSAL), University of Salamanca, Salamanca, Spain
| | - José Alberto Montoya-Alonso
- Faculty of Veterinary Medicine, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Trasmontaña s/n, 35413-Arucas, Las Palmas, Spain
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Hezzell MJ, Boswood A, López-Alvarez J, Lötter N, Elliott J. Treatment of dogs with compensated myxomatous mitral valve disease with spironolactone-a pilot study. J Vet Cardiol 2017; 19:325-338. [PMID: 28734620 DOI: 10.1016/j.jvc.2017.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/25/2017] [Accepted: 06/15/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Spironolactone improves outcome in dogs with advanced myxomatous mitral valve disease (MMVD). Its efficacy in preclinical MMVD is unknown. The hypothesis was the administration of spironolactone to dogs with compensated MMVD demonstrating risk factors for poorer prognosis will decrease the rate of disease progression. The aim was to provide pilot data to evaluate preliminary effects and sample size calculation for a definitive clinical trial. ANIMALS Twenty-five client-owned dogs with MMVD with at least one of the following; left atrial to aortic ratio (LA:Ao) ≥ 1.5, normalized left ventricular internal diameter in diastole ≥ 1.6), N-terminal pro-B-type natriuretic peptide (NT-proBNP) > 550 pmol/L, cardiac troponin I > 0.025 ng/mL. METHODS Prospective, single-center, equally randomized, placebo-controlled, double-blinded, parallel grouped pilot study. No dogs were receiving medications for cardiac disease before the enrollment. RESULTS Twelve dogs received placebo; 13 received spironolactone. One dog in the spironolactone group died suddenly, 1 developed congestive heart failure, and 2 received suboptimal spironolactone doses. At enrollment, NT-proBNP was significantly higher in the spironolactone group (p=0.005). Left atrial to aortic ratio (p=0.002) and left ventricular internal diameter in diastole (p=0.005) increased over time in the placebo group, but not the spironolactone group; the change did not differ significantly between groups. The change in biomarker concentrations did not differ significantly between groups; there was a tendency toward an increase in NT-proBNP over time in the placebo group. Enrollment of 76 dogs would be necessary to demonstrate a difference in the change in LA:Ao over 6 months between the groups. CONCLUSIONS Preliminary results support undertaking a larger clinical trial of treatment of dogs with preclinical MMVD with spironolactone.
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Affiliation(s)
- M J Hezzell
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK.
| | - A Boswood
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - J López-Alvarez
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - N Lötter
- Department of Veterinary Basic Sciences, The Royal Veterinary College, London, UK
| | - J Elliott
- Department of Veterinary Basic Sciences, The Royal Veterinary College, London, UK
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Reimann MJ, Møller JE, Häggström J, Martinussen T, Zatrazemi SSC, Svanholm L, Nielsen LBM, Pedersen HD, Olsen LH. Mitral Regurgitation Severity and Left Ventricular Systolic Dimension Predict Survival in Young Cavalier King Charles Spaniels. J Vet Intern Med 2017; 31:1008-1016. [PMID: 28573754 PMCID: PMC5508320 DOI: 10.1111/jvim.14759] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/17/2017] [Accepted: 04/26/2017] [Indexed: 11/30/2022] Open
Abstract
Background Development and progression of myxomatous mitral valve disease (MMVD) in dogs are difficult to predict. Identification at a young age of dogs at high risk of adverse outcome in the future is desirable. Hypothesis/Objectives To study the predictive value of selected clinical and echocardiographic characteristics associated with MMVD obtained at a young age for prediction of long‐term cardiac and all‐cause mortality in Cavalier King Charles Spaniels (CKCS). Animals 1125 privately owned CKCS. Methods A retrospective study including CKCS examined at the age of 1–3 years. Long‐term outcome was assessed by telephone interview with owners. The value of variables for predicting mortality was investigated by Cox proportional hazard and Kaplan‐Meier analyses. Results Presence of moderate to severe mitral regurgitation (MR) (hazard ratio (HR) = 3.03, 95% confidence interval (95% CI) = 1.48–6.23, P = 0.0025) even intermittent moderate to severe MR (HR = 2.23, 95% CI = 1.48–6.23, P = 0.039) on color flow Doppler echocardiography was significantly associated with increased hazard of cardiac death. An interaction between MR and sex was significant for all‐cause mortality (P = 0.035), showing that males with moderate to severe MR had a higher all‐cause mortality compared to males with no MR (HR = 2.38, 95% CI = 1.27–4.49, P = 0.0071), whereas no difference was found between female MR groups. The risk of cardiac (HR = 1.37, 95% CI = 1.14–1.63, P < 0.001) and all‐cause (HR = 1.13, 95% CI = 1.02–1.24, P = 0.016) mortality increased with increasing left ventricular end‐systolic internal dimension normalized for body weight (LVIDSN). Conclusions and clinical importance Moderate to severe MR, even if intermittent, and increased LVIDSN in dogs <3 years of age were associated with cardiac death later in life in CKCS.
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Affiliation(s)
- M J Reimann
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - J E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - J Häggström
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - T Martinussen
- Department of Public Health, University of Copenhagen, København K, Denmark
| | - S S C Zatrazemi
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - L Svanholm
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - L B M Nielsen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - H D Pedersen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - L H Olsen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
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Winter RL, Saunders AB, Gordon SG, Miller MW, Fosgate GT, Suchodolski JS, Steiner JM. Biologic variability of cardiac troponin I in healthy dogs and dogs with different stages of myxomatous mitral valve disease using standard and high-sensitivity immunoassays. Vet Clin Pathol 2017; 46:299-307. [PMID: 28449360 DOI: 10.1111/vcp.12495] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Biologic variability (BV) is one aspect of interpreting changes in biomarker concentrations known to be clinically important in people with cardiac disease, but it has not been adequately addressed in dogs so far. OBJECTIVES The purpose of the study was to determine BV of cardiac troponin I (cTnI) in healthy dogs and dogs with 3 stages of myxomatous mitral valve disease (MMVD). METHODS Healthy dogs and dogs with 3 stages of MMVD were prospectively assigned to groups based on comprehensive clinical evaluation using current guidelines. Concentrations of cTnI were measured hourly, daily, and weekly using standard and high-sensitivity immunoassays. Within- (CVI ) and between-subject (CVG ) coefficients of variability, percent reference change value (RCV), and index of individuality (IoI) were calculated. RESULTS All 10 healthy dogs and 76/112 (68%) of samples from 28 MMVD dogs had cTnI concentrations below the limit of detection (LOD) using a standard sensitivity immunoassay. Only 49/160 (31%) of healthy dog samples and no MMVD samples had cTnI below the high-sensitivity immunoassay LOD. Data analysis for the high-sensitivity immunoassay revealed CVI of 48.1%, CVG of 60.1%, RCV of 134.0%, and IoI of 0.804 in healthy dogs. In MMVD dogs, CVI was 39.6%, CVG was 80.7%, RCV was 110%, and IoI was 0.494. Of all MMVD dogs, those with Stage B2 had the lowest RCV of 91%. CONCLUSIONS Biologic variability affects cTnI concentrations in healthy dogs and dogs with MMVD. Consideration of BV may be clinically relevant when monitoring individual changes in cTnI values, using high-sensitivity immunoassays.
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Affiliation(s)
- Randolph L Winter
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Matthew W Miller
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Geoffrey T Fosgate
- Department of Production Animal Studies, University of Pretoria, Onderstepoort, South Africa
| | - Jan S Suchodolski
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Jörg M Steiner
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
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Strunz CMC, Marcondes-Santos M, Takada JY, Fragata FS, Mansur ADP. Quality of Life Score as a Predictor of Death in Dogs with Degenerative Mitral Valve Disease. Arq Bras Cardiol 2017; 108:347-353. [PMID: 28380134 PMCID: PMC5421474 DOI: 10.5935/abc.20170032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/01/2016] [Indexed: 11/20/2022] Open
Abstract
Background The knowledge of the variables predicting mortality is important in clinical
practice and for therapeutic monitoring in mitral valve disease. Objectives To determine whether a quality of life score evaluated with the Functional
Evaluation of Cardiac Health questionnaire would predict mortality in dogs
with degenerative mitral valve disease (DMVD). Methods Thirty-six client-owned dogs with mitral valve disease underwent clinical,
laboratory, and echocardiographic evaluations at baseline and were monitored
for 6 months. Cardiovascular death was the primary outcome. Results The 36 dogs were classified as survivors or nonsurvivors. Higher values of
the following variables were obtained at baseline in the nonsurviving group
(12 dogs): amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels,
plasma norepinephrine, heart rate, quality of life score, diastolic left
ventricular internal dimension to aortic root ratio, systolic left
ventricular internal dimension to aortic root ratio, and left atrium to
aortic root ratio. NT-proBNP levels and quality life score were
independently associated with death in the multivariable analysis. Conclusion The quality life score was an independent variable for cardiac death in dogs
with DMVD. This result is encouraging, as this score is easy to apply and
does not require any technology, only a veterinarian and an observant owner.
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Affiliation(s)
| | | | | | - Fernanda S Fragata
- Hospital Veterinário Sena Madureira, Vila Mariana, São Paulo, SP - Brazil
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Winter RL, Saunders AB, Gordon SG, Buch JS, Miller MW. Biologic variability of N-terminal pro-brain natriuretic peptide in healthy dogs and dogs with myxomatous mitral valve disease. J Vet Cardiol 2017; 19:124-131. [PMID: 28111138 DOI: 10.1016/j.jvc.2016.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 11/11/2016] [Accepted: 11/21/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION To determine the biologic variability of N-terminal pro-brain natriuretic peptide (NTproBNP) in healthy dogs and dogs with various stages of myxomatous mitral valve disease (MMVD). ANIMALS Thirty-eight privately owned dogs: 28 with MMVD and 10 healthy controls. MATERIALS AND METHODS Prospective clinical study with comprehensive evaluation used to group dogs as healthy or into three stages of MMVD based on current guidelines. NTproBNP was measured hourly, daily, and weekly. For each group, analytical (CVA), within-subject (CVI), and between-subject (CVG) coefficients of variability were calculated in addition to percent critical change value (CCV) and index of individuality (IoI). RESULTS For healthy dogs, calculated NTproBNP values were: CVA = 4.2%; CVI = 25.2%; CVG = 49.3%; IoI = 0.52, and CCV = 70.8%. For dogs with MMVD, calculated NTproBNP values were: CVA = 6.2%; CVI = 20.0%; CVG = 61.3%; IoI = 0.34, and CCV = 58.2%. CONCLUSIONS Biologic variability affects NTproBNP concentrations in healthy dogs and dogs with MMVD. Monitoring serial individual changes in NTproBNP may be clinically relevant in addition to using population-based reference ranges to determine changes in disease status.
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Affiliation(s)
- Randolph L Winter
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA.
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Jesse S Buch
- Immunoassay R&D, IDEXX Laboratories, Westbrook, ME, USA
| | - Matthew W Miller
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
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Abstract
Blood-based assays for various cardiac biomarkers can assist in the diagnosis of heart disease in dogs and cats. The two most common markers are cardiac troponin-I and N-terminal pro-B-type natriuretic peptide. Biomarker assays can assist in differentiating cardiac from noncardiac causes of respiratory signs and detection of preclinical cardiomyopathy. Increasingly, studies indicate that cardiac biomarker testing can help assess the risk of morbidity and mortality in animals with heart disease. Usage of cardiac biomarker testing in clinical practice relies on proper patient selection, correct interpretation of test results, and incorporation of biomarker testing into existing diagnostic methods.
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Affiliation(s)
- Mark A Oyama
- Section of Cardiology, Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104, USA.
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López-Alvarez J, Elliott J, Pfeiffer D, Chang YM, Mattin M, Moonarmart W, Hezzell MJ, Boswood A. Clinical severity score system in dogs with degenerative mitral valve disease. J Vet Intern Med 2015; 29:575-81. [PMID: 25818211 PMCID: PMC4895509 DOI: 10.1111/jvim.12544] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 10/18/2014] [Accepted: 12/23/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Several risk factors already have been determined for dogs with degenerative mitral valve disease (DMVD). Risk factors often have been considered in isolation and have not always taken into account additional information provided by the history and physical examination (PE). HYPOTHESIS/OBJECTIVES Data obtained from history and PE of dogs with DMVD provide prognostic information and can be used for risk stratification. ANIMALS Client-owned dogs (n = 244) with DMVD recruited from first opinion practice. METHODS Prospective longitudinal follow-up of dogs with DMVD. History and PE data were obtained at 6-month intervals and analyzed with time-dependent Cox models to derive relative risk of cardiac death. Independent hazard ratios were used to derive a clinical severity score (CSS), the prognostic value of which was evaluated by analyzing the median survival times for different risk groups and ROC analysis. Analysis of the progression of CSS over time also was undertaken. RESULTS History of cough, exercise intolerance, decreased appetite, breathlessness (difficulty breathing) and syncope with PE findings of heart murmur intensity louder than III/VI and absence of respiratory sinus arrhythmia were independently associated with outcome and allowed development of the CSS. Clinical severity score distinguished groups of dogs with significantly different outcomes. CONCLUSIONS AND CLINICAL IMPORTANCE Routinely obtained clinical findings allow risk stratification of dogs with DMVD. Results of ancillary diagnostic tests may be complementary to history and PE findings and always should be interpreted in conjunction with these findings.
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Affiliation(s)
- J López-Alvarez
- Department of Clinical Sciences and Services, Royal Veterinary College, London, UK
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Mattin M, Boswood A, Church D, McGreevy P, O’Neill D, Thomson P, Brodbelt D. Degenerative mitral valve disease: Survival of dogs attending primary-care practice in England. Prev Vet Med 2015; 122:436-42. [DOI: 10.1016/j.prevetmed.2015.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/09/2015] [Accepted: 05/23/2015] [Indexed: 11/26/2022]
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Cahill RJ, Pigeon K, Strong-Townsend MI, Drexel JP, Clark GH, Buch JS. Analytical validation of a second-generation immunoassay for the quantification of N-terminal pro-B-type natriuretic peptide in canine blood. J Vet Diagn Invest 2015; 27:61-7. [PMID: 25525139 DOI: 10.1177/1040638714562826] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been shown to have clinical utility as a biomarker in dogs with heart disease. There were several limitations associated with early diagnostic assay formats including a limited dynamic range and the need for protease inhibitors to maintain sample stability. A second-generation Cardiopet® proBNP enzyme-linked immunosorbent assay (IDEXX Laboratories Inc., Westbrook, Maine) was developed to address these limitations, and the present study reports the results of the analytical method validation for the second-generation assay. Coefficients of variation for intra-assay, interassay, and total precision based on 8 samples ranged from 3.9% to 8.9%, 2.0% to 5.0%, and 5.5% to 10.6%, respectively. Analytical sensitivity was established at 102 pmol/l. Accuracy averaged 102.0% based on the serial dilutions of 5 high-dose canine samples. Bilirubin, lipids, and hemoglobin had no effect on results. Reproducibility across 3 unique assay lots was excellent with an average coefficient of determination (r (2)) of 0.99 and slope of 1.03. Both ethylenediamine tetra-acetic acid plasma and serum gave equivalent results at time of blood draw (slope = 1.02, r (2) = 0.89; n = 51) but NT-proBNP was more stable in plasma at 25°C with median half-life measured at 244 hr and 136 hr for plasma and serum, respectively. Plasma is the preferred sample type and is considered stable up to 48 hr at room temperature whereas serum should be frozen or refrigerated when submitted for testing. Results of this study validate the second-generation canine Cardiopet proBNP assay for accurate and precise measurement of NT-proBNP in routine sample types from canine patients.
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Osuga T, Nakamura K, Morita T, Lim SY, Nisa K, Yokoyama N, Sasaki N, Morishita K, Ohta H, Takiguchi M. Vitamin D Status in Different Stages of Disease Severity in Dogs with Chronic Valvular Heart Disease. J Vet Intern Med 2015; 29:1518-23. [PMID: 26332427 PMCID: PMC4895654 DOI: 10.1111/jvim.13606] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/09/2015] [Accepted: 07/29/2015] [Indexed: 11/26/2022] Open
Abstract
Background In humans with heart disease, vitamin D deficiency is associated with disease progression and a poor prognosis. A recent study showed that serum 25‐hydroxyvitamin D [25(OH)D] concentration, the hallmark of vitamin D status, was lower in dogs with heart failure than in normal dogs, and a low concentration was associated with poor outcome in dogs with heart failure. Objectives To elucidate the vitamin D status of dogs with chronic valvular heart disease (CVHD) at different stages of disease severity. Animals Forty‐three client‐owned dogs with CVHD. Methods In this cross‐sectional study, dogs were divided into 3 groups (14 dogs in Stage B1, 17 dogs in Stage B2, and 12 dogs in Stage C/D) according to ACVIM guidelines. Dogs underwent clinical examination including echocardiography. Serum 25(OH)D concentrations were measured in each dog. Results Serum 25(OH)D concentration was significantly lower in Stage B2 (median, 33.2 nmol/L; range, 4.9–171.7 nmol/L) and C/D (13.1 nmol/L; 4.9–58.1 nmol/L) than in Stage B1 (52.5 nmol/L; 33.5–178.0 nmol/L) and was not significantly different between Stage B2 and Stage C/D. Among clinical variables, there were significant negative correlations between 25(OH)D concentration and both left atrial‐to‐aortic root ratio and left ventricular end‐diastolic diameter normalized for body weight. Conclusions and Clinical Importance These results indicate that vitamin D status is associated with the degree of cardiac remodeling, and the serum 25(OH)D concentration begins to decrease before the onset of heart failure in dogs with CVHD.
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Affiliation(s)
- T Osuga
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - K Nakamura
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - T Morita
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - S Y Lim
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - K Nisa
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - N Yokoyama
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - N Sasaki
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - K Morishita
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - H Ohta
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - M Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Smith KF, Quinn RL, Rahilly LJ. Biomarkers for differentiation of causes of respiratory distress in dogs and cats: Part 1 - Cardiac diseases and pulmonary hypertension. J Vet Emerg Crit Care (San Antonio) 2015; 25:311-29. [DOI: 10.1111/vec.12318] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/22/2015] [Indexed: 12/18/2022]
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Sargent J, Muzzi R, Mukherjee R, Somarathne S, Schranz K, Stephenson H, Connolly D, Brodbelt D, Fuentes VL. Echocardiographic predictors of survival in dogs with myxomatous mitral valve disease. J Vet Cardiol 2015; 17:1-12. [PMID: 25586168 DOI: 10.1016/j.jvc.2014.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 10/29/2014] [Accepted: 11/04/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To evaluate vena contracta and other echocardiographic measures of myxomatous mitral valve disease (MMVD) severity in a multivariable analysis of survival in dogs. ANIMALS 70 dogs diagnosed with MMVD from stored echocardiographic images that met study inclusion criteria. METHODS Left heart dimensions were measured as well as mitral regurgitant jet area/left atrial area (JAR), early mitral filling velocity (Evel), extent of mitral valve prolapse in right and left views (ProlR, ProlL), Prol indexed to aortic diameter (ProlR:Ao, ProlL:Ao), presence of a flail leaflet (FlailR, FlailL), and mitral regurgitation vena contracta diameter (VCR, VCL) indexed to aortic diameter (VCR:Ao, VCL:Ao). Follow-up from referring veterinarians was obtained by questionnaire or telephone to determine survival times. Inter- and intra-observer agreement was evaluated with Bland-Altman plots and weighted Kappa analysis. Survival was analyzed using Kaplan-Meier curves, logrank tests and Cox's proportional hazards. RESULTS Logrank analysis showed VCL:Ao, VCR:Ao, FlailL, ProlR:Ao, ProlL:Ao, left ventricular internal dimension in diastole indexed to aortic diameter (LVIDD:Ao) >2.87, left atrium to aorta ratio (LA/Ao) >1.6, and Evel >1.4 m/s were predictors of cardiac mortality. In a multivariable analysis, the independent predictors of cardiac mortality were Evel >1.4 m/s [hazard ratio (HR) 5.0, 95% confidence interval (CI) 2.5-10.3], FlailL (HR 3.1, 95% CI 1.3-7.9), and ProlR:Ao (HR 2.8, 95% CI 1.3-6.3). CONCLUSIONS Echocardiographic measures of mitral regurgitation severity and mitral valve pathology provide valuable prognostic information independent of chamber enlargement in dogs with MMVD.
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Affiliation(s)
- Julia Sargent
- The Royal Veterinary College, Department of Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom.
| | - Ruthnea Muzzi
- Department of Veterinary Medicine, Federal University of Lavras, Minas Gerais, Brazil
| | - Rajat Mukherjee
- Wood Street Veterinary Hospital, 74 Wood Street, Barnet EN5 4BW, United Kingdom
| | - Sharlene Somarathne
- The Royal Veterinary College, Department of Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom
| | - Katherine Schranz
- The Royal Veterinary College, Department of Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom
| | - Hannah Stephenson
- The Royal Veterinary College, Department of Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom
| | - David Connolly
- The Royal Veterinary College, Department of Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom
| | - David Brodbelt
- The Royal Veterinary College, Department of Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom
| | - Virginia Luis Fuentes
- The Royal Veterinary College, Department of Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom
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Fox PR, Oyama MA, Hezzell MJ, Rush JE, Nguyenba TP, DeFrancesco TC, Lehmkuhl LB, Kellihan HB, Bulmer B, Gordon SG, Cunningham SM, MacGregor J, Stepien RL, Lefbom B, Adin D, Lamb K. Relationship of plasma N-terminal pro-brain natriuretic peptide concentrations to heart failure classification and cause of respiratory distress in dogs using a 2nd generation ELISA assay. J Vet Intern Med 2014; 29:171-9. [PMID: 25308881 PMCID: PMC4858067 DOI: 10.1111/jvim.12472] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/03/2014] [Accepted: 08/28/2014] [Indexed: 12/02/2022] Open
Abstract
Background Cardiac biomarkers provide objective data that augments clinical assessment of heart disease (HD). Hypothesis/Objectives Determine the utility of plasma N‐terminal pro‐brain natriuretic peptide concentration [NT‐proBNP] measured by a 2nd generation canine ELISA assay to discriminate cardiac from noncardiac respiratory distress and evaluate HD severity. Animals Client‐owned dogs (n = 291). Methods Multicenter, cross‐sectional, prospective investigation. Medical history, physical examination, echocardiography, and thoracic radiography classified 113 asymptomatic dogs (group 1, n = 39 without HD; group 2, n = 74 with HD), and 178 with respiratory distress (group 3, n = 104 respiratory disease, either with or without concurrent HD; group 4, n = 74 with congestive heart failure [CHF]). HD severity was graded using International Small Animal Cardiac Health Council (ISACHC) and ACVIM Consensus (ACVIM‐HD) schemes without knowledge of [NT‐proBNP] results. Receiver‐operating characteristic curve analysis assessed the capacity of [NT‐proBNP] to discriminate between dogs with cardiac and noncardiac respiratory distress. Multivariate general linear models containing key clinical variables tested associations between [NT‐proBNP] and HD severity. Results Plasma [NT‐proBNP] (median; IQR) was higher in CHF dogs (5,110; 2,769–8,466 pmol/L) compared to those with noncardiac respiratory distress (1,287; 672–2,704 pmol/L; P < .0001). A cut‐off >2,447 pmol/L discriminated CHF from noncardiac respiratory distress (81.1% sensitivity; 73.1% specificity; area under curve, 0.84). A multivariate model comprising left atrial to aortic ratio, heart rate, left ventricular diameter, end‐systole, and ACVIM‐HD scheme most accurately associated average plasma [NT‐proBNP] with HD severity. Conclusions and Clinical Importance Plasma [NT‐proBNP] was useful for discriminating CHF from noncardiac respiratory distress. Average plasma [NT‐BNP] increased significantly as a function of HD severity using the ACVIM‐HD classification scheme.
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Affiliation(s)
- P R Fox
- The Animal Medical Center, New York, NY
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Ljungvall I, Rishniw M, Porciello F, Ferasin L, Ohad DG. Murmur intensity in small-breed dogs with myxomatous mitral valve disease reflects disease severity. J Small Anim Pract 2014; 55:545-50. [DOI: 10.1111/jsap.12265] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 07/17/2014] [Accepted: 07/21/2014] [Indexed: 11/27/2022]
Affiliation(s)
- I. Ljungvall
- Department of Clinical Sciences; University Animal Hospital, Swedish University of Agricultural Science; SE-750 07 Uppsala Sweden
| | - M. Rishniw
- Veterinary Information Network; Davis CA 95616 USA
| | - F. Porciello
- Department of Clinical Sciences; School of Veterinary Medicine, University of Perugia; Perugia 06100 Italy
| | - L. Ferasin
- Wey Referrals; 25 Chertsey Rd, Woking Surrey GU21 5BP
| | - D. G. Ohad
- Department of Clinical Sciences; The Koret School of Veterinary Medicine, Robert H. Smith Faculty of Agriculture, Food and Environment, Hebrew University of Jerusalem; Rehovot 76100 Israel
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