Prognostic value of measuring heart rate variability at the time of hospital admission in horses with colic

Integration of machine learning and viscoelastic testing to improve survival prediction in horses experiencing acute abdominal pain at a veterinary teaching hospital

BACKGROUND

Viscoelastic coagulation testing (VCT) identifies subclinical disruption of coagulation homeostasis and may improve prognostication, particularly for patients with severe systemic inflammation or shock. Machine learning (ML) algorithms may capture complex relationships between clinical variables better than linear regression (GLM).

OBJECTIVE

To evaluate the utility of ML models incorporating VCT and clinical data to predict survival outcomes in horses with acute abdominal pain.

STUDY DESIGN

Retrospective observational cohort study.

METHODS

VCT (VCM Vet™) was performed on 57 horses with acute abdominal pain at admission, with clinical data collected retrospectively. Coagulopathy was defined as ≥2 abnormal VCT parameters. GLM and random forest (RF) classification models were developed to predict short-term survival. A training cohort of 40 horses was used for model development, and model performance was determined using the remaining 17 horses. RF models were implemented in a web-based application to demonstrate clinical application.

RESULTS

There were 31 survivors and 26 non-survivors. The majority of cases were colitis (47.7%), with smaller proportions of impactions, strangulating obstructions and other causes of colic. Coagulopathy diagnosis alone performed poorly for survival prediction (sensitivity 81% [95% CI 64-94], specificity 31% [95% CI 15-50], AUC = 0.515). Final GLM included SIRS score (OR 0.37 [95% CI 0.071-1.68]; p = 0.2), L-lactate (OR 0.51 [0.25-0.82]; p = 0.02), clot time (CT; OR 1.0 [0.99-1.0], p = 0.39), and clot amplitude at 10 min (A10; OR 0.89 [0.74-1.02], p = 0.2). Final RF model included heart rate, PCV, L-lactate, white blood cell count, neutrophil count, clot amplitude at 20 min (A20) and CT. RF models improved sensitivity (RFfull 91% [95% CI 60-100]; RFreduced 83% [95% CI 42-99]) and specificity (both 83% [95% CI 42-99]) compared to GLM (sensitivity 65% [95% CI 47-79], specificity 42% [95% CI 26-61]).

MAIN LIMITATIONS

Small number of horses, convenience sampling. Model validation with an independent population is needed to support clinical applicability.

CONCLUSIONS

L-lactate remains a key predictor of survival in horses with colic. The integration of VCT with clinical data in machine learning models may enhance prognostication.

Transcutaneous Auricular Vagal Nerve Stimulation in Healthy Non-Sedated Horses: A Feasibility Study

This study aimed to evaluate the feasibility of transcutaneous auricular vagal nerve stimulation (tAVNS) in healthy horses and its effect on heart rate variability (HRV). The study comprised three phases: the selection of mares, their acclimatization to the tAVNS, and the stimulation phase. Stimulation was performed with two electrodes positioned on the right pinna. The settings were 0.5 mA, 250 μs, and 25 Hz for pulse amplitude, pulse width, and pulse frequency, respectively. HRV was analysed before (B1), during (T), and after (B2) the tAVNS. From the 44 mares initially included, only 7 completed the three phases. In these mares, the heart rate (HR) was significantly lower, and frequency domain parameters showed an increased parasympathetic tone in B2 compared with B1. However, in 3/7 mares, the HR was significantly higher during T compared with B1 and B2, compatible with a decreased parasympathetic tone, while in 4/7 mares, the HR was significantly lower and the parasympathetic nervous system index was significantly higher during T and B2 compared with B1. The tAVNS is an economical and easy procedure to perform and has the potential to stimulate vagal activity; however, it was poorly tolerated in the mares included in this study.

Insights into equine piroplasmosis in Venezuelan sport horses: Molecular diagnosis, clinical, and cardiovascular findings

Equine piroplasmosis (EP) is a tick-borne infectious disease highly prevalent in tropical and subtropical regions, such as Venezuela. EP affects wild and domestic equids leading to several clinical presentations, from asymptomatic to severely affected animals. In this study, thirty-three (33) sport horses under regular training activities and from endemic regions of north-central Venezuela were submitted to an observational survey, case-control, to describe the presence of clinical signs and natural EP infections. A conventional PCR assay targeting the SSU rRNA gene revealed EP etiologic agents in 13 out of 33 sampled horses (~ 39.4% infections). Nine (9) of these EP-positive samples were confirmed as infected with Babesia caballi (6/9 = 66.7%) or Theileria equi (3/9 = 33.3%) by DNA sequencing and BLASTN analyses. A phylogeny of SSU rRNA gene sequences revealed that these new B. caballi and T. equi sequences clustered within the worldwide distributed phylogenetic genotype A, respectively. No acute EP cases were observed in this study; however, six (6) PCR-positive animals displayed mild clinical signs compatible with EP, including a mild leukocytosis (P < 0.05). The heart rate variability frequency domain analysis in four (4) of these EP-positive infected animals revealed a significant (P < 0.05) higher low-frequency/high-frequency ratio suggesting a sympathovagal imbalance in these chronically infected animals. Other clinical and cardiovascular parameters were similar between the different groups. Sport horses are routinely submitted to intense training programs and sport-related activities that could lead to loss of the host-parasite equilibrium that characterizes enzootic regions, increasing the likelihood of infection reactivation and the risk of transmission. Heart rate variability analysis contributes to evaluate the sympathovagal balance and detecting homeostasis disturbances in sport horses. Molecular diagnostic tests for EP based on the detection of parasite DNA in equine blood samples should be included in the health programs of sport horses in endemic areas.

Nociceptive pain and anxiety in equines: Physiological and behavioral alterations

Pain and anxiety are two of the most important concerns in clinical veterinary medicine because they arise as consequences of multiple factors that can severely affect animal welfare. The aim of the present review was to provide a description and interpretation of the physiological and behavioral alterations associated with pain and anxiety in equines. To this end, we conducted an extensive review of diverse sources on the topic. The article begins by describing the neurophysiological pathway of pain, followed by a discussion of the importance of the limbic system in responses to pain and anxiety, since prolonged exposure to situations that cause stress and pain generates such physiological changes as tachycardia, tachypnea, hypertension, hyperthermia, and heart rate variability (HRV), often accompanied by altered emotional states, deficient rest, and even aggressiveness. In the long term, animals may show deficiencies in their ability to deal with changes in the environment due to alterations in the functioning of their immune, nervous, and endocrinologic systems. In conclusion, pain and anxiety directly impact the homeostasis of organisms, so it is necessary to conduct objective evaluations of both sensations using behavioral scales, like the horse grimace scale, complemented by assessments of blood biomarkers to analyze their correlation with physiological parameters: Heart rate, respiratory rate, HRV, theparasympathetic tone activity index, lactate and glucose levels, and temperature. Additional tools - infrared thermography, for example - can also be used in these efforts to improve the quality of life and welfare of horses.

Accuracy of a heart rate monitor for calculating heart rate variability parameters in exercising horses

Heart rate is evaluated in exercising horses to monitor the level of fitness to exercise, and it is usually acquired using heart rate monitors (HRM) or telemetric electrocardiograms (ECG). While HRM are commonly available and easy-to-use for horse's owners, ECG is a more expensive equipment requiring user's experience. Interest for heart rate variability (HRV) in horses is increasing for both research and clinical purposes. HRV is usually calculated from interbeat intervals (IBI) obtained by ECG. The aim of this study was to determine the accuracy of an HRM to detect IBI for the calculation of HRV in both resting and exercising horses. Simultaneous ECG and HRM recordings were performed on 13 horses and ponies under normal training conditions for at least 45 minutes. IBI from ECG were corrected using a dedicated software. IBI from HRM were exported without correction. Two HRV-parameters were calculated on both recordings for resting and exercising periods: the standard deviation of R-R intervals (SDRR) and the root mean square of successive differences (RMSSD). Agreement and concordance between the two systems were determined using Bland-Altman plot and Lin's correlation coefficient, respectively. Effects of variables were consequently assessed. For both HRV-parameters during resting and exercising periods, the means of the differences between the two systems were lower than 0.47 ms with a correlation coefficient higher than 0.999. Height, weight and body condition score had no effect on the results. The studied HRM could be of interest as easy-to-use device for obtaining HRV-parameters SDRR and RMSSD in resting and exercising horses.