Effects of Age, Sex, and Exercise on Measurement of Serum CTnI Levels and Some Parameters Related to the Cardiovascular Capacity of Caspian Horses

Due to their high specificity and exclusive cardiac myocyte sensitivity, cardiac troponins T and I (cTnT, cTnI) are currently regarded as ideal biomarkers to identify cardiomyocyte damage, myocardial injury, myocardial infarction, and chronic heart failure. In fact, cTnI is considered the most reliable biomarker for diagnosing heart-related issues. This study aimed to investigate the effects of age, gender, and exercise training on serum cTnI levels and various parameters related to the cardiovascular capacity of Caspian horses. For this purpose, 50 adult Caspian horses over 3 years old, both male and female, were selected from horse breeding centres and clubs in the provinces of Tehran, Alborz, and Gilan. To account for age-related differences, the horses were divided into three groups: Group A (less than 5 years), Group B (between 5 and 10 years), and Group C (over 10 years). To measure cTnI levels, 10 mL of blood was collected from the jugular vein of each horse using a venoject blood collection tube before exercise and another 10 mL 2 h post-exercise. The samples were refrigerated and centrifuged for 30 min after collection. Two millilitres of serum obtained from each horse at both time points was stored at -20°C for subsequent analysis. Troponin I levels were measured in the laboratory using the electrochemical luminescence (ECL) method. The results of this study reveal for the first time that the normal average of serum cTnI, packed cell volume (PCV), and blood haemoglobin (Hb) levels in Caspian horses is 2.5 ng/L, 35.52%, and 12.1%, respectively. Furthermore, the findings indicate that exercise significantly increases serum levels of cTnI, PCV, and blood haemoglobin; however, age and gender did not appear to affect these measured parameters. Therefore, it can be concluded that exercise stimulates the release of troponin due to myocardial injury.

Plasma Cardiac Troponin-I Concentration in Normal Horses and in Horses with Cardiac Abnormalities

Cardiac troponin-I (cTnI) is a highly sensitive and specific marker of myocardial injury detectable in plasma by immunoassay techniques. Inclusion criteria over a 3-year period required a diagnosis of cardiac disease accompanied by electrocardiographic (ECG) and cardiac ultrasound examinations (n = 23) in adult horses (≥2 years of age). A second group of normal adult ponies (n = 12) was studied as a reference group. Heparinized jugular venous blood samples were collected and centrifuged within 30 min, and the plasma was separated and frozen at -70 °C for subsequent batched cTnI analysis. The lower limit of detection was 0.01 ng/mL, and the upper limit was 100 ng/mL of plasma. Normal equine plasma cTnI concentrations ranged from 0.01 to 0.03 ng/mL (n = 12). Horses with non-arrhythmogenic murmurs (n = 4) included tricuspid (0.05 ng/mL cTnI), mitral (0.07), and aortic insufficiencies (0.01, 0.02). Horses with benign atrial fibrillation (n = 8) had a cTnI range of <0.01-0.09 ng/mL, with four horses having cTnI concentrations falling slightly outside the reference range (0.04, 0.05, 0.06, and 0.09). Horses with ventricular arrhythmias (ventricular premature contractions or ventricular tachycardia) and documentable myocardial toxicities or immunological reactions (n = 5) had cTnI concentrations of 0.05, 0.21, 0.31, 15.18, and >100 ng/mL. Horses with ventricular arrhythmias but no documentation of myocardial toxicity (n = 3) had cTnI concentrations of 0.34, 0.46, and 80.42 ng/mL. When grouped by arrhythmia type and compared using the Mann-Whitney Rank Sum Test, the median ventricular arrhythmia cTnI (0.40 ng/mL) was significantly higher than the median atrial fibrillation cTnI (0.04 ng/mL, p < 0.001). It was concluded that horses with myocardial toxicities and ventricular arrhythmias often had severe elevations in plasma cTnI.

Physiological stress responses in horses participating in novice endurance rides

Horses participating in endurance events encounter enormous physical challenges. Heart rate (HR) and heart rate variability (HRV) have been reported before and after endurance rides, but these have not been determined during the rides. Moreover, the modulation in HRV and haematology in horses with different ride results (completed a course or disqualified due to irregular gait) have not been elucidated. Therefore, this study aimed to investigate changes in HR, HRV, and haematological parameters during novice endurance rides and to compare these parameters between horses that successfully completed the course (SC) or were disqualified for irregular gait (FTQ-GA). Beat-to-beat (RR) intervals of 16 healthy horses (aged 6-14 years) were recorded before and throughout the approximately 40 km endurance event. Blood samples were taken at the pre-ride inspection and after passing each veterinary inspection. HRV and haematology measures were determined from nine SC and seven FTQ-GA horses. Horses with different ride results demonstrated distinctive physiological stress responses. Increases in PCV, RBC, WBC and neutrophils after completing the ride were found only in SC horses, implying that they were ridden with greater effort than FTQ-GA horses. A reduction in HRV during warm-up, followed by a significant reduction during the first and second riding phases, was observed. HRV returned to baseline at the compulsory rest period of both phases. FTQ-GA horses experienced lower RR intervals, RR triangular index, modified deceleration capacity, very-low-frequency band, and parasympathetic nervous system index, coinciding with higher HR and sympathetic nervous system and stress indices than SC horses. These results indicated that endurance horses revealed a shift toward sympathetic activity during the ride. Lower parasympathetic activity in FTQ-GA horses suggests they were under more stress or discomfort than SC horses in novice endurance rides. These results have welfare implications, indicating the need for additional rest breaks in FTQ-GA horses.

Blood-Based Markers for Skeletal and Cardiac Muscle Function in Eventing Horses before and after Cross-Country Rides and How They Are Influenced by Plasma Volume Shift

Horses competing in cross-country tests are subjected to high physical demands. Within the scope of this prospective longitudinal study, blood values of 20 elite eventing horses were examined before and after two- to four-star cross-country rides. The aim was to find out whether blood-based markers for skeletal muscle and cardiac muscle function change after cross-country exercise. Parameters that provide information about fluid balance, muscle enzymes, metabolites and cardiac muscle-specific markers were investigated. We developed an approach to eliminate the concentration changes caused by reduced plasma volume. Parameters were measured pre, 10 and 30 min post exercise and the next morning and were evaluated using a mixed model. Thirty minutes after exercise, most parameter concentrations changed in an exercise-dependent manner. The next morning, most exercise-related markers recovered rapidly, while creatine kinase (CK) (26% increase; p = 0.008) and lactate dehydrogenase (LDH) (15% increase; p < 0.001) showed a declining but sustained increase. Cardiac troponin I (cTnI) increased above the reference range in 40 of the 55 rides (73%) and in 18 of 20 horses in the morning after exercise.

Training vs. racing: A comparison of arrhythmias and the repeatability of findings in Thoroughbred Chuckwagon racehorses

Arrhythmias are commonly reported in exercising horses, however due to regulatory constraints electrocardiograms (ECGs) are acquired during training but not competition, raising questions about the repeatability of findings. The aims were (1) compare training and competition arrhythmias and (2) describe the repeatability of arrhythmias during maximal-intensity exercise. A convenience sample of 52 healthy Thoroughbreds (aged 8.7 ± 2.5 years) competing in the World Professional Chuckwagon Association were obtained, totaling 152 training or competition ECGs (2-7 ECGs/horse). Speed, heart rate (HR) and arrhythmias (supraventricular premature complex, SVPC; ventricular premature complex, VPC) were examined. Pre- and post-recovery (approximately 6 min) blood samples measured lactate and high-sensitivity troponin-T. Training and competition arrythmias were compared (Friedman's test) and reliability of repeated ECGs assessed (intraclass correlation; P < 0.05). Training vs. competition: Forty horses had clean tracing from training and competition (n = 80 ECGs); the number and type of arrhythmias were not different. In training, VPCs were present in 7/40 horses (median [interquartile range, IQR]/ECG; range; 0 [0,0]; 0-4) and 9/40 horses (0 [0,0]; 0-5) in active-recovery. In competition, VPCs were present in 7/40 horses (0 [0,0]; 0-8) and 8/40 horses (0 [0,0]; 0-5) in active-recovery. Arrhythmias were primarily single premature complexes. Training and competition speed, HR, lactate and troponin-T did not differ however, sampling was too early for peak serum Troponin-T levels. Repeatability: total arrhythmias between serial ECGs did not differ. The reliability to detect SVPCs and VPCs was poor to moderate, and poor, respectively. Overall, the total number of arrhythmias was repeatable, but the reliability of arrhythmia type was poor to moderate.

Frequency of cardiac arrhythmias in horses during straight and untethered swimming

BACKGROUND

Cardiac arrhythmias have not been previously reported in horses while swimming.

OBJECTIVES

To describe the type and frequency of encountered arrhythmias during repetitive swimming cycles.

STUDY DESIGN

Descriptive observational study.

METHODS

Sixteen horses swam five pool lengths (75 m), each separated by an active recovery walk. Continuous electrocardiograms (ECGs) were recorded (n = 80) and analysed during the pre-swim, swim and active-recovery periods. Arrhythmias were categorised as sinus arrhythmia (SA), sinus block, sinus pause (compensatory and non-compensatory), second degree atrioventricular block (2AVB) for physiological arrhythmias, supraventricular premature depolarisation (SVPD) and ventricular premature depolarisation (VPD) for non-physiological arrhythmias. A linear mixed-effects model was used to examine the effects of repetitive swim lengths on arrhythmias and swimming parameters. Data were reported as median [interquartile range].

RESULTS

Fifteen horses (94%) experienced at least one arrhythmia; however, the frequency remained low and 2AVB were only observed during the pre-swim period. The swimming heart rate (HR) was 162 bpm [141;173]. Sinus blocks, sinus pauses, SA, SVPD and VPD were all recorded at least once during swimming. Except for one VPD couplet, all premature depolarisations were isolated. During active-recovery, the HR was 105 bpm [103;106], with SA observed in 13 horses (81%), isolated SVPD in six horses (38%), sinus pause in one horse (6%) but no VPD present.

MAIN LIMITATIONS

Limited number of horses precluding population prevalence assessment.

CONCLUSION AND CLINICAL IMPORTANCE

High-quality underwater ECGs were acquired in swimming horses for the first time. The frequency of arrhythmias remained low and rare pathological arrhythmias were observed during repetitive swimming and active-recovery cycles. Swimming with active-recovery periods is not a high-risk cardio-arrhythmic exercise.

INVESTIGATION OF THE USE OF SERUM BIOMARKERS FOR THE DETECTION OF CARDIAC DISEASE IN MARINE MAMMALS

Cardiac disease has been extensively documented in marine mammals; however, it remains difficult to diagnose antemortem. Assays measuring cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are used as sensitive and specific biomarkers of cardiac disease in many species, but have not been widely investigated in marine mammals. This study aimed to provide a set of reference values for cTnI and NT-proBNP in belugas (BW) (Delphinapterus leucas), sea otters (SO) (Enhydra lutris), Steller sea lions (SSL) (Eumetopias jubatus), and California sea lions (CSL) (Zalophus californianus) with and without cardiac disease, and to determine if these biomarkers are useful indicators of cardiac disease in these species. First, existing immunoassays for cTnI and NT-proBNP were successfully validated utilizing species-specific heart lysate spiked serum. Cohorts were defined by histopathology as animals with no evidence of cardiac disease ("control"), with confirmed cardiac disease ("disease"), and with concurrent renal and cardiac disease ("renal") for which serum samples were then analyzed. Serum concentration ranges for cTnI (ng/ml) and NT-proBNP (pmol/L) were determined for control and disease cohorts. There was significantly higher cTnI (P= 0.003) and NT-proBNP (P= 0.004) concentrations in the CSL disease cohort, as well as positive trends in BW, SO, and SSL disease cohorts that did not reach statistical significance. NT-proBNP concentrations were significantly higher in the CSL renal cohort compared with the control (P < 0.001) and disease (P= 0.007) cohorts. These results suggest that cTnI and NT-proBNP may be clinically useful in the antemortem diagnosis of cardiac disease in CSL, and warrant further investigation in BW, SO, and SL.

Sympathovagal Balance Is a Strong Predictor of Post High-Volume Endurance Exercise Cardiac Arrhythmia

Regular physical activity is important for cardiovascular health. However, high-volume endurance exercise has been associated with increased number of electrocardiogram (ECG) abnormalities, including disturbances in cardiac rhythm (arrhythmias) and abnormalities in ECG pattern. The aim of this study was to assess if heart rate variability (HRV) is associated with ECG abnormalities. Fifteen participants with previous cycling experience completed a 21-day high-volume endurance exercise cycle over 3,515 km. Participants wore a 5-lead Holter monitor for 24 h pre- and post-exercise, which was used to quantify ECG abnormalities and export sinus R-to-R intervals (NN) used to calculate HRV characteristics. As noise is prevalent in 24-h HRV recordings, both 24-h and heart rate collected during stable periods of time (i.e., deep sleep) were examined. Participants experienced significantly more arrhythmias post high-volume endurance exercise (median = 35) compared to pre (median = 12; p = 0.041). All 24-h and deep sleep HRV outcomes were not different pre-to-post high-volume endurance exercise (p &gt; 0.05). Strong and significant associations with arrhythmia number post-exercise were found for total arrhythmia (total arrhythmia number pre-exercise, ρ = 0.79; age, ρ = 0.73), supraventricular arrhythmia (supraventricular arrhythmia number pre-exercise: ρ = 0.74; age: ρ = 0.66), and ventricular arrhythmia (age: ρ = 0.54). As a result, age and arrhythmia number pre-exercise were controlled for in hierarchical regression, which revealed that only deep sleep derived low frequency to high frequency (LF/HF) ratio post high-volume endurance exercise predicted post total arrhythmia number (B = 0.63, R2Δ = 34%, p = 0.013) and supraventricular arrhythmia number (B = 0.77, R2Δ = 69%, p &lt; 0.001). In this study of recreationally active people, only deep sleep derived LF/HF ratio was associated with more total and supraventricular arrhythmias after high-volume endurance exercise. This finding suggests that measurement of sympathovagal balance during deep sleep might be useful to monitor arrhythmia risk after prolonged high-volume endurance exercise performance.

Evaluation of Different Blood Parameters From Endurance Horses Competing at 160 km

The purpose of this study was to assess a change in different blood parameters before and after a 160 km endurance race and to evaluate differences in cardiac biomarkers between horses that completed the race and horses that did not. The study population consisted of 52 healthy endurance horses. Horses participating in the study were assigned to three groups: horses that successfully completed the race ("finishers"), horses that failed to qualify at the veterinary check for primarily metabolic reasons ("metabolic") and horses that failed to qualify at the veterinary check for primarily gait related reasons ("gait related"). The latter two groups were combined to form a final group of "non-finishers" that were excluded for either "gait related" or "metabolic" disorders. Venous blood samples were taken before and after the endurance race. Serum and EDTA-plasma were analyzed for cardiac troponin I (cTNI), heart fatty acid binding protein (HFABP), alpha-hydroxybutyrate dehydrogenase (α-HBDH), atrial natriuretic peptide (ANP), lactate dehydrogenase (LDH), symmetric dimethylarginine (SDMA) and asymmetric dimethylarginine (ADMA). Lactate dehydrogenase (P = .001), SDMA (P= .001) and ADMA (P= .002) increased significantly after the endurance race in the finisher group. A significant increase in cTNI and α-HBDH concentration after the endurance race compared to the values before the endurance race was detected in the finisher (P= .001, P= .001) and gait related group (P= .002, P= .007). The longer the distance completed, the more these five blood parameters increased. No differences between the groups could be found and none of the measured blood parameters showed significant differences among groups before or after racing.

Evaluation of electrocardiographic repolarization parameters after administration of trimethoprim-sulfadiazine, detomidine, or their combination in horses

OBJECTIVE

To determine whether administration of trimethoprim-sulfadiazine (TMS), detomidine (DET), or TMS plus DET would be associated with changes in ECG repolarization parameters in horses.

ANIMALS

9 healthy adult horses.

PROCEDURES

Each horse received 4 treatments in a blinded, randomized, crossover study design as follows: TMS, 16 to 24 mg/kg, IV; DET, 0.015 to 0.02 mg/kg, IV; TMS plus DET; and saline (0.9% NaCl) solution. Surface ECG traces were obtained over 24 hours, and repolarization parameters were measured at predefined time points after each treatment and compared with a 2-way ANOVA for repeated measures.

RESULTS

Heart rate-corrected QT intervals (QTc) were significantly increased after administration of DET (mean ± SD difference in QTc, 36.57 ± 23.07 milliseconds; increase of 7%) and TMS plus DET (44.96 ± 29.16 milliseconds; increase of 9%), compared with baseline (before treatment) values and values after administration of saline solution. Saline solution and TMS alone did not affect QTc.

CONCLUSIONS AND CLINICAL RELEVANCE

Administration of DET or TMS plus DET was associated with a significant and possibly clinically relevant prolongation of QTc, with prolongation of 7% to 9%, a range that is considered as a risk factor for the development of cardiac arrhythmias in people. Results were unexpected because DET is considered to be a safe sedative for horses.

Prevalence of cardiac arrhythmias and R-R interval variation in healthy Thoroughbred horses during official Chuckwagon races and recovery

The prevalence and severity of cardiac arrhythmias in healthy racehorses undergoing competition is not well defined. The aim was to characterize arrhythmias in Thoroughbreds participating in official Chuckwagon races and to determine normal beat-to-beat (R-R) variability during supramaximal exercise. Electrocardiograph (ECG) recordings were obtained during pre-race, race, and active-recovery from 82 clinically healthy Thoroughbreds. ECG recordings were analyzed for arrhythmias and mean percent R-R deviation. Plasma lactate and high-sensitivity troponin (hs-cTnT) were also measured. Fifty-two ECGs were included in the analysis. Arrhythmias were seen in 48/52 horses (92%) and were predominantly isolated events. No complex rhythms were observed. During the race, 92% of horses had arrhythmias (81% supraventricular premature complex [SVPC]; 33% ventricular premature complex [VPC]). Eleven percent of racing arrhythmias were VPCs (all singlets except for two couplets). During active-recovery, 58% of horses had arrhythmias (56% SVPC; 15% VPCs): Three horses had VPC couplets and one horse had a VPC triplet. All plasma hs-cTnT were within normal limits. The measured lactate was 28.5 ± 4.5 mmol/L, confirming supramaximal exercise. R-R variation ranged between -9.5 to +18.8% during pre-race (mean heart rate [HR], 155 ± 22 beats per min [bpm]), -27.8 to +45.3% during racing (mean HR, 200 ± 9 bpm) and -16.4 to +40.1% during active-recovery (mean HR, 165 ± 14 bpm). Maximal and 1st percentile R-R shortening and lengthening were significantly greater at race than pre-race and active-recovery (P < 0.0001). Racing and active-recovery maximal R-R lengthening were significantly greater than pre-race (P = 0.0003). Supraventricular premature complexes and VPCs are prevalent in healthy horses undergoing Chuckwagon racing. R-R variation is greater during racing than has previously been described.

Cardiac arrhythmias in poorly performing Standardbred and Norwegian-Swedish Coldblooded trotters undergoing high-speed treadmill testing

The significance of cardiac arrhythmias and their possible association with upper airway obstruction are frequently considered in the clinical investigation of poor performance. The specific aims of this retrospective study of a group of poorly performing Standardbred and Norwegian-Swedish Coldblooded trotters were to: (1) describe the overall frequency and frequency distributions of arrhythmias; (2) describe arrhythmia characteristics including percent prematurity, relative recovery cycle lengths and QRS morphology; (3) describe variability of normal RR intervals; and (4) explore possible associations between upper airway abnormalities and arrhythmia categories during peak exercise and recovery. The records of 103 trotters presented to the Norwegian University of Life Sciences for high-speed treadmill testing were reviewed. The occurrence of at least one arrhythmic event was high (77-78%) when considering all exercise periods and 6-10% prematurity criteria. Triplets, salvos, and/or paroxysmal tachyarrhythmias occurred in 8% of horses during peak exercise. Complex ventricular arrhythmias occurred in 15% of horses in the first 2 min of recovery. Evaluation of QRS morphology and return cycle lengths demonstrated areas of overlap in characteristics typically attributed to either supraventricular or ventricular arrhythmias. There was no association between airway diagnosis and arrhythmias during any exercise period. The maximum average HR during peak exercise was an excellent predicter for complex ventricular arrhythmias during recovery. Because perfect categorization of arrhythmias is not possible, future studies should report descriptive arrhythmia information. Prospective studies that evaluate various degrees of upper airway obstruction and the effect on known initiators of arrhythmogenesis are needed.

Hypercapnia and hyperlactatemia were positively associated with higher-grade arrhythmias during peak exercise in horses during poor performance evaluation on a high-speed treadmill

Cardiac arrhythmias are common in horses during exercise, especially immediately post-exercise. The objectives of this study were to: (1) describe the frequency and type of cardiac arrhythmias detected in horses during incremental high-speed treadmill exercise testing (ITET); (2) determine if arterial blood gas (ABG) changes at peak and immediately post-exercise were associated with arrhythmias; and (3) determine whether upper or lower airway disease was associated with exercising cardiac arrhythmias. Horses (n = 368) presenting for an ITET underwent resting and exercising upper airway endoscopy, resting, exercising and post-exercise electrocardiography, resting and post-exercise echocardiography and exercising ABG. Arrhythmias were graded by the most severe arrhythmia present. Grade 1 arrhythmias were defined as one or two atrial (APCs) or ventricular premature complexes (VPCs), or one APC and one VPC, detected in 6.9% at peak and 16% at 0-2 min post exercise.. Grade 2 arrhythmias were >2 APCs or VPCs, or both, detected in 5.8% at peak and 16.6% at 0-2 min post exercise. Grade 3 included complex arrhythmias (couplets, triplets, R on T, multiform complexes or paroxysmal atrial or ventricular tachycardia), detected in 4.4% at peak and 7.3% at 0-2 min post exercise. Both partial pressure of arterial CO₂ (PaCO₂; P = 0.008) and lactate (P = 0.031) were significantly associated with arrhythmias occurring at peak exercise, but not immediately post-exercise. As PaCO₂ and lactate increased, arrhythmia severity increased. Blood pH was significantly associated with grades 2 and 3 arrhythmias at 0-2 min post ITET (OR = 0.0002; P < 0.001). There was no significant association between grades 2 and 3 cardiac arrhythmias, inflammatory airway disease (IAD), or exercise-induced pulmonary hemorrhage (EIPH). When adjusted for lactate concentration (P = 0.06), higher PaCO₂ concentrations in horses with and without exercising upper respiratory tract (URT) obstruction were associated with higher likelihood of grades 2 and 3 arrhythmias (P < 0.01). This study demonstrated that at peak exercise, with severe hypercapnia and hyperlactatemia, there was increased risk for grades 2 or 3 cardiac arrhythmias and, as the PaCO₂ and lactate values increased further, the severity of those arrhythmias increased.

Effects of endurance racing on horse plasma extracellular particle miRNA

BACKGROUND

Physical exercise is an essential factor in preventing and treating metabolic diseases by promoting systemic benefits throughout the body. The molecular factors involved in this process are poorly understood. Micro RNAs (miRNAs) are small non-coding RNAs that inhibit mRNA transcription. MiRNAs, which can participate in the benefits of exercise to health, circulate in plasma in extracellular particles (EP). Horses that undergo endurance racing are an excellent model to study the impact of long-duration/low intensity exercise in plasma EP miRNAs.

OBJECTIVES

To evaluate the effects of 160 km endurance racing on horse plasma extracellular particles and their miRNA population.

STUDY DESIGN

Cohort study.

METHODS

We collected plasma from five Arabian horses during five time-points of an endurance ride. Extracellular particles were purified from plasma and characterised by electron microscopy, resistive pulse sensing (qNano) and western blotting. Small RNAs were purified from horse plasma EP, and sequencing was performed.

RESULTS

Endurance racing increased EP concentration and average diameter compared to before the race. Western blotting showed a high concentration of extracellular vesicles proteins 2 hours after the race, which returned to baseline 15 hours after the race. MicroRNA differential expression analysis revealed increasing levels of eca-miR-486-5p during and after the race, and decreasing levels of eca-miR-9083 after the end.

CONCLUSIONS

This study adds new data about the variation in plasma EP concentrations after long-distance exercise and brings new insights about the roles of exercise-derived EP miRNAs during low-intensity endurance exercise.

Alterations of cardiac and renal biomarkers in horses naturally infected with theileria equi

Equine theileriosis due to Theileria equi is probably the most widespread and pathogenic disease of equines, which comes with major cardiac and renal complications. This study was undertaken to investigate the biomarkers of cardiac and renal functions in horses infected with T. equi and determine the association between these parameters and the level of parasitemia. Giemsa-stained blood smears from 300 horses with ages of 3-4 years old were examined for detection of T. equi on erythrocytes. Moreover, multiplex PCR was employed for confirmation of the diagnosis in the 28 positive cases. Based on the rate of red blood cell infection, the infected animals were subdivided into horses with low (n = 9), moderate (n = 13) and high (n = 6) parasitemia. The concentrations of urea, creatinine, cystatin-C, cardiac troponin I (cTn-I), homocysteine (Hcy), myocardial fractions of creatine kinase (CK-MB) and d-dimer were determined in control (healthy) horses (n = 20) and the infected animals. The results revealed that both the renal (urea, creatinine and cystatin-C) and the cardiac (cTn-I, Hcy, CK-MB and d-dimer) biomarkers increased in a parasitemia burden-dependent pattern. However, urea, creatinine, cTn-I and d-dimer levels were not significantly influenced in the horses infected with low rate (<1 %) of parasitemia (p> 0.05). Moreover, all of the biomarkers were significantly and positively associated with the parasitemia (R2> 0.5). In conclusion, T. equi infection was related to cardiac and renal complications evidenced by increase in the levels of biomarkers and evaluation of these indices may have promise for early diagnosis of the complications.

Relationship between Resting and Recovery Heart Rate in Horses

In endurance racing the heart rate (HR) of horses in the veterinary gates has to reach a maximum set to continue racing. There is no literature on the relationship between resting HR (HRresting) and HR after exercise (HRrecovery). This relationship was examined in seven horses and the results were related to their v4 (speed at which the blood lactate concentration is 4 mmol/L). Horses were submitted to an exercise test to determine v4. Thereafter, horses were exercised on a treadmill in randomized order for 10 and 60 min at different speeds. HR was measured before exercise and several times until 30 min of recovery. The relationship between HRresting and HRrecovery was significant in 16 out of 35 comparisons. There were no significant relationships between the v4 of the horses and their HRresting and between v4 and HRrecovery after 10 min of exercise, regardless of the speed of exercise, with one exception. The relationship between the v4 of the horses and their HRrecovery after 60 min of exercise was significant in the fifth minute after exercise at 3.5 m/s only. Conclusion: Because HRresting and HRrecovery are often related, pre-determined arbitrary HRrecovery values may not allow for fair competition during endurance racing.

Rapid screening for cardiac arrhythmias in competition draft horses

Cardiac arrhythmias may cause decreased performance and sudden death during exercise. Our objectives were: (1) to determine prevalence of unrecognised arrhythmias in a population of competition draft horses by performing short duration screening electrocardiograms (ECGs) at rest; and (2) to assess utility of a commercial handheld device for recording equine ECGs. Owners or trainers of 244 draft horses (age 0.5-16 years), including 82 Percherons, 69 Belgians, 69 Clydesdales, 11 Belgian mules, 8 Shires, and 5 Percheron mules, were queried to determine signalment, performance history, and known arrhythmias. All horses were auscultated for 30 s and ECGs were obtained in 204 horses using a handheld recording device (AliveCor®). ECGs were reviewed for quality and used to determine heart rate (HR) and rhythm. When ECG tracing quality permitted, PQ and QT intervals were also measured. ECGs displaying RR intervals adequate for HR determination and rhythm assessment were recorded from 161 horses (79%) while tracings with consistent P waves, QRS complexes, and T waves were recorded from only 47 horses (23%). Four arrhythmias were detected by both auscultation and ECG: atrial fibrillation (1), premature complexes (1), and second-degree atrioventricular block (2). None of these horses had a history of poor performance or previous recognition of an arrhythmia. The prevalence of unrecognised, and potentially clinically significant, arrhythmias in draft horses at rest appears to be low (2/244; 0.8%, 95% confidence interval 0.1-2.9%). Longer recordings at rest, as well as recordings during and immediately after exercise, would likely have revealed a higher prevalence of arrhythmias.

Cardiovascular Causes of Poor Performance and Exercise Intolerance and Assessment of Safety in the Equine Athlete

Horses have a high prevalence of resting arrhythmias, cardiac murmurs, and valvular regurgitation, and training can increase the prevalence. This makes it challenging for equine veterinarians who are asked to evaluate horses for poor performance to determine the clinical relevance of some findings. In addition, cardiac disease has the potential to cause collapse or sudden death, putting both the horse and rider at risk. Further diagnostics, such as echocardiograms and resting and exercising ECGs can help to sort out the impact of an abnormality found on resting physical examination. However uncertainty over the importance of some findings continues to exist.

Effect of induced chronic atrial fibrillation on exercise performance in Standardbred trotters

Background

Atrial fibrillation (AF) is the most common arrhythmia affecting performance in horses. However, no previous studies have quantified the performance reduction in horses suffering from AF.

Objectives

To quantify the effect of AF on maximum velocity (V_max), maximum heart rate (HR_max), heart rate recovery (T₁₀₀), hematologic parameters and development of abnormal QRS complexes.

Animals

Nine Standardbred trotters.

Methods

Two‐arm controlled trial. Six horses had AF induced by means of a pacemaker and 3 served as sham‐operated controls. All horses were subjected to an exercise test to fatigue before (SET1) and after (SET2) 2 months of AF or sham. The V_max and HR_max were assessed using a linear mixed normal model. Abnormal QRS complexes were counted manually on surface ECGs.

Results

Atrial fibrillation resulted in a 1.56 m/sec decrease in V_max (P < .0001). In the AF group, HR_max ± SD increased from 226 ± 11 bpm at SET1 to 311 ± 27 bpm at SET 2. The AF group had higher HR_max at SET2 compared with controls (P < .0001), whereas no difference between the control and AF groups was observed at SET1 (P = .96). Several episodes of wide complex tachycardia were observed during exercise in 3 of the AF horses during SET2.

Conclusions and Clinical Importance

Atrial fibrillation resulted in a significant reduction in performance, an increase in HR and development of abnormal QRS complexes during exercise, which may be a risk factor for collapse or sudden cardiac death.

Prospective pre- and post-race evaluation of biochemical, electrophysiologic, and echocardiographic indices in 30 racing thoroughbred horses that received furosemide

Background

Exercise induced cardiac fatigue (EICF) and cardiac dysrhythmias are well described conditions identified in high-level human athletes that increase in frequency with intensity and duration of exercise. Identification of these conditions requires an understanding of normal pre- and post-race cardiac assessment values. The objectives of this study were to (1) characterize selected indices of cardiac function, electrophysiologic parameters, and biochemical markers of heart dysfunction prior to and immediately after high level racing in Thoroughbred horses receiving furosemide; and (2) create pre- and post-race reference values in order to make recommendations on possible screening practices for this population in the future.

Results

Thirty Thoroughbred horses were enrolled in the study with an age range of 3–6 years. All horses received furosemide prior to racing. Physical exams, ECGs, and echocardiograms were performed prior to racing (T0) and within 30–60 min following the race (T1). Blood samples were obtained at T0, T1, 4 h post-race (T4) and 24 h after the race (T24). Electrolytes, hematocrit, cardiac troponin I, and partial pressure CO2 values were obtained at all time points. Heart rate was significantly increased post-race compared to baseline value with a median difference of 49 bpm, 95% CI [31,58],(P < 0.0001). No dysrhythmias were noted during ECG assessment. Following the race, an increase in number of horses demonstrating regurgitation through the aorta and AV valves was noted. Systolic function measured by fractional shortening increased significantly with a mean difference of 7.9%, 95% CI [4.8, 10.9], (P < 0.0001). Cardiac troponin I was not different at pre- and immediately post-race time points, but was significantly increased at T4 (P < 0.001). Troponin returned to baseline value by T24.

Conclusions

This study utilized a before and after study design where each horse served as its own control, as such the possible effect of regression to the mean cannot be ruled out. The reference intervals generated in this study may be used to identify selected echocardiographic and electrocardiographic abnormalities in racing horses receiving furosemide.

24-Hour Kinetics of Cardiac Troponin-T Using a "High-Sensitivity" Assay in Thoroughbred Chuckwagon Racing Geldings after Race and Associated Clinical Sampling Guidelines

Background

A “high‐sensitivity” cardiac troponin‐T (hscTnT) assay recently has been validated for use in horses and is a specific biomarker of myocardial damage. Postexercise release kinetics of cTnT utilizing the hscTnT assay have yet to be established in horses.

Objectives

To determine: (1) cTnT release kinetics in racing Thoroughbreds after a high‐intensity 5/8th mile Chuckwagon race; (2) the effects of age on pre‐ and postrace cTnT concentrations; and (3) sampling guidelines for clinicians evaluating horses presenting after exercise.

Animals

Samples were obtained from 38 Thoroughbred geldings aged 5–16 years before racing and immediately, 2, 3, 4, 6, 12, and 24 hour postrace.

Methods

Prospective, observational study with convenience sampling. A fifth‐generation hscTnT assay was used for plasma sample analysis, and concentrations were compared at all time‐points. Correlations were determined between cTnT concentrations and age. Biochemistry analysis was performed to assess rhabdomyolysis, renal failure, and exercise‐induced dehydration.

Results

All horses with measureable cTnT concentrations had significant postexercise increases in cTnT with a median peak (8.0 ng/L) at 3‐hour postrace. All horses had peak postexercise cTnT concentrations 2‐ to 6‐hour postrace ≤ the 99th percentile upper reference limit of 23.2 ng/L, after which all cTnT concentrations decreased until returning to baseline by 12–24 hours. There was no correlation over time between cTnT concentrations and age.

Conclusions and Clinical Importance

In racing Thoroughbreds completing short‐duration, high‐intensity Chuckwagon races, cTnT concentrations are expected to be increased 2‐ to 6‐hour postrace and to decrease by 12–24 hours while remaining ≤23.2 ng/L throughout. This study contributes to establishing guidelines for clinical use of the hscTnT assay in exercising horses.

The heart remains the core: cardiac causes of poor performance in horses compared to human athletes

Cardiac remodelling occurs in response to exercise and is generally beneficial for athletic performance due to the increase in cardiac output. However, this remodelling also may lead to an increased prevalence of cardiac murmurs and arrhythmias. In most cases, these are not considered to be significant. However, in some cases, there may be potentially deleterious consequences. Whilst sudden cardiac death (SCD) is a rare occurrence, the consequences are catastrophic for both the horse and potentially the rider or driver. Furthermore, the sudden death of a horse in the public arena has negative connotations in regards to public perception of welfare during equestrian sports. Prediction of which individuals might be susceptible to potential deleterious effects of exercise is a focus of interest in both human and equine athletes but remains a challenge because many athletes experience cardiac murmurs and exercise-induced arrhythmias that are clinically irrelevant. This review summarises the effects of exercise on cardiac remodelling in the horse and the potential effects on athletic performance and SCD. The use of biomarkers and their future potential in the management of athletic horses is also reviewed.

Left Ventricular Function After Prolonged Exercise in Equine Endurance Athletes

BACKGROUND

Prolonged exercise in human athletes is associated with transient impairment of left ventricular (LV) function, known as cardiac fatigue. Cardiac effects of prolonged exercise in horses remain unknown.

OBJECTIVES

To investigate the effects of prolonged exercise on LV systolic and diastolic function in horses.

ANIMALS

Twenty-six horses competing in 120-160 km endurance rides.

METHODS

Cross-sectional field study. Echocardiography was performed before and after rides, and the following morning, and included two-dimensional echocardiography, anatomical M-mode, pulsed-wave tissue Doppler imaging, and two-dimensional speckle tracking. Correlation between echocardiographic variables and cardiac troponin I was evaluated.

RESULTS

Early diastolic myocardial velocities decreased significantly in longitudinal (baseline: -17.4 ± 2.4cm/s; end of ride: -15.8 ± 3.2cm/s (P = .013); morning after: -15.4 ± 3.0cm/s (P = .0033)) and radial directions (-32.8 ± 3.4cm/s; -28.1 ± 5.8cm/s (P < .001); -26.4 ± 5.5cm/s (P < .001)). Early diastolic strain rates decreased significantly in longitudinal (1.58 ± 0.27s(-1) ; 1.45 ± 0.26s(-1) (P = .036); 1.41 ± 0.25s(-1) (P = .013)) and circumferential directions (2.43 ± 0.29s(-1) ; 1.96 ± 0.46s(-1) (P < .001); 2.11 ± 0.32s(-1) (P < .001)). Systolic variables showed ambiguous results. No correlations with serum cardiac troponin I concentrations were evident.

CONCLUSIONS AND CLINICAL IMPORTANCE

Prolonged exercise in horses is associated with impaired LV diastolic function. Reduced ventricular filling persisted for 7-21 hours despite normalization of biochemical indicators of hydration status, indicating that the observed changes were not entirely related to altered preload conditions. The clinical relevance of cardiac fatigue in horses remains uncertain.