Intracardiac heartworms in dogs: Clinical and echocardiographic characteristics in 72 cases (2010-2019)

Right Ventricle Strain Assessed by 2-Dimensional Speckle Tracking Echocardiography (2D-STE) to Evaluate Pulmonary Hypertension in Dogs with Dirofilaria immitis

Echocardiographic assessment of the right ventricle is helpful for analysing the pathophysiology of heartworm disease and detecting pulmonary hypertension (PH) in dogs. In veterinary cardiology, the study of myocardial deformation using two-dimensional speckle tracking (2D-STE) echocardiography has become increasingly acknowledged as useful for quantifying right ventricular function. The aim of this study was to evaluate the usefulness of myocardial deformation strain of the right ventricular free wall (FWS), global deformation strain of the right ventricle, including the interventricular septum (GS), and tissue motion annular displacement of the tricuspid valve (TMAD) in a cohort of dogs with heartworm (Dirofilaria immitis) disease and to determine cut-off values for detecting the presence of PH. Out of the 93 dogs tested, 71% were diagnosed with heartworm infection. PH was identified in 41% of the infected dogs following the American College of Veterinary Internal Medicine (ACVIM) guidelines, based on the peak tricuspid regurgitation velocity to calculate the tricuspid regurgitation pressure gradient (TRPG), while other routine measurements were used, including the right pulmonary artery distensibility index (RPADi). The 2D-STE mode measurements were determined using Right Ventricular Automated Function Imaging (RV AFI®) software. The statistical analysis showed significant differences in the studied parameters among dogs with and without PH. Additionally, sensitivity (sen) and specificity (sp) cut-off values were obtained (GS ≥ -21.25%, sen 96%, sp 86.4%; FWS ≥ -21.95%, sen 92.56%, sp 95.5%; TMAD ≤ 0.85 cm, sen 70.4%, sp 83.3%). These results demonstrated that GS, FWS, and TMAD could be used as supplementary and alternative variables to conventional echocardiographic measurements when detecting PH in dogs with heartworm disease.

Interventional Heartworm Extraction in Two Dogs: The Clinical Application of Impedance Cardiography

Heartworm (HW) disease, caused by Dirofilaria immitis, is a life-threatening ailment in dogs. HW disrupts blood flow and decreases cardiac output (CO). The accurate monitoring of CO during HW extraction is pivotal for patient survival and overall health.

OBJECTIVE

This study aimed to assess the efficacy of using impedance cardiography (ICG) as a non-invasive approach for monitoring CO during interventional HW extraction.

METHODS

Two cases of HW infections were treated via surgical extraction. The CO and mean arterial pressure (MAP) were monitored using the ICG technique during the anesthesia stabilization, extraction process, and post-extraction phases.

RESULTS

In Case 1, the CO increased by 115% post-procedure, and in Case 2, the CO increased by 116%. In contrast, the MAP varied between the two cases. The ICG method provided real-time CO data without major disruptions during the extraction surgery.

CONCLUSION

The ICG technique for CO monitoring during interventional HW extractions is effective.

Retrospective study of canine blood xenotransfusion compared with type-matched feline blood allotransfusion to cats: indications, effectiveness, limitations and adverse effects

OBJECTIVES

Xenotransfusion is the transfusion of blood from one species to another. With varying availability of allogenic feline blood (AFB) and in emergency conditions, circumstances occur when canine blood is transfused to cats. This study aimed to characterise the indications, effectiveness, limitations, and acute and late transfusion-related adverse effects of canine blood xenotransfusion compared with matched AFB to anaemic cats, and their survival and longer-term outcome.

METHODS

This retrospective study (2013-2020) examined cats receiving canine blood xenotransfusions or AFB.

RESULTS

The study included 311 cats (xenotransfusion [X-group], n = 105; allotransfusion [A-group], n = 206). Xenotransfusion was more frequent among cats sustaining haemorrhage than in those with haemolysis (P <0.01) or hypoproliferative anaemia (P <0.001). Financial constraints were the most common reason to elect xenotransfusion (49%). The post-transfusion mean packed cell volume was higher (P <0.001) in the X-group (22%) compared with the A-group (18%), and also higher (P <0.001) at 48-96 h post-transfusion (23% vs 18%, respectively). Transfusion-related adverse effects (TRAEs) were more frequent (P = 0.001) in the X-group (37.1%) compared with the A-group (19.4%), as were delayed haemolytic transfusion reactions (85% vs 42.5%, respectively; P <0.001). Acute transfusion reactions (ATRs) were more frequent (P <0.001) in the A-group (60%) compared with the X-group (20%). TRAEs were unassociated with survival to discharge. The survival to discharge rate of the X-group (55%) was lower (P = 0.007) than in the A-group (73%), while post-discharge survival rates to 30 days of cats surviving to discharge were 90% and 88%, respectively (P = 0.85).

CONCLUSIONS AND RELEVANCE

Canine blood xenotransfusions to cats might save lives in emergency conditions when AFB is unavailable or blood typing is infeasible. The survival to discharge rate of the X-group was lower than that of the A-group. The longer-term survival rate of cats administered xenotransfusions and surviving to discharge from the hospital was good.

Heartworm adulticide treatment: a tropical perspective

Dirofilaria immitis (the canine heartworm) is widespread in the tropics, with prevalence surpassing 30% in high-risk areas. In addition to the suitable climatic conditions that favour mosquito abundance and filarial larva development, there is low compliance with the recommended year-round use of preventives in these transmission hotspots. This represents a major concern, considering that melarsomine (first-line heartworm adulticide) is unavailable in several tropical countries, resulting in the so-called slow-kill protocol being the only available adulticide treatment option. In this article, the members of TroCCAP (Tropical Council for Companion Animal Parasites) review the current distribution of heartworm in the tropics and the availability of melarsomine, and discuss alternatives for the management of heartworm infections in dogs.

Management and outcome of intracardiac heartworms in dogs

BACKGROUND

Intracardiac heartworm (IH) disease is a serious condition that can become life threatening if the patient develops caval syndrome. We aim to describe the management and outcome of IH in dogs evaluated by Medvet's New Orleans cardiology service from November 2015 to December 2021.

METHODS

Records of 27 dogs with IH were examined retrospectively. Follow-up information was obtained from phone conversations with referring veterinarians and owners.

RESULTS

Nine of 27 dogs had a previous diagnosis of heartworm disease and were undergoing "slow kill" treatment; 12/27 dogs' heartworm disease was a new diagnosis, and 6/27 had either scheduled or started adulticide therapy. Nine dogs had heartworm extraction. No dogs died during the heartworm extraction procedure. Four of 9 dogs have died (survival time 1; 676; 1815 and 2184 days). One dog died the day after the procedure secondary to continued respiratory distress; the other three died of non-cardiac causes. Five of nine are alive (median follow-up 1062 (range 648-1831) days. Eleven dogs had IH resolution. In 7/11 this occurred while undergoing stabilization for heartworm extraction. In 4/11 heartworm extraction was not recommended because of low IH burden. All dogs with IH resolution were discharged from the hospital. Four of 11 have died (survival time 6; 22, 58 and 835 days), and 6/11 are alive (median follow-up 523 (range 268-2081) days. One was lost to follow-up after 18 days. Five dogs were medically managed. In one of five dogs, extraction was not recommended because of low IH burden. In four of five extraction was recommended but declined. One of five has died (survival 26 days), and four of five are alive (follow-up 155, 371, 935 and 947 days). Two dogs were killed at the time of diagnosis. Fifteen of 27 dogs were considered to have caval syndrome.

CONCLUSION

The results suggest that patients with IH resolution have a good long-term prognosis. Most often IH resolution occurred while the dog was undergoing stabilization for heartworm extraction. When IHs are present, heartworm extraction should still be considered the treatment of choice and recommended as first-line therapy whenever possible.

Echocardiographic Assessment of the Pulmonary Vein to Pulmonary Artery Ratio in Canine Heartworm Disease

Background:Dirofilaria immitis produces proliferative pulmonary endarteritis and pulmonary thromboembolism in infected dogs. The pulmonary vascular lesions lead to irreversible and persistent structural damage and, as a consequence, sustained precapillary pulmonary hypertension (PH). The purpose of this study was to assess the diagnostic value of the pulmonary vein to pulmonary artery ratio (PV:PA ratio) to determine moderate or severe PH (>50 mmHg) in dogs with heartworm disease.

METHODS

A total of 151 naturally heartworm-infected and 66 healthy dogs were included in the study. The presence/absence of PH was based on the right pulmonary artery distensibility index (RPAD index < 29.5%), and the PV:PA ratio was echocardiographically measured by the time-motion mode (M mode) and two-dimensional mode (2D mode). Other echocardiographic parameters were also assessed (pulmonary trunk to aorta ratio, tricuspid regurgitation pressure gradient, and AT:ET ratio).

RESULTS

The results of the PV:PA ratio showed a highly positive correlation between the M and 2D modes (r = 0.928). The PV:PA ratio obtained by the M mode was identified as the strongest predictor for RPAD index (R² 0.628, p < 0.0001) with a good diagnostic accuracy (AUC = 0.99). The results of PV/PA by the 2D mode showed a similar prediction for the RPAD index (R² 0.606, p < 0.0001) with a good diagnostic accuracy (AUC = 0.98). Both of the 2D and M modes' PV:PA ratios decreased significantly with the presence of PH. A cut-off value of ≤0.845 showed high sensitivity and specificity for the M mode (97% and 94%, respectively) and the 2D mode (96% and 93%, respectively).

CONCLUSIONS

The PV:PA ratio may be useful as a complementary diagnostic method for the estimation of moderate or severe PH in dogs with heartworm.

A dog presenting with syncope due to two different etiologies

OBJECTIVE

The treatment of syncope depends largely on its possible etiology. Therefore, identifying the cause of syncope is very important in treatment planning. Herein, we report an etiology of syncope caused by pulmonary hypertension (PH) associated with canine filariasis, followed by syncope due to bradyarrhythmia 1 year later.

MATERIALS AND METHODS

An 8-year-old male English Cocker Spaniel was referred to our hospital for a second opinion regarding syncope that the dog had started experiencing approximately 2 months prior. Based on the examination findings, we diagnosed that the fainting was due to heartworm disease and associated PH. After increasing the dose of pimobendan (0.50 mg/kg, q12h), the syncope subsided. However, syncope recurred on the 215th day of the first episode.

RESULTS

The findings that differed from those during the initial examination were that cardiac arrest was observed for approximately 5 sec during auscultation, along with sinus arrest. Therefore, to further investigate for syncope, a Holter electrocardiograph was obtained for 3 days. Consequently, sinus arrest was identified as the etiology of the recurrent syncope, and the patient was diagnosed with sick sinus syndrome, Rubenstein classification type II. Following cilostazol (10 mg/kg, q12h) administration, the syncope subsided.

CONCLUSION

This case reports syncope in a dog, which typically occurs due to different etiologies. When a dog has PH, it may be important to think about the possibility of arrhythmias caused by a bigger right heart.

Evaluation of Pulmonary Hypertension in Dogs with Heartworm Disease Using the Computed Tomographic Pulmonary Trunk to Aorta Diameter Ratio

Dirofilaria immitis causes proliferative pulmonary endoarteritis that leads to the appearance of chronic precapillary pulmonary hypertension (PH) in dogs. Pulmonary trunk to aorta ratio (PT:Ao ratio) obtained by computed tomography (CT) was studied and the quantitative measure of the diameters of the pulmonary trunk (PT), the descending thoracic aorta (DAo) and ascending thoracic aorta (AAo) were evaluated for the determination of the presence of moderate to severe PH in 59 dogs. The diagnosis of PH was echocardiographically determined, based on the determination of the right pulmonary artery distensibility (RPAD) index (<29.5%), and compared with other parameters for estimating PH. The results showed a very high concordance: 0.976 (p-value 0.000) between the two CT methods (PT:DAo and PT:AAo) with an excellent intraclass correlation coefficient > 0.95. Moreover, cut-off values of ≥1.111 for PT:DAo, and ≥1.057 for PT:AAo were determined for dogs with an RPAD index < 29.5%, which suggests a cut-off value between healthy dogs and the presence of PH. As has been previously published, The PT:Ao ratios did not determine the presence of mild PH, so the measurements cannot be considered useful for the early diagnosis of PH in dogs with heartworm.

Efficacy of ultrasound in diagnosis of dirofilariasis in dogs caused by Dirofilaria immitis

Ultrasonic diagnostics is a modern and effective method of laboratory testing of both animals and humans, used for estimation of overall state, and for detection of different pathologies in organs and systems. The aim of the present study was to establish the efficacy of ultrasonic diagnostics of dog dirofilariasis caused by Dirofilaria immitis parasitism, based on several indexes of invasion intensity. It was established that the number of D. immitis helminths found depended on the intensity indexes of microdirafilariasis invasion: using echocardiography, there were no helminths found under the index lower than 40 larvae/cm3. Under the index higher than that, we visualized 1–10 parasite individuals in the cavity of the right ventricle and right atrium, and at the tricuspid valve leaflets. It was established by the results of echocardiography of dogs invaded by D. immitis that the level of invasion intensity impacts significantly on the animals’ heart structure and function, and on their intracardiac hemodynamics. It was proved that under increase of microfilaria number in the blood, heart function deteriorates. Under the invasion intensity lower than 40 larvae/cm3, the changes were characterized by a slight increase in thickness of the posterior wall of the left ventricle in diastole, aorta diameter, left atrium and pulmonary artery (by 6.2%). Under the invasion intensity of 40–60 larvae/cm3, the deterioration in heart structure and function was followed by thickening of the interventricular septum in diastole, posterior wall of the left ventricle in diastole (by 5.6%), increase in ejection fraction index (by 7.0%), widening of aorta root, pulmonary artery, diameter of the left ventricle (by 21.4%), and with increase in indexes of ratio between diameters of the left ventricle and pulmonary artery, and aorta (by 15.6%). Signs of hemodynamic deterioration were established in sick animals, which was characterized by increase of blood speed in the tricuspid valve (by 33.7%), and its decrease in the pulmonary artery (14.1%). Under the invasion intensity higher than 60 larvae/cm3, the aforementioned indexes changed even more significantly. We observed thickening of the posterior wall of the right ventricle in diastole, decrease of the end-systolic size of the left ventricle (by 13.0%), blood speed increase in the aorta and mitral valve (by 12.2%). The obtained results show the necessity of echocardiographic testing of dogs with cardiac dirofilariasis, which allows effective proof of the diagnosis and also helps to understand the overall state of the animal more deeply and to provide it with the appropriate symptomatic cure.

Hematological parameters of dogs for parasitism Dirofilaria immitis

The relationship between helminths and the host is built on a subtle molecular biological basis. Their pathogenic effect is characterized by the mechanical, toxic, inoculating effect on the host organism and the state of reactivity of his organism, immunological and allergic reorganization. It has been proved that helminths of the species Dirofilaria immitis are the most pathogenic nematodes of this genus because the localization of the imaginal stage of the parasite causes more complex pathogenesis of the invasion. The study aimed to establish changes in hematological parameters of dogs infected with D. immitis, considering the intensity of microfilariasis invasion. Studies have shown that the intensity of the invasion of up to 20 larvae/cm3 in the blood of dogs, significant changes in the number of erythrocytes, leukocytes, platelets, hemoglobin, and hematocrit and ESR were not found. The intensity of the invasion of 20–40 larvae/cm3 in infected dogs in the blood decreases the number of erythrocytes by 11.92 % (P < 0.05), the hemoglobin content by 16.33 % (P < 0.05), the hematocrit by 12.70% (P < 0.05) and the number of leukocytes increases by 15.17 % (P < 0.05). Indicators of the intensity of invasion of 40–60 larvae/cm3 in infected dogs showed more significant changes in the blood, which are characterized by a decrease in the number of erythrocytes by 25.54 % (P < 0.001), platelets by 34.03 % (P < 0.01), hemoglobin content by 30.86 % (P < 0.001), hematocrit by 20.56 % (P < 0.001) and an increase in the number of leukocytes by 32.75 % (P < 0.001) and ESR by 1.84 times 0.001). At indicators of the intensity of invasion of more than 60 larvae/cm3, in dogs significant (P < 0.001) decrease in the number of erythrocytes by 47.21 %, thrombocytes by 42.84 %, the content of hemoglobin by 42.27 %, the indicator of hematocrit by 41.57 % and an increase in the number of leukocytes by 44.98 % and ESR by 2.51 times. In the leukoform of dogs with increasing rates of microfilariae invasion, the number of eosinophils gradually increases to 62.38 % (P < 0.001), rod-shaped neutrophils to 27.48 % (P < 0.05), monocytes to 23.21 % (P < 0.01) and the number of lymphocytes is reduced to 45.45 % (P < 0.001). The data obtained indicate the importance of determining these indicators for heartworm disease, which complements the picture of clinical examination of animals and will allow more effective treatment of dogs in this invasion.

Clinical and blood count findings in dogs naturally infected with Dirofilaria immitis

Dirofilaria immitis is a nematode that infects canids worldwide as well as other mammalian species, including humans. Worms and dogs are well adapted to one another, making dogs the best urban host for the parasite. Nevertheless, 30% of dogs do not sufficiently present microfilaremia, that is, the low larval load impairs transmission by mosquitoes and diagnosis by its detection in the blood samples. Therefore, the canine diagnosis must always include a microfilaria test and serological tests to detect adult worm antigens. To describe the clinical findings in naturally infected dogs in Rio de Janeiro, 34 dogs were included in the study. All dogs were evaluated for history, anamnesis, physical examination, complete blood count (CBC), D. immitis testing for antigens (ELISA test SNAP 4Dx Plus®), and microfilarial burden. The most frequent complaint from the owners was coughing (14.7%, 5/34). The most common CBC finding was eosinophilia (29.4%), followed by thrombocytopenia (26.5%) and neutrophilia (14.7%). Of the 34 animals, 91.2% were microfilaremic, with a mean count of 11.939 microfilaria/mL. Veterinarians working in areas endemic to D. immitis should always undergo screening tests and pulmonary auscultation, and increased expiratory sounds, even in the absence of coughing, can be considered a sign of the disease, along with eosinophilia, thrombocytopenia, and neutrophilia.

Differential diagnosis of Dirofilaria immitis nematodes (Nematoda, Onchocercidae)

Heartworm disease is a widespread anthropozoonotic disease of carnivorous animals, as well as humans. It is caused by nematodes belonging to the suborder Filariata, family Onchocercidae, genus Dirofilaria. There are about 26 species of heartworms in nature, the most common and pathogenic species in dogs and cats in most countries is Dirofilaria immitis Leidy, 1856. Mature helminths parasitize in the right ventricle and pulmonary arteries, large veins of animals and cause heart and vascular disorders, and death. Therefore, the aim of the study was to investigate the features of morphological and metric structure of adult nematodes of D. immitis isolated from the heart of dogs. Morphological studies have shown that in males the most characteristic differential features are the presence of two unequal spicules, specifically positioned relative to each other, as well as well-defined preanal and less pronounced adanal and postanal papillae. In female heartworms, the characteristic morphological features are the shape and location of the vulva. There is a difference in the structure of the esophagus in males and females. In females, the anterior and posterior parts of the esophagus are well expressed, with enlargements, in males these divisions are not pronounced. To increase the efficiency of species identification of D. immitis nematodes, it is proposed to use metric parameters that characterize the overall body size, body and width of esophagus in different areas, length of esophagus, and the location of the nerve ring. In males, 11 indicators are also suggested that characterize the size of the spicules and the location of the cloaca. In females, seven additional parameters are pointed out that characterize the location of the vulva, anus and body width in these areas. The obtained data expand the already existing data on the peculiarities of the morphological structure of parasitic nematodes of the species D. immitis and their identification.

First Autochthonous Infection of a Cat with Dirofilaria immitis in Austria

This case report is about a seven-year-old male neutered European Shorthair cat infected by Dirofilaria immitis as the first reported autochthonous Dirofilaria immitis infection in Austria. There was no history of periods abroad. Echocardiography showed suspected D. immitis in the right cardiac chamber with increased pulmonary pressure and ascites. Surgical removal of the heartworms was performed. Twenty adult heartworms were removed by transvenous jugular approach under general anesthesia and stored in 4% formalin. Five out of 20 specimens were examined via light and stereomicroscopy and feline heartworm infection was confirmed. Amplification of a 203 bp or 724 bp fragment of the cytochrome c oxidase subunit I gene was unsuccessful. After surgery the cat developed acute renal failure but recovered quickly. One year later, the cat underwent a control examination including echocardiography and blood work. There were no more D. immitis detectable at echocardiography. Lung pressure was mildly increased. Complete blood count and creatinine were unremarkable. The Knott's test and Dirofilaria-Antigen-test produced negative results. The cat did not show any clinical signs during the follow-up period. The aim of this case report is to highlight the growing risk of acquiring infection with D. immitis not only for Austrian dogs, but also for cats. This case report represents the first report of autochthonous D. immitis infection in Austria. Moreover, even if the prognosis in cats with caval syndrome due to feline heartworm disease is guarded to poor, surgical removal of the filariae can be a successful treatment option.