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Lim S, Collins S, Hamer SA, Tarleton RL, Saunders AB. Positive clinical outcome using a modified dosing regimen of benznidazole in dogs at high risk for infection or acutely infected with Trypanosoma cruzi. J Vet Intern Med 2024. [PMID: 38500407 DOI: 10.1111/jvim.17028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/15/2024] [Indexed: 03/20/2024] Open
Abstract
Trypanosoma cruzi infection in dogs can cause heart failure and sudden death with few treatment options available. A litter of 4 dogs living in a T cruzi endemic area were randomized to prophylaxis and nonprophylaxis groups as part of a study evaluating a modified benznidazole dosing regimen administered twice weekly to prevent T cruzi infection during a vector transmission season. The 2 dogs that received prophylaxis remained healthy without T cruzi infection or cardiac disease for >2 years. One dog that did not receive prophylaxis died unexpectedly with acute T cruzi-induced pancarditis, and the second dog tested positive for T cruzi and developed complex arrhythmias with markedly increased cardiac troponin I and improved with a higher benznidazole treatment dose. Although the small sample size precludes definitive conclusions, we describe the potential clinical benefit of prophylactic and early treatment with modified benznidazole dosing regimens for dogs with T cruzi infection.
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Affiliation(s)
- Sukjung Lim
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | | | - Sarah A Hamer
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Research, Texas A&M University, College Station, Texas, USA
| | - Rick L Tarleton
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, USA
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
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Denton M, Vitt JP, Saunders AB, Wesselowski S. Double Outlet Right Atrium in an American Domestic Shorthair Cat. CASE (Phila) 2024; 8:241-246. [PMID: 38524989 PMCID: PMC10955103 DOI: 10.1016/j.case.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•DORA should be considered in cases with radiographic evidence of LA enlargement. •TTE can diagnose DORA. •Cats with DORA may remain undiagnosed until adulthood.
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Affiliation(s)
- Matthew Denton
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Jordan P. Vitt
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Ashley B. Saunders
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Sonya Wesselowski
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
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Malcolm EL, Saunders AB. Complex Tetralogy of Fallot in an Acyanotic Adult Dog. CASE (Phila) 2024; 8:231-235. [PMID: 38524971 PMCID: PMC10954675 DOI: 10.1016/j.case.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•TOF with PA hypoplasia can be diagnosed in adult dogs. •MAPCAs were suspected on the basis of TTE detection of collateral vessels. •Acyanosis in this dog was attributed to multiple sources of pulmonary blood flow. •Augmented reality can provide unique imaging capabilities for complex heart defects.
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Affiliation(s)
- Elizabeth L. Malcolm
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Ashley B. Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
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Wesselowski S, Saunders AB. Transesophageal echocardiography using a microprobe for determination of transcatheter procedural candidacy, device selection, and procedural monitoring in small dogs with patent ductus arteriosus. J Vet Cardiol 2024; 52:35-42. [PMID: 38422726 DOI: 10.1016/j.jvc.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Small dogs with patent ductus arteriosus (PDA) may be unable to undergo transesophageal echocardiography (TEE) with traditional probes. OBJECTIVES To report the utility of TEE using a microprobe in dogs weighing less than 4 kg diagnosed with PDA for determination of transcatheter procedural candidacy, device selection, and intraoperative procedural guidance. ANIMALS Eight dogs weighing less than 4 kg diagnosed with PDA. MATERIALS AND METHODS All dogs had standard transthoracic echocardiography and microprobe TEE imaging. The quality of TEE images was graded as optimal, adequate, or poor. The ability of TEE to assess PDA anatomy, determine procedural candidacy, provide procedural guidance, detect deployed devices, and assess residual flow was recorded. RESULTS The median age of included dogs was 6.4 months (range: 3.2-15.7 months) and the median body weight was 2.2 kg (range: 1.4-3.8 kg). Microprobe TEE images were adequate or optimal in all dogs and were integral for guiding procedural candidacy decisions. Transcatheter procedures were not pursued in two dogs based on TEE images. In the other six dogs, TEE procedural guidance was useful during transvenous (n = 5) and transarterial (n = 1) PDA occlusion attempts. Each deployed device (n = 4) was easily detected with the TEE microprobe. Real-time confirmation of adequate device sizing and placement was possible prior to release and residual flow could be monitored after release. CONCLUSIONS Transesophageal echocardiography using a microprobe in dogs weighing less than 4 kg diagnosed with PDA allowed for characterization of PDA anatomy and determination of transcatheter procedural candidacy. Microprobe TEE images were integral for PDA device selection and offered valuable intraoperative procedural guidance.
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Affiliation(s)
- S Wesselowski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA.
| | - A B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
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Busselman RE, Curtis-Robles R, Meyers AC, Zecca IB, Auckland LD, Hodo CL, Christopher D, Saunders AB, Hamer SA. Abundant triatomines in Texas dog kennel environments: Triatomine collections, infection with Trypanosoma cruzi, and blood feeding hosts. Acta Trop 2024; 250:107087. [PMID: 38061614 DOI: 10.1016/j.actatropica.2023.107087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023]
Abstract
Triatomine insects are vectors of the protozoan parasite Trypanosoma cruzi- the causative agent of Chagas disease. Chagas disease is endemic to Latin America and the southern United States and can cause severe cardiac damage in infected mammals, ranging from chronic disease to sudden death. Identifying interactions among triatomines, T. cruzi discrete typing units (DTUs), and blood feeding hosts is necessary to understand parasite transmission dynamics and effectively protect animal and human health. Through manual insect trapping efforts, kennel staff collections, and with the help of a trained scent detection dog, we collected triatomines from 10 multi-dog kennels across central and south Texas over a one-year period (2018-2019) and tested a subset to determine their T. cruzi infection status and identify the primary bloodmeal hosts. We collected 550 triatomines, including Triatoma gerstaeckeri (n = 515), Triatoma lecticularia (n = 15), Triatoma sanguisuga (n = 6), and Triatoma indictiva (n = 2), with an additional 10 nymphs and 2 adults unable to be identified to species. The trained dog collected 42 triatomines, including nymphs, from areas not previously considered vector habitat by the kennel owners. Using qPCR, we found a T. cruzi infection prevalence of 47 % (74/157), with T. lecticularia individuals more likely to be infected with T. cruzi than other species. Infected insects harbored two T. cruzi discrete typing units: TcI (64 %), TcIV (23 %), and mixed TcI/TcIV infections (13 %). Bloodmeal host identification was successful in 50/149 triatomines, revealing the majority (74 %) fed on a dog (Canis lupus), with other host species including humans (Homo sapiens), raccoons (Procyon lotor), chickens (Gallus gallus), wild pig (Sus scrofa), black vulture (Coragyps atratus), cat (Felis catus), and curve-billed thrasher (Toxostoma curviostre). Given the frequency of interactions between dogs and infected triatomines in these kennel environments, dogs may be an apt target for future vector control and T. cruzi intervention efforts.
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Affiliation(s)
- R E Busselman
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, United States
| | - R Curtis-Robles
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, United States
| | - A C Meyers
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, United States
| | - I B Zecca
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, United States
| | - L D Auckland
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, United States
| | - C L Hodo
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, United States; Michale E. Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, Bastrop, TX, United States
| | | | - A B Saunders
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, United States
| | - S A Hamer
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, United States.
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Wesselowski S, Sykes KT, Saunders AB, Werre SR. Echocardiographic values and prevalence of cardiac abnormalities in clinically healthy adult Borzoi dogs. Am J Vet Res 2024:1-10. [PMID: 38154250 DOI: 10.2460/ajvr.23.11.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To develop breed-specific echocardiographic values for normal Borzoi and to report the prevalence of structural cardiac abnormalities. ANIMALS 146 clinically healthy, adult Borzoi dogs. METHODS Cardiac auscultation and standard echocardiograms were performed. Longitudinal follow-up was described in a subset of dogs (n = 25). RESULTS Most Borzoi were structurally normal (119/146, 81.5%), with breed-specific echocardiographic values generated independently for each sex, as females weighed significantly less than males (30.4 ± 3.8 kg vs 38.3 ± 4.1 kg, respectively; P < .001), and a significant impact of sex was found on most measurements. Physiologic heart murmurs were identified in 64/119 (53.8%) normal dogs. Thirty-six (30.2%) structurally normal dogs had trace or mild mitral regurgitation, and 43 (36.1%) had trace or mild tricuspid regurgitation. Structural cardiac disease was identified in 21 dogs (14.4%), including 9 dogs (6.2%) with dilated cardiomyopathy (DCM), 9 dogs (6.2%) with stage B1 myxomatous mitral valve disease (MMVD), and 3 (2.1%) dogs with congenital abnormalities. Seven dogs (4.8%) had equivocal abnormalities. During follow-up, new dogs were diagnosed with occult DCM (n = 3), equivocal DCM (1), and stage B1 MMVD (2). Two dogs originally diagnosed with DCM (1 occult and 1 equivocal) normalized after diet change. CLINICAL RELEVANCE Borzoi dogs commonly have physiologic heart murmurs and mild atrioventricular valve regurgitation. Both DCM and MMVD were identified at similar frequencies in healthy Borzoi, although dogs with MMVD all had normal heart sizes. Echocardiographic screening for DCM in Borzoi should be considered, with breed-specific echocardiographic values now available for improved diagnostic confidence.
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Affiliation(s)
- Sonya Wesselowski
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - K Tess Sykes
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - Stephen R Werre
- Department of Population Health Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rodriguez CA, Busselman RE, Shen H, Saunders AB, Tarleton R, Hamer SA. Validation of a multiplex microsphere immunoassay for detection of antibodies to Trypanosoma cruzi in dogs. J Vet Diagn Invest 2023; 35:704-709. [PMID: 37670473 PMCID: PMC10621557 DOI: 10.1177/10406387231198525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
The vector-borne protozoan parasite Trypanosoma cruzi causes Chagas disease in humans, dogs, and many other mammalian hosts. Canine Chagas disease is increasingly diagnosed in dogs of the southern United States where triatomine insect vectors occur, and there are limited veterinary testing options; only the indirect fluorescent antibody (IFA) test is offered at a single accredited diagnostic laboratory. We evaluated a multiplex microsphere immunoassay (MIA) for the detection of antibodies against T. cruzi in dogs and compared it with existing serologic methods to establish cutoff values and relative sensitivity and specificity. We tested 135 canine sera that had been characterized using the IFA and off-label use of 2 commercial rapid assays with our multiplex MIA against 12 antigens: 9 T. cruzi antigens, a negative control recombinant protein (green fluorescent protein, GFP), a Leishmania antigen, and a canine parvovirus antigen (used as an antibody control given near-ubiquitous parvoviral vaccination). The median fluorescence intensity (MFI) ratio between each T. cruzi antigen and GFP was calculated for every sample. Samples with an antigen:GFP MFI ratio > 4 SDs above the mean of 25 known-negative sera were considered positive to that antigen. Samples testing positive to ≥ 2 antigens were considered positive for T. cruzi antibodies. Compared to the IFA, our multiplex MIA had a relative sensitivity of 100% and specificity of 97.0%. Given its precision, high-throughput format, potential for automation, and lack of subjective interpretation, our multiplex MIA should be considered a valid and improved assay for T. cruzi antibodies in dogs.
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Affiliation(s)
- Carlos A. Rodriguez
- Texas A&M Veterinary Medical Diagnostic Laboratory, College Station, TX, USA
- Departments of Veterinary Integrative Biosciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Rachel E. Busselman
- Departments of Veterinary Integrative Biosciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Huifeng Shen
- Emory University School of Medicine, Atlanta, GA, USA
- University of Georgia, Athens, GA, USA
| | - Ashley B. Saunders
- Small Animal Clinical Sciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | | | - Sarah A. Hamer
- Departments of Veterinary Integrative Biosciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA
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Wesselowski S, Lidbury J, Saunders AB, Gordon SG, Suchodolski JS, Steiner JM. Analytical validation, sample stability, and clinical evaluation of a new high-sensitivity cardiac troponin I immunoassay for use in dogs, with comparison to a previous ultrasensitive assay. PLoS One 2023; 18:e0288801. [PMID: 37463140 DOI: 10.1371/journal.pone.0288801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
Cardiac troponin I (cTnI) is considered the gold standard biomarker for myocardial injury and shows a high degree of homology between humans and dogs. The ADVIA Centaur XP High-Sensitivity Troponin I (AC-cTnI-HS) assay has been validated for use in humans but not dogs. The study objectives were to analytically validate the AC-cTnI-HS assay in dogs, to assess correlation between the AC-cTnI-HS and a previous ADVIA Centaur TnI-Ultra (AC-cTnI-U) assay, to assess cTnI sample storage stability, and to clinically evaluate the AC-cTnI-HS assay in healthy dogs and dogs with cardiac disease. Canine serum samples were used for analytical validation. Intra- and inter-assay variability, dilutional parallelism, and spiking recovery were assessed. Samples from 196 client-owned dogs were evaluated (healthy dogs (n = 39) or dogs with congenital heart disease (n = 54), myxomatous mitral valve disease (n = 68), dilated cardiomyopathy (n = 15), or myocarditis (n = 20)). Inter- and intra-assay coefficient of variation (%CV) was between 2.8-41.4% and 3.8-30.2%, respectively, with pools with concentrations >20 pg/mL all having %CVs <10%. The observed to expected ratios for dilutional parallelism and spiking recovery experiments ranged between 92.3 and 266.7.0% and 84.3 and 108%, respectively. A strong correlation between the AC-cTnI-HS and AC-cTnI-U assays was observed (Spearman's ρ = 0.927), though a proportional bias existed, with AC-cTnI-HS assay concentrations being proportionally lower than AC-cTnI-U assay concentrations. Serum samples stored at -80°C had stable cTnI measurements for up to 2.7 years and after a single freeze-thaw cycle. Healthy dogs and dogs with congenital heart disease had significantly lower cTnI concentrations than dogs in the other three groups. The AC-cTnI-HS assay precisely, reproducibly, and accurately measures cTnI concentrations in dog serum with cTnI concentrations >20 pg/mL.
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Affiliation(s)
- Sonya Wesselowski
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States of America
| | - Jonathan Lidbury
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States of America
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States of America
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States of America
| | - Jan S Suchodolski
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States of America
| | - Joerg M Steiner
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States of America
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Molli A, Wesselowski S, Saunders AB, Gordon SG. Advanced imaging in an adult dog with anomalous origin of the left coronary artery from the pulmonary artery and extensive collateral coronary circulation. J Vet Cardiol 2023; 48:31-36. [PMID: 37379743 DOI: 10.1016/j.jvc.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/30/2023]
Abstract
A three-year-old, spayed female, Bichon Frise was diagnosed with an anomalous origin of the left coronary artery from the pulmonary artery, a rare congenital coronary artery defect which has only been reported in two other dogs. Echocardiography was initially performed, though the final diagnosis was made with angiography and computed tomography angiography. An extensive network of collateral coronary circulation allowed for communication between the dilated, tortuous right coronary artery, and the anomalous left coronary artery. Though collateral circulation likely prolonged the patient's life, it is suspected that coronary steal phenomenon and chronic myocardial ischemia ultimately led to fatal ventricular arrhythmias. The dog died suddenly at the age of six, three years after initial diagnosis.
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Affiliation(s)
- A Molli
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - S Wesselowski
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA.
| | - A B Saunders
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - S G Gordon
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
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Barnett BG, Wesselowski SR, Gordon SG, Saunders AB, Promislow DEL, Schwartz SM, Chou L, Evans JB, Kaeberlein M, Creevy KE. A masked, placebo-controlled, randomized clinical trial evaluating safety and the effect on cardiac function of low-dose rapamycin in 17 healthy client-owned dogs. Front Vet Sci 2023; 10:1168711. [PMID: 37275618 PMCID: PMC10233048 DOI: 10.3389/fvets.2023.1168711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/03/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Geroscience studies of low-dose rapamycin in laboratory species have identified numerous benefits, including reversing age-related cardiac dysfunction. Cardiovascular benefits have been observed in dogs with 10 weeks of treatment, raising questions about possible benefits and adverse effects of long-term use of low-dose rapamycin. The objectives of this study were to assess the impact of 6 months of low-dose rapamycin on echocardiographic indices of cardiac function in healthy dogs and to document the occurrence of adverse events. Methods Seventeen client-owned dogs aged 6-10 years, weighing 18-36 kg, and without significant systemic disease were included in a prospective, randomized, placebo-controlled, masked clinical trial. Low-dose rapamycin (0.025 mg/kg) or placebo was administered three times per week for 6 months. Baseline, 6-month, and 12-month evaluation included physical examination, cardiology examination, and clinicopathology. Three-month evaluation included physical examination and clinicopathology. Owners completed online questionnaires every 2 weeks. Results There were no statistically significant differences in echocardiographic parameters between rapamycin and placebo groups at 6 or 12 months. No clinically significant adverse events occurred. In 26.8% of the bi-weekly surveys owners whose dogs received rapamycin reported perceived positive changes in behavior or health, compared to 8.1% in the placebo group (p = 0.04). Discussion While no clinically significant change in cardiac function was observed in dogs treated with low-dose rapamycin, the drug was well-tolerated with no significant adverse events.
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Affiliation(s)
- Brian G Barnett
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Sonya R Wesselowski
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Daniel E L Promislow
- Department of Biology, University of Washington, Seattle, WA, United States
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
| | - Stephen M Schwartz
- Epidemiology Program, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Lucy Chou
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Jeremy B Evans
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Matt Kaeberlein
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
| | - Kate E Creevy
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
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Bustamante JM, White BE, Wilkerson GK, Hodo CL, Auckland LD, Wang W, McCain S, Hamer SA, Saunders AB, Tarleton RL. Frequency Variation and Dose Modification of Benznidazole Administration for the Treatment of Trypanosoma cruzi Infection in Mice, Dogs, and Nonhuman Primates. Antimicrob Agents Chemother 2023; 67:e0013223. [PMID: 37039666 PMCID: PMC10190575 DOI: 10.1128/aac.00132-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/22/2023] [Indexed: 04/12/2023] Open
Abstract
Trypanosoma cruzi naturally infects a broad range of mammalian species and frequently results in the pathology that has been most extensively characterized in human Chagas disease. Currently employed treatment regimens fail to achieve parasitological cure of T. cruzi infection in the majority of cases. In this study, we have extended our previous investigations of more effective, higher dose, intermittent administration protocols using the FDA-approved drug benznidazole (BNZ), in experimentally infected mice and in naturally infected dogs and nonhuman primates (NHP). Collectively, these studies demonstrate that twice-weekly administration of BNZ for more than 4 months at doses that are ~2.5-fold that of previously used daily dosing protocols, provided the best chance to obtain parasitological cure. Dosing less frequently or for shorter time periods was less dependable in all species. Prior treatment using an ineffective dosing regimen in NHPs did not prevent the attainment of parasitological cure with an intensified BNZ dosing protocol. Furthermore, parasites isolated after a failed BNZ treatment showed nearly identical susceptibility to BNZ as those obtained prior to treatment, confirming the low risk of induction of drug resistance with BNZ and the ability to adjust the treatment protocol when an initial regimen fails. These results provide guidance for the use of BNZ as an effective treatment for T. cruzi infection and encourage its wider use, minimally in high value dogs and at-risk NHP, but also potentially in humans, until better options are available.
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Affiliation(s)
- Juan M. Bustamante
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
| | - Brooke E. White
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
| | - Gregory K. Wilkerson
- MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, Bastrop, Texas, USA
| | - Carolyn L. Hodo
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine and Biomedical Research, Texas A&M University, College Station, Texas, USA
| | - Lisa D. Auckland
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine and Biomedical Research, Texas A&M University, College Station, Texas, USA
| | - Wei Wang
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
| | | | - Sarah A. Hamer
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine and Biomedical Research, Texas A&M University, College Station, Texas, USA
| | - Ashley B. Saunders
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Rick L. Tarleton
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
- Department of Cellular Biology, University of Georgia, Athens, Georgia, USA
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13
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Matthews DJ, Fries RC, Jeffery ND, Hamer SA, Saunders AB. Cardiac Magnetic Resonance Imaging Detects Myocardial Abnormalities in Naturally Infected Dogs with Chronic Asymptomatic Chagas Disease. Animals (Basel) 2023; 13:ani13081393. [PMID: 37106957 PMCID: PMC10135195 DOI: 10.3390/ani13081393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Trypanosoma cruzi infection causes inflammation and fibrosis, resulting in cardiac damage in dogs. The objectives of this study were to describe cardiac magnetic resonance imaging (CMR) in naturally infected dogs with chronic Chagas disease and the frequency of abnormalities for CMR and cardiac diagnostic tests. Ten asymptomatic, client-owned dogs seropositive for T. cruzi were prospectively enrolled in an observational study evaluating echocardiography, ECG (standard and ambulatory), cardiac troponin I (cTnI), and CMR. Standard ECG measurements (3/10) and cTnI concentration (1/10) outside the reference range were uncommon. Ambulatory ECG abnormalities were documented more frequently (6/10 dogs) than with standard ECG and included ventricular arrhythmias (4), supraventricular premature beats (3), second-degree atrioventricular block (2), and sinus arrest (1). Echocardiographic abnormalities were documented in 6/10 dogs including mildly increased left ventricular internal dimension in diastole (1) and decreased right ventricular (RV) systolic function based on reductions in tricuspid annular plane systolic excursion (3) and RV S' (4). Abnormalities were detected with CMR in 7/10 dogs including delayed myocardial enhancement in 5 of which 2 also had increased extracellular volume, abnormal wall motion in 5, and loss of apical compact myocardium in 1. In conclusion, CMR abnormalities were common, and the results of this study suggest CMR can provide useful information in dogs with T. cruzi infection and may support naturally infected dogs for future clinical investigation as an animal model for Chagas disease.
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Affiliation(s)
- Derek J Matthews
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474, USA
| | - Ryan C Fries
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802, USA
| | - Nicholas D Jeffery
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474, USA
| | - Sarah A Hamer
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4458, USA
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474, USA
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14
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Christopher DM, Curtis-Robles R, Hamer GL, Bejcek J, Saunders AB, Roachell WD, Cropper TL, Hamer SA. Collection of triatomines from sylvatic habitats by a Trypanosoma cruzi-infected scent detection dog in Texas, USA. PLoS Negl Trop Dis 2023; 17:e0010813. [PMID: 36940217 PMCID: PMC10063167 DOI: 10.1371/journal.pntd.0010813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/30/2023] [Accepted: 02/14/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Triatomine insects, vectors of the etiologic agent of Chagas disease (Trypanosoma cruzi), are challenging to locate in sylvatic habitats. Collection techniques used in the United States often rely on methods to intercept seasonally dispersing adults or on community scientists' encounters. Neither method is suited for detecting nest habitats likely to harbor triatomines, which is important for vector surveillance and control. Furthermore, manual inspection of suspected harborages is difficult and unlikely to reveal novel locations and host associations. Similar to a team that used a trained dog to detect sylvatic triatomines in Paraguay, we worked with a trained scent detection dog to detect triatomines in sylvatic locations across Texas. PRINCIPLE METHODOLOGY/FINDINGS Ziza, a 3-year-old German Shorthaired Pointer previously naturally infected with T. cruzi, was trained to detect triatomines. Over the course of 6 weeks in the fall of 2017, the dog and her handler searched at 17 sites across Texas. The dog detected 60 triatomines at 6 sites; an additional 50 triatomines were contemporaneously collected at 1 of these sites and 2 additional sites without the assistance of the dog. Approximately 0.98 triatomines per hour were found when only humans were conducting searches; when working with the dog, approximately 1.71 triatomines per hour were found. In total, 3 adults and 107 nymphs of four species (Triatoma gerstaeckeri, Triatoma protracta, Triatoma sanguisuga, and Triatoma indictiva) were collected. PCR testing of a subset revealed T. cruzi infection, including DTUs TcI and TcIV, in 27% of nymphs (n = 103) and 66% of adults (n = 3). Bloodmeal analysis of a subset of triatomines (n = 5) revealed feeding on Virginia opossum (Didelphis virginiana), Southern plains woodrat (Neotoma micropus), and eastern cottontail (Sylvilagus floridanus). CONCLUSION/SIGNIFICANCE A trained scent detection dog enhanced triatomine detections in sylvatic habitats. This approach is effective at detecting nidicolous triatomines. Control of sylvatic sources of triatomines is challenging, but this new knowledge of specific sylvatic habitats and key hosts may reveal opportunities for novel vector control methods to block the transmission of T. cruzi to humans and domestic animals.
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Affiliation(s)
| | - Rachel Curtis-Robles
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, United States of America
| | - Gabriel L. Hamer
- Department of Entomology, Texas A&M University, College Station, Texas, United States of America
| | - Justin Bejcek
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, United States of America
- Department of Entomology, Texas A&M University, College Station, Texas, United States of America
| | - Ashley B. Saunders
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, United States of America
| | - Walter D. Roachell
- Public Health Command Central, JBSA-Fort Sam Houston, San Antonio, Texas, United States of America
| | - Thomas Leo Cropper
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, San Antonio Texas
| | - Sarah A. Hamer
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, United States of America
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15
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Bustamante JM, White BE, Wilkerson GK, Hodo CL, Auckland LD, Wang W, McCain S, Hamer SA, Saunders AB, Tarleton RL. Frequency variation and dose modification of benznidazole administration for the treatment of Trypanosoma cruzi infection in mice, dogs and non-human primates. bioRxiv 2023. [PMID: 36778432 PMCID: PMC9915573 DOI: 10.1101/2023.02.01.526739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Trypanosoma cruzi naturally infects a broad range of mammalian species and frequently results in the pathology that has been most extensively characterized in human Chagas disease. Currently employed treatment regimens fail to achieve parasitological cure of T. cruzi infection in the majority of cases. In this study, we have extended our previous investigations of more effective, higher dose, intermittent administration protocols using the FDA-approved drug benznidazole (BNZ), in experimentally infected mice and in naturally infected dogs and non-human primates (NHP). Collectively these studies demonstrate that twice-weekly administration of BNZ for more than 4 months at doses that are ∼2.5-fold that of previously used daily dosing protocols, provided the best chance to obtain parasitological cure. Dosing less frequently or for shorter time periods was less dependable in all species. Prior treatment using an ineffective dosing regimen in NHPs did not prevent the attainment of parasitological cure with an intensified BNZ dosing protocol. Furthermore, parasites isolated after a failed BNZ treatment showed nearly identical susceptibility to BNZ as those obtained prior to treatment, confirming the low risk of induction of drug resistance with BNZ and the ability to adjust the treatment protocol when an initial regimen fails. These results provide guidance for the use of BNZ as an effective treatment for T. cruzi infection and encourage its wider use, minimally in high value dogs and at-risk NHP, but also potentially in humans, until better options are available.
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Affiliation(s)
- Juan M Bustamante
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
| | - Brooke E White
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
| | - Gregory K Wilkerson
- MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, Bastrop, Texas, USA
| | - Carolyn L Hodo
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine and Biomedical Research, Texas A&M University, College Station, Texas, USA
| | - Lisa D Auckland
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine and Biomedical Research, Texas A&M University, College Station, Texas, USA
| | - Wei Wang
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
| | | | - Sarah A Hamer
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine and Biomedical Research, Texas A&M University, College Station, Texas, USA
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Rick L Tarleton
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
- Department of Cellular Biology, University of Georgia, Athens, Georgia, USA
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Gavic EA, Achen SE, Fox PR, Benjamin EJ, Goodwin J, Gunasekaran T, Schober KE, Tjostheim SS, Vickers J, Ward JL, Russell DS, Rishniw M, Hamer SA, Saunders AB. Trypanosoma cruzi infection diagnosed in dogs in nonendemic areas and results from a survey suggest a need for increased Chagas disease awareness in North America. J Am Vet Med Assoc 2023; 261:705-712. [PMID: 36735504 DOI: 10.2460/javma.22.10.0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the clinical presentation and outcome in dogs diagnosed with Trypanosoma cruzi infection in nonendemic areas and to survey veterinary cardiologists in North America for Chagas disease awareness. ANIMALS 12 client-owned dogs; 83 respondents from a veterinary cardiology listserv. PROCEDURES A retrospective, multicenter medical records review to identify dogs diagnosed with American trypanosomiasis between December 2010 and December 2020. An anonymous online survey was conducted August 9 to 22, 2022. RESULTS Diagnosis was made using indirect fluorescent antibody titer (n = 9), quantitative PCR assay (1), or postmortem histopathology (2). Time spent in Texas was < 1 year (n = 7) or 2 to 8 years (5). Time in nonendemic areas prior to diagnosis was < 1 year (n = 10) and > 3 years (2). Eleven had cardiac abnormalities. Of the 12 dogs, 5 had died unexpectedly (range, 1 to 108 days after diagnosis), 4 were still alive at last follow-up (range, 60 to 369 days after diagnosis), 2 were euthanized because of heart disease (1 and 98 days after diagnosis), and 1 was lost to follow-up. Survey results were obtained from 83 cardiologists in North America, of which the self-reported knowledge about Chagas disease was limited in 49% (41/83) and 69% (57/83) expressed interest in learning resources. CLINICAL RELEVANCE Results highlight the potential for encountering dogs with T cruzi infection in nonendemic areas and need for raising awareness about Chagas disease in North America.
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Affiliation(s)
| | | | | | - Eduardo J Benjamin
- 3Veterinary Teaching Hospital, College of Veterinary Medicine, Washington State University, Pullman, WA
| | | | | | - Karsten E Schober
- 5Department of Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - Sonja S Tjostheim
- 6Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI
| | - John Vickers
- 7Castle Pines Veterinary Hospital, Castle Pines, CO
| | - Jessica L Ward
- 8Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA
| | - Duncan S Russell
- 9Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR
| | | | - Sarah A Hamer
- 11Department of Veterinary Integrative Biosciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX
| | - Ashley B Saunders
- 12Department of Small Animal Clinical Sciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX
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17
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Stoner CH, Saunders AB. Evaluation of two probes for transesophageal echocardiography in small dogs: imaging capabilities, image quality, and usability. J Vet Cardiol 2023; 45:41-49. [PMID: 36696791 DOI: 10.1016/j.jvc.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 12/12/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTIONS Patient size is a limiting factor for transesophageal echocardiography (TEE) in small dogs. The objective of this study was to describe imaging capabilities of two probes for TEE in small dogs. ANIMALS, MATERIALS, AND METHODS Prospective study in 10 client-owned dogs weighing <4 kg with congenital heart disease (CHD). Dogs had TEE performed with a microprobe (10T-D, GE Medical) and intracardiac echocardiography (ICE) catheter-based probe (AcuNav™, Biosense Webster) in the esophagus in alternating order. Ease of placement, ability to acquire images of the CHD, image quality, and probe limitations were recorded. RESULTS Median weight was 2.4 kg (range, 1.0-3.2). Congenital abnormalities included patent ductus arteriosus (n = 9) and pulmonary valve stenosis (n = 1). The 10T-D microprobe was easy to place (n = 8) or achievable with gentle manipulation (n = 2), and image quality of the CHD was optimal (n = 8), adequate (n = 1), or poor (n = 1). The ICE probe was difficult to place in the esophagus even with an external support system (n = 9) or could not be placed (n = 1), and image quality of the CHD was optimal (n = 2), adequate (n = 3), or poor (n = 5). Both probes provided images in a 1.0-kg dog. Probe limitations included lack of lateral motion (microprobe), the need for an external support system (ICE probe) and inability to consistently maintain contact with the esophagus (ICE probe). CONCLUSION The 10T-D microprobe provided high-quality TEE images more consistently than the ICE probe in the majority of dogs in this study; however, the lack of lateral motion can diminish its utility in some dogs.
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Affiliation(s)
- C H Stoner
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - A B Saunders
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA.
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18
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Sykes KT, Wesselowski S, Saunders AB, Tjostheim SS, Potter BM, Gelzer ARM, Katz N, Ward JL, Karlin ET, Markovic LE, Magee AN, Abbott JA, Kadotani S, Menciotti G. A multicenter, retrospective study of cardiac disease in Borzoi dogs. Front Vet Sci 2023; 10:1102494. [PMID: 36777677 PMCID: PMC9909344 DOI: 10.3389/fvets.2023.1102494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
Borzoi are large, relatively uncommon sighthounds anecdotally reported to suffer from sudden death. This multicenter retrospective cohort study aimed to describe the sample of Borzoi presenting to veterinary cardiologists for evaluation, with records searched from 14 centers across a study period of up to 20 years. The study sample was comprised of 152 client-owned Borzoi, with dogs most commonly presenting for pre-breed screening in 87/152 (52%), followed by evaluation of an arrhythmia in 28/152 (18%). Of the 131/152 (86%) dogs that had an echocardiogram performed, 85/131 (65%) were structurally normal, with 40/85 (47%) structurally normal dogs having trace or mild atrioventricular valve regurgitation. Tricuspid valve dysplasia was the most commonly diagnosed congenital cardiac disease (n = 6). Myxomatous mitral valve disease (n = 12) and dilated cardiomyopathy (n = 13) were diagnosed at similar frequencies, though 92% of valve disease cases were mild. Only 48/152 (32%) Borzoi had a diagnostic electrocardiogram (ECG) and/or a Holter monitor for arrhythmia screening. Despite this, ventricular arrhythmias were identified during the entirety of the available cardiac evaluation including diagnostic ECG, contemporaneous ECG monitoring during the echocardiogram, and/or Holter monitor in 25/131 (19%) dogs in which an echocardiographic diagnosis was available. Of these 25 Borzoi, 76% had minimal or no structural cardiac disease identified, and five had a family history of sudden death. A sudden death outcome was reported in 3/55 (5%) Borzoi with long-term outcome data available. In conclusion, Borzoi commonly have trace or mild atrioventricular valve insufficiencies, and may develop ventricular arrhythmias and dilated cardiomyopathy.
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Affiliation(s)
- K. Tess Sykes
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Texas A&M University, College Station, TX, United States
| | - Sonya Wesselowski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Texas A&M University, College Station, TX, United States,*Correspondence: Sonya Wesselowski ✉
| | - Ashley B. Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Texas A&M University, College Station, TX, United States
| | - Sonja S. Tjostheim
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, United States
| | - Brianna M. Potter
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Anna R. M. Gelzer
- Department of Clinical Studies and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Natalie Katz
- College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Jessica L. Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Emily T. Karlin
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, United States
| | - Lauren E. Markovic
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - Aliya N. Magee
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Jonathan A. Abbott
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Saki Kadotani
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Giulio Menciotti
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
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Hamer SA, Saunders AB. Veterinary Chagas Disease (American Trypanosomiasis) in the United States. Vet Clin North Am Small Anim Pract 2022; 52:1267-1281. [DOI: 10.1016/j.cvsm.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Bustamante JM, Padilla AM, White B, Auckland LD, Busselman RE, Collins S, Malcolm EL, Wilson BF, Saunders AB, Hamer SA, Tarleton RL. Prophylactic low-dose, bi-weekly benznidazole treatment fails to prevent Trypanosoma cruzi infection in dogs under intense transmission pressure. PLoS Negl Trop Dis 2022; 16:e0010688. [PMID: 36315597 PMCID: PMC9648846 DOI: 10.1371/journal.pntd.0010688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/10/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
Trypanosoma cruzi naturally infects a wide variety of wild and domesticated mammals, in addition to humans. Depending on the infection dose and other factors, the acute infection can be life-threatening, and in all cases, the risk of chagasic heart disease is high in persistently infected hosts. Domestic, working, and semi-feral dogs in the Americas are at significant risk of T. cruzi infection and in certain settings in the southern United States, the risk of new infections can exceed 30% per year, even with the use of vector control protocols. In this study, we explored whether intermittent low-dose treatment with the trypanocidal compound benznidazole (BNZ) during the transmission season, could alter the number of new infections in dogs in an area of known, intense transmission pressure. Preliminary studies in mice suggested that twice-weekly administration of BNZ could prevent or truncate infections when parasites were delivered at the mid-point between BNZ doses. Pre-transmission season screening of 126 dogs identified 53 dogs (42.1%) as T. cruzi infection positive, based upon blood PCR and Luminex-based serology. Serial monitoring of the 67 uninfected dogs during the high transmission season (May to October) revealed 15 (22.4%) new infections, 6 in the untreated control group and 9 in the group receiving BNZ prophylaxis, indicating no impact of this prophylaxis regimen on the incidence of new infections. Although these studies suggest that rigorously timed and more potent dosing regimen may be needed to achieve an immediate benefit of prophylaxis, additional studies would be needed to determine if drug prophylaxis reduced disease severity despite this failure to prevent new infections.
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Affiliation(s)
- Juan M. Bustamante
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Angel M. Padilla
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Brooke White
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
| | - Lisa D. Auckland
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Rachel E. Busselman
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Stephanie Collins
- Chaparral Veterinary Center, Jourdanton, Texas, United States of America
| | - Elizabeth L. Malcolm
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, United States of America
| | - Briana F. Wilson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, United States of America
| | - Ashley B. Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, United States of America
| | - Sarah A. Hamer
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Rick L. Tarleton
- Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America
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21
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Tayce JD, Saunders AB. The Use of a Modified Script Concordance Test in Clinical Rounds to Foster and Assess Clinical Reasoning Skills. J Vet Med Educ 2022; 49:556-559. [PMID: 34784257 DOI: 10.3138/jvme-2021-0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The development of clinical reasoning skills is a high priority during clinical service, but an unpredictable case load and limited time for formal instruction makes it challenging for faculty to foster and assess students' individual clinical reasoning skills. We developed an assessment for learning activity that helps students build their clinical reasoning skills based on a modified version of the script concordance test (SCT). To modify the standard SCT, we simplified it by limiting students to a 3-point Likert scale instead of a 5-point scale and added a free-text box for students to provide justification for their answer. Students completed the modified SCT during clinical rounds to prompt a group discussion with the instructor. Student feedback was positive, and the instructor gained valuable insight into the students' thought process. A modified SCT can be adopted as part of a multimodal approach to teaching on the clinic floor. The purpose of this article is to describe our modifications to the standard SCT and findings from implementation in a clinical rounds setting as a method of formative assessment for learning and developing clinical reasoning skills.
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Gordon SG, Saunders AB, Wesselowski SR. Asymptomatic Canine Degenerative Valve Disease. Vet Clin North Am Small Anim Pract 2022; 52:819-840. [DOI: 10.1016/j.cvsm.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Boutet BG, Gordon SG, De Solis CN, Lepiz MA, Saunders AB, Wesselowski S. Feasibility and clinical utility of transvenous intracardiac echocardiography in conscious, sedated horses. J Vet Cardiol 2022; 42:15-22. [DOI: 10.1016/j.jvc.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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Malcolm EL, Saunders AB, Vitt JP, Boutet BG, Hamer SA. Antiparasitic treatment with itraconazole and amiodarone in 2 dogs with severe, symptomatic Chagas cardiomyopathy. J Vet Intern Med 2022; 36:1100-1105. [PMID: 35388923 PMCID: PMC9151465 DOI: 10.1111/jvim.16422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 03/14/2022] [Accepted: 03/25/2022] [Indexed: 01/06/2023] Open
Abstract
Chagas cardiomyopathy, caused by the protozoal parasite Trypanosoma cruzi, is characterized by arrhythmias, myocardial damage, heart failure, and sudden death. We describe 2 dogs with severe, symptomatic Chagas cardiomyopathy characterized by myocardial dysfunction and electrocardiographic abnormalities that were managed with a combination of cardiac medications and antiparasitic treatment with itraconazole and amiodarone. Both dogs died suddenly within 6 months of diagnosis. These cases highlight the need for early detection of Chagas disease in dogs and continued research to develop effective antiparasitic treatment protocols.
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Affiliation(s)
- Elizabeth L Malcolm
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Jordan P Vitt
- Heart of Veterinary Cardiology PLLC, Seattle, Washington, USA
| | - Bruno G Boutet
- Caring Hearts Veterinary Cardiology, Grande-Digue, New Brunswick, Canada
| | - Sarah A Hamer
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
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Alvarez-Sanchez A, Townsend KL, LeBlanc NL, Milovancev M, Scollan KF, Heatley J, Hoppes S, Saunders AB, Gordon SG, Pesce K, Swift ST, Brenner E, Thomason JD, Eshar D. Epicardial pacemaker implantation and outcome in eight pet ferrets (Mustela putorius furo). J Vet Cardiol 2022; 41:44-56. [DOI: 10.1016/j.jvc.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
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Stoner CH, Saunders AB, Heseltine JC, Cook AK, Lidbury JA. Prospective evaluation of complications associated with transesophageal echocardiography in dogs with congenital heart disease. J Vet Intern Med 2022; 36:406-416. [PMID: 34997940 PMCID: PMC8965207 DOI: 10.1111/jvim.16356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 01/09/2023] Open
Abstract
Background Transesophageal echocardiography (TEE) is useful in the assessment and procedural monitoring of congenital heart disease (CHD) with a relatively low complication rate in humans. Objectives To evaluate the safety of TEE and report complications in dogs. Animals Forty client‐owned dogs with CHD. Methods Prospective observational study including gastroesophagoscopy before and after TEE imaging. TEE was planned with a GE 6VT‐D adult probe in dogs weighing ≥4 kg and a GE 10T‐D microprobe alternating with an intracardiac echocardiography probe placed in the esophagus in dogs <4 kg. Difficulties with probe placement, probe interference and TEE probe imaging times were recorded. Dogs were monitored in the recovery period after TEE using an established nausea scoring system. Results New gastroesophageal abnormalities were identified after TEE in 4 dogs including 4 areas of mucosal damage involving <25% of the lower esophageal sphincter (n = 4) and 1 lesion at the heart base (n = 1) and were not attributed to longer imaging times or a specific probe. Lesions identified before TEE in 4 dogs remained unchanged after TEE. The 6VT‐D probe could not be placed in 1 dog with enlarged tonsils, and it obstructed fluoroscopic views in 3 dogs. The probes did not compress any structures in dogs in which fluoroscopy was performed (n = 20). Four dogs had evidence to suggest nausea after the procedure. Conclusions and Clinical Importance While major complications remain possible, complications in this study were mild and few in number. Dog size and probe characteristics are factors to consider when performing TEE.
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Affiliation(s)
- Caitlin H Stoner
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Johanna C Heseltine
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Audrey K Cook
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Jonathan A Lidbury
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
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Wesselowski S, Cusack K, Saunders AB, Jeffery N. Pre-procedural femoral vessel ultrasound in dogs with patent ductus arteriosus: diameter, image quality and relationship with arterial catheterization. J Vet Cardiol 2021; 39:69-78. [PMID: 34996021 DOI: 10.1016/j.jvc.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION /Objectives: Patent ductus arteriosus (PDA) in dogs is often treated via minimally invasive transvascular occlusion using femoral artery access. This study compared ultrasound-derived diameter and image quality of the right femoral artery (RFA) and vein (RFV) in dogs with PDA using a linear ultrasound probe (L-P) and phased-array transthoracic echocardiography probe (TTE-P). The case outcome was assessed. ANIMALS, MATERIALS & METHODS Forty-five client-owned dogs with PDA were prospectively enrolled. Ultrasound-measured RFA and RFV diameters were obtained on images acquired with both probes pre-operatively and compared using Bland-Altman plots. The image quality of RFA and RFV was scored on L-P and TTE-P images. RESULTS Comparison of RFA and RFV diameter from L-P versus TTE-P images revealed: [Mean difference (limits of agreement): RFA = 0.009 mm (-0.78-0.79 mm), RFV = 0.523 mm (-1.75-2.79 mm)]. Image quality scores were significantly higher for L-P than TTE-P (P < 0.0001). In six small dogs, measurable images were unattainable with TTE-P. Dogs of similar body weight had variable RFA diameters. Twenty-seven dogs had RFA catheterization. In 21/27 dogs, RFA diameter exceeded the external diameter of the introducer used for catheterization, and in 6/27, it was smaller. CONCLUSIONS Pre-procedural ultrasound of the RFA in dogs with PDA is useful given variable RFA diameter relative to body weight. Despite poorer image quality, RFA diameters from TTE-P images were very similar to L-P images on average, suggesting TTE-Ps are suitable for pre-procedural planning in most dogs. Vasospasm, hypotension or differences in the location of ultrasound measurement versus catheterization might produce variation in pre-procedural versus intraoperative RFA size.
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Affiliation(s)
- S Wesselowski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX, 77843-4474, USA.
| | - K Cusack
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX, 77843-4474, USA
| | - A B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX, 77843-4474, USA
| | - N Jeffery
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX, 77843-4474, USA
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Busselman RE, Meyers AC, Zecca IB, Auckland LD, Castro AH, Dowd RE, Curtis-Robles R, Hodo CL, Saunders AB, Hamer SA. High incidence of Trypanosoma cruzi infections in dogs directly detected through longitudinal tracking at 10 multi-dog kennels, Texas, USA. PLoS Negl Trop Dis 2021; 15:e0009935. [PMID: 34758049 PMCID: PMC8631682 DOI: 10.1371/journal.pntd.0009935] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/30/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
Canine Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, is increasingly recognized as a health concern for dogs in the USA, and infected dogs may signal geographic regions of risk for human disease. Dogs living in multi-dog kennel environments (kennels with more than one dog) where triatomine vectors are endemic may be at high risk for infection. We monitored a cohort of 64 T. cruzi-infected and uninfected dogs across 10 kennels in Texas, USA, to characterize changes in infection status over one year. We used robust diagnostic criteria in which reactivity on multiple independent platforms was required to be considered positive. Among the 30 dogs enrolled as serologically- and/or PCR-positive, all but one dog showed sustained positive T. cruzi diagnostic results over time. Among the 34 dogs enrolled as serologically- and PCR-negative, 10 new T. cruzi infections were recorded over a 12-month period. The resulting incidence rate for dogs initially enrolled as T. cruzi-negative was 30.7 T. cruzi infections per 100 dogs per year. This study highlights the risk of T. cruzi infection to dogs in kennel environments. To protect both dog and human health, there is an urgent need to develop more integrated vector control methods as well as prophylactic and curative antiparasitic treatment options for T. cruzi infection in dogs.
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Affiliation(s)
- Rachel E. Busselman
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Alyssa C. Meyers
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Italo B. Zecca
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Lisa D. Auckland
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Andres H. Castro
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Rebecca E. Dowd
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Rachel Curtis-Robles
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
| | - Carolyn L. Hodo
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, Bastrop, Texas, United States of America
| | - Ashley B. Saunders
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, United States of America
| | - Sarah A. Hamer
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas, United States of America
- * E-mail:
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Wesselowski S, Gordon SG, Meddaugh N, Saunders AB, Häggström J, Cusack K, Janacek BW, Matthews DJ. Prediction of clinically important acquired cardiac disease without an echocardiogram in large breed dogs using a combination of clinical, radiographic and electrocardiographic variables. J Vet Cardiol 2021; 40:126-141. [PMID: 34483077 DOI: 10.1016/j.jvc.2021.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Large breed (LB) dogs develop dilated cardiomyopathy (DCM) and myxomatous mitral valve disease (MMVD). Echocardiography is required for a definitive diagnosis but is not always available. Our objective was to assess the clinical utility of thoracic radiographs alone and in combination with physical examination and electrocardiography findings for the prediction of clinically important DCM or MMVD in LB dogs. ANIMALS Four hundred fifty-five client-owned dogs ≥20 kg with concurrent thoracic radiographs and echocardiogram. MATERIALS AND METHODS Medical records were reviewed and stored thoracic radiographs and echocardiographic images were measured to classify dogs as normal heart size (NHS), preclinical DCM, clinical DCM, preclinical MMVD (with cardiomegaly), clinical MMVD, or equivocal. Dogs with preclinical MMVD, without cardiomegaly, were classified as NHS. Vertebral heart size (VHS) and vertebral left atrial size (VLAS) were measured. Receiver operating characteristic curves and prediction models were derived. RESULTS Prevalence of MMVD (39.3%) was higher than the prevalence of DCM (24.8%), though most MMVD dogs (67.0%) lacked cardiomegaly and were classified as NHS for analysis. The area under the curve for VHS to discriminate between NHS and clinical DCM/MMVD or preclinical DCM/MMVD was 0.861 and 0.712, respectively, while for VLAS, it was 0.891 and 0.722, respectively. Predictive models incorporating physical examination and electrocardiography findings in addition to VHS/VLAS increased area under the curve to 0.978 (NHS vs. clinical DCM/MMVD) and 0.829 (NHS vs. preclinical DCM/MMVD). CONCLUSIONS Thoracic radiographs were useful for predicting clinically important DCM or MMVD in LB dogs, with improved discriminatory ability when physical examination abnormalities and arrhythmias were accounted for.
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Affiliation(s)
- S Wesselowski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA.
| | - S G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - N Meddaugh
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - A B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - J Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Box 7045, 7507 Uppsala, Sweden
| | - K Cusack
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - B W Janacek
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - D J Matthews
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
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Saunders AB. Key considerations in the approach to congenital heart disease in dogs and cats. J Small Anim Pract 2021; 62:613-623. [PMID: 34180062 DOI: 10.1111/jsap.13360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/12/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
Congenital heart disease is an important subset of all cardiovascular disease in dogs and cats that is present at birth and most often detected in young animals but can be diagnosed in adulthood. The range of abnormalities that can occur during development of the heart is vast incorporating simple and complex defects, varying degrees of severity and clinical presentations that include heart failure and cyanosis. While some defects do not result in morbidity in an individual animal, others cause severe clinical signs and death at a young age. Advances in imaging and expanding treatment options offer increasingly more possibilities in the diagnosis and management of congenital heart disease which is the focus of this review. The objective is to provide a broad overview of current practice and highlight key aspects to guide practitioners in their approach to congenital heart disease diagnosis and knowledge of available treatment options.
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Affiliation(s)
- A B Saunders
- 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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Matthews DJ, Saunders AB, Meyers AC, Gordon SG, Hamer SA. Cardiac diagnostic test results and outcomes in 44 dogs naturally infected with Trypanosoma cruzi. J Vet Intern Med 2021; 35:1800-1809. [PMID: 33993542 PMCID: PMC8295658 DOI: 10.1111/jvim.16166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 12/30/2022] Open
Abstract
Background The protozoal parasite Trypanosoma cruzi causes myocarditis in dogs. Objectives To describe the cardiac diagnostic test results and outcomes of dogs naturally infected with T. cruzi. Animals Forty‐four client‐owned dogs. Methods Medical records were retrospectively reviewed to identify dogs with an indirect fluorescent antibody test result for T. cruzi ≥1 : 80. Data collected included signalment, cardiac diagnostic test results (ECG, echocardiography, cardiac troponin I) and outcome. Outcomes were categorized as alive, dead (cardiac or noncardiac) or lost to follow up. Results ECG abnormalities were present in 41 dogs with ventricular arrhythmias (n = 28) and atrioventricular block (AVB) (n = 15) most commonly identified. Echocardiographic chamber enlargement was present in 28 dogs and most often included the right ventricle (RV) (n = 15) and left atrium (n = 12). Troponin was ≥2 times the reference range in 20/36 (56%) dogs. In univariate analysis using nonparametric Kaplan‐Meier, ventricular arrhythmias with a modified Lown score ≥2 (P = .02), presence of AVB (P = .04), and RV enlargement (P = .006) were associated with decreased survival times. Right ventricular enlargement (HR 3.6; 95% confidence interval [CI] 1.4‐9.3; P = .007) and higher body weight at presentation (HR 1.0; 95% CI 1.0‐1.1; P = .04) were associated with decreased time to death in the final explanatory multivariable model. Conclusions and Clinical Importance Cardiac abnormalities were common and variable, and RV enlargement was associated with shorter survival time. A diagnostic evaluation that includes screening for arrhythmias, echocardiography, and cTnI can provide useful information related to the characterization of heart disease in dogs seropositive for T. cruzi.
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Affiliation(s)
- Derek J Matthews
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Alyssa C Meyers
- Department of Veterinary Integrative Bioscience, Texas A&M University, College Station, Texas, USA
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Sarah A Hamer
- Department of Veterinary Integrative Bioscience, Texas A&M University, College Station, Texas, USA
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Meyers AC, Edwards EE, Sanders JP, Saunders AB, Hamer SA. Fatal Chagas myocarditis in government working dogs in the southern United States: Cross-reactivity and differential diagnoses in five cases across six months. Vet Parasitol Reg Stud Reports 2021; 24:100545. [PMID: 34024363 DOI: 10.1016/j.vprsr.2021.100545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
We describe the diagnostics surrounding the deaths of five working dogs over six-months to provide an enhanced clinical and diagnostic understanding of canine Chagas disease. Cases were five dogs with antibodies to Trypanosoma cruzi. Medical records were reviewed for diagnostic history. Testing was performed from samples collected before or immediately after death, including measurement of cardiac troponin I, histology, PCR and serology for Leishmania spp. and T. cruzi. Four dogs had a 2 to 7-year history of T. cruzi antibodies, while one positive dog had an unknown duration of exposure. Age at death ranged from 2 to 11 years and four dogs were actively working. The cardiac troponin I was elevated in all four dogs for which it was measured, although postmortem reference ranges are not established. Histopathologic diagnoses included mild to severe, chronic, lymphoplasmacytic to histiocytic myocarditis with variable fibrosis. Notably, only one dog had T. cruzi amastigotes observed in the heart histologically. T. cruzi DNA was detected in three other hearts. Although all five dogs tested antibody-positive for T. cruzi using three independent tests, all were also indirect fluorescent antibody-positive for Leishmania spp., interpreted as cross-reaction. Chagas disease in dogs is a diagnostic challenge owing to cross-reactions and variable clinical, histologic and molecular presentations. The use and interpretation of multiple diagnostic strategies is useful in diagnosis. This study demonstrates techniques used to diagnose and characterize Chagas disease in an at-risk dog population.
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Affiliation(s)
- Alyssa C Meyers
- Department of Veterinary Integrative Bioscience, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Erin E Edwards
- Texas A&M Veterinary Medical Diagnostic Laboratory, College Station, TX 77843, USA
| | - John P Sanders
- Office of Workforce Health and Safety, Department of Homeland Security, Office of the Chief Human Capital Officer, Washington, District of Columbia, USA
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Sarah A Hamer
- Department of Veterinary Integrative Bioscience, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA.
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Tayce JD, Saunders AB, Keefe L, Korich J. The Creation of a Collaborative, Case-Based Learning Experience in a Large-Enrollment Classroom. J Vet Med Educ 2021; 48:14-20. [PMID: 33594954 DOI: 10.3138/jvme.2019-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Numerous educational studies have shown that passive learning methods are frequently associated with disappointing learning outcomes, yet many faculty instructors continue to rely on passive didactic lectures. This article describes the creation of an active learning teaching approach-referred to as the collaborative, case-based classroom-that combines three pedagogical strategies: peer-assisted learning, case-based learning, and just-in-time teaching. Data from student surveys of a third-year cardiology elective showed a preference for this teaching approach compared with a case-based lecture. Six major themes emerged from survey analysis: engagement/interactivity, instructional benefit, clinical reasoning, clinical relevance, peer-assisted learning, and timely feedback. Although detailed here in the context of a cardiology elective, the collaborative, case-based classroom is a teaching approach that could be modified to fit a variety of other teaching environments.
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Romano AE, Saunders AB, Gordon SG, Wesselowski S. Intracardiac heartworms in dogs: Clinical and echocardiographic characteristics in 72 cases (2010-2019). J Vet Intern Med 2021; 35:88-97. [PMID: 33617036 PMCID: PMC7848357 DOI: 10.1111/jvim.15985] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Heartworms, a cause of pulmonary hypertension (PH) in dogs, can migrate from the pulmonary arteries into the heart resulting in life-threatening caval syndrome (CS). OBJECTIVES To describe clinical and echocardiographic characteristics in dogs with intracardiac heartworms including estimated heartworm burden and frequency of PH and pigmenturia. ANIMALS Seventy-two client-owned dogs with heartworms. METHODS Retrospective study. Data collected from an electronic medical records search for dogs with intracardiac heartworms included clinicopathologic, echocardiographic, and procedural findings. Dogs with heartworms isolated to the pulmonary arteries were excluded. RESULTS Estimated intracardiac heartworm burden was low in 14 of 72 (19%) and high in 58 of 72 (81%) dogs. The majority were small breed (54/72; 75%; 29/72; 40% Chihuahuas) and had a high likelihood of PH (67/72; 93%). Pigmenturia was the second most common clinical finding (31/72; 43%) after lethargy (32/72; 44%). Anemia (37/55; 36%), pigmenturia (30/58; 52%), and bilirubinuria (28/36; 78%) were significantly more common in dogs with a high worm burden (P < .05). Based on the presence of anemia, pigmenturia, and clinical signs, 18 of 72 dogs (25%) were considered to have CS. CONCLUSIONS AND CLINICAL IMPORTANCE Although the majority of dogs with intracardiac heartworms had a high worm burden and high likelihood of PH, only 25% had clinical evidence of CS. Echocardiography is a useful tool to identify intracardiac heartworms, detect likelihood of PH, and could be useful for staging heartworm positive small breed dogs for intracardiac heartworm migration.
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Affiliation(s)
- Abigail E. Romano
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Texas A&M UniversityCollege StationTexasUSA
| | - Ashley B. Saunders
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Texas A&M UniversityCollege StationTexasUSA
| | - Sonya G. Gordon
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Texas A&M UniversityCollege StationTexasUSA
| | - Sonya Wesselowski
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Texas A&M UniversityCollege StationTexasUSA
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Cusack K, Wesselowski S, Saunders AB, Jeffery N. Correlations between age, body size, sex, and conformation and ultrasound-measured femoral vessel diameter in the dog, with implications for transvascular procedural planning. Vet Radiol Ultrasound 2020; 62:98-107. [PMID: 33128828 DOI: 10.1111/vru.12920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/03/2020] [Accepted: 08/17/2020] [Indexed: 12/01/2022] Open
Abstract
Transvascular interventional radiology procedures have advanced in veterinary medicine, but basic knowledge about expected vascular size and vascular imaging requires further exploration. A prospective analytical study of 230 client-owned dogs was carried out to investigate correlations between ultrasound-measured femoral artery (FA) and femoral vein (FV) diameter and various morphometric and demographic dog variables, compare ultrasound-measured femoral vessel diameter to diameter predicted by body weight, compare right- and left-sided femoral vessel diameter, and assess measurement repeatability. Internal diameter of the FA and FV was measured with ultrasound bilaterally. Allometrically scaled body weight had the strongest correlation with FA and FV diameter (correlation coefficients: 0.92 and 0.80, respectively), although thigh circumference (FA: 0.89; FV:0.78) and withers height (FA: 0.84; FV: 0.76) were also strongly correlated. Within the entire population, males had a smaller FA (P = .005), but not FV (P = .278), than females and age was negatively associated with FA (P = .031) and FV (P < .001) diameter. Compared to ultrasound-derived measurements, body weight-predicted diameter overestimated by at least one French gauge in 32.6% and 35.2% of dogs for the FA and FV, respectively. Comparison of left and right FA and FV diameter revealed minimal mean differences, though limits of agreement could encompass multiple French gauge sizes: (Mean difference [limits of agreement]: FA = 0.00 mm [0.85-0.84 mm]; FV = 0.04 mm [1.92-1.99 mm]). Intra- and interoperator repeatability coefficients of variation were <9%. Femoral vessel diameter in dogs is influenced by multiple factors, with potential for clinically relevant differences between right- and left-sided vessels. Ultrasound measurement of femoral vessels could improve transvascular preprocedural planning.
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Affiliation(s)
- Katrina Cusack
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Sonya Wesselowski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Nicholas Jeffery
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
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Sykes KT, Saunders AB, Hoffmann AR, Porter BF. Histologic comparison in two Doberman pinschers with a dilated cardiomyopathy phenotype. J Vet Cardiol 2020; 33:1-5. [PMID: 33221699 DOI: 10.1016/j.jvc.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
Idiopathic dilated cardiomyopathy (DCM) is a common acquired cardiac disease in large breed dogs with a high prevalence in Doberman pinschers. It is characterized histologically by attenuated wavy fibers and fatty infiltration with degeneration. The phenotypic appearance of DCM includes ventricular dilation with systolic dysfunction and ventricular arrhythmias. These changes can be caused by other etiologies, including infectious, toxic, metabolic, and nutritional deficiencies. Chagas disease is the result of an infection with the protozoal parasite, Trypanosoma cruzi, transmitted by an insect vector. Histopathology of the myocardium is characterized by inflammation, fibrosis, and pseudocysts containing T. cruzi amastigotes. Differentiating idiopathic DCM from infectious myocarditis can be challenging when the clinical presentation and diagnostic test results are similar in affected dogs. We present thoracic radiographs, echocardiography, and post-mortem histopathology images obtained from two Doberman pinschers with similar signalment, clinical presentation, and electrocardiographic and echocardiographic appearance but with different appearing radiographs and different etiologies for their heart disease, one with idiopathic DCM and one with myocarditis attributed to Chagas disease, to highlight the value of considering alternative etiologies for DCM to guide additional clinical evaluation and owner counseling.
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Affiliation(s)
- K T Sykes
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA
| | - A B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA.
| | - A R Hoffmann
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA
| | - B F Porter
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA
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Abstract
Trypanosomiasis manifests as myocardial dysfunction with arrhythmias in dogs. Arrhythmias in this dog prompted further evaluation with echocardiography. Echocardiography confirms cardiac enlargement and dysfunction in Chagas myocarditis. Bundle branch block and ventricular aneurysms are features of Chagas disease. These features are more frequently described in humans than in dogs.
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Affiliation(s)
- Caitlin H Stoner
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
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Sykes KT, Gordon SG, Saunders AB, Vitt JP, O'Brien MT, Fries RC. Palliative combined cutting and high-pressure balloon valvuloplasty in six dogs with severe, symptomatic subaortic stenosis. J Vet Cardiol 2020; 31:36-50. [PMID: 32977126 DOI: 10.1016/j.jvc.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 08/08/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION/OBJECTIVES Severe subaortic stenosis (SAS) is a congenital heart defect in dogs that often results in clinical signs and reduced survival. The objective of this study was to describe characteristics of dogs with severe, symptomatic SAS who underwent combined cutting and high-pressure balloon valvuloplasty (CB/HPBV). ANIMALS, MATERIALS, AND METHODS Retrospective description of the clinical characteristics, CB/HPBV procedural deviations from reported methodology and outcomes in a series of six client-owned dogs with severe, symptomatic SAS. RESULTS Breeds included two each of Newfoundland, Golden retriever, and German shepherd. Median age was 10.1 months (range: 5-72.3 months), and median weight was 25.5 kg (range: 21.8-36.4 kg). Before CB/HPBV, clinical signs were present in all dogs; four were managed for congestive heart failure (CHF). Three dogs had concurrent congenital heart disease. Median Doppler-estimated left ventricular outflow tract pressure gradient was pre-operatively 149.7 mmHg (range: 89.9-254.7 mmHg) and post-operatively 134.1 mmHg (range: 83.9-181.2 mmHg). Median aortoseptal angle was steep at 136° (range: 109-143°). Clinical improvement was documented in all dogs, based on temporary discontinuation of diuretics and/or owner-perceived reduction in clinical signs. At the time of writing, three dogs had died suddenly, one was euthanized because of recurrence of clinical signs, and one died in CHF. Median survival time was 26.4 months after procedure (range: 6.3-45.8 months). One dog remained alive at 44 months after procedure. CONCLUSIONS Palliative CB/HPBV is a potential therapeutic option for dogs with severe, symptomatic SAS complicated by concurrent congenital heart disease, arrhythmias, or CHF.
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Affiliation(s)
- K T Sykes
- College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - S G Gordon
- College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - A B Saunders
- College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA.
| | - J P Vitt
- University of Illinois College of Veterinary Medicine, 1008 West Hazelwood Drive, Urbana, IL 61802, USA
| | - M T O'Brien
- Charles River Laboratories, 15 Worman's Mill Ct Suite I, Frederick, MD 21701, USA
| | - R C Fries
- University of Illinois College of Veterinary Medicine, 1008 West Hazelwood Drive, Urbana, IL 61802, USA
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Saunders AB, Wesselowski S, Cusack K. Transesophageal Echocardiography–Guided Dirofilaria immitis Extraction from the Right Atrium in a Dog. CASE 2020; 4:299-302. [PMID: 32875199 PMCID: PMC7451933 DOI: 10.1016/j.case.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Dirifilaria immitis infection, worms can migrate into the heart. Clinical signs are caused by hemolysis and and obstruction of blood flow. Transesophageal echocardiography guides removal of radiolucent foreign objects. TEE findings assisted in the extraction of intracardiac heartworms from a dog.
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Affiliation(s)
- Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Sonya Wesselowski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Katrina Cusack
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
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Meyers AC, Ellis MM, Purnell JC, Auckland LD, Meinders M, Saunders AB, Hamer SA. Selected cardiac abnormalities in Trypanosoma cruzi serologically positive, discordant, and negative working dogs along the Texas-Mexico border. BMC Vet Res 2020; 16:101. [PMID: 32228593 PMCID: PMC7106864 DOI: 10.1186/s12917-020-02322-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/19/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chagas disease is increasingly recognized in the southern U.S., where triatomine vectors transmit Trypanosoma cruzi among wildlife and domestic dogs with occasional vector spillover to humans. As in humans, clinical outcome in dogs is variable, ranging from acute death to asymptomatic infections or chronic heart disease. In order to characterize cardiac manifestations of T. cruzi infections, we tracked a cohort of naturally-infected dogs and a matched cohort of uninfected dogs. We hypothesized that selected measures of cardiac disease (abnormal rate, abnormal rhythm, and elevated cardiac troponin I (cTnI; a biomarker of cardiac injury)) would occur more commonly in infected than uninfected dogs matched by age, breed, sex and location. In addition to the clearly positive and negative dogs, we specifically tracked dogs with discordant test results across three independent serological assays to gather clinical data that might elucidate the infection status of these animals and inform the utility of the different testing approaches. RESULTS We placed an ambulatory ECG monitor (Holter) on 48 government working dogs and analyzed 39 successful recordings that met length and quality criteria from 17 T. cruzi-infected, 18 uninfected dogs and 4 dogs with discordant results. Overall, 76.5% of positive, 100.0% of discordant, and 11.1% of negative dogs showed > 1 ECG abnormality (p < 0.0001), and positive and discordant dogs had a higher mean number of different types of ECG abnormalities than negative dogs (p < 0.001-0.014). The most common cardiac abnormalities included supraventricular and ventricular arrhythmias and atrioventricular block. Positive dogs had higher serum concentrations of cTnI than both negative dogs (p = 0.044) and discordant dogs (p = 0.06). Based on dog handler reports, nearly all (4/5; 80%) dogs with reported performance decline or fatigue were T. cruzi-infected dogs. CONCLUSIONS Further understanding cardiac manifestations in dogs naturally infected with T. cruzi is critical for prognostication, establishing a baseline for drug and vaccine studies, and better understanding of zoonotic risk.
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Affiliation(s)
- Alyssa C Meyers
- Veterinary Integrative Biosciences Department, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, MS4458, College Station, TX, 77843-4458, USA
| | - Megan M Ellis
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1601 Campus Delivery, Fort Collins, CO, 80523-1601, USA
| | - Julia C Purnell
- Veterinary Integrative Biosciences Department, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, MS4458, College Station, TX, 77843-4458, USA
| | - Lisa D Auckland
- Veterinary Integrative Biosciences Department, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, MS4458, College Station, TX, 77843-4458, USA
| | - Marvin Meinders
- National Association of Federal Veterinarians, 1910 Sunderland Pl NW, Washington, D.C, 20036, USA
| | - Ashley B Saunders
- Veterinary Integrative Biosciences Department, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, MS4458, College Station, TX, 77843-4458, USA
| | - Sarah A Hamer
- Veterinary Integrative Biosciences Department, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, MS4458, College Station, TX, 77843-4458, USA.
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Boswood A, Gordon SG, Häggström J, Vanselow M, 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. Temporal changes in clinical and radiographic variables in dogs with preclinical myxomatous mitral valve disease: The EPIC study. J Vet Intern Med 2020; 34:1108-1118. [PMID: 32200574 PMCID: PMC7255670 DOI: 10.1111/jvim.15753] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/27/2020] [Indexed: 01/01/2023] Open
Abstract
Background The Evaluation of pimobendan in dogs with cardiomegaly caused by preclinical myxomatous mitral valve disease (EPIC) study monitored dogs with myxomatous mitral valve disease (MMVD) as they developed congestive heart failure (CHF). Objectives To describe the changes in clinical and radiographic variables occurring as dogs with MMVD and cardiomegaly develop CHF, compared to similar dogs that do not develop CHF. Animals One hundred and thirty‐five, and 73 dogs that did or did not develop CHF, respectively. Materials and methods The following variables were evaluated in 2 groups of dogs (dogs that did or did not develop CHF): Heart rate (HR), clinic respiratory rate (RR), home‐measured resting respiratory rate (RRR), rectal temperature (RT), body weight (BW), and vertebral heart sum (VHS). Absolute value and rate of change of each variable were calculated for each day a dog was in study. Daily means were calculated and plotted against time. The onset of CHF or last visit before leaving the study were set as reference time points. Results The most extreme values and rate of change occurred in variables immediately before onset of CHF. Vertebral heart sum increased earliest. Heart rate, RR, and RRR also increased. Rectal temperature and BW decreased. Increases in RR and RRR were most extreme and occurred immediately before CHF. Conclusions and Clinical Importance Dogs with MMVD and cardiomegaly experience increases in HR, RR, RRR, and VHS, and decreases in BW and RT as they develop CHF. The variables with highest absolute change and rate of change were RR and RRR. These findings reinforce the value of RR and RRR as indicators of impending or incipient CHF.
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Affiliation(s)
- Adrian Boswood
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas
| | - Jens Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | | - Gerhard Wess
- Clinic of Small Animal Medicine, University of Munich, Munich, Germany
| | - Rebecca L Stepien
- School of Veterinary Medicine, Medical Sciences, University of Wisconsin Madison, Madison, Wisconsin
| | - Mark A Oyama
- Clinical Studies-Philadelphia, MJR-VHUP-Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bruce W Keene
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina
| | - John Bonagura
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio
| | | | - Mark Patteson
- HeartVets @ Vale Referrals, The Animal Hospital, Stinchcombe, Dursley Glos, UK
| | | | - Philip R Fox
- Department of Cardiology and Caspary Research Institute, Animal Medical Center, New York, New York
| | | | - Richard Woolley
- Cardio Respiratory Pet Referrals, Mordialloc, Melbourne, Victoria, Australia
| | - Viktor Szatmári
- Faculty of Veterinary Medicine, Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands
| | | | | | - M Lynne O'Sullivan
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | | | | | - John Rush
- School of Veterinary Medicine, Clinical Sciences, Tufts University Cummings, North Grafton, Massachusetts
| | | | | | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas
| | - Ingrid Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | | - Eric Bomassi
- Centre Hospitalier Vétérinaire des Cordeliers, Cardiology, Meaux, Paris, France
| | - Amara H Estrada
- University of Florida College of Veterinary Medicine, Small Animal Clinical Sciences, Gainesville, Florida
| | | | - N Sydney Moise
- Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Jonathan A Abbott
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia
| | - Yoko Fujii
- Azabu University, Surgery 1, Kanagawa, Japan
| | - Alan Spier
- Blue Pearl Veterinary Partners, Tampa, Florida
| | - Michael W Luethy
- Chicago Veterinary Emergency and Specialty Center, Chicago, Illinois
| | | | - Masami Uechi
- Japan Animal Specialty Medical Institute Inc., JASMINE Veterinary Cardiovascular Medical Center, Yokohama, Japan
| | | | | | - Philip Watson
- Boehringer Ingelheim, Animal Health, Ingelheim am Rhein, Germany
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Zecca IB, Hodo CL, Slack S, Auckland L, Rodgers S, Killets KC, Saunders AB, Hamer SA. Prevalence of Trypanosoma cruzi infection and associated histologic findings in domestic cats (Felis catus). Vet Parasitol 2019; 278:109014. [PMID: 31972512 DOI: 10.1016/j.vetpar.2019.109014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/14/2019] [Accepted: 12/15/2019] [Indexed: 01/27/2023]
Abstract
Trypanosoma cruzi is a zoonotic protozoan parasite transmitted by triatomines that infects a wide range of mammals. South Texas is a hotspot for triatomines, T. cruzi-infected dogs and wildlife, and local transmission to humans also occurs. However, little is known about the infection of domestic cats (Felis catus) in the United States. Given the role cats play in the ecology of T. cruzi in Mexico and South America, we hypothesized that T. cruzi infection occurs in cats from south Texas, sometimes associated with cardiac pathology. In 2017, 167 euthanized cats from a south Texas shelter were sampled across winter, spring, and summer. We collected whole blood and hearts from all cats, with additional tissues from a subset. Serum samples were screened for T. cruzi antibodies using two independent rapid immunochromatographic tests and an indirect fluorescent antibody test. Cats were considered seropositive if they were positive on at least two independent serological tests. Blood clot, heart tissue and other tissues were subjected to qPCR for parasite detection and discrete typing unit (DTU) determination. Tissues from selected seropositive or PCR-positive animals and a subset of negative animals were processed routinely for histopathology and examined by a board-certified pathologist. A total of 19 cats (11.4%) were seropositive and three cats (1.8%) - one of which was seropositive - had one or more PCR-positive tissues. Infected tissues included heart, bicep femoris muscle, sciatic nerve, esophagus, and mesentery. Genotyping of the parastite to the level of DTU showed that exclusively DTU TcI was present, despite past studies showing both TcI and TcIV in vectors of the region. Eight of 19 (42.1%) seropositive cats exhibited lymphoplasmacytic inflammation, sometimes with fibrosis, in cardiac tissue compared to 28.6% of 28 seronegative cats (P = 0.10). Domestic cats are affected hosts in the eco-epidemiology of Chagas disease. Future prospective studies are needed to understand disease progression. Veterinarians in the southern United States should consider T. cruzi in their index of suspicion in cats with exposure to vectors and undetermined cardiac abnormalities.
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Affiliation(s)
- Italo B Zecca
- Texas A&M University College of Veterinary Medicine & Biomedical Sciences, 4458 TAMU, 77843-4458, College Station, TX, 77840, USA
| | - Carolyn L Hodo
- Texas A&M University College of Veterinary Medicine & Biomedical Sciences, 4458 TAMU, 77843-4458, College Station, TX, 77840, USA; The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, 650 Cool Water Drive, Bastrop, TX, 78602, USA
| | - Sarah Slack
- Texas A&M University College of Veterinary Medicine & Biomedical Sciences, 4458 TAMU, 77843-4458, College Station, TX, 77840, USA
| | - Lisa Auckland
- Texas A&M University College of Veterinary Medicine & Biomedical Sciences, 4458 TAMU, 77843-4458, College Station, TX, 77840, USA
| | - Sandy Rodgers
- Texas A&M University Veterinary Medical Diagnostic Laboratory, 483 Agronomy Rd, College Station, TX, 77843, USA
| | - Keswick C Killets
- Texas A&M University College of Veterinary Medicine & Biomedical Sciences, 4458 TAMU, 77843-4458, College Station, TX, 77840, USA
| | - Ashley B Saunders
- Texas A&M University College of Veterinary Medicine & Biomedical Sciences, 4458 TAMU, 77843-4458, College Station, TX, 77840, USA
| | - Sarah A Hamer
- Texas A&M University College of Veterinary Medicine & Biomedical Sciences, 4458 TAMU, 77843-4458, College Station, TX, 77840, USA.
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Meyers AC, Hamer SA, Matthews D, Gordon SG, Saunders AB. Risk factors and select cardiac characteristics in dogs naturally infected with Trypanosoma cruzi presenting to a teaching hospital in Texas. J Vet Intern Med 2019; 33:1695-1706. [PMID: 31119786 PMCID: PMC6639495 DOI: 10.1111/jvim.15516] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 05/03/2019] [Indexed: 12/18/2022] Open
Abstract
Background Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, causes sudden death and chronic heart disease with no currently approved treatment. Objective To report epidemiologic and select cardiac characteristics associated with T. cruzi infection in dogs presenting to a teaching hospital in Texas. Animals Three hundred seventy‐five client‐owned dogs. Methods A retrospective search of medical records identified dogs tested for T. cruzi antibodies or with histologic T. cruzi parasites. Data retrieved included signalment, location of residence, reported reason for testing, cardiac troponin I (cTnI) concentration, and ECG abnormalities. Results Trypanosoma cruzi‐infected dogs (N = 63, 16.8%) were significantly younger than negative dogs (N = 312) (mean, 5.9 ± 3.8 versus 7.4 ± 4.0 years; P = .007) with no difference by sex or breed. Ninety‐one breeds were tested; the highest percent infected were non‐sporting (10/35; 29%) and toy breed (10/42; 24%) groups. The odds of infection were 13 times greater among dogs with an infected housemate or littermate (95% confidence interval [CI], 3.94‐50.45; P < .001). Infected dogs were more likely to have ventricular arrhythmias (odds ratio [OR], 2.19; 95% CI, 1.15‐4.33, P = .02), combinations of ECG abnormalities (OR, 2.91; 95% CI, 1.37‐5.99; P = .004), and cTnI >0.129 ng/mL (ADVIA; OR, 10.71; 95% CI, 1.60‐212.21; P = .035). Conclusions and Clinical Importance Dogs infected with T. cruzi were identified in Texas in many breed groups including breeds affected by well‐described heart diseases that mimic Chagas disease suggesting a need for increased awareness, including knowledge of when to consider testing.
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Affiliation(s)
- Alyssa C Meyers
- Department of Veterinary Integrative Bioscience, Texas A&M University, College Station, Texas
| | - Sarah A Hamer
- Department of Veterinary Integrative Bioscience, Texas A&M University, College Station, Texas
| | - Derek Matthews
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
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Fries RC, Gordon SG, Saunders AB, Miller MW, Hariu CD, Schaeffer DJ. Quantitative assessment of two- and three-dimensional transthoracic and two-dimensional transesophageal echocardiography, computed tomography, and magnetic resonance imaging in normal canine hearts. J Vet Cardiol 2018; 21:79-92. [PMID: 30797448 DOI: 10.1016/j.jvc.2018.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/08/2018] [Accepted: 09/20/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objective of the study was to evaluate the accuracy of two- and three-dimensional (2D, 3D) transthoracic echocardiography (TTE), 2D transesophageal echocardiography, and computed tomography angiography (CTA) compared with cardiac magnetic resonance imaging (CMR) in normal dogs and to assess repeatability of 2D and 3D TTE for the assessment of left ventricular (LV) and left atrial (LA) dimensions. ANIMALS The study was performed on six healthy dogs. MATERIALS AND METHODS Transthoracic echocardiography, transesophageal echocardiography, CTA, and CMR were performed on each dog. Right ventricular (RV) and LV volumes (in systole and diastole), ejection fraction (EF), and LA and right atrial (RA) volumes were assessed. Repeatability and intrarater and interrater measurements of variability were quantified by average coefficient of variation (CV) for 2D and 3D TTE. RESULTS No clinically relevant differences in LV volume were detected between CMR and all modalities. Importantly, 3D TTE had the lowest CV (6.45%), correlated with (rs = 0.62, p = 0.01), and had the highest overlap in distribution with CMR (OVL >80%). Left ventricular EF and LA size via CTA compared best with CMR and RV and RA volumes were best estimated by 3D TTE. Assessment of LV and LA volumes via 3D TTE had moderate repeatability (15-21%) compared with LV M-mode measurements and 2D LA-to-aortic ratio (<10%), respectively. For LV size, interrater CV for 3D TTE (19.4%) was lower than 2D TTE (23.1%). CONCLUSIONS Measurements of LV, RV, and RA volumes via 3D TTE and LA volume and LV EF assessed by CTA compared best with CMR. Three-dimensional echocardiography had lower interrater and intrarater CV compared with 2D TTE.
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Affiliation(s)
- R C Fries
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, 4474 TAMU, College Station, TX 77843-4474, USA.
| | - S G Gordon
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, 4474 TAMU, College Station, TX 77843-4474, USA
| | - A B Saunders
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, 4474 TAMU, College Station, TX 77843-4474, USA
| | - M W Miller
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, 4474 TAMU, College Station, TX 77843-4474, USA
| | - C D Hariu
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, 4474 TAMU, College Station, TX 77843-4474, USA
| | - D J Schaeffer
- University of Illinois College of Veterinary Medicine, 1008 West Hazelwood Drive, Urbana, IL 61802, USA
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Wesselowski S, Cusack K, Gordon SG, Jeffery N, Saunders AB. Artificial cardiac pacemaker placement in dogs with a cohort of myocarditis suspects and association of ultrasensitive cardiac troponin I with survival. J Vet Cardiol 2018; 22:84-95. [PMID: 30573438 DOI: 10.1016/j.jvc.2018.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Artificial cardiac pacemakers (APs) are a common treatment for symptomatic bradyarrhythmias in dogs, some of which may be triggered by underlying myocarditis. Severely elevated cardiac troponin I (cTnI) concentrations support a diagnosis of myocarditis. The association of ultrasensitive-cTnI (US-cTnI) concentration with survival in a large cohort of dogs receiving APs is not described. ANIMALS, MATERIALS, AND METHODS The study included 110 dogs receiving APs over a 5-year period. Medical records were retrospectively reviewed to characterize the entire population receiving APs, with further analysis in dogs with preprocedural US-cTnI concentrations (n = 64) classified as normal/group 1 (n = 11), mildly to moderately elevated/group 2 (n = 27), and severely elevated/myocarditis suspects/group 3 (n = 26). RESULTS Median survival time was 1079 days for the entire population, 1167 days for group 2, 949 days for group 3, and not met in group 1. There was not a statistically significant difference in survival between group 2 and group 3. Overall, US-cTnI had a mild, negative association with survival. Age had a stronger negative association. Infectious etiologies were identified in a minority of group 3 cases. A possible association between severely elevated US-cTnI and a sudden death outcome was noted. CONCLUSIONS The negative association of US-cTnI with survival outcomes was mild, with age having a larger effect. Although a sudden death outcome may be seen more commonly in myocarditis suspects, group 3 survival time was similar to that of the entire canine population. Plausible infectious causes of myocarditis were infrequently identified.
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Affiliation(s)
- S Wesselowski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA.
| | - K Cusack
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - S G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - N Jeffery
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
| | - A B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843-4474, USA
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Wesselowski S, Saunders AB, Gordon SG. Anatomy, baseline characteristics, and procedural outcome of patent ductus arteriosus in German Shepherd dogs. J Vet Intern Med 2018; 33:471-477. [PMID: 30556180 PMCID: PMC6430865 DOI: 10.1111/jvim.15401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 11/20/2018] [Indexed: 11/26/2022] Open
Abstract
Background German Shepherd dogs (GSD) are predisposed to developing patent ductus arteriosus (PDA) and are reportedly prone to type III (tubular) PDA anatomy. Dogs with type III anatomy are not considered favorable candidates for device‐based intervention. Objective To describe the PDA anatomy, baseline characteristics, and procedural outcome of GSD with PDA. Animals Twenty‐eight client‐owned GSD. Methods Retrospective review of medical records of 28 GSD diagnosed with PDA that underwent surgical ligation or transcatheter device closure between 2007 and 2017. Results German Shepherd dogs with PDA often presented with clinical signs (50%), concurrent congenital heart disease (35.7%), and arrhythmias (29%). Dogs were typically mature at presentation (median age, 12.1 months) and evenly distributed by sex (57% female). The PDA anatomy was classified in 24 of 28 GSD, with type II anatomy being most common (21/24). Three dogs had unusual anatomy (type IV in 1, type V in 2). Median minimal ductal diameter (MDD) in this population was larger than previously reported in a mixed population and ranged between 4.4 and 4.9 mm depending upon imaging modality. Successful closure was achieved using an Amplatz canine duct occluder (ACDO) in 22 dogs or by surgical ligation in 6 dogs. No cases of type III anatomy were confirmed. Conclusions and Clinical Importance The majority of GSD in this population had type II PDA anatomy that was amenable to ACDO deployment. Predisposition for large MDD and occasional, unusual PDA anatomy suggests that transesophageal echocardiography may be beneficial for optimal procedural planning in this breed.
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Affiliation(s)
- Sonya Wesselowski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas
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Doocy KR, Saunders AB, Gordon SG, Jeffery N. Comparative, multidimensional imaging of patent ductus arteriosus and a proposed update to the morphology classification system for dogs. J Vet Intern Med 2018; 32:648-657. [PMID: 29460426 PMCID: PMC5866990 DOI: 10.1111/jvim.15068] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/08/2017] [Accepted: 01/18/2018] [Indexed: 11/26/2022] Open
Abstract
Background Accurately assessing the morphology and shape of the patent ductus arteriosus (PDA) and obtaining measurements are important to avoid procedural complications. Objectives To characterize and compare PDA morphology, shape, and dimensions with angiography and echocardiography. Animals 25 client‐owned dogs with echocardiographically confirmed PDA. Methods Prospective case series. Imaging consisted of single plane angiography, transthoracic echocardiography from the right (TTE‐R) and left (TTE‐L), and two‐dimensional, biplane, and three‐dimensional transesophageal echocardiography (TEE‐2D and TEE‐3D). Measurements included angiographic minimal ductal diameter (MDD), echocardiographic pulmonary ostium in a single dimension (TTE‐R, TTE‐L, and TEE‐2D) and in perpendicular dimensions (TEE‐3D) with similar measurements of the ampulla 3 mm above the MDD or pulmonary ostium. The morphology and shape of the PDA were characterized. Results Catheter‐based occlusion (N = 20) and surgical ligation (N = 5) were performed without complication. Angiographic morphology was classified as type II (N = 19), type III (N = 1), and other (N = 1). Angiographic MDD and TEE‐2D pulmonary ostium measurements were significantly (P = .008) but weakly correlated (r = .56); similar relationships were found for ampulla diameter measurements (P < .0001; r = .75). In general, TEE‐2D did not correlate with other imaging modalities measurements. Based on TEE‐3D measurements, the majority of pulmonary ostium (17/24; 71%) and ampulla (19/24; 79%) were oval. Conclusions and Clinical Importance Measurements using different imaging modalities are not interchangeable. TEE‐3D provided an en face view of the PDA that cannot be replicated with other echocardiographic techniques and demonstrated an oval shape in the majority of dogs. We propose an update to the current classification system to include additional PDA morphologies.
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Affiliation(s)
- Kelley R Doocy
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Nicholas Jeffery
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wesselowski S, Saunders AB, Gordon SG. Relationship between Device Size and Body Weight in Dogs with Patent Ductus Arteriosus Undergoing Amplatz Canine Duct Occluder Deployment. J Vet Intern Med 2017; 31:1388-1391. [PMID: 28782853 PMCID: PMC5598890 DOI: 10.1111/jvim.14797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/10/2017] [Accepted: 06/27/2017] [Indexed: 11/23/2022] Open
Abstract
Background Deployment of the Amplatz Canine Duct Occluder (ACDO) is the preferred method for minimally invasive occlusion of patent ductus arteriosus (PDA) in dogs, with appropriate device sizing crucial to successful closure. Dogs of any body weight can be affected by PDA. Objectives To describe the range of ACDO sizes deployed in dogs of various body weights for improved procedural planning and inventory selection and to investigate for correlation between minimal ductal diameter (MDD) and body weight. Animals A total of 152 dogs undergoing ACDO deployment between 2008 and 2016. Methods Body weight, age, breed, sex, and MDD obtained by angiography (MDD‐A), MDD obtained by transesophageal echocardiography (MDD‐TEE), and ACDO size deployed were retrospectively evaluated. Results Correlation between body weight and ACDO size, MDD‐A and MDD‐TEE was poor, with R‐squared values of 0.4, 0.36, and 0.3, respectively. Femoral artery diameter in the smallest population of dogs placed inherent limitations on the use of larger device sizes, with no limitations on the wide range of device sizes required as patient size increased. The most commonly used ACDO devices were size 3 through 6, representing 57% of the devices deployed within the entire study population. Conclusions and Clinical Importance Patent ductus arteriosus anatomy varies on an individual basis, with poor correlation between MDD and body weight. Weight‐based assumptions about expected ACDO device size for a given patient are not recommended.
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Affiliation(s)
- S Wesselowski
- College of Veterinary Medicine, Texas A&M University, College Station, TX
| | - A B Saunders
- College of Veterinary Medicine, Texas A&M University, College Station, TX
| | - S G Gordon
- College of Veterinary Medicine, Texas A&M University, College Station, TX
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Wierzbicki MA, Raines SB, Gordon SG, Criscione JC, Saunders AB, Birch S, Due B, Keller B, Nash LD, Miller MW, Maitland DJ. An experimental canine patent ductus arteriosus occlusion device based on shape memory polymer foam in a nitinol cage. J Mech Behav Biomed Mater 2017; 75:279-292. [PMID: 28759840 DOI: 10.1016/j.jmbbm.2017.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 12/01/2022]
Abstract
Patent ductus arteriosus (PDA) is a congenital cardiovascular defect in which a fetal connection between the aorta and pulmonary artery does not spontaneously close shortly after birth. If left uncorrected serious complications and even death can occur. Surgical ligation is the traditional treatment method; however, it is an invasive procedure, that motivates development of a minimally invasive option. Shape memory polymer (SMP) foams are unique materials that hold promise in the field of minimally invasive occlusion devices. In this work, a prototype nitinol foam cage (NFC) incorporating SMP foams has been designed and evaluated in multiple mechanical and in vitro verification tests. The NFC demonstrated acceptable fatigue resistance in a preliminary strut integrity test, withstanding one million cycles without complete strut fracture. Radial force analysis of both thick- and thin-walled prototype variations generated less vessel distension and wall tension in a vessel mimic compared to a commercial device. The NFCs exhibited negligible in vitro migration, comparable to that of a commercial device, using simplified, ideal models of PDA. Deployment characteristics of the prototypes were evaluated and compared to that of a commercial device when delivered into physiological models of PDA. During mock deployments, a veterinary cardiologist noted that, while deliverable, the thin-walled NFC prototype exhibited poor deployment characteristics, however the thick-walled NFC had deployment characteristics comparable to that of a commercial device. The promising results of this study warrant further investigation of the NFC device for canine PDA closure.
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Affiliation(s)
- Mark A Wierzbicki
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843, USA
| | - Sarah B Raines
- Department of Electrical Engineering, Texas A&M University, USA
| | - Sonya G Gordon
- Department of Small Animal Clinical Sciences of Veterinary Medicine and Biomedical Sciences, Texas A&M University, USA
| | - John C Criscione
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843, USA
| | - Ashley B Saunders
- Department of Small Animal Clinical Sciences of Veterinary Medicine and Biomedical Sciences, Texas A&M University, USA
| | - Scott Birch
- The Center for Educational Technologies, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, USA
| | - Bradley Due
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843, USA
| | - Brandis Keller
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843, USA
| | - Landon D Nash
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843, USA
| | - Matthew W Miller
- Texas Institute for Preclinical Studies, Texas A&M University, MS 4478, College Station, TX 77845, USA
| | - Duncan J Maitland
- Department of Biomedical Engineering, Texas A&M University, MS 3120, 5045 Emerging Technologies Building, College Station, TX 77843, USA.
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