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Pirintr P, Saengklub N, Boonpala P, Hamlin RL, Kijtawornrat A. Impact of a combination of pimobendan, furosemide, and enalapril on heart rate variability in naturally occurring, symptomatic, myxomatous mitral valve degeneration dogs. BMC Vet Res 2023; 19:201. [PMID: 37821927 PMCID: PMC10568857 DOI: 10.1186/s12917-023-03770-6] [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: 09/06/2022] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Pimobendan, diuretics, and an angiotensin-converting enzyme inhibitor (ACEi) are widely used for the management of chronic valvular heart disease in dogs; however, the effects of that combination on heart rate variability (HRV) are unknown. The purpose of this study was to assess the HRV of symptomatic myxomatous mitral valve degeneration (MMVD) dogs in response to therapy with a combination of pimobendan, diuretics, and ACEi. RESULTS MMVD stage C (n = 17) dogs were enrolled and a 1-hour Holter recording together with echocardiography, blood pressure measurement, and blood chemistry profiles were obtained before and 1, 3, and 6 months after oral treatment with pimobendan (0.25 mg/kg), enalapril (0.5 mg/kg), and furosemide (2 mg/kg) twice daily. The results revealed that MMVD stage C dogs at the baseline had lower values of time-domain indices, low frequency (LF), high frequency (HF), and total power, as well as higher value of LF/HF. Triple therapy significantly increases these parameters in MMVD stage C dogs (P < 0.05). A positive moderate correlation was observed between time domain parameters and a left ventricular internal diastole diameter normalized to body weight (P < 0.05). CONCLUSIONS It can be concluded that MMVD stage C dogs possess low HRV due to either the withdrawal of parasympathetic tone or enhanced sympathetic activation, and a combination therapy was shown to enhance cardiac autonomic modulation inferred from the increased heart rate variability. Therefore, a combination therapy may be useful for restoring normal autonomic nervous system activity in dogs with MMVD stage C.
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Affiliation(s)
- Prapawadee Pirintr
- Department of Veterinary Biosciences and Veterinary Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai, 50100, Thailand
| | - Nakkawee Saengklub
- Department of Physiology, Faculty of Pharmacy, Mahidol University, 447 Sriayuthaya Rd., Ratchathewi, Bangkok, 10400, Thailand
| | - Pakit Boonpala
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Robert L Hamlin
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, 1900 Coffey Rd, Columbus, OH, 43210, USA
- QTest Labs, LTD, 6456 Fiesta Dr, Columbus, OH, 43235, USA
| | - Anusak Kijtawornrat
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Rd., Pathumwan, Bangkok, 10330, Thailand.
- Chulalongkorn University Laboratory Animal Center (CULAC), Chulalongkorn University, Henri-Dunant Rd., Pathumwan, Bangkok, 10330, Thailand.
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Boonpala P, Saengklub N, Srikam S, Ji-Au W, Panyasing Y, Kumphune S, Kijtawornrat A. Pimobendan prevents cardiac dysfunction, mitigates cardiac mitochondrial dysfunction, and preserves myocyte ultrastructure in a rat model of mitral regurgitation. BMC Vet Res 2023; 19:130. [PMID: 37612694 PMCID: PMC10463781 DOI: 10.1186/s12917-023-03693-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Pimobendan has been proven to delay the onset of congestive heart failure (CHF) in dogs with mitral regurgitation (MR); however, molecular underlying mechanisms have not been fully elucidated. This study aimed to investigate (1) the effects of pimobendan on cardiac function, cardiac mitochondrial quality and morphology, and cardiac ultrastructure in a rat model of chronic MR and (2) the direct effect of pimobendan on intracellular reactive oxygen species (ROS) production in cardiac cells. MR was surgically induced in 20 Sprague-Dawley rats, and sham procedures were performed on 10 rats. Eight weeks post-surgery, the MR rats were randomly divided into two groups: the MR group and the MR + pimobendan group. Pimobendan (0.15 mg/kg) was administered twice a day via oral gavage for 4 weeks, whereas the sham and MR groups received equivalent volumes of drinking water. Echocardiography was performed at baseline (8 weeks post-surgery) and at the end of the study (4 weeks after treatment). At the end of the study protocol, all rats were euthanized, and their hearts were immediately collected, weighed, and used for transmission electron microscopy and mitochondrial quality assessments. To evaluate the role of pimobendan on intracellular ROS production, preventive or scavenging properties were tested with H2O2-induced ROS generation in rat cardiac myoblasts (H9c2). RESULTS Pimobendan preserved cardiac functions and structure in MR rats. In addition, pimobendan significantly improved mitochondrial quality by attenuating ROS production and depolarization (P < 0.05). The cardiac ultrastructure and mitochondrial morphology were significantly preserved in the MR + pimobendan group. In addition, pimobendan appeared to play as a ROS scavenger, but not as a ROS preventer, in H2O2-induced ROS production in H9c2 cells. CONCLUSIONS Pimobendan demonstrated cardioprotective effects on cardiac function and ultrastructure by preserving mitochondrial quality and acted as an ROS scavenger in a rat model of MR.
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Affiliation(s)
- Pakit Boonpala
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
- Chulalongkorn University Laboratory Animal Center, Chulalongkorn University, Bangkok, Thailand
| | - Nakkawee Saengklub
- Department of Physiology, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Sirinapa Srikam
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wilawan Ji-Au
- Department of Pathology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yaowalak Panyasing
- Department of Pathology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Sarawut Kumphune
- Biomedical Engineering Institute (BMEI), Chiang Mai University, Chiang Mai, Thailand
- Biomedical Engineering and Innovation Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Anusak Kijtawornrat
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand.
- Chulalongkorn University Laboratory Animal Center, Chulalongkorn University, Bangkok, Thailand.
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Vila J, Alost E. Management and outcome of intracardiac heartworms in dogs. Parasit Vectors 2023; 16:146. [PMID: 37106387 PMCID: PMC10142162 DOI: 10.1186/s13071-023-05677-5] [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: 12/27/2022] [Accepted: 01/18/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Intracardiac heartworm (IH) disease is a serious condition that can become life threatening if the patient develops caval syndrome. We aim to describe the management and outcome of IH in dogs evaluated by Medvet's New Orleans cardiology service from November 2015 to December 2021. METHODS Records of 27 dogs with IH were examined retrospectively. Follow-up information was obtained from phone conversations with referring veterinarians and owners. RESULTS Nine of 27 dogs had a previous diagnosis of heartworm disease and were undergoing "slow kill" treatment; 12/27 dogs' heartworm disease was a new diagnosis, and 6/27 had either scheduled or started adulticide therapy. Nine dogs had heartworm extraction. No dogs died during the heartworm extraction procedure. Four of 9 dogs have died (survival time 1; 676; 1815 and 2184 days). One dog died the day after the procedure secondary to continued respiratory distress; the other three died of non-cardiac causes. Five of nine are alive (median follow-up 1062 (range 648-1831) days. Eleven dogs had IH resolution. In 7/11 this occurred while undergoing stabilization for heartworm extraction. In 4/11 heartworm extraction was not recommended because of low IH burden. All dogs with IH resolution were discharged from the hospital. Four of 11 have died (survival time 6; 22, 58 and 835 days), and 6/11 are alive (median follow-up 523 (range 268-2081) days. One was lost to follow-up after 18 days. Five dogs were medically managed. In one of five dogs, extraction was not recommended because of low IH burden. In four of five extraction was recommended but declined. One of five has died (survival 26 days), and four of five are alive (follow-up 155, 371, 935 and 947 days). Two dogs were killed at the time of diagnosis. Fifteen of 27 dogs were considered to have caval syndrome. CONCLUSION The results suggest that patients with IH resolution have a good long-term prognosis. Most often IH resolution occurred while the dog was undergoing stabilization for heartworm extraction. When IHs are present, heartworm extraction should still be considered the treatment of choice and recommended as first-line therapy whenever possible.
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Aoki T, Niimi S. Two cases of new-born puppies with transient pulmonary edema. Vet Res Forum 2023; 14:237-241. [PMID: 37181856 PMCID: PMC10170463 DOI: 10.30466/vrf.2022.546719.3349] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/01/2022] [Indexed: 05/16/2023]
Abstract
Acute pulmonary edema in puppies generally occurs due to congenital left-right shunts such as patent ductus arteriosus or large ventricular septal defects. Herein, we presented two cases of puppies with no apparent congenital cardiovascular disease. Case 1: A 12-day-old male Labrador Retriever, weighing 1.15 kg, was unable to suckle sufficiently from its dam and exhibited laboured breathing. Pulmonary edema was identified in all lung lobes by radiography, furthermore, echocardiography revealed significant enlargement of the left side of the heart. Pulmonary edema secondary to volume overload was suspected and furosemide was administered. The respiratory status was improved on the following day. Pimobendan was administered orally in addition to furosemide and both were withdrawn 6 weeks later when the heart size was normalized. Case 2: A 15-day-old female Standard Poodle, weighing 0.68 kg, was less active than other littermates and exhibited laboured breathing. Radiography revealed pulmonary edema in the right posterior lobe, dilatation of the caudal vena cava and ascites. Echocardiography revealed significant enlargement of the left atrium and ventricle perhaps owing to decreased left ventricular contractility. Furosemide and pimobendan were administered. One week later, appetite was improved and supraventricular tachycardia of 375 bpm was observed. Therefore, tachycardia-induced dilated cardiomyopathy was suspected which returned to sinus rhythm with diltiazem treatment, however, it was recurred. Upon sotalol monotherapy, a normal heart size was observed seven months later. In conclusion, we encountered two new-born puppies with transient pulmonary edema that were temporarily treated with pimobendan and furosemide.
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Affiliation(s)
- Takuma Aoki
- Correspondence Takuma Aoki. DVM, PhD Department of Veterinary Medicine, Azabu University, Sagamihara, Kanagawa, Japan E-mail:
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Klein S, Nolte I, Rumstedt K, Sehn M, Raue JF, Weiner F, Treese JS, Beyerbach M, Bach JP. The effect of treatment with pimobendan in dogs with preclinical mitral valve disease - a placebo-controlled double-blinded crossover study. BMC Vet Res 2021; 17:310. [PMID: 34563187 PMCID: PMC8467240 DOI: 10.1186/s12917-021-03014-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 05/31/2021] [Accepted: 08/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background Pimobendan is a widely used medication for the treatment of dogs with congestive heart failure (CHF) and preclinical degenerative mitral valve disease (DMVD) with cardiomegaly. The benefit of a treatment in dogs with preclinical DMVD but without cardiomegaly has not yet been elucidated. Some positive effects concerning life quality and a decrease in cardiac biomarkers could be verified. This study aimed to further investigate these results using a placebo-controlled double-blinded crossover design. Out of a total of 15 dogs, eight were allocated to sequence-group AB, in which dogs received pimobendan (A) during the first treatment period and placebo (B) during the second period. Accordingly, sequence-group BA was treated first with placebo followed by pimobendan. Each treatment period lasted six months and included a baseline investigation and follow-ups after 90 and 180 days. The investigations included a questionnaire completed by the owners, echocardiographic examination, and measurements of NT-proBNP, cTnI and lactate before and after a standardised submaximal exercise test. Results NT-proBNP values decreased significantly during the treatment period with pimobendan, and the post-exercise increase was attenuated at day 180. No significant treatment effects could be verified for cTnI and lactate, neither pre- nor post-exercise. Left ventricular size decreased under treatment, whereas no significant changes in left atrial size were detected. The owners described their dogs under treatment with pimobendan as being more active at day 90 (11/15) and day 180 (12/15). Those animals treated with placebo were described as being more active at day 90 (2/15) and day 180 (5/15). Conclusions Pimobendan had reducing effects on the concentrations of pre- and post-exercise cardiac biomarkers and the size of the left ventricle in dogs with DMVD ACVIM B1. Exercise testing in addition to an assessment of cardiac biomarkers might improve the decision when to initiate pimobendan treatment in dogs with DMVD. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-021-03014-5.
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Affiliation(s)
- Stephanie Klein
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Ingo Nolte
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany.
| | - Katja Rumstedt
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Maximiliane Sehn
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | | | - Franziska Weiner
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Julia Sophie Treese
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Martin Beyerbach
- Institute for Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health at the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Jan-Peter Bach
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
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Mikawa S, Nagakawa M, Ogi H, Akabane R, Koyama Y, Sakatani A, Ogawa M, Miyakawa H, Shigemoto J, Tokuriki T, Toda N, Miyagawa Y, Takemura N. Use of vertebral left atrial size for staging of dogs with myxomatous valve disease. J Vet Cardiol 2020; 30:92-99. [PMID: 32707334 DOI: 10.1016/j.jvc.2020.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/25/2019] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/OBJECTIVES The American College of Veterinary Internal Medicine (ACVIM) guidelines suggest that pimobendan should be initiated in dogs which meet all criteria of stage B2 myxomatous mitral valve disease (MMVD): murmur intensity ≥ 3/6, left atrial-to-aortic ratio ≥ 1.6, normalized left ventricular internal diameter in diastole ≥ 1.7, and vertebral heart size > 10.5. Recently, a new radiographic index for left atrial enlargement, vertebral left atrial size (VLAS), was proposed. The objective of the present study was to evaluate whether VLAS is useful in staging MMVD and if it can distinguish between ACVIM stages B1 and B2. ANIMALS Ninety-seven client-owned dogs with MMVD were evaluated and classified as ACVIM stage B1, B2, or C-D. MATERIALS AND METHODS The echocardiographs and radiographs of all the dogs were retrospectively evaluated to obtain left atrial-to-aortic ratio, normalized left ventricular internal diameter in diastole, and VLAS values. The data were analyzed to assess the correlation between these measurements and VLAS, and the optimal cutoff value of VLAS was determined. RESULTS A VLAS cutoff value of 2.6 provided the greatest diagnostic accuracy for identification of dogs with ACVIM stage B2 MMVD (area under the curve, 0.96; sensitivity, 95%; specificity, 84%). A VLAS ≥2.5 exhibited the highest sensitivity (sensitivity, 100%; specificity, 78%), and a VLAS ≥ 3.1 exhibited the highest specificity (sensitivity, 47%; specificity, 100%). CONCLUSIONS VLAS is a helpful index for monitoring MMVD using radiography. A VLAS cutoff value of 2.5 could be used to identify dogs that may benefit from echocardiography to determine if they have reached ACVIM stage B2.
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Affiliation(s)
- S Mikawa
- Department of Clinical Pathology, Faculty of Veterinary Medicine, Okayama University of Science, 1-3 Ikoinooka, Imabari-shi, Ehime 794-8555, Japan.
| | - M Nagakawa
- Laboratory of Veterinary Internal Medicine II, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - H Ogi
- Laboratory of Veterinary Internal Medicine II, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - R Akabane
- Laboratory of Veterinary Internal Medicine II, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Y Koyama
- Laboratory of Veterinary Internal Medicine II, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - A Sakatani
- Laboratory of Veterinary Internal Medicine II, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - M Ogawa
- Laboratory of Veterinary Internal Medicine II, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - H Miyakawa
- Laboratory of Veterinary Internal Medicine II, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - J Shigemoto
- Oji Pet Clinic, 1-22-9 Toshima, Kita-ku, Tokyo 114-0003, Japan
| | - T Tokuriki
- Laboratory of Veterinary Internal Medicine II, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - N Toda
- Laboratory of Veterinary Internal Medicine II, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Y Miyagawa
- Laboratory of Veterinary Internal Medicine II, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - N Takemura
- Laboratory of Veterinary Internal Medicine II, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
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Sekihara T, Sonoura T, Nakamura Y, Sunayama I, Morishita Y, Ishimi M, Yamato M, Yoshimura T, Yasuoka Y. Disappearance of an anticoagulation-resistant left atrial appendage thrombus after administration of low-dose pimobendan. J Cardiol Cases 2020; 21:157-160. [PMID: 32256866 DOI: 10.1016/j.jccase.2019.12.007] [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: 07/24/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022] Open
Abstract
Anticoagulation therapy is essential for preventing thrombus formation in the left atrial appendage (LAA) and subsequent ischemic strokes in patients with atrial fibrillation (AF). The complete disappearance of any existing LAA thrombi is crucial before AF ablation. Currently, warfarin and direct oral anticoagulants are widely used for this purpose. However, treatment strategies for anticoagulation-resistant LAA thrombi are not well established. Here, we present a case of an 85-year-old male who was scheduled to undergo AF ablation. He developed an LAA thrombus that was resistant to 300 mg/day of dabigatran. Low-dose pimobendan was prescribed in addition to dabigatran; three months later, the thrombus was dissolved successfully. This case demonstrates the potential efficacy of a low-dose oral inotrope for treating an anticoagulation-resistant LAA thrombus. <Learning objective: Treatment strategies for anticoagulation-resistant left atrial appendage thrombi are not well established. This case demonstrates that a low-dose oral inotrope, such as pimobendan, is capable of dissolving such thrombi and is a potentially useful treatment modality.>.
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Affiliation(s)
- Takayuki Sekihara
- National Hospital Organization, Osaka-Minami Medical Center, Cardiovascular Division, Osaka Prefecture, Japan
| | - Takuryu Sonoura
- National Hospital Organization, Osaka-Minami Medical Center, Cardiovascular Division, Osaka Prefecture, Japan
| | - Yuka Nakamura
- National Hospital Organization, Osaka-Minami Medical Center, Cardiovascular Division, Osaka Prefecture, Japan
| | - Isamu Sunayama
- National Hospital Organization, Osaka-Minami Medical Center, Cardiovascular Division, Osaka Prefecture, Japan
| | - Yu Morishita
- National Hospital Organization, Osaka-Minami Medical Center, Cardiovascular Division, Osaka Prefecture, Japan
| | - Masashi Ishimi
- National Hospital Organization, Osaka-Minami Medical Center, Cardiovascular Division, Osaka Prefecture, Japan
| | - Masashi Yamato
- National Hospital Organization, Osaka-Minami Medical Center, Cardiovascular Division, Osaka Prefecture, Japan
| | - Takahiro Yoshimura
- National Hospital Organization, Osaka-Minami Medical Center, Cardiovascular Division, Osaka Prefecture, Japan
| | - Yoshinori Yasuoka
- National Hospital Organization, Osaka-Minami Medical Center, Cardiovascular Division, Osaka Prefecture, Japan
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Iwanuk N, Nolte I, Wall L, Sehn M, Raue J, Pilgram A, Rumstedt K, Bach JP. Effect of Pimobendan on NT-proBNP and c troponin I before and after a submaximal exercise test in dogs with preclinical mitral valve disease without cardiomegaly - a randomised, double-blinded trial. BMC Vet Res 2019; 15:237. [PMID: 31288807 PMCID: PMC6617668 DOI: 10.1186/s12917-019-1980-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 09/26/2018] [Accepted: 06/26/2019] [Indexed: 11/14/2022] Open
Abstract
Background Exercise testing in conjunction with measurement of cardiac biomarkers NT-proBNP and cTnI is a useful tool for monitoring the effect of treatment on cardiac patients. Administering Pimobendan in dogs with degenerative mitral valve disease (DMVD) and cardiomegaly results in delaying the onset of clinical symptoms and prolonging life. Its effect in dogs with DMVD without cardiomegaly has not been well examined. The aim of the current study was to investigate the effect of administering Pimobendan in dogs with DMVD without cardiomegaly using exercise testing in conjunction with measuring cardiac biomarkers in addition to echocardiography. Twenty-one dogs with asymptomatic DMVD without echocardiographic signs of cardiomegaly participated in a randomised, double-blinded trial. Dogs were divided into a Pimobendan-group (n = 11) and a placebo-group (n = 10) in a double-blinded study design and underwent a standardised submaximal exercise test (SSET). One dog in the Pimobendan-group was retrospectively removed from the study after being diagnosed with Leishmaniosis. Cardiac biomarkers NT-proBNP and cTnI were measured before and after exercise. Follow-up appointments were performed at days 90 and 180. Results Dogs in the Pimobendan-group had significantly lower post-exercise NT-proBNP-levels after being administered Pimobendan than at the beginning of the study. They also had lower pre- and post-exercise-NT-proBNP-levels than those dogs in the placebo-group. There was neither a significant difference regarding the measured cTnI levels nor an increase in cTnI between the groups at any time. Conclusions Pimobendan lowers NT-proBNP in dogs with presymptomatic mitral valve disease without cardiomegaly before and after submaximal exercise. This indicates a reduction in cardiac wall stress. If dogs with asymptomatic DMVD without cardiomegaly benefit from treatment with Pimobendan (for example, through a longer survival time) warrants further investigation.
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Affiliation(s)
- Nayeli Iwanuk
- Small Animal Clinic, University of Veterinary Medicine Hanover, Foundation, Bünteweg 9, D-30559, Hannover, Germany
| | - Ingo Nolte
- Small Animal Clinic, University of Veterinary Medicine Hanover, Foundation, Bünteweg 9, D-30559, Hannover, Germany.
| | - Leona Wall
- Small Animal Clinic, University of Veterinary Medicine Hanover, Foundation, Bünteweg 9, D-30559, Hannover, Germany
| | - Maximiliane Sehn
- Small Animal Clinic, University of Veterinary Medicine Hanover, Foundation, Bünteweg 9, D-30559, Hannover, Germany
| | - Jonathan Raue
- Small Animal Clinic, University of Veterinary Medicine Hanover, Foundation, Bünteweg 9, D-30559, Hannover, Germany
| | - Anna Pilgram
- Small Animal Clinic, University of Veterinary Medicine Hanover, Foundation, Bünteweg 9, D-30559, Hannover, Germany
| | - Katja Rumstedt
- Small Animal Clinic, University of Veterinary Medicine Hanover, Foundation, Bünteweg 9, D-30559, Hannover, Germany
| | - Jan-Peter Bach
- Small Animal Clinic, University of Veterinary Medicine Hanover, Foundation, Bünteweg 9, D-30559, Hannover, Germany
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Guth BD, Chiang AY, Doyle J, Engwall MJ, Guillon JM, Hoffmann P, Koerner J, Mittelstadt S, Ottinger S, Pierson JB, Pugsley MK, Rossman EI, Walisser J, Sarazan RD. The evaluation of drug-induced changes in cardiac inotropy in dogs: Results from a HESI-sponsored consortium. J Pharmacol Toxicol Methods 2015; 75:70-90. [PMID: 25843226 DOI: 10.1016/j.vascn.2015.02.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/12/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Drug-induced effects on the cardiovascular system remain a major cause of drug attrition. While hemodynamic (blood pressure (BP) and heart rate (HR)) and electrophysiological methods have been used in testing drug safety for years, animal models for assessing myocardial contractility are used less frequently and their translation to humans has not been established. The goal of these studies was to determine whether assessment of contractility and hemodynamics, when measured across different laboratories using the same protocol, could consistently detect drug-induced changes in the inotropic state of the heart using drugs known to have clinically relevant positive and negative effects on myocardial contractility. METHODS A 4×4 double Latin square design (n=8) design using Beagle dogs was developed. Drugs were administrated orally. Arterial blood pressure, left ventricular pressure (LVP) and the electrocardiogram were assessed. Each of the six laboratories studied at least 2 drugs (one positive inotrope (pimobendan or amrinone) and one negative inotrope) (itraconazole or atenolol) at 3 doses selected to match clinical exposure data and a vehicle control. Animals were instrumented with an ITS telemetry system, DSI's D70-PCTP system or DSI's Physiotel Digital system. Data acquisition and analysis systems were Ponemah, Notocord or EMKA. RESULTS Derived parameters included: diastolic, systolic and mean arterial BP, peak systolic LVP, HR, end-diastolic LVP, and LVdP/dtmax as the primary contractility index. Blood samples were drawn to confirm drug exposures predicted from independent pharmacokinetic studies. Across the laboratories, a consistent change in LVdP/dtmax was captured despite some differences in the absolute values of some of the hemodynamic parameters prior to treatment. DISCUSSION These findings indicate that this experimental model, using the chronically instrumented conscious dog, can accurately and consistently detect changes in cardiac contractility, across multiple sites and instrumentation systems, and that data obtained in this model may also translate to clinical outcomes.
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Takeda N, Hayashi Y, Arino T, Takeda A, Noma K. Effect of pimobendan in patients with chronic heart failure. Exp Clin Cardiol 2001; 6:195-199. [PMID: 20428258 PMCID: PMC2858999] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess the effects of a calcium sensitizer, pimobendan, in patients with mild to moderate chronic heart failure. PATIENTS AND METHODS Pimobendan was administered at a dose of 2.5 mg/day for 12 months to 34 patients with chronic heart failure (New York Heart Association functional class IIm to III) after treatment with diuretics and angiotensin-converting enzyme inhibitors. The etiologies of heart failure were dilated cardiomyopathy (DCM), old myocardial infarction (OMI) and other heart disease (Others). The effects of pimobendan were assessed by echocardiography, blood pool scintigraphy, Holter monitoring, (123)I-meta-iodobenzylguanidine (MIBG) imaging and (123)I-beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) imaging. RESULTS Pimobendan produced improvement of symptoms in the majority of patients. Improvement was more common in the DCM group than in the OMI group. Left ventricular internal diameter measured by echocardiography was significantly decreased. Left ventricular ejection fraction was significantly increased in the DCM and Others groups. The heart to mediastinum ratio on MIBG imaging was significantly increased in the DCM and Others groups, and the heart to mediastinum ratio on BMIPP imaging was significantly increased in the DCM group. CONCLUSIONS Pimobendan is effective in patients with chronic heart failure but is less effective in patients with OMI than in patients with DCM or other heart diseases.
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Affiliation(s)
- Nobuakira Takeda
- Correspondence and reprints: Dr Nobuakira Takeda, Department of General Medicine, Aoto Hospital, Jikei University School of Medicine, Aoto 6-41-2, Katsushika-ku, Tokyo 125-8506, Japan. Telephone 81-3-3603-2111, fax 81-3-3603-2234, e-mail
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