Browsing by Author "Abbott, Jonathan A."
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- Accuracy of Noninvasively Determined Pulmonary Artery Pressure in Dogs With Myxomatous Mitral Valve DiseaseMenciotti, Giulio (Virginia Tech, 2020-07-23)Development of pulmonary hypertension is an independent predictor of poor outcome in dogs affected by myxomatous valvular degeneration (MMVD). Systolic pulmonary arterial pressure is routinely estimated by Doppler echocardiography applying the simplified Bernoulli equation to the velocity of tricuspid regurgitation (sPAP_D). The accuracy of this estimation is unknown in dogs with MMVD, but experimental studies suggest that the method is imperfect. In order to fill this knowledge gap we prospectively enrolled dogs affected by MMVD and cardiac remodeling - American College of Veterinary Internal Medicine (ACVIM) stages B2 and C MMVD for which treatment had been unchanged for at least one month. A flow-directed thermodilution monitoring catheter was percutaneously placed in the right jugular vein and advanced to the main pulmonary artery. Pulmonary arterial systolic pressure was recorded through this catheter connected to a pressure-transducer and data acquisition-analysis system (sPAP_C). A second operator simultaneously acquired tricuspid regurgitant velocity spectra to calculate sPAP_D. Each operator was blinded to the result of the other technique. Twenty dogs were enrolled. Technical difficulties prevented catheterization in 2 dogs. Eighteen measurement pairs were therefore used for comparison of sPAP_C and sPAP_D through Bland-Altman analysis and linear regression. A statistically significant bias between sPAP_C and sPAP_D (mean difference=0.5mmHg; Confidence interval: -6.5mmHg, +7.5mmHg) was not detected. The limits of agreement between the techniques were wide (-27.3mmHg, +28.2mmHg). Regression analysis failed to identify a significant linear association between the two techniques (r=0.11, p=0.17). In conclusion, sPAP_D poorly agrees with sPAP_C measurement in dogs affected by MMVD in ACVIM stages B2 and C. In these dogs, sPAP_D could under- or over-estimate sPAP_C by more than 20mmHg, and therefore caution should be used when interpreting PASP_D.
- Advanced Echocardiographic Imaging In Dogs With Myxomatous Mitral Valve DiseaseMenciotti, Giulio (Virginia Tech, 2017-05-23)Myxomatous mitral valve degeneration (MMVD) is the most common canine cardiac disease. In the studies presented in this dissertation, we used advanced echocardiographic techniques to elucidate several aspects of MMVD in dogs. Our hypothesis was that the mitral valve (MV) morphology could have a role in the development of MMVD. First, we tested whether we could use real time three-dimensional transthoracic echocardiography (RT-3DTTE), and an offline software for MV analysis to evaluate canine MV. We described that the technique was feasible and repeatable, we evaluated the morphology of the MV in healthy dogs, and we provided reference values for MV morphologic variables in this species. Then, we used the same technique to compare healthy dogs to dogs affected by MMVD. We found that dogs affected by MMVD have more circular and flatter valve. We then analyzed the MV of healthy Cavalier King Charles Spaniels (CKCSs), given the high predisposition of this breed for MMVD. Our findings indicate that compared to healthy dogs of other breeds, the MV of healthy CKCSs is flatter and has less leaflet tenting, corroborating our hypothesis that an altered MV morphology could represent a predisposing factor for disease development. We also used RT–3DTTE to characterize the area of the regurgitant MV orifice of dogs affected with MMVD, finding that the technique requires further standardization in order to become clinically useful. The elevation of pulmonary venous pressure caused by MMVD can, in some dogs, cause pulmonary arterial hypertension (PH), which is a risk factor associated with worse outcome in dogs with MMVD. Diagnosis of PH in dogs with MMVD is usually made by estimating pulmonary pressure using Doppler echocardiography. We are currently evaluating the accuracy of this technique, compared to invasive measurement of pulmonary pressure. Only preliminary data are presented regarding this study, as the disclosure of the blinding would have infringed the power of the study. Our preliminary results demonstrate that there is only moderate agreement between the two techniques, indicating that caution should be used when deriving the non-invasive estimation of systolic pulmonary pressure in order to make clinical decisions.
- Cardiac Biomarkers in Hyperthyroid CatsSangster, Jodi Kirsten (Virginia Tech, 2013-04-03)Background: Hyperthyroidism has substantial effects on the circulatory system. The cardiac biomarkers NT-proBNP and troponin I (cTNI) have proven useful in identifying cats with myocardial disease but have not been as extensively investigated in hyperthyroidism. Hypothesis: Plasma NT-proBNP and cTNI concentrations are higher in cats with primary cardiac disease than in cats with hyperthyroidism and higher in cats with hyperthyroidism than in healthy control cats. Animals: Twenty-three hyperthyroid cats, 19 cats with HCM without congestive heart failure, and 19 euthyroid, normotensive healthy cats eight years of age or older. Fourteen of the hyperthyroid cats were re-evaluated three months after administration of 131I. Methods: A complete history, physical examination, complete blood count, serum biochemistries, urinalysis, blood pressure measurement, serum T4 concentration, plasma concentrations of NT-proBNP and cTNI, and echocardiogram was prospectively obtained from each cat. Results: Hyperthyroid and HCM cats had plasma NT-proBNP and cTNI concentrations that were significantly greater than healthy older cats, but there was no significant difference between hyperthyroid and HCM cats with respect to concentration of either biomarker. In hyperthyroid cats that were re-evaluated three months after 131I treatment, plasma NT-proBNP and cTNI concentrations as well as ventricular wall thickness decreased. Conclusions and Clinical Relevance: Although there may be a role for NT-proBNP in monitoring the cardiac response to treatment of hyperthyroidism, neither NT-proBNP nor cTNI can be used to distinguish hyperthyroid cats from cats with HCM. Therefore, the thyroid status of older cats should be ascertained prior to interpreting results of cardiac biomarker testing.
- Comparison of the mitral valve morphologies of Cavalier King Charles Spaniels and dogs of other breeds using 3D transthoracic echocardiographyMenciotti, Giulio; Borgarelli, Michele; Aherne, Michael; Camacho, Paula; Haggstrom, Jens; Ljungvall, Ingrid; Lahmers, Sunshine M.; Abbott, Jonathan A. (Wiley, 2018-09-01)Background: Myxomatous mitral valve disease (MMVD) is more prevalent in Cavalier King Charles Spaniels (CKCSs) compared to dogs of other breeds at a given age. Abnormal valvular stress is thought to contribute to the development and progression of MMVD, and a relationship exists between mitral valve (MV) morphology and stress acting on the valve. Objectives: To determine whether the MV morphology of healthy adult CKCSs differs from the morphology of healthy adult dogs of other breeds determined by RT-3DTTE. Animals: Thirty-five healthy CKCSs and 41 healthy dogs of other breeds. Methods: Prospective cross-sectional study. Dogs underwent physical examination, conventional echocardiography, and RT-3DTTE. RT–3DTTE datasets were analyzed using dedicated software for MV morphologic analysis. Morphologic variables were compared between CKCSs and dogs of other breeds. Results: The MV of healthy CKCSs had a smaller annulus height (0.46 ± 0.11 vs. 0.56 ± 0.17; P =.0021), tenting height (0.26 ± 0.12 vs. 0.42 ± 0.18; P <.001), tenting area (0.42 ± 0.15 vs. 0.79 ± 0.34; P <.001), normalized tenting volume (0.09 [0.05–0.13] vs. 0.14 [0.10–0.20]; P <.001), and normalized area of the posterior leaflet (0.57 ± 0.15 vs. 0.66 ± 0.18; P =.016) compared to healthy dogs of other breeds; this results in CKCSs having a flatter MV with reduced tenting, compared to the MV of other breeds. Conclusions and Clinical Importance: These morphologic features could confer a mechanical disadvantage and play a role in the predisposition of CKCSs to the early development of MMVD.
- Development and evaluation of methods for structured recording of heart murmur findings using SNOMED CT® post-coordinationGreen, Julie Meadows (Virginia Tech, 2004-12-10)Objective: Structured recording of examination findings, such as heart murmurs, is important for effective retrieval and analysis of data. Our study proposes two models for post-coordinating murmur findings and evaluates their ability to record murmurs found in clinical records. Methods: Two models were proposed for post-coordinating murmur findings: the Concept-dependent Attributes model and the Interprets/Has interpretation model. A micro-nomenclature was created based on each model by using the subset and extension mechanisms provided for by the SNOMED-CT® framework. Within each micro-nomenclature a partonomy of cardiac cycle timing values was generated. In order for each model to be capable of representing clinical data, a mechanism for handling range values was developed. One hundred murmurs taken from clinical records were entered into two systems that were built based on each model to enter and display murmur data. Results: Both models were able to record all 100 murmur findings; both required the addition of the same number of concepts into their respective micro-nomenclatures. However, the Interprets/Has interpretation model required twice the storage space for recording murmurs. Conclusion: We found little difference in the requirements for implementation of either model. In fact, data stored using these models could be easily inter-converted. This will allow system developers to choose a model based on their own preferences. If at a later date a method is chosen for modeling within SNOMED-CT, the data can be converted to conform if necessary.
- Development and Resolution of Pulmonary Arterial Hypertension in RAO HorsesMartin, Robert Brian (Virginia Tech, 2003-08-12)Equine recurrent airway obstruction (RAO) is associated with airway inflammation and bronchoconstriction in clinically affected horses. Horses demonstrating severe pulmonary compromise develop concurrent secondary pulmonary hypertension. The development of pulmonary hypertension is well documented in RAO affected horses, however, it is not known how rapidly increases in pulmonary artery pressure occur after the onset of RAO. It is also not known if pulmonary hypertension resolves concurrently with resolution of RAO. The goal of this study was to measure pulmonary artery pressure in RAO affected horses during the development and resolution of RAO. To accomplish this, three RAO affected and three normal horses were placed in a challenge environment where clinical parameters, pulmonary function, right heart and pulmonary artery pressures were measured on day 1, 3 and 5. After evaluating horses on day five, their environment was modified to reduce exposure to respirable debris and anti-inflammatory medication (dexamethasone) was initiated. Identical clinical parameters were measured on days 7 and 9. In our study, the arterial oxygen content in RAO horses was significantly less that that of control horses from day 1 through day 9. A concurrent increase in pulmonary artery pressure also developed on day 3 in RAO affected horses, and persisted through day 5. While some trend towards a difference between groups was noted, no other significant differences were observed between RAO and normal horses. These findings suggest that horses with severe RAO also develop significant increase in pulmonary artery pressure, which rapidly resolves with appropriate management of RAO.
- Echocardiographic and electrocardiographic evaluation of North American Irish WolfhoundsTyrrell, William D., Jr.; Abbott, Jonathan A.; Rosenthal, Steven L.; Dentino, Mariellen; Abrams, Frances (2020-03)Background Cardiac disease is an important cause of morbidity and mortality in Irish Wolfhounds (IWs), but its prevalence and clinical characteristics in North American IWs are incompletely described. Hypothesis/Objectives That atrial fibrillation (AF) is a diagnostic marker of echocardiographic abnormalities, and that clinical characteristics predict development of IW cardiomyopathy (IWCM). To define the prevalence of arrhythmias and echocardiographic abnormalities in North American IWs. Animals Six hundred and forty-five adult IWs presented for screening examinations intended to identify familial cardiac disease. Methods In this retrospective cohort study, reference intervals defined based on echocardiographic data from IW classified as normal, were used to define the prevalence of structural and functional abnormalities. A logistic model was developed to identify clinical findings that predict future development of IWCM. Results The prevalence of AF was 8.9% (95% confidence interval [CI], 6.6-11.2) of which 55.5% had echocardiographic abnormalities. IWCM defined by left atrial enlargement, left ventricular dilatation, and systolic dysfunction had a prevalence of 1.8% (0.72-2.8). Positive and negative likelihood ratios for AF in the identification of IWCM were, respectively, 10.8 (7.29-16) and 0.2 (0.06-0.69). Multivariable logistic regression identified AF (odds ratio [OR]; 10.6, 95% CI, 2.67-42.3) and male sex (OR; 3.8, 95% CI, 1.02-14) as predictors of future development of IWCM. Conclusions and Clinical Importance Atrial fibrillation is common in North American IW. It occurs in association with structural cardiac disease but also in its absence. Irish Wolfhounds cardiomyopathy is characterized by chamber enlargement but minimally decreased ejection phase indices of myocardial function. Atrial fibrillation is a risk factor for future development of IWCM.
- Echocardiographic Assessment of the Canine Right Heart: Reference Intervals and RepeatabilityGentile, Jessica M. (Virginia Tech, 2012-01-27)Objectives: Phase 1) Establish echocardiographic reference intervals for measurements of the normal canine right heart. Phase 2) Describe the repeatability of normal right heart echocardiographic measurements. Phase 3) Describe the repeatability of right heart echocardiographic measurements which predict pulmonary artery pressure. Materials and Methods: Phase 1) 45 healthy adult dogs. Dogs underwent one echocardiographic examination by the same operator. Phase 2) 6 randomly selected dogs from the pool of Phase 1 dogs. Dogs underwent repeated echocardiograms by two operators. Phase 3) 4 client-owned dogs. Dogs underwent repeated echocardiographic examination by two operators. Results: Phase 1) The linear relationship between dimension and transformed body weight was highly variable. For linear dimensions, most of the scaling exponents were close to the theoretical value of 1/3. For area measurements, most of the scaling exponents were close to 2/3. Phase 2) Of the 168 within-day, between-day and between-operator coefficients of variation (CV) generated, 154 (91.7%) were below 15% and 135 (80.4%) were less than 10%. Phase 3) Of the 100 within-day, between-day and between-operator CVs generated, 72 (72%) were below 20% and 46 (46%) were below 10%. Conclusions: The right heart can be measured with relatively low repeatability. Measurement of the tricuspid regurgitation velocity should be the first priority when attempting to predict pulmonary artery pressure. If tricuspid regurgitation is not present, the use of transpulmonic acceleration time (AT) and the ratio of transpulmonic acceleration-to-ejection time (AT:ET) to indirectly assess pulmonary artery pressure is recommended.
- Echocardiographic Investigation of Canine Myxomatous Mitral Valvular DiseaseWesselowski, Sonya Rae (Virginia Tech, 2014-07-14)Objectives: To further characterize the echocardiographic anatomy of the canine mitral valve in healthy dogs and those affected by myxomatous mitral valve disease (MMVD), and to compare the level of agreement between two methods of assessment of left atrial size in identification of left atrial enlargement in dogs with MMVD. Animals: Sixty dogs with MMVD and 22 normal dogs were prospectively studied with 2-dimensional echocardiography. Methods: The length (AMVL), width (AMVW) and area (AMVA) of the anterior mitral valve leaflet and the diameter of the mitral valve annulus in systole (MVAs) and diastole (MVAd) were measured. Left atrial size was evaluated with the left atrial to aortic root ratio (LA:Ao) and by measuring left atrial volume indexed to body weight (LA Vol/BW). All patients were staged using published ACVIM guidelines and separated into groups B1 and B2/C. Results: Measurements of AMVL, AMVW, AMVA, MVAs and MVAd were all significantly greater in the B2/C group than in the control group. AMVW was significantly greater in group B1 than control. Twelve dogs had left atrial enlargement identified with LA Vol/BW that were considered normal using LA:Ao. Diagnostic disagreement between these two measurements was significant (P = 0.00012). The majority of dogs with diagnostic disagreement had concurrent echocardiographic evidence of more advanced mitral regurgitation. Conclusions: Relative to normal dogs, AMVL, AMVW, AMVA, MVAs and MVAd are greater in patients with advanced MMVD. LA Vol/BW may be superior to LA:Ao for identification of mild left atrial enlargement.
- Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly: The EPIC Study-A Randomized Clinical TrialBoswood, Adrian; Haggstrom, Jens; Gordon, Sonya G.; Wess, G.; Stepien, R. L.; Oyama, Mark A.; Keene, Bruce W.; Bonagura, John; MacDonald, Kristin A.; Patteson, M.; Smith, S.; Fox, P. R.; Sanderson, Karen; Woolley, Richard; Szatmari, Viktor; Menaut, Pierre; Church, Whitney M.; O'Sullivan, M. Lynne; Jaudon, J-P; Kresken, Jan-Gerd; Rush, J.; Barrett, K. A.; Rosenthal, S. L.; Saunders, Ashley B.; Ljungvall, Ingrid; Deinert, Michael; Bomassi, Eric; Estrada, Amara H.; Fernandez Del Palacio, Maria J.; Moise, N. Sydney; Abbott, Jonathan A.; Fujii, Yoko; Spier, Alan; Luethy, Michael W.; Santilli, Roberto A.; Uechi, Masami; Tidholm, Anna; Watson, P. (American College of Veterinary Internal Medicine, 2016-11)Background: Pimobendan is effective in treatment of dogs with congestive heart failure (CHF) secondary to myxomatous mitral valve disease (MMVD). Its effect on dogs before the onset of CHF is unknown. Hypothesis/Objectives: Administration of pimobendan (0.4-0.6 mg/kg/d in divided doses) to dogs with increased heart size secondary to preclinical MMVD, not receiving other cardiovascular medications, will delay the onset of signs of CHF, cardiac-related death, or euthanasia. Animals: 360 client-owned dogs with MMVD with left atrial-to-aortic ratio >= 1.6, normalized left ventricular internal diameter in diastole >= 1.7, and vertebral heart sum >10.5. Methods: Prospective, randomized, placebo-controlled, blinded, multicenter clinical trial. Primary outcome variable was time to a composite of the onset of CHF, cardiac-related death, or euthanasia. Results: Median time to primary endpoint was 1228 days (95% CI: 856-NA) in the pimobendan group and 766 days (95% CI: 667-875) in the placebo group (P = .0038). Hazard ratio for the pimobendan group was 0.64 (95% CI: 0.47-0.87) compared with the placebo group. The benefit persisted after adjustment for other variables. Adverse events were not different between treatment groups. Dogs in the pimobendan group lived longer (median survival time was 1059 days (95% CI: 952-NA) in the pimobendan group and 902 days (95% CI: 747-1061) in the placebo group) (P = .012). Conclusions and Clinical Importance: Administration of pimobendan to dogs with MMVD and echocardiographic and radiographic evidence of cardiomegaly results in prolongation of preclinical period and is safe and well tolerated. Prolongation of preclinical period by approximately 15 months represents substantial clinical benefit.
- Evaluation of hemostasis in hyperthyroid catsKeebaugh, Audrey Elizabeth (Virginia Tech, 2020-07-17)Background: Hyperthyroid cats are predisposed to thrombus formation. The mechanism for thrombogenesis is currently unknown, but could be associated with altered hemostasis as seen in hyperthyroid humans. Objective: The purpose of this study was to evaluate markers of hemostasis in hyperthyroid cats compared to healthy cats, and in hyperthyroid cats before and after treatments with radioactive iodine (RIT). Methods: Twenty-five cats with hyperthyroidism and 13 healthy euthyroid cats > 8 years of age were studied. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, antithrombin (AT), D-dimers, thrombin-antithrombin complexes (TAT), von Willebrand Factor antigen (vWF:Ag), and activity of factors VIII and IX were measured. An echocardiogram was performed in all cats and healthy cats with abnormal echocardiograms were excluded. Measurements of hemostasis were evaluated again in 7 cats > 6 months after RIT and deemed to have restored euthyroid status. Results: There is a significant likelihood of being in hypercoagulable state based on hyperthyroid state (P = 0.019) and serum T4 level is significantly associated with predicating hypercoagulability (P = 0.043). Hyperthyroidism is associated with significantly higher median fibrinogen concentration (P < 0.0001), higher median AT activity (P < 0.0001), and higher median vWF:Ag level (P = 0.01) with all values decreasing significantly post-RIT. Fibrinogen and AT had a strong positive correlation with serum T4 value (r = 0.79; 95% CI 0.63 - 0.89 and r = 0.70; 95% CI 0.50 - 0.84, respectively). Presence of an abnormal echocardiogram in hyperthyroid cats was associated with a significantly higher median fibrinogen concentration (P = 0.03). Echocardiographic status did not have a significant impact on the remaining hemostatic markers in hyperthyroid cats. Conclusions: These results provide evidence of altered hemostasis and hypercoagulability in hyperthyroid cats that do not appear to be solely attributed to cardiac abnormalities. These differences of altered hemostasis resolved after radioiodine therapy, but further studies are warranted to determine if hypercoagulable state resolves.
- Evaluation of pressor sentivity to norepinephrine infusion in dogs with iatrogenic hyperadrenocorticismMartinez, Nivia Ivellise (Virginia Tech, 2002-04-15)Objective: To evaluate pressor sensitivity to catecholamines in dogs after induction of iatrogenic hyperadrenocorticism (I-HAC) by serial arterial blood pressure measurements during infusions of increasing dose rates of norepinephrine. Animals: Eight dogs with I-HAC induced by administration of oral hydrocortisone at a mean dose of 3.3 mg/kg PO TID for 42-49 days and 8 control dogs which received empty gelatin capsules PO TID for 42-49 days. Procedure: Systolic, diastolic, mean blood pressure and heart rate measurements were recorded after sequential administration of increasing dose rates of norepinephrine (0.1, 0.125, 0.2, 0.3, 0.4, 0.6 and 0.8 mg/kg/min) for 10 minutes. The changes in systolic, diastolic, mean blood pressure and heart rate were compared between control dogs and dogs with I-HAC. Results: Dogs in the I-HAC group had a more pronounced pressor response to norepinephrine infusions than control dogs. The infusions were not completed in 7 of the 8 dogs in the I-HAC group versus 3 dogs in the control group due to severe elevations in systolic blood pressure. The mean change in systolic blood pressure was consistently higher in dogs in the I-HAC group. The difference was statistically significant at the 0.2 mg/kg/min norepinephrine dose rate. The mean change in heart rate was consistently lower in the I-HAC group, a difference that was significant at the 0.2 mg/kg/min norepinephrine dose rate. Conclusions and clinical relevance: Increased pressor sensitivity or decreased baroreceptor response to norepinephrine was seen in dogs with I-HAC suggesting that this mechanism is involved in the development of hypertension in canine hyperadrenocorticism.
- Evaluation of right ventricular function using conventional and real-time 3-dimensional echocardiography in normal dogs and dogs with myxomatous mitral valve diseaseAherne, Michael (Virginia Tech, 2017-06-06)Objectives: To investigate the feasibility of real-time three-dimensional (3D) echocardiographic analysis of right ventricular (RV) function in healthy dogs and to compare conventional and 3D echocardiographic (3DE) indices of RV function in dogs with various stages of myxomatous mitral valve disease (MMVD), classified per the guidelines of the American College of Veterinary Internal Medicine, to those from healthy dogs. Animals: Twenty-two healthy dogs and 56 dogs with MMVD Methods: All dogs underwent conventional and 3D echocardiographic examinations. Measurements of 3DE RV function indices including RV end-diastolic volume (EDV), RV end-systolic volume (ESV), RV stroke volume (SV), and RV ejection fraction (EF) were recorded. Measurements of conventional indices of RV function were also obtained. RV EDV, ESV, and SV were indexed to bodyweight (BW) and analyzed using commercially available software. Results: Three-dimensional RV datasets could be acquired and analyzed in all dogs. Intra- and inter-observer coefficents of variation were > 20% for all 3D RV indices. Right ventricular EDV and ESV were decreased and RV EF was increased in dogs with advanced MMVD when compared to controls. Several conventional echocardiographic indices of RV function also differed between the control group and various MMVD groups. Conclusions: Real-time 3DE RV assessment is feasible in normal dogs with acceptable intra- and inter-observer variability. Several 3DE indices of RV systolic function differ between dogs with advanced MMVD when compared to normal dogs. Further investigation is required to determine if these differences have clinical implications.
- 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 StudyBoswood, Adrian; Gordon, Sonya G.; Haggstrom, Jens; Wess, G.; Stepien, R. L.; Oyama, Mark A.; Keene, Bruce W.; Bonagura, John; MacDonald, Kristin A.; Patteson, M.; Smith, S.; Fox, P. R.; Sanderson, Karen; Woolley, Richard; Szatmari, Viktor; Menaut, Pierre; Church, Whitney M.; O'Sullivan, M. Lynne; Jaudon, J-P; Kresken, Jan-Gerd; Rush, J.; Barrett, K. A.; Rosenthal, S. L.; Saunders, Ashley B.; Ljungvall, Ingrid; Deinert, Michael; Bomassi, Eric; Estrada, Amara H.; Fernandez Del Palacio, Maria J.; Moise, N. Sydney; Abbott, Jonathan A.; Fujii, Yoko; Spier, Alan; Luethy, Michael W.; Santilli, Roberto A.; Uechi, Masami; Tidholm, Anna; Schummer, Christoph; Watson, P. (American College of Veterinary Internal Medicine, 2018-01)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 (D) 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 DLVIDDN was 1.26, P - 0.0003. Hazard ratio for a 0.1 increase in DLA: 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.
- The longitudinal outcome of canine myxomatous mitral valve disease in dogs: The LOOK Mitral studyFranchini, Alessandra (Virginia Tech, 2022-06-07)Myxomatous mitral valve disease (MMVD) is the most common heart disease in dogs. However, prospectively acquired data describing the natural history and prognostic factors in a large population of dogs affected by this disease are sparse. Thus, the Longitudinal Outcome of canine (K9) myxomatous mitral valve disease registry (LOOKmitral) was established to prospectively collect clinical and diagnostic data from a large population of dogs affected by MMVD. A total of 6,102 dogs were enrolled in the LOOK-mitral registry from November 1st, 2015, to October 31st, 2018, in thirteen cardiology specialty practices. We first described the baseline characteristics of the dogs enrolled in the registry, which mainly confirmed previous findings. Moreover, we provided new additional results, such as the presence of systolic dysfunction in some small breed dogs and how the intensity of the murmur correlates with the severity of MMVD also in large breed dogs. Second, we described the baseline treatment characteristics at the time of enrollment. These data showed that the results of the "Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly" (EPIC) trial and left atrial and left ventricular dimensions, assessed by echocardiography, influenced veterinary cardiologist's prescription of cardiovascular drugs in affected dogs. Lastly, we evaluated predictors of reoccurrence of congestive signs within 180 days after successfully treating the first episodes of heart failure in dogs enrolled in the LOOKMitral registry. While this study failed to identify accurate predictors of recurrence, dogs with larger left ventricular internal dimensions at end-diastole were more likely to present with reoccurrence of clinical signs suggesting that closer monitoring of these dogs may be recommended.
- Measurement Variation and Repeatability of Echocardiographic Variables Used to Estimate Pulmonary Artery Pressure in DogsAbbott, Jonathan A.; Gentile-Solomon, J. M. (American College of Veterinary Internal Medicine, 2017-11)Background: Pulmonary hypertension (PH) is an important clinical entity in dogs. Pulmonary hypertension is generally identified based on echocardiographic findings, but measurement variation of the variables most often used in this context has not been reported. Objective: To define measurement variation of echocardiographic variables that are used to estimate pulmonary artery pressure. Animals: Four dogs with subclinical tricuspid valve regurgitation were selected from a hospital population. Methods: Prospective descriptive study - dogs were subject to repeated echocardiographic examination by 2 operators. Each dog was echocardiographically examined 12 times, once by each operator during mornings and afternoons of 3 nonconsecutive days. Measurement variation was defined by coefficients of variation and by mean square errors (MSE) from ANOVA models. Repeatability coefficients (RC) were calculated from MSE. Results: Of 50 within-day, between-day, and interoperator coefficients of variation (CVs), 37 were less than 10% and 46 were less than 15%. The range of peak velocity of tricuspid valve regurgitation (VTR) V-TR was 1.87-3.34 m/s. Analysis of variance revealed a significant effect (P < 0.05) of operator for 7 of 10 measurements. Within-operator/between-day/withinsubject and between-operator/between-day/within-subject RCs of V-TR were, respectively, 0.3 and 0.6 m/s. Conclusions and Clinical Importance: With regard to repeatability, VTR is superior to other methods used for echocardiographic estimation of systolic pulmonary artery pressure. When TR is absent, the acceleration time of pulmonary ejection and the acceleration-to-ejection time ratio are alternative measures. A change in V-TR exceeding 0.3 m/s might be outside the range of expected within-operator variation.
- Pharmacodynamic evaluation of beta-blockade associated with atenolol in healthy dogsWaterman, Mari (Virginia Tech, 2018-09-24)Objective: Dosing intervals of 12 and 24 hours for atenolol have been recommended, but an evidentiary basis is lacking. To test the hypothesis that repeated, once-daily oral administration of atenolol attenuates the heart rate response to isoproterenol for 24 hours, we performed a double-blind, randomized, placebo-controlled cross-over experiment. Animals: Twenty healthy dogs Procedures: Dogs were randomly assigned to receive either placebo (P) and then atenolol (A), [1 mg/kg PO q24h] or vice versa. Treatment periods were 5-7 days; time between periods was 7 days. Heart rates (bpm) at rest (HRr) and during constant rate [0.2 μg/kg/min] infusion of isoproterenol (HRi) were electrocardiographically obtained 0, 0.25, 3, 6, 12, 18, and 24 hours after final administration of drug or placebo. A mixed model ANOVA was used to evaluate the effects of treatment (Tr), time after drug or placebo administration (t), interaction of treatment and time (Tr*t) as well as period and sequence on HRr and HRi. Results: Sequence or period effects were not detected. There was a significant effect of Tr (p <0.0001) and Tr*t (p <0.0001) on HRi. Atenolol significantly attenuated HRi for 24 hours but did so maximally at 3 hours (least squares means ± SE, A: 146±5 bpm, P: 208±5 bpm); the effect at 24 hours was small (A: 193±5, P: 206±5). Atenolol had a small but significant effect (p <0.0001) on HRr. Conclusions and Clinical Relevance: The results of this study support a dosing interval that is less than 24 hours.
- Plasma N-terminal Proatrial Natriuretic Peptide Concentration in Cats with Hypertrophic CardiomyopathyMacLean, Heidi Norma (Virginia Tech, 2004-03-12)Objective: We sought to determine N-terminal proatrial natriuretic peptide concentrations [Nt-proANP] in plasma from cats with hypertrophic cardiomyopathy (HCM). Secondarily, we wished to evaluate the relationship between [Nt-proANP] and echocardiographic variables. Methods: Venous blood samples were obtained from seventeen cats with HCM and from nineteen healthy cats. Plasma [Nt-proANP] was determined using an ELISA assay. The relationship between plasma [Nt-proANP] and M-mode, 2-dimensional and Doppler echocardiographic variables was evaluated. Cats that were hyperthyroid or had evidence of renal disease were excluded from the study. Results: The mean plasma [Nt-proANP] was higher in cats with HCM (3.81 +/- 1.23 pmol/l) than in control cats (3.08 +/- 1.41 pmol/l); however, this difference was not statistically significant (p=0.17). There was a significant correlation between plasma [Nt-proANP] and left ventricular posterior wall thickness (r = 0.42; p=0.01). Additionally, plasma [Nt-proANP] was correlated with left atrial size (r = 0.35; p=0.03). A linear regression model was developed to further explore these relationships. LAs2D and LVPWd had an interactive effect on plasma [Nt-proANP] (R2 = 0.2737; p= 0.02). There was no correlation between any other echocardiographic variable and plasma [Nt-proANP]. There was no correlation between plasma [Nt-proANP] and heart rate (HR), body-weight, or age. Conclusions: Cats with HCM do not have significantly higher plasma [Nt-proANP] than normal cats. There was a significant linear relationship between [Nt-proANP] and LAs2D, LVPWd and the model that described their interaction.
- Prevalence and Prognostic Importance of Pulmonary Hypertension in Dogs with Myxomatous Mitral Valve DiseaseBorgarelli, Michele; Abbott, Jonathan A.; Braz-Ruivo, L.; Chiavegato, D.; Crosara, S.; Lamb, K.; Ljungvall, Ingrid; Poggi, M.; Santilli, Roberto A.; Haggstrom, Jens (American College of Veterinary Internal Medicine, 2015-03)BackgroundPulmonary hypertension (PH) is common in dogs with myxomatous mitral valve disease (MMVD) but its effect on clinical outcome has not been investigated. Hypothesis/objectivesThe presence of PH worsens the outcome in dogs with MMVD. To compare survival times of dogs with MMVD and PH to those without PH. AnimalsTwo hundred and twelve client-owned dogs. MethodsCase review study. Medical records of dogs diagnosed with ACVIM stage B2 and C MMVD between January 2010 and December 2011 were retrospectively reviewed. Long-term outcome was determined by telephone interview or from the medical record. End of the observation period was March 2013. PH was identified if tricuspid regurgitation peak velocity was >3m/s. ResultsTwo hundred and twelve were identified. Eighty-three dogs (39%) had PH. PH was more commonly identified in stage C compared to B2 (P<.0001). One hundred and five (49.5%) dogs died during the observation period. Median survival time for the entire study population was 567days (95% CI 512-743). Stage C (P=.003), the presence of PH (P=.009), left atrial to aortic root ratio (LA/Ao) >1.7 (P=.0002), normalized left-ventricular end-diastolic diameter (LVEDn) >1.73 (P=.048), and tricuspid regurgitation pressure gradient (TRPG) >55mmHg (P=.009) were associated with worse outcomes in the univariate analyses. The presence of TRPG >55mmHg (HR 1.8 95% CI 1-2.9; P=.05) and LA/Ao>1.7 (HR 2 95% CI 1.2-3.4; P=.01) remained significant predictors of worse outcome in the multivariate analysis. Conclusions and Clinical ImportanceIn dogs with MMVD, moderate to severe PH worsens outcome.
- Prevalence of Cardiomyopathy in Apparently Healthy CatsPaige, Christopher Francis (Virginia Tech, 2007-06-29)Subclinical cardiomyopathy (CM) sometimes is identified after abnormalities are detected during auscultation of apparently healthy cats. Little is known regarding the prevalence of CM in this population. Furthermore, the clinical importance of auscultatory abnormalities in apparently healthy cats is unclear. In order to estimate the prevalence of murmurs and CM, we prospectively evaluated a sample of apparently healthy cats. Cats with systemic hypertension or hyperthyroidism were excluded. 103 cats were subject to physical and echocardiographic examinations which were performed by two different investigators; the echocardiographer was unaware of the physical findings. Left ventricular wall thickness was determined by two-dimensional echocardiography in short- and long-axis planes. Left ventricular hypertrophy (LVH) was defined as an end-diastolic wall thickness greater than or equal to 6 mm. Cats with LVH but without left ventricular dilation were considered to have hypertrophic CM (HCM). Cardiomyopathy was identified in 16 cats (15.5%; 95% CI: [9.2, 24.0]); 15 had HCM and one had arrythmogenic right ventricular cardiomyopathy. Murmurs were detected in 16 cats (15.5%; 95% CI: [9.2; 24.0]); of these cats, 5 had CM. Of 15 cats with HCM, 11 had segmental LVH, three cats had diffuse LVH, and one cat had borderline LVH and marked systolic anterior motion of the mitral valve. The sensitivity and specificity of murmurs for detection of a CM was 31% and 87%, respectively. The prevalence of feline subclinical CM in Southwest Virginia is near 16%; approximately a third of these cats had murmurs. In apparently healthy cats, a cardiac murmur is an insensitive marker of the presence of CM.