Passive containment and reverse remodeling by a novel textile cardiac support device

BACKGROUND

Progressive remodeling and dilation of cardiac chambers is responsible in part for myocardial dysfunction in chronic heart failure. Preclinical studies with suitable animal models indicate that a passive cardiac constraint device can promote reverse remodeling, with improvement in cardiac function. We hypothesize that such a device could provide benefit for stable heart failure patients in New York Heart Association (NYHA) class II and III.

METHODS AND RESULTS

From April 1999 to March 2000, 27 patients received Acorn's Cardiac Support Device (CSD) during an initial safety/feasibility study. In 11 patients, the only surgical measure was CSD placement. Most patients suffered from idiopathic cardiomyopathy; 4 were in NYHA class II, one was in class II/III, and 6 were in class III. All were stable on intensive medical treatment. The CSD, a textile polyester device, was fitted snugly around the heart during surgery. All patients survived surgery and recovered smoothly. Three months after surgery, 56% of patients were in NYHA class I, 33% were in class II, and 11% were in class II/III. Echocardiography showed an improvement in left ventricular ejection fraction from an average of 22% to 28% and 33% at 3 and 6 months, respectively. Simultaneously, the left ventricular end-diastolic dimension decreased from 74 mm to 68 mm and 65 mm, respectively. Mitral valve regurgitation (on a scale of 0 to 4+) decreased from 1.3 to 0.7 by 3 months. Quality-of-life indices correlated with the apparent reversal of ventricular remodeling. Preoperative cardiac medications remained virtually unchanged after implant.

CONCLUSIONS

In the short- and intermediate-term, CSD implantation seems to ameliorate symptoms and improve cardiac and functional performance in heart failure patients. Worldwide randomized trials are currently underway.

Use of plasma creatine kinase pharmacokinetics to estimate the amount of excercise-induced muscle damage in Beagles

OBJECTIVE

To assess the effects of moderate exercise on plasma creatine kinase (CK) pharmacokinetics and to estimate exercise-induced muscle damage in dogs.

ANIMALS

6 untrained adult Beagles.

PROCEDURE

The study was divided into 3 phases. In phase 1, dogs ran for 1 hour at a speed of 9 km/h, and samples were used to determine the area under the plasma CK activity versus time curve (AUC) induced by exercise. In phases 2 and 3, pharmacokinetics of CK were calculated in dogs during exercise and at rest, respectively. Values for AUC and plasma clearance (CI) were used to estimate muscle damage.

RESULTS

At rest, values for Cl, steady-state volume of distribution (Vdss), and mean retention time (MRT) were 0.32+/-0.02 ml/kg of body weight/min, 57+/-173 ml/kg, and 3.0+/-0.57 h, respectively. During exercise, Cl decreased significantly (0.26+/-0.03 ml/kg/min), MRT increased significantly, (4.4+/-0.97 h), and Vdss remained unchanged. Peak of plasma CK activity (151+/-58.8 U/L) was observed 3 hours after completion of exercise. Estimated equivalent amount of muscle corresponding to the quantity of CK released was 41+/-29.3 mg/kg.

CONCLUSION AND CLINICAL RELEVANCE

These results revealed that exercise had a minor effect on CK disposition and that the equivalent amount of muscle damaged by moderate exercise was negligible. This study illustrates the relevance for use of the minimally invasive and quantitative pharmacokinetic approach when estimating muscle damage.

Comparison of four methods for determination of total protein concentrations in pleural and peritoneal fluid from dogs

OBJECTIVE

To compare 4 techniques for determination of total protein concentrations in peritoneal and pleural effusions from dogs.

SAMPLE POPULATION

23 peritoneal and 12 pleural fluid samples from 35 dogs with various abnormalities.

PROCEDURE

Samples were collected into tubes containing EDTA, centrifuged, and stored at -20 C until total protein concentrations were assessed. Protein concentration in each sample was determined by use of urine test strips, refractometry, and Bradford and biuret techniques. Accuracy of each method was determined, using dilutions of human control sera.

RESULTS

There was good correlation among results of all quantitative procedures. Results of the biuret technique were more accurate than results of the Bradford assay. Refractometry underestimated protein concentration in samples with < 20 g of protein/L. Results of urine test strips correctly classified effusion samples into 2 groups on the basis of total protein concentrations less than or greater than 20 g/L.

CONCLUSIONS AND CLINICAL RELEVANCE

Results of any of these 4 techniques can be used to rapidly and efficiently differentiate peritoneal and pleural fluid from dogs into transudates and exudates on the basis of total protein concentration less than or greater than 20 g/L, respectively.

Safety and feasibility of a cardiac support device

The Cardiac Support Device (CSD), a preformed-knitted polyester device surgically placed over the cardiac ventricles, prevents left ventricular (LV) remodeling and improves LV ejection fraction (EF) in dogs with heart failure (HF). This study was designed to examine the safety of the CSD in patients with advanced HF. As of December 31, 1999, the CSD was implanted into 22 patients with myocardial disease. Ten patients had concomitant mitral valve repair, two patients had valve replacement (one patient aortic and one patient mitral), one patient had LV assist device (LVAD) placement, and eight patients received only the CSD. The CSD was placed while on bypass with the heart beating, attached to the epicardium groove, and tailored anteriorly to snugly fit the ventricles. There were no intraoperative deaths or complications. Two patients died early from non-CSD-related causes 4 and 23 days postoperatively; one late death occurred. Of the remaining 19 patients, none had any CSD-related adverse events during an average 3.5 +/- 0.4 month follow-up. All patients had completed 3-month follow-up. No patients had evidence of constrictive and/or restrictive physiology. Mitral valve regurgitation (MVR) improved in all patients. [table: see text] Initial findings indicate that the CSD is safe and improves heart failure symptoms and LV function. Additional studies and longer follow-up are needed to confirm these results.

Overestimation of the predictive value of positives by the usual calculations of the specificity of diagnostic tests

The specificity of a diagnostic test for a given disease, i.e. the percentage of true negatives, can be calculated from either the results from a group of healthy animals or possibly from a group which also contains diseased animals which are free of the particular disease for which the test has been performed. The specificity may be much lower in the latter case and the predictive value of positives thus greatly reduced. In the example of creatine kinase being used for the diagnosis of muscle diseases in dogs, the specificity at the thresholds of 105 and 150 U/L (upper limits of the 95% and 99.7% interquantiles) decreased from 0.98 and 1.0 to 0.66 and 0.78, respectively.

In vivo quantification of muscle damage in dogs after general anaesthesia with halothane and propofol

Muscle damage in dogs anaesthetised with halothane and propofol was quantified by measurement of the area under the curve of plasma creatine kinase (CK) versus time. Plasma CK remained unchanged during anaesthesia for two and a half and five hours. Following halothane anaesthesia of dogs (resting on one side directly on the surgical table or on cushions, and with or without rotation of the body every 30 minutes), plasma CK was elevated in some animals to 10,000 U/litre by the 12th hour (baseline value < or = 100 u/litre), whereas it remained almost unchanged in other animals. Plasma CK then returned to reference values on day 2 or 3. The mean equivalent of muscle damaged ranged from 0.6 to 0.9 g/kg bodyweight. No muscle damage could be demonstrated in animals anaesthetised with propofol. It is therefore concluded that plasma CK should not be used as a diagnostic aid following halothane anaesthesia because of false positives due to the halothane anaesthesia itself and that propofol is best suited for the investigation of muscle damage due to surgical procedures.

Plasma erythropoietin concentrations in dogs and cats: reference values and changes with anaemia and/or chronic renal failure

Reference ranges of plasma erythropoietin concentration measured by immunoassay in 67 healthy cats and 40 healthy dogs were 1.9 to 22.9 mU ml-1 and 1.3 to 13.4 mU ml-1 respectively. Very significant increases of plasma erythropoietin concentration were observed in 22 cats and 32 dogs with anaemia without chronic renal failure (CRF), but 35 cats and 37 dogs with CRF had normal or moderately reduced erythropoietin concentrations. In cats there was almost no overlap of erythropoietin between the groups but in dogs there was a significant overlap. The measurement of plasma erythropoietin is therefore probably more useful in the diagnosis of anaemia in cats than in dogs, either with or without CRF.

The effect of experimental renal failure on tolfenamic acid disposition in the dog

The pharmacokinetic disposition of tolfenamic acid, an NSAID, after a single administration of tolfenamic acid (4 mg kg(-1)) by the intravenous (IV) route was compared in eight dogs before and after a surgically induced renal failure. Renal impairment was confirmed by a significant increase (p <0.001) of water intake, urine volume, and urea and creatinine plasma concentration. PAH and inulin clearances decreased after surgery from 15.2 +/- 4.2 to 9.5 +/- 0.8 mL kg(-1) min(-1) (p < 0.05) and from 4.37 +/- 1.15 to 2.43 +/- 0.88 mL kg(-1) min(-1) (p=0.067),respectively. After surgery, clearance of TA was significantly (p <0.001) increased, from 2.22 +/- 1.68 to 3.59 +/- 1.81 mL kg (-1) min(-1). There was no modification of the steady-state volume of distribution (p > 0.05) and the mean residence time was significantly decreased from 606 +/- 199 to 373 +/- 302 min (p < 0.05). No variation of binding to plasma proteins (> or = 99%) was observed. These results suggest that renal insufficiency could increase hepatic metabolism and/or alter the enterohepatic cycle of TA.

A non-invasive and quantitative method for the study of tissue injury caused by intramuscular injection of drugs in horses

The present study was undertaken to measure the weight of muscle destroyed by an intramuscular injection of phenylbutazone (PBZ) in horses. In six horses, CK disposition parameters were evaluated after intravenous (i.v.) and intramuscular (i.m.) administration of a CK horse preparation. The same horses received PBZ, a potentially irritating agent, by i.v. and i.m. (neck and hindquarter) routes. Data were analysed using compartmental approaches and instantaneous CK flux was calculated using a discrete deconvolution method. For a 150 U/kg CK dose, the steady-state volume of distribution was 0.050 +/- 0.0115 L/kg and the plasma half-life was 112 +/- 18 min. After CK i.m. administration, the half-life of the terminal phase was 11.8 +/- 5.3 h indicating a flip-flop process and the mean bioavailability of CK was close to 100%. After PBZ i.m. administration, the CK activity was significantly increased with peak values of 508 +/- 109 U/L after the neck administration and 873 +/- 365 U/L after the gluteal administration. By measuring the total amount of CK released from injured muscle, it was calculated that an equivalent of 0.044 +/- 0.029 g/kg of muscle was destroyed after PBZ administration in the neck. The corresponding figure was 0.118 +/- 0.048 g/kg after intragluteal PBZ administration. By deconvoluting plasma CK activity, it was shown that the CK entry rate was maximum for the first 30-60 min following PBZ administration, which then decreased slowly to return to the control value after a delay of 24-48 h after PBZ administration. It was concluded that the CK release pattern following a controlled muscular damage was a non-invasive approach useful for quantifying the amount of damaged muscle, and that the calculation of CK input rate by deconvolution was of potential interest in describing events at the muscle cell level.

In vivo non-invasive quantification of muscle damage following a single intramuscular injection of phenylbutazone in sheep

Intramuscular drug administration can lead to more or less extensive muscle damage. The aim of the present study was to show the possibility of quantitating, in vivo and non-invasively, the equivalence of muscle destroyed by the administration of a test drug (phenylbutazone) known for its injurious properties. Creatine kinase (CK) kinetic parameters (clearance, volume of distribution) were measured in 6 sheep after an iv administration of muscle CK homogenate. In the same 6 sheep, CK release after iv and im 8 mg phenylbutazone/kg was measured. The calculated total CK released, based on the CK plasma clearance (0.28 mL/kg/min) and area under the curve of CK activity after im phenylbutazone administration was 191 +/- 140 U/kg. By relating this quantity to that of CK gluteal muscle (5114 +/- 891 U/g), it was calculated that im phenylbutazone administration was able to destroy an equivalence of 2.4 +/- 2.1 g of muscle. For the 2 main sites of im administration (neck and gluteal muscle), general equations are proposed to calculate the equivalence of muscle destroyed in sheep when only plasma CK activity following a test drug administration is available.

In vivo quantification of muscle damage in dogs after intramuscular administration of drugs

Intramuscular injections of a vitamin B preparation, imidocarb, imidocarb+lidocaine, and a preparation of salts of fatty acids produced significant increases in plasma creatine kinase activity in groups of five to six dogs. Activities peaked between 3 and 8 h, and were as high as 23 times base values with the fatty acid salts preparation. Quantification of the equivalent muscle damage gave means of 0.04, 0.25, 0.23 and 0.30 g kg-1 body weight, respectively, for each of the above preparations.

Disposition of creatine kinase activity in dog plasma following intravenous and intramuscular injection of skeletal muscle homogenates

The fate of skeletal muscle-derived creatine kinase (CK) was investigated in six dogs. After i.m. and i.v. injections of 3000 g and 105,000 g supernatants of dog muscle homogenates, plasma CK activity was measured up to 48 h. There was no significant difference in pharmacokinetic parameters dependent on the type of supernatant injected. After i.v. injection, the volume of distribution of CK was equal to the plasma volume, CK clearance was relatively low (about 0.5 mL/kg/min) and its terminal half-life of elimination was about 2.5 h. After i.m. injection, the CK terminal half-life was about 6.5 h, demonstrating a flip-flop mechanism, i.e. a limiting absorption process from the site of injection. Bioavailability after i.m. injection was about 65%, and the rate of absorption from muscle injection site was relatively slow: peak activity occurred at the second hour post administration, and most CK activity had been absorbed by 24 h. These pharmacokinetic parameters can be used as a basis for a minimally invasive means of quantitating muscle damage either after intramuscular drug administration or in canine sports medicine.

Serum chemistry values for Arabian sand gazelles (Gazella subgutturosa marica)

Values for urea, creatinine, glucose, total bilirubin, sodium, potassium, chloride, calcium, phosphates, magnesium, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, lactate deshydrogenase, and creatine-kinase are reported for the first time for 32 sand gazelles (Gazella subgutturosa marica) in Saudi Arabia. Comparisons were made between two groups: one sampled before a trip and the other sampled after a 14 hr trip. Only aspartate aminotransferase was higher in the second group; magnesium and phosphates were lower in that group.

Pharmacokinetic variables and bioavailability from muscle of creatine kinase in cattle

Pharmacokinetic variables of skeletal muscle creatine kinase (CK) activity after IV administration of a muscle extract; CK bioavailability after IM administration of the muscle extract; and effect of IM administration of saline solution, to appreciate the possible release of CK consecutive to muscle puncture, were determined in 6 cows. A general equation for the quantitative estimation of skeletal muscle damage also was derived. Administration of saline solution IM had no effect on plasma CK activity (ANOVA, P > 0.05) in any of the cows. After IV administration of the muscle extract (150 U/kg of body weight), mean volume of the central compartment, plasma half-life, and plasma clearance of CK were 0.027 +/- 0.007 L/kg, 520 +/- 109 minutes, and 6.43 +/- 2.29 ml/kg/h, respectively. After IM administration (150 U/kg), mean bioavailability of CK was 51 +/- 17% and maximal plasma CK activity (500 +/- 97 U/L) was observed at 454 +/- 131 minutes. The rate of CK activity entry into plasma was determined by use of deconvolution analysis. Two peaks were observed; the first appeared before the 30th minute after IM administration, and the second appeared at 3.3 +/- 1.1 hours. Amplitudes were 6.31 +/- 4.45 and 6.57 +/- 3.08 U/kg/h, for the first and the second peaks, respectively. The quantity of CK liberated from control muscle was 0.69 +/- 0.12 U/kg/h, corresponding to a normal daily catabolism of 5.8 +/- 1.0 mg of muscle/kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Kinetic evaluation of muscle damage during exercise by calculation of amount of creatine kinase released

To quantify the extent of muscle alteration during prolonged exercise, the release rate of creatine kinase (CK) from striated muscle was measured in six horses during a rest period (6 h) and during three exercise tests (15, 30, and 60 km) at a constant speed of 200 m/min. CK clearance was measured after intravenous bolus administration (150 U/kg) of a CK solution obtained from horse muscle. The CK steady-state volume of distribution was 0.059 +/- 0.0215 l/kg, the terminal half-life was 123 +/- 28 min, and the plasma clearance was 0.36 +/- 0.10 ml.kg-1 x min-1. After an intramuscular CK administration, the CK systemic availability was 74.1 +/- 21.2% and the half time of absorption was 9.4 +/- 5.7 h, indicating a slow process for CK transit through the lymphatic system. The CK release rate was only significantly increased during the 60-km exercise test. The increase of CK plasma activity was observed after a delay of approximately 5 h and peaked after the end of the race; the estimated CK release rate was 9.92 +/- 2.62 U.kg-1 x h-1 over a mean duration period of 65.8 +/- 15.8 h. With the CK activity of horse striated muscle taken into account, a 60-km race released a quantity of CK corresponding to an equivalent of 18.8 +/- 4.3 g striated muscle. It is concluded that the equivalent amount of damaged muscle may be considered as negligible for a 60-km test and that only very high plasma CK activity levels (at least higher than 10,000 U/l) may provide some evidence of a myolysis.

Genetic blood markers in Arabian, Barb and Arab-Barb horses in Morocco

Gene frequencies at 16 blood group and protein polymorphism loci (A, C, D, K, P, Q, U, Al, Gc, Es, A1B, Tf, PGD, PGM, GPI and Pi) are given for three horse breeds in Morocco (Arabian, Arab-Barb and Barb). These data are used to calculate average heterozygosity (h), Nei's standard genetic distance (DN) and probability of exclusion (PE). Variability expressed as the average heterozygosity was lower in the Arabian (0.330 +/- 0.066), while it was higher and almost the same in the Arab-Barb (0.413 +/- 0.071) and the Barb (0.414 +/- 0.070). The shortest genetic distance was found between Barb and Arab-Barb. The 16 loci used are at least 95% effective for recognizing incorrect paternity in these breeds. The Barb and Arab-Barb genetic profiles obtained showed the rare variants interesting perhaps in the context of European and American breeds: notably Dcfgkm, Ddekl, Es-N, Tf-A and Pi-W.

Creatine kinase in dog plasma: preanalytical factors of variation, reference values and diagnostic significance

In the dog, plasma creatine kinase (CK) activity was stable up to one week at +4 degrees C and one month at -20 degrees C. Activity was higher in serum than in plasma due to interference by CK from the platelets. The reference values were determined in 232 dogs using the IFCC recommended method. There was a significant decrease in activity with age but no effect of sex. In adults, plasma CK exhibited a log-normal distribution ranging from 20 to 104 U per litre. In 510 dogs with various diseases, the overall sensitivity and specificity of CK determination were 40 per cent and 98 per cent, respectively. The numerous false negatives could result from the relatively short half-life of the enzyme, while the false positives could be due to secondary muscle damage.

Creatine kinase in the dog: a review

In the dog, creatine kinase (CK) is mostly present in the skeletal muscles, myocardium, brain and intestine. The MM isoenzyme predominates in muscles and myocardium. In plasma, reference values depend on the technique used and CK-MB accounts for about 30-45% of total CK activity. Sex has no influence on plasma CK activity, which is higher in young dogs than in adults. Plasma CK is elevated after physical exercise. After its release from the cells, CK reaches the plasma mostly via the lymphatic route and then remains in the plasma compartment. It is rapidly cleared with a half-life of about 2 hours. Muscle diseases are the main source of plasma CK elevations: inherited myopathies, malignant hyperthermia, hypothyroidism, vitamin E-selenium deficiency, prolonged decubitus, intramuscular injections, surgery, etc. Plasma CK is also increased in experimental myocardial infarction, for which the dog is an interesting model, allowing quantification of the damage by measuring the total CK activity released.

[Nervous syndrome in sheep on the Ivory Coast. I. Epidemiological and clinical study, methods of diagnosis and treatment]

The ovine nervous syndrome in Côte-d'Ivoire is similar to the cerebrocortical necrosis (CCN) due to vitamin B1 deficiency. All classical symptoms of CCN were observed (locomotor ataxia with subsequent paralysis) and histological evidence for polioencephalomalacia was given. However, the circumstances for occurrence of the disease are very different in the two cases, i.e. CCN is a disease encountered in young fattening ruminants in developed countries while the ovine nervous syndrome is mainly observed in Côte-d'Ivoire during the dry season when pastures become sparse and dry and when the feed supply is insufficient. Thus, the main cause, which is rather univocal, is a sudden decrease in the nutritive value of the diet, but the accurate etiopathogenesis of the disease has not yet been determined. In a flock where 10-30% of the animals are ill, the mortality may reach 80-90%. No classical biochemical assays were specific enough to establish a precise diagnosis of the nervous syndrome. However, it should be pointed out that the CK (creatinine kinase) values very regularly rose and that the ASAT (aspartate aminotransferase) values were high in 75% of the cases. In the present African field conditions, the precise diagnosis is based on the efficiency of the vitamin B1 treatment and, for the dead animals, on the histological analysis of the brain.

Plasma potassium measurement with a new reagent carrier (Reflotron): comparison with ion-selective electrode results

Potassium concentrations were measured in the plasma of 336 animals with a new reagent carrier (Reflotron; Boehringer Mannheim) K+ and with an ion-specific electrode system: results were highly correlated (r = 0.991; y = 0.993 x + 0.02) and day-to-day coefficient of variation of the new reagent measurements was lower than 2.5 per cent. This system offers a good alternative to the ion-selective electrode system for plasma potassium measurement in veterinary practice.

Kidney tubule enzymes and extracellular DNA in urine as markers for nephrotoxicity in the guinea pig

Guinea pigs were given a single intraperitoneal injection of 1.35 mg/kg body weight of mercuric chloride; then various kidney enzymes and extracellular DNA were assayed in urine. Dramatic increases of all studied markers were observed on the first day following treatment. Sequential collection of urines allowed for kinetic studies: membrane markers alkaline phosphatase and gamma-glutamyltransferase were first released, then cytosolic lactate dehydrogenase and mitochondrial glutamate dehydrogenase, finally extracellular DNA; DNA release is equated with cell death. The features of kidney damage revealed by comparative and quantitative studies of these noninvasive markers suggest that brush border erasure was more extensive than cell necrosis.

Variations of plasma creatine kinase in rabbits following repetitive blood sampling effects of pretreatment with acepromazine, carazolol and dantrolene

Plasma creatine kinase activity increased significantly (P less than 0.001) in rabbits sampled every two hours for 12 hours (mean from 509 to 2242 U/l), but did not change when rabbits had been accustomed to laboratory handling procedures for two weeks. This increase was not alleviated or only moderately by pretreatment with acepromazine (per os, 2.5 mg.kg-1), carazolol (intravenously, 0.05 mg.kg-1) or dantrolene (intravenously, 1.0 mg.kg-1). Thus, when using plasma creatine kinase in rabbits, e.g. to test muscle damage or local tolerance of drugs, animals should be made familiar with laboratory procedures before any experiment.

Determination of plasma alpha-amylase in the dog: a test of the specificity of new methods

Commercially available chromogenic substrates for the assay of alpha-amylase were tested for specificity in dog plasma. Blocked alpha-4-nitrophenylmaltoheptaoside and non-blocked beta-4-nitrophenylmaltoheptaoside showed no interference with glucoamylase and were suitable for the measurement of alpha-amylase in dog plasma. In contrast, an alpha-4-nitrophenylmaltoheptaoside showed interference, and was therefore an inappropriate substrate. Reference values with the blocked substrate in a group of 82 non-selected 3 month- to 10 year-old male and female dogs were 355 +/- 131 U/l (mean +/- standard deviation) at 30 degrees C.