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Partington C, Hodgkiss-Geere H, Woods GRT, Dukes-McEwan J, Flanagan J, Biourge V, German AJ. The effect of obesity and subsequent weight reduction on cardiac morphology and function in cats. BMC Vet Res 2024; 20:154. [PMID: 38658930 PMCID: PMC11040875 DOI: 10.1186/s12917-024-04011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND In people, obesity is a risk factor for cardiovascular disease, associated with systemic hypertension, cardiac remodelling and systolic and diastolic dysfunction. Weight reduction can reverse myocardial remodelling and reduce risk of subsequent cardiovascular disease. In cats, far less is known regarding the effects of obesity and subsequent weight reduction on cardiovascular morphology and function. This prospective study aimed to assess cardiac morphology and function, heart rate variability, cardiac biomarkers and body composition before and after controlled weight reduction in cats with obesity. Body composition analysis (by dual energy x-ray absorptiometry, DEXA) and cardiovascular assessment (echocardiography, systemic arterial systolic blood pressure, electrocardiography, plasma cardiac biomarkers) were performed prior to weight management in twenty cats with obesity. These investigations were repeated in eleven cats that reached target weight. RESULTS At baseline, systemic hypertension was not documented, but the majority of cats with obesity (15 out of 19) showed echocardiographic evidence of diastolic dysfunction. Eleven of 20 cats had increased maximal end-diastolic septal or left ventricular free wall thickness (≥ 6.0 mm) at baseline. Median (interquartile range) percentage of weight lost in the cats reaching target weight was 26% (17-29%), with a median reduction in body fat mass of 45% (26-64%). Both the end-diastolic left ventricular free wall (median magnitude of change -0.85 mm, IQR -0.05 mm to -1.55 mm, P = 0.019; median percentage reduction 14.0%) and end-diastolic interventricular septum (median magnitude of change -0.5 mm, IQR -0.2 mm to -1.225 mm, P = 0.047; median percentage reduction 7.9%) thickness decreased after weight reduction. Following weight reduction, pulsed wave tissue Doppler imaging of the left ventricular free wall was consistent with improved diastolic function in 4 out of 8 cats, however there was no significant difference in overall diastolic function class. Further, there was no change in heart rate variability or cardiac biomarkers with weight reduction. CONCLUSION An increase in left ventricular wall thickness and diastolic dysfunction were common echocardiographic features in cats with obesity within our study and may be reversible with successful weight and fat mass loss. Further studies are required to clarify the clinical consequences of these findings.
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Affiliation(s)
- Catheryn Partington
- Institute of Infection, Veterinary, Ecological and Sciences, Department of Small Animal Clinical Sciences, Teaching Hospital, University of Liverpool, Neston, UK.
- Present address: Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK.
| | - Hannah Hodgkiss-Geere
- Institute of Infection, Veterinary, Ecological and Sciences, Department of Small Animal Clinical Sciences, Teaching Hospital, University of Liverpool, Neston, UK
| | - Georgia R T Woods
- Institute of Life Course and Medical Sciences, Department of Small Animal Clinical Sciences, Teaching Hospital, University of Liverpool, Neston, UK
| | - Joanna Dukes-McEwan
- Institute of Infection, Veterinary, Ecological and Sciences, Department of Small Animal Clinical Sciences, Teaching Hospital, University of Liverpool, Neston, UK
| | | | | | - Alexander J German
- Institute of Life Course and Medical Sciences, Department of Small Animal Clinical Sciences, Teaching Hospital, University of Liverpool, Neston, UK
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Tuleski GLR, Pscheidt MJGR, dos Santos JP, Sousa MG. Timolol 0.5% ophthalmic solution influences cardiac function in healthy cats. J Feline Med Surg 2022; 24:e57-e69. [PMID: 35470745 PMCID: PMC11104227 DOI: 10.1177/1098612x221083372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to ascertain the effect of a drop of timolol 0.5% ophthalmic solution on the systolic function of the left ventricle (LV) and left atrium (LA), and to confirm if timolol helped appraisal of diastolic function by reducing heart rate (HR) and separating the transmitral outflow waves from tissue Doppler imaging (TDI). METHODS A total of 41 client-owned healthy cats underwent two echocardiograms 20 mins apart. The timolol group (33 cats) received a drop of timolol solution after the first examination. Standard and speckle-tracking echocardiography evaluated the LV and LA function of both groups at the two time points evaluated. RESULTS Timolol reduced HR (19%), and fractional shortening from LV (20.3%) and LA (16.6%). Septal S' decreased by 51% (from 7.7 to 5.2 cm/s) and lateral S' dropped by 43.1% (7.3 to 5.1 cm/s). Most longitudinal techniques did not change after timolol, including the mitral annular plane systolic excursion from the interventricular annulus, tricuspid annular plane systolic excursion, LV longitudinal strain and LV tissue motion annular displacement. The isovolumic relaxation time increased by 15.2% (from 54 to 64.6 ms), with most cats presenting this variable above the reference (>60 ms). Timolol did not support diastolic assessment, enabling evaluation in only 2/11 cats when using lateral TDI and 1/9 cats using septal TDI. Regarding side effects, miosis occurred in 18 cats (54.5%). CONCLUSIONS AND RELEVANCE Timolol reduced systolic function, decreasing standard echocardiographic variables. Regarding diastolic evaluation, although timolol decreased HR, it did not separate the mitral diastolic waves, as expected.
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Affiliation(s)
- Giovana LR Tuleski
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | | | - Júlio Pereira dos Santos
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Marlos Gonçalves Sousa
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
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Kittleson MD, Côté E. The Feline Cardiomyopathies: 3. Cardiomyopathies other than HCM. J Feline Med Surg 2021; 23:1053-1067. [PMID: 34693805 PMCID: PMC8723175 DOI: 10.1177/1098612x211030218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Practical relevance: Although feline hypertrophic cardiomyopathy (HCM) occurs more commonly,
dilated cardiomyopathy (DCM), restrictive cardiomyopathy (RCM),
arrhythmogenic right ventricular cardiomyopathy (ARVC), left ventricular
noncompaction (LVNC) and cardiomyopathy – nonspecific phenotype (NCM;
formerly unclassified cardiomyopathy) are all recognized in domestic
cats. Patient group: Any adult domestic cat, of either sex and of any breed, can be affected. Diagnostics: The non-HCM cardiomyopathies are rarely suspected in subclinically affected
cats, so most are first identified when a cat presents with signs of heart
failure or systemic thromboembolic disease. The definitive clinical
confirmatory test for these other feline cardiomyopathies is
echocardiography. Key findings: ‘Cardiomyopathy – nonspecific phenotype’ is a catch-all term that groups
hearts with myocardial changes that either do not meet the criteria for any
one type of cardiomyopathy (HCM, RCM, DCM, ARVC, LVNC) or meet the
echocardiography criteria for more than one type. RCM is characterized by
diastolic dysfunction due to fibrosis that results in a restrictive
transmitral flow pattern on Doppler echocardiography and usually marked left
or biatrial enlargement. DCM is characterized by decreased myocardial
contractility and is rare in cats. When it occurs, it is seldom due to
taurine deficiency. However, since taurine-deficient DCM is usually
reversible, a diet history should be obtained, whole blood and plasma
taurine levels should be measured and taurine should be supplemented in the
diet if the diet is not commercially manufactured. ARVC should be suspected
in adult cats with severe right heart enlargement and right heart failure
(ascites and/or pleural effusion), especially if arrhythmia is present.
Feline LVNC is rare; its significance continues to be explored. Treatment of
the consequences of these cardiomyopathies (management of heart failure,
thromboprophylaxis, treatment of systemic arterial thromboembolism) is the
same as for HCM. Conclusions: While these other cardiomyopathies are less prevalent than HCM in cats, their
clinical and radiographic presentation is often indistinguishable from HCM.
Echocardiography is usually the only ante-mortem method to determine which
type of cardiomyopathy is present. However, since treatment and prognosis
are often similar for the feline cardiomyopathies, distinguishing among the
cardiomyopathies is often not essential for determining appropriate
therapy. Areas of uncertainty: The feline cardiomyopathies do not always fit into one distinct category.
Interrelationships among cardiomyopathies in cats may exist and
understanding these relationships in the future might provide critical
insights regarding treatment and prognosis.
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Affiliation(s)
| | - Etienne Côté
- Department of Companion Animals, Atlantic
Veterinary College, University of Prince Edward Island, Charlottetown,
Prince Edward Island, Canada
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van Hoek I, Hodgkiss-Geere H, Bode EF, Hamilton-Elliott J, Mõtsküla P, Palermo V, Pereira YM, Culshaw GJ, Laxalde J, Dukes-McEwan J. Association of diet with left ventricular wall thickness, troponin I and IGF-1 in cats with subclinical hypertrophic cardiomyopathy. J Vet Intern Med 2020; 34:2197-2210. [PMID: 33118674 PMCID: PMC7694815 DOI: 10.1111/jvim.15925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cats with subclinical hypertrophic cardiomyopathy (sHCM) have elevated serum insulin and serum amyloid A concentrations correlating with the degree of cardiac hypertrophy. Diet might affect these and other cardiac variables. OBJECTIVE Evaluate the effect of a complete, balanced diet with restricted starch and supplemented with eicosapentaenoic acid + docosahexaenoic acid (EPA + DHA) on echocardiographic variables and cardiac biomarkers in cats with sHCM. ANIMALS Forty-four client-owned cats with sHCM. METHODS A prospective, randomized, double-blind, multicenter study enrolled cats with end-diastole interventricular septum thickness (IVSd) or left ventricular wall thickness (LVWd) ≥6 mm, or both. Nonsedated, fasted cats were examined at baseline and after 6 and 12 months of Test (restricted starch and EPA + DHA supplements) (n = 23) or Control (unrestricted starch without EPA + DHA supplementation) (n = 21) diet. Assessments included auscultation, body weight, body condition score, echocardiography and blood analysis. Linear and generalized mixed models analyzed diet, time and diet * time interactions (5% significance level). RESULTS No differences between diet groups were significant for any variable at any timepoint. There were significant decreases in the Test but not Control group in maximum IVSd (P = .03), maximum LVWd (P = .02) and insulin-like growth factor-1 levels (P = .04) after 12 months, and in ultrasensitive cardiac troponin I (cTnI) (P = .001) after 6 months; effect sizes (95% confidence interval) were 0.53 (0.09; 0.99), 0.63 (0.18; 1.09), 0.61 (0.16; 1.07), and 0.37 (-0.06; 0.8), respectively. CONCLUSIONS AND CLINICAL IMPORTANCE Cats with sHCM fed Test diet had significant decreases in echocardiographic variables of sHCM and in cTnI and IGF-1.
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Affiliation(s)
| | - Hannah Hodgkiss-Geere
- Department of Small Animal Clinical Science, Institute of Veterinary Science, Leahurst, University of Liverpool, Neston, United Kingdom
| | - Elizabeth F Bode
- Department of Small Animal Clinical Science, Institute of Veterinary Science, Leahurst, University of Liverpool, Neston, United Kingdom
| | - Julie Hamilton-Elliott
- Department of Small Animal Clinical Science, Institute of Veterinary Science, Leahurst, University of Liverpool, Neston, United Kingdom
| | - Paul Mõtsküla
- Estonian University of Life Sciences, Tartu, Estonia
| | | | | | | | | | - Joanna Dukes-McEwan
- Department of Small Animal Clinical Science, Institute of Veterinary Science, Leahurst, University of Liverpool, Neston, United Kingdom
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Lima CR, Martins DF, Reed WR. Physiological Responses Induced by Manual Therapy in Animal Models: A Scoping Review. Front Neurosci 2020; 14:430. [PMID: 32457570 PMCID: PMC7227122 DOI: 10.3389/fnins.2020.00430] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/08/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Physiological responses related to manual therapy (MT) treatment have been investigated over decades using various animal models. However, these studies have not been compiled and their collective findings appraised. The purpose of this scoping review was to assess current scientific knowledge on the physiological responses related to MT and/or simulated MT procedures in animal models so as to act as a resource to better inform future mechanistic and clinical research incorporating these therapeutic interventions. Methods: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, and Index of Chiropractic Literature (ICL) were searched from database inception to August 2019. Eligible studies were: (a) published in English; (b) non-cadaveric animal-based; (c) original data studies; (d) included a form of MT or simulated MT as treatment; (e) included quantification of at least one delivery parameter of MT treatment; (f) quantification of at least one physiological measure that could potentially contribute to therapeutic mechanisms of action of the MT. MT studies were categorized according to three main intervention types: (1) mobilization; (2) manipulation; and (3) massage. Two-phase screening procedures were conducted by a pair of independent reviewers, data were extracted from eligible studies and qualitatively reported. Results: The literature search resulted in 231 articles of which 78 met inclusion criteria and were sorted by intervention type. Joint mobilization induced changes in nociceptive response and inflammatory profile, gene expression, receptor activation, neurotransmitter release and enzymatic activity. Spinal manipulation produced changes in muscle spindle response, nocifensive reflex response and neuronal activity, electromyography, and immunologic response. Physiological changes associated with massage therapy included autonomic, circulatory, lymphatic and immunologic functions, visceral response, gene expression, neuroanatomy, function and pathology, and cellular response to in vitro simulated massage. Conclusion: Pre-clinical research supports an association between MT physiological response and multiple potential short-term MT therapeutic mechanisms. Optimization of MT delivery and/or treatment efficacy will require additional preclinical investigation in which MT delivery parameters are controlled and reported using pathological and/or chronic pain models that mimic neuromusculoskeletal conditions for which MT has demonstrated clinical benefit.
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Affiliation(s)
- Carla Rigo Lima
- Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Daniel Fernandes Martins
- Postgraduate Program in Health Sciences, Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Brazil
| | - William Ray Reed
- Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
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Almeida V, Uscategui R, Restan W, Feliciano M, Ortiz E, Kawanami A, Barros F, Santos V, Vicente W. Cardiovascular assessment in Female Spotted Paca ( Cuniculus paca ). ARQ BRAS MED VET ZOO 2019. [DOI: 10.1590/1678-4162-10146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Aiming to provide cardiovascular morphophysiology information on the Cuniculus paca, an important neotropical rodent, eight healthy adult females of this species were evaluated three times by echocardiography under general anesthesia with isoflurane every 15 days. The exams were performed by a single experienced evaluator with the animals positioned in right and left decubitus. Posteriorly, two expert evaluators measured the cardiac chambers, walls and flow patterns, by B-mode, M-mode, and Doppler ultrasonography. The resulting values were compared among evaluators and periods by the Bland-Altman agreement test and several descriptive statistics were presented for each parameter. Echocardiographic images were obtained between the second and fifth left and right intercostal spaces, enabling the measurement of heart chambers and walls, mitral, tricuspid, aortic and pulmonary valves blood flows, and the ejection and shortening fractions calculation. None of the studied variables showed inter-observers or inter-periods variations. This study provided some normal echocardiographic variables, applicable to epidemiological, pathophysiological or case studies in the Cuniculus paca and phylogenetically close species.
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Affiliation(s)
| | | | | | - M.A.R. Feliciano
- Universidade Estadual Paulista, Brazil; Universidade Federal do Recôncavo da Bahia, Brazil
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Schober KE, Chetboul V. Echocardiographic evaluation of left ventricular diastolic function in cats: Hemodynamic determinants and pattern recognition. J Vet Cardiol 2016; 17 Suppl 1:S102-33. [PMID: 26776572 DOI: 10.1016/j.jvc.2015.02.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 01/26/2015] [Accepted: 02/04/2015] [Indexed: 10/22/2022]
Abstract
Left ventricular (LV) diastolic dysfunction is highly prevalent in cats and is a functional hallmark of feline cardiomyopathy. The majority of cats with hypertrophic, restrictive, and dilated cardiomyopathy have echocardiographic evidence of abnormal LV filling, even during the occult (preclinical) phase. Moderate and severe diastolic dysfunction is an indicator of advanced myocardial disease, is associated with clinical signs including exercise intolerance and congestive heart failure, affects outcome, and influences therapeutic decisions. Therefore, identification and quantification of LV diastolic dysfunction are clinically important. Surrogate measures of diastolic function determined by transthoracic two-dimensional, M-mode, and Doppler echocardiographic (DE) methods have been used widely for such purpose. Major functional characteristics of LV diastole, including global function, relaxation and untwist, chamber compliance, filling volume, and the resultant filling pressures can be semi-quantified by echocardiographic methods, and variables retrieved from transmitral flow, pulmonary vein flow, and tissue Doppler recordings are most frequently used. Although there is still a critical lack of well-designed studies in the field, knowledge has steadily accumulated over the past 20 years, reference ranges of diastolic echocardiographic variables have been determined, epidemiological studies have been conducted, and new treatments of diastolic dysfunction in cats have been evaluated. This report will give the reader a summary of the current status in the field of feline diastology with focus on the noninvasive diagnostic methods and interpretation of echocardiographic surrogate measures of LV diastolic function. Lastly, a grading system using a composite of left atrial size and various DE variables potentially useful in the functional classification of LV diastole in cats is introduced.
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Affiliation(s)
- Karsten E Schober
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA.
| | - Valérie Chetboul
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie d'Alfort (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), 7 avenue du general de Gaulle, 94704 Maisons-Alfort cedex, France
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Gunther-Harrington CT, Ontiveros ES, Hodge TE, Visser LC, Stern JA. Effects of 0.5% Timolol Maleate Ophthalmic Solution on Heart Rate and Selected Echocardiographic Indices in Apparently Healthy Cats. J Vet Intern Med 2016; 30:733-40. [PMID: 26969017 PMCID: PMC4913573 DOI: 10.1111/jvim.13931] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 01/25/2016] [Accepted: 02/25/2016] [Indexed: 11/28/2022] Open
Abstract
Background Echocardiographic assessment of diastolic function is challenging in cats, partially because of transmitral flow pattern fusion associated with high heart rates. With heart rate (HR) reduction, transmitral flow waveforms separate, allowing identification of diastolic dysfunction. Timolol, an ophthalmic, nonselective beta‐blocker used in glaucoma is safe and transiently decreases HR in clinical trials. Hypothesis Administration of timolol ophthalmic solution decreases HR and facilitates echocardiographic assessment of diastolic function in cats without inducing clinically relevant adverse effects. Animals Twenty‐five apparently healthy cats. Methods Electrocardiograms and echocardiograms including transmitral flow patterns were evaluated before and 20 minutes after ocular administration of 1 drop of timolol 0.5% solution. Twenty cats underwent treatment with timolol, and 5 different cats served as untreated controls to evaluate the effects of acclimation to the hospital environment on HR. Results Acclimation to the hospital had no effect on HR in control cats. After timolol administration, a significant median HR reduction of 25 bpm was observed (P < .0001). Timolol had no effect on E/A ratio in cats without E/A fusion (7/20, P = .44). Of the 13 cats with E and A waves that were fused before timolol application, separation of these waves was identified in 8 cats (62%) after timolol treatment. No bradyarrhythmias were noted after timolol administration, but 2 cats had first‐degree atrioventricular block. Timolol resulted in resolution of dynamic outflow tract obstruction in 6 of 6 cats. Conclusions and clinical importance Ocular administration of timolol safely decreases HR in cats and could facilitate assessment of diastolic function.
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Affiliation(s)
- C T Gunther-Harrington
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, CA
| | - E S Ontiveros
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, CA
| | - T E Hodge
- Veterinary Medical Center, University of California, San Diego, CA
| | - L C Visser
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, CA
| | - J A Stern
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, CA
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Turner Giannico A, Ayres Garcia DA, Lima L, de Lara FA, Corona Ponczek CA, Shaw GC, Montiani-Ferreira F, Rodrigues Froes T. Determination of Normal Echocardiographic, Electrocardiographic, and Radiographic Cardiac Parameters in the Conscious New Zealand White Rabbit. J Exot Pet Med 2015. [DOI: 10.1053/j.jepm.2015.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Linney CJ, Dukes-McEwan J, Stephenson HM, López-Alvarez J, Fonfara S. Left atrial size, atrial function and left ventricular diastolic function in cats with hypertrophic cardiomyopathy. J Small Anim Pract 2014; 55:198-206. [DOI: 10.1111/jsap.12186] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- C. J. Linney
- Department of Cardiology, Small Animal Teaching Hospital; School of Veterinary Science, University of Liverpool; Leahurst Neston CH64 7TE
| | - J. Dukes-McEwan
- Department of Cardiology, Small Animal Teaching Hospital; School of Veterinary Science, University of Liverpool; Leahurst Neston CH64 7TE
- Department of Musculoskeletal Biology; Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool; Liverpool L69 3GA
| | - H. M. Stephenson
- Department of Cardiology, Small Animal Teaching Hospital; School of Veterinary Science, University of Liverpool; Leahurst Neston CH64 7TE
| | - J. López-Alvarez
- Department of Cardiology, Small Animal Teaching Hospital; School of Veterinary Science, University of Liverpool; Leahurst Neston CH64 7TE
| | - S. Fonfara
- Department of Cardiology, Small Animal Teaching Hospital; School of Veterinary Science, University of Liverpool; Leahurst Neston CH64 7TE
- Department of Musculoskeletal Biology; Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool; Liverpool L69 3GA
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