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Johnson AJ, Rozanski EA, de Laforcade AM, Davila C, Rush JE, Guillaumin J. Viscoelastic coagulation monitoring parameters in cats with acute arterial thromboembolism. J Vet Intern Med 2024; 38:2045-2051. [PMID: 38747192 PMCID: PMC11256171 DOI: 10.1111/jvim.17050] [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] [Received: 02/08/2023] [Accepted: 03/08/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Hypercoagulability has been documented in cats with cardiac disease. However, hemostatic parameters, including viscoelastic coagulation monitoring (VCM) have not been reported in cats with arterial thromboembolism (ATE). HYPOTHESIS/OBJECTIVES Compare VCM parameters in cats with acute cardiogenic ATE and in control cats. ANIMALS Sixteen cats with ATE and 30 control cats. METHODS Multicenter university-based prospective study. Cardiogenic ATE was diagnosed based on physical examination and by ultrasonographically-diagnosed left atrial enlargement. Viscoelastic coagulation monitor analysis, CBC, serum biochemistry profile and coagulation profile were performed at admission in cats with ATE. Analysis from healthy control cats was performed using blood collected by direct venipuncture. Our objective was comparison of VCM parameters clot time (CT), clot formation time (CFT), alpha angle (Angle), maximum clot formation (MCF), amplitude at 10 and 20 minutes (A10 and A20, respectively) and clot lysis index at 30 and 45 minutes (LI30 and LI45, respectively) between ATE and control cats. RESULTS Cats with ATE had a decreased angle compared to control cats, with a median (range) of 43° (30-48°) compared to 47° (14-59°; P = .01). The parameters A10, A20 and MCF were decreased in ATE cats compared to control cats with a median (range) of 19 units (8-32) compared to 22 units (6-38), 24.5 units (11-40) compared to 29 units (10-47) and 29.5 units (13-44) compared to 33.5 units (14-53), respectively (P = .01, .01 and .01, respectively). The parameters CT, CFT, LI30 and LI45 were similar between groups (P = .22, .09, .62 and .34, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE Cats with cardiogenic ATE cats have VCM parameters consistent with hypocoagulability compared with healthy cats.
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Affiliation(s)
- Amanda J. Johnson
- Foster Hospital for Small Animals at Tufts Cummings School of Veterinary MedicineNorth GraftonMassachusettsUSA
| | - Elizabeth A. Rozanski
- Foster Hospital for Small Animals at Tufts Cummings School of Veterinary MedicineNorth GraftonMassachusettsUSA
| | - Armelle M. de Laforcade
- Foster Hospital for Small Animals at Tufts Cummings School of Veterinary MedicineNorth GraftonMassachusettsUSA
| | - Claudia Davila
- Foster Hospital for Small Animals at Tufts Cummings School of Veterinary MedicineNorth GraftonMassachusettsUSA
| | - John E. Rush
- Foster Hospital for Small Animals at Tufts Cummings School of Veterinary MedicineNorth GraftonMassachusettsUSA
| | - Julien Guillaumin
- Department of Clinical SciencesColorado State UniversityFort CollinsColoradoUSA
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Dutton LC, Spalla I, Seo J, Silva J, Novo Matos J. Aortic annular plane systolic excursion in cats with hypertrophic cardiomyopathy. J Vet Intern Med 2024; 38:61-70. [PMID: 38038190 PMCID: PMC10800187 DOI: 10.1111/jvim.16962] [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] [Received: 06/14/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Impairment of left ventricular (LV) longitudinal function is an early marker of systolic dysfunction in hypertrophic cardiomyopathy (HCM). Aortic annular plane systolic excursion (AAPSE) is a measure of LV longitudinal function in people that has not been evaluated in cats. HYPOTHESIS Aortic annular plane systolic excursion is lower in cats with HCM compared to control cats, and cats in stage C have the lowest AAPSE. ANIMALS One hundred seventy-five cats: 60 normal, 61 HCM stage B and 54 HCM stage C cats. MATERIALS Multicenter retrospective case-control study. Electronic medical records from 4 referral hospitals were reviewed for cats diagnosed with HCM and normal cats. HCM was defined as LV wall thickness ≥6 mm and normal cats ≤5 mm. M-mode bisecting the aorta in right parasternal short-axis view was used to measure AAPSE. RESULTS Aortic annular plane systolic excursion was lower in HCM cats compared to normal cats (3.9 ± 0.9 mm versus 4.6 ± 0.9 mm, P < .001) and was lowest in HCM stage C (2.4 ± 0.6 mm, P < .001). An AAPSE <2.9 mm gave a sensitivity of 83% (95% CI 71%-91%) and specificity of 92% (95% CI 82%-97%) to differentiate HCM stage C from stage B. AAPSE correlated with mitral annular plane systolic excursion (r = .6 [.4-.7], P < .001), and atrial fractional shortening (r = .6 [.5-.7], P < .001), but showed no correlation with LV fractional shortening. CONCLUSIONS AND CLINICAL IMPORTANCE Aortic annular plane systolic excursion is an easily acquired echocardiographic variable and might be a new measurement of LV systolic performance in cats with HCM.
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Affiliation(s)
- Luke C Dutton
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Joonbum Seo
- Animal Referral Centre, Auckland, New Zealand
| | - Joel Silva
- North Downs Specialist Referrals, The Friesian Buildings 3 & 4, Bletchingley, Surrey, UK
| | - Jose Novo Matos
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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3
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Tosuwan J, Surachetpong SD, Hunprasit V. Assessment of left atrial myocardial deformation using two-dimensional speckle-tracking echocardiography in cats with cardiogenic and non-cardiogenic arterial thromboembolism. Int J Vet Sci Med 2023; 11:11-22. [PMID: 37025927 PMCID: PMC10071954 DOI: 10.1080/23144599.2023.2196853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Arterial thromboembolism (ATE) in cats usually relates to cardiogenic causes that can be diagnosed by conventional echocardiography. Two-dimensional speckle-tracking echocardiography (2D-STE) is a new ultrasound modality with higher sensitivity. Our objective was to investigate left atrial myocardial deformation in cats with both cardiogenic and non-cardiogenic ATE and normal cats using 2D-STE. Twenty-three normal cats and 21 cats with ATE cats were recruited and performed conventional echocardiography and 2D-STE. From the results, left atrial (LA) strain and strain rate from 2D-STE were significantly decreased in cats with cardiogenic ATE (P < 0.001), but there was no significant difference in non-cardiogenic ATE compared with normal cats. From the correlation test, the use of left atrial strain during the reservoir phase (LASr) could represent the overall LA deformation. The intra- and inter-observer coefficient of variation of LASr was less than 15%. The logistic regression revealed that the LASr value of less than 11% was a significant factor for the occurrence of ATE (odd ratio = 189.0, P < 0.001). In conclusion, LASr derived by 2D-STE is a repeatable and non-invasive technique to assess LA myocardial deformation in cats with ATE. By 2D-STE, impaired LA function was detected in cats with cardiogenic ATE. LASr < 11% may use as a predictor of the risk of ATE occurrence in cats.
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Kuo MYW, Häggström J, Gordon SG, Höglund K, Côté E, Lu TL, Dirven M, Rishniw M, Hung YW, Ljungvall I. Veterinary echocardiographers' preferences for left atrial size assessment in cats: the BENEFIT project. J Vet Cardiol 2023; 51:145-156. [PMID: 38128420 DOI: 10.1016/j.jvc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 10/13/2023] [Accepted: 11/05/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION/OBJECTIVES Veterinary echocardiographers' preferences for left atrial (LA) size assessment in cats have not been systematically investigated. The primary aim of this prospective exploratory study was to investigate echocardiographers' preferences concerning LA size assessment in cats. A secondary aim was to investigate echocardiographers' preferences for assessing LA size in subgroups based on geographic, demographic, and professional profiles. ANIMALS, MATERIALS, AND METHODS An online survey instrument was designed, verified, and distributed globally to veterinary echocardiographers. RESULTS A total of 655 veterinary echocardiographers from six continents and 54 countries, working in specialty practice (56%) and in general practice (38%), provided data. Linear two-dimensional (2D) technique was favored by most echocardiographers (n = 612) for LA size assessment. Most commonly, respondents combined linear 2D with subjective assessment (n = 227), while 209 used linear 2D-based methods alone. Most echocardiographers using linear 2D-based methods preferred the right parasternal short-axis view and to index the LA to the aorta (Ao). Approximately 10% of the respondents obtained LA dimensions from a right parasternal long-axis four-chamber view. Approximately one-third of echocardiographers that made linear measurements from 2D echocardiograms shared the same preferences regarding cat position, acquisition view, indexing method and time point identification for the LA measurement. The responses were comparably homogeneous across geographic location, level of training, years performing echocardiography, and type of practice. DISCUSSION/CONCLUSION Most veterinary echocardiographers assessed LA size in cats using linear 2D echocardiography from a right parasternal short-axis view, and indexed LA to Ao. Respondents' preferences were similar over geographic, demographic, and professional backgrounds.
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Affiliation(s)
- M Y-W Kuo
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden.
| | - J Häggström
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - S G Gordon
- Department of Small Animal Clinical Science, Texas A&M University, College Station, TX, USA
| | - K Höglund
- Department of Anatomy, Physiology and Biochemistry, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - E Côté
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Prince Edward Island, Canada
| | - T-L Lu
- Chuan Animal Hospital, Taipei, Taiwan
| | - M Dirven
- Evidensia Södra Animal Hospital, Kungens Kurva, Sweden
| | - M Rishniw
- Veterinary Information Network, Davis, CA, USA
| | - Y-W Hung
- Cardiospecial Veterinary Hospital, Taipei, Taiwan
| | - I Ljungvall
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Caivano D, Rishniw M, Colangeli G, Birettoni F, Nisini N, Porciello F. Two-dimensional echocardiographic estimates of left atrial volumes obtained from two different views in dogs are similar but not interchangeable. Vet J 2023; 293:105966. [PMID: 36801487 DOI: 10.1016/j.tvjl.2023.105966] [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] [Received: 09/09/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/21/2023]
Abstract
Left atrial (LA) volumes using a monoplane Simpson's Method of Discs (SMOD) can be obtained from the right parasternal long axis four-chamber (RPLA) or from the left apical four-chamber (LA4C) views in dogs; however, little information exists regarding the agreement of LA volume estimates using a SMOD on images obtained from LA4C and RPLA views. Therefore, we sought to examine the agreement between the two methods of obtaining LA volumes in a heterogenous population of healthy and diseased dogs. Additionally, we compared the LA volumes obtained by SMOD with estimates obtained from simple cube or sphere volume formulae. Archived echocardiographic examinations were retrieved and, where both RPLA and LA4C views were adequately recorded, included in the study. We obtained measurements from 194 dogs that were either apparently healthy (n = 80) or had various cardiac diseases (n = 114). The LA volumes of each dog was measured using a SMOD, from both views, in systole and diastole. Estimates of LA volumes obtained from simple cube or sphere volume formulae from RPLA-derived LA diameters were also calculated. We then used Limits of Agreement analysis to determine agreement between the estimates obtained with each view, and those calculated from linear dimensions. The two methods obtained by SMOD provided similar estimates for both systolic and diastolic volumes but did not agree sufficiently to be interchangeable. The LA4C view often slightly underestimated the LA volumes at small LA sizes and overestimated the LA volumes at large LA sizes compared to RPLA method, with increasing disagreement as the LA size increased. Estimates based on cube method overestimated volumes compared to both SMOD methods, whereas those based on sphere method performed reasonably. Our study suggests that monoplane volume estimates from the RPLA and LA4C views are similar but not interchangeable. Clinicians can also perform a rough estimate of LA volumes using RPLA-derived LA diameters to calculate the sphere volume.
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Affiliation(s)
- D Caivano
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia 06126, Italy.
| | - M Rishniw
- Veterinary Information Network, Davis, CA 95616, USA; Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - G Colangeli
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia 06126, Italy
| | - F Birettoni
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia 06126, Italy
| | - N Nisini
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia 06126, Italy
| | - F Porciello
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia 06126, Italy
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Bastos RF, Tuleski GLR, Franco LFC, Sousa MG. Tpeak—Tend, a novel electrocardiographic marker in cats with hypertrophic cardiomyopathy—a brief communication. Vet Res Commun 2022; 47:559-565. [DOI: 10.1007/s11259-022-10004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/18/2022] [Indexed: 11/05/2022]
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Busato F, Drigo M, Zoia A. Reduced risk of arterial thromboembolism in cats with pleural effusion due to congestive heart failure. J Feline Med Surg 2022; 24:e142-e152. [PMID: 35549930 PMCID: PMC10812273 DOI: 10.1177/1098612x221094663] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of the study was to determine whether cardiogenic pleural effusion in cats is associated with a lower risk of arterial thromboembolism (ATE) compared with cats with cardiac disease without evidence of pleural effusion. METHODS A cross-sectional study was conducted on owned cats with natural occurring cardiac diseases. Cats included were classified in three groups: those with cardiac disease but no evidence of congestive heart failure (CHF); those with evidence of cardiogenic pulmonary oedema; and those with evidence of cardiogenic pleural effusion. Prevalence of ATE was calculated and the variables analysed for an association with this outcome were the presence and type of CHF, sex and neuter status, age, breed, type of cardiac diseases and left atrial (LA) dimension. A multivariable logistic regression model was used to fit the association between ATE and these variables. RESULTS A total of 366 cats with cardiac disease met the inclusion criteria: 179 were included in the group with cardiac disease but no evidence of CHF, 66 in the group with evidence of cardiogenic pulmonary oedema and 121 in the group with evidence of cardiogenic pleural effusion. Prevalence of ATE (58/366 [15.8%]) was significantly different among groups (with no evidence of CHF, 28/179 [15.6%]; with evidence of cardiogenic pulmonary oedema, 22/66 [33.3%]; with evidence of cardiogenic pleural effusion, 8/121 [6.6%]; P <0.001). Cats with ATE had a significantly higher LA to aortic root ratio (2.30 ± 0.46) than those without ATE (2.04 ± 0.46; P <0.001). Multivariable logistic regression analysis indicated that the group with evidence of cardiogenic pleural effusion was associated with a lower risk of developing ATE compared with groups with cardiac disease but no evidence of CHF and with evidence of cardiogenic pulmonary oedema (P = 0.005 and P <0.001, respectively). CONCLUSIONS AND RELEVANCE Presence of cardiogenic pleural effusion is associated with a lower risk of developing ATE, while LA enlargement is a risk factor for ATE.
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Affiliation(s)
- Francesca Busato
- Division of Internal Medicine, San Marco Veterinary Clinic, Veggiano (PD), Italy
| | - Michele Drigo
- Department of Medicina Animale, Produzione e Salute, Padua University, Legnaro (PD), Italy
| | - Andrea Zoia
- Division of Internal Medicine, San Marco Veterinary Clinic, Veggiano (PD), Italy
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Schober KE, Fox PR, Abbott J, Côté E, Luis‐Fuentes V, Matos JN, Stern JA, Visser L, Scollan KF, Chetboul V, Schrope D, Glaus T, Santilli R, Pariaut R, Stepien R, Arqued‐Soubeyran V, Toaldo MB, Estrada A, MacDonald K, Karlin ET, Rush J. Retrospective evaluation of hypertrophic cardiomyopathy in 68 dogs. J Vet Intern Med 2022; 36:865-876. [PMID: 35322461 PMCID: PMC9151492 DOI: 10.1111/jvim.16402] [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] [Received: 04/14/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is a lack of clinical data on hypertrophic cardiomyopathy (HCM) in dogs. HYPOTHESIS/OBJECTIVES To investigate signalment, clinical signs, diagnostic findings, and survival in dogs with HCM. ANIMALS Sixty-eight client-owned dogs. METHODS Retrospective multicenter study. Medical records were searched between 2003 and 2015. The diagnosis of left ventricular (LV) hypertrophy was made by echocardiographic examination. RESULTS Three hundred and forty-five dogs with LV hypertrophy were identified, of which 277 were excluded. The remaining 68 dogs were 0.3 to 14 years old and predominantly <10 kg (85%), and without a sex predilection. Twenty-four % were Shih Tzu and 24% terrier breeds. Most (80%) had a systolic heart murmur. Owner-determined exercise intolerance (37%) and syncope (18%) were most commonly reported signs. The majority (84%) of dogs had symmetrical LV hypertrophy, whereas asymmetrical septal and LV free wall hypertrophy was observed in 9% and 6% of dogs, respectively. Isolated basal interventricular septal hypertrophy was not observed. Commonly recorded were systolic anterior motion of the mitral valve (60%) and LV diastolic dysfunction (89% of dogs where diastolic function was evaluated). Six dogs died unexpectedly, and 3 developed congestive heart failure. Known survival times were between 1 day and 114 months after diagnosis. CONCLUSIONS AND CLINICAL IMPORTANCE Hypertrophic cardiomyopathy in dogs should be considered as a differential diagnosis if LV hypertrophy is identified. Small breed dogs are overrepresented, and it is uncommon for dogs with HCM to develop CHF although sudden death can occur.
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Affiliation(s)
- Karsten E. Schober
- Department of Veterinary Clinical SciencesThe Ohio State UniversityColumbusOhioUSA
| | - Phillip R. Fox
- Department of CardiologyThe Animal Medical CenterNew YorkNew YorkUSA
| | - Jonathan Abbott
- Department of Small Animal Clinical SciencesUniversity of TennesseeKnoxvilleTennesseeUSA
| | - Etienne Côté
- Ecole Nationale Vétérinaire d'Alfort, Unite de Cardiologie d'Alfort (UCA)Université Paris‐EstMaisons‐AlfortFrance
| | | | - Jose Novo Matos
- Clinical Sciences and ServicesRoyal Veterinary CollegeLondonUK
- Clinic for Small Animal Internal MedicineUniversity of ZürichZürichSwitzerland
| | - Joshua A. Stern
- Department of Medicine and EpidemiologyUniversity of CaliforniaDavisCaliforniaUSA
| | - Lance Visser
- Department of Medicine and EpidemiologyUniversity of CaliforniaDavisCaliforniaUSA
| | | | - Valerie Chetboul
- Atlantic Veterinary CollegeUniversity of Prince Edward IslandPrince Edward IslandCanada
| | - Donald Schrope
- Department of CardiologyOradell Animal HospitalParamusNew JerseyUSA
| | - Tony Glaus
- Clinic for Small Animal Internal MedicineUniversity of ZürichZürichSwitzerland
| | | | - Romain Pariaut
- Department of Clinical SciencesCornell College of Veterinary MedicineIthacaNew YorkUSA
| | - Rebecca Stepien
- Department of Medical SciencesUniversity of Wisconsin School of Veterinary MedicineMadisonWisconsinUSA
| | - Vanessa Arqued‐Soubeyran
- Ecole Nationale Vétérinaire d'Alfort, Unite de Cardiologie d'Alfort (UCA)Université Paris‐EstMaisons‐AlfortFrance
| | - Marco Baron Toaldo
- Clinic for Small Animal Internal MedicineUniversity of ZürichZürichSwitzerland
| | - Amara Estrada
- Department of Small Animal Clinical SciencesUniversity of FloridaGainesvilleFloridaUSA
| | | | - Emily T. Karlin
- Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - John Rush
- Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
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Hung L, Hopper BJ, Lenard Z. Retrospective analysis of radiographic signs in feline pleural effusions to predict disease aetiology. BMC Vet Res 2022; 18:118. [PMID: 35346189 PMCID: PMC8959281 DOI: 10.1186/s12917-022-03218-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/15/2022] [Indexed: 11/14/2022] Open
Abstract
Background The objectives of the study were to determine the prevalence of underlying conditions causing pleural effusion in cats and to calculate the positive predictive values, negative predictive values, sensitivity and specificity of radiographic signs to predict aetiology of the pleural fluid. Methods Data from 148 cats with pleural effusion and diagnosed with known aetiologies were retrospectively analysed. Sixty one cats had thoracic radiographs evaluated by consensus through pre-defined radiographic signs by two radiologists blinded to the diagnoses. Results Congestive heart failure (53.4%) was the most common diagnosis, followed by neoplasia (20.3%), pyothorax (10.8%), idiopathic chylous effusion (5.4%), feline infectious peritonitis (1.4%) and "other" or cats with multiple diagnoses (total 8.8%). Cats with an enlarged cardiac silhouette had a high positive predictive value of congestive heart failure (90%). Mediastinal masses (100%)and pulmonary masses (100%) were highly predictive of neoplastic disease. Pulmonary nodules (50%) were poorly predictive of neoplastic disease. The remainder of the radiographic variables were not informative predictors of underlying disease. Conclusions In our sample of cats, congestive heart failure was the most common cause of pleural effusion. Radiographically enlarged cardiac silhouette and presence of a mediastinal mass may be useful predictors of aetiology, however there are limitations to the use of radiography alone as a diagnostic tool. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-022-03218-3.
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Suzuki R, Saito T, Yuchi Y, Kanno H, Teshima T, Matsumoto H, Koyama H. Detection of Congestive Heart Failure and Myocardial Dysfunction in Cats With Cardiomyopathy by Using Two-Dimensional Speckle-Tracking Echocardiography. Front Vet Sci 2021; 8:771244. [PMID: 34869741 PMCID: PMC8634135 DOI: 10.3389/fvets.2021.771244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Congestive heart failure (CHF) is a life-threatening condition in cats with cardiomyopathy. We hypothesized that myocardial dysfunction may induce progression to CHF pathophysiology in cats with cardiomyopathy. However, no previous studies have evaluated the involvement of myocardial dysfunction in cats with CHF. In this study, we aimed to evaluate the relationship between CHF and myocardial function assessed using two-dimensional speckle-tracking echocardiography (2D-STE). Sixteen client-owned healthy cats and 32 cats with cardiomyopathy were enrolled in this study. Cats were classified into three groups: healthy cats, cardiomyopathy without CHF (CM group), and cardiomyopathy with CHF (CHF group). Left ventricular (LV) longitudinal and circumferential strains (SL and SC, respectively), and right ventricular (RV) SL were measured using 2D-STE. Logistic regression analysis was performed to assess the relationship between CHF and echocardiographic variables, including 2D-STE. Results comparing the healthy cats and CM vs. CHF groups showed that increased left atrial to aortic diameter ratio and decreased LV apical SC were significantly associated with the existence of CHF (odds ratio [95% confidence interval]: 1.40 [1.16-1.78] and 1.59 [1.06-2.36], respectively). Results comparing the CM vs. CHF group showed that increased end-diastolic RV internal dimension and decreased RV SL were significantly associated with the existence of CHF (odds ratio: 1.07 [1.00-1.13] and 1.34 [1.07-1.68], respectively). Left atrial enlargement and depressed LV apical myocardial function may be useful tools for predicting the progression to CHF in cats. Furthermore, RV enlargement and dysfunction may lead to the onset of CHF in asymptomatic cats with cardiomyopathy.
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Affiliation(s)
- Ryohei Suzuki
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Takahiro Saito
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Yunosuke Yuchi
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Haruka Kanno
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Takahiro Teshima
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Hirotaka Matsumoto
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Hidekazu Koyama
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Musashino, Japan
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Abstract
PRACTICAL RELEVANCE The feline cardiomyopathies are the most prevalent type of heart disease in adult domestic cats. Several forms have been identified (see Parts 2 and 3), with hypertrophic cardiomyopathy (HCM) being the most common. Clinically the cardiomyopathies are often indistinguishable. Cats with subclinical cardiomyopathy may or may not have characteristic physical examination findings (eg, heart murmur, gallop sound), or radiographic cardiomegaly. Cats with severe disease may develop signs of heart failure (eg, dyspnea, tachypnea) or systemic arterial thromboembolism (ATE; eg, pain and paralysis). Sudden death is possible. Treatment usually does not alter the progression from subclinical to clinical disease and often the treatment approach, once clinical signs are apparent, is the same regardless of the type of cardiomyopathy. However, differentiating cardiomyopathy from normal variation may be important prognostically. PATIENT GROUP Domestic cats of any age from 3 months upward, of either sex and of any breed, can be affected. Mixed-breed cats are most commonly affected but certain breeds are disproportionately prone to developing HCM. DIAGNOSTICS Subclinical feline cardiomyopathies may be suspected based on physical examination findings, thoracic radiographs and cardiac biomarker results but often the disease is clinically silent. The definitive clinical confirmatory test is echocardiography. Left heart failure (pulmonary edema and/or pleural effusion) is most commonly diagnosed radiographically, but point-of-care ultrasound and amino terminal pro-B-type natriuretic peptide (NT-proBNP) biomarker testing can also be useful, especially when the stress of taking radiographs is best avoided. KEY FINDINGS Knowledge of pathophysiological mechanisms helps the practitioner identify the feline cardiomyopathies and understand how these diseases progress and how they manifest clinically (heart failure, ATE). Existing diagnostic tests have strengths and limitations, and being aware of these can help a practitioner deliver optimal recommendations regarding referral. CONCLUSIONS Several types of feline cardiomyopathies exist in both subclinical (mild to severe disease) and clinical (severe disease) phases. Heart failure and ATE are the most common clinical manifestations of severe cardiomyopathy and are therapeutic targets regardless of the type of cardiomyopathy. The long-term prognosis is often guarded or poor once overt clinical manifestations are present. AREAS OF UNCERTAINTY Some cats with presumed cardiomyopathy do not have echocardiographic features that fit the classic cardiomyopathies (cardiomyopathy - nonspecific phenotype). Although no definitive treatment is usually available, understanding how cardiomyopathies evolve remains worthy of investigation.
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Affiliation(s)
- Mark D Kittleson
- School of Veterinary Medicine, Department of Medicine and Epidemiology, University of California, Davis, and Veterinary Information Network, 777 West Covell Boulevard, Davis, CA 95616, USA
| | - Etienne Côté
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
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Abstract
Practical relevance: Hypertrophic cardiomyopathy (HCM) is the most common form of feline
cardiomyopathy observed clinically and may affect up to approximately 15% of
the domestic cat population, primarily as a subclinical disease.
Fortunately, severe HCM, leading to heart failure or arterial
thromboembolism (ATE), only occurs in a small proportion of these cats. Patient group: Domestic cats of any age from 3 months upward, of either sex and of any
breed, can be affected. A higher prevalence in male and domestic shorthair
cats has been reported. Diagnostics: Subclinical feline HCM may or may not produce a heart murmur or gallop sound.
Substantial left atrial enlargement can often be identified radiographically
in cats with severe HCM. Biomarkers should not be relied on solely to
diagnose the disease. While severe feline HCM can usually be diagnosed via
echocardiography alone, feline HCM with mild to moderate left ventricular
(LV) wall thickening is a diagnosis of exclusion, which means there is no
definitive test for HCM in these cats and so other disorders that can cause
mild to moderate LV wall thickening (eg, hyperthyroidism, systemic
hypertension, acromegaly, dehydration) need to be ruled out. Key findings: While a genetic cause of HCM has been identified in two breeds and is
suspected in another, for most cats the cause is unknown. Systolic anterior
motion of the mitral valve (SAM) is the most common cause of dynamic left
ventricular outflow tract obstruction (DLVOTO) and, in turn, the most common
cause of a heart murmur with feline HCM. While severe DLVOTO is probably
clinically significant and so should be treated, lesser degrees probably are
not. Furthermore, since SAM can likely be induced in most cats with HCM, the
distinction between HCM without obstruction and HCM with obstruction (HOCM)
is of limited importance in cats. Diastolic dysfunction, and its
consequences of abnormally increased atrial pressure leading to signs of
heart failure, and sluggish atrial blood flow leading to ATE, is the primary
abnormality that causes clinical signs and death in affected cats. Treatment
(eg, loop diuretics) is aimed at controlling heart failure. Preventive
treatment (eg, antithrombotic drugs) is aimed at reducing the risk of
complications (eg, ATE). Conclusions: Most cats with HCM show no overt clinical signs and live a normal or
near-normal life despite this disease. However, a substantial minority of
cats develop overt clinical signs referable to heart failure or ATE that
require treatment. For most cats with clinical signs caused by HCM, the
long-term prognosis is poor to grave despite therapy. Areas of uncertainty: Genetic mutations (variants) that cause HCM have been identified in a few
breeds, but, despite valiant efforts, the cause of HCM in the vast majority
of cats remains unknown. No treatment currently exists that reverses or even
slows the cardiomyopathic process in HCM, again despite valiant efforts. The
search goes on.
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Affiliation(s)
- Mark D Kittleson
- School of Veterinary Medicine, Department of Medicine and Epidemiology, University of California, Davis, and Veterinary Information Network, 777 West Covell Boulevard, Davis, CA 95616, USA
| | - Etienne Côté
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
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13
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Kochie SL, Schober KE, Rhinehart J, Winter RL, Bonagura JD, Showers A, Yildez V. Effects of pimobendan on left atrial transport function in cats. J Vet Intern Med 2020; 35:10-21. [PMID: 33241877 PMCID: PMC7848333 DOI: 10.1111/jvim.15976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Arterial thromboembolism is a sequela of hypertrophic cardiomyopathy (HCM) in cats related to left atrial (LA) enlargement and dysfunction. HYPOTHESIS Pimobendan improves LA transport function in cats. ANIMALS Twenty-two client-owned cats with HCM and 11 healthy cats. METHODS Prospective, double-blind, randomized, placebo-controlled clinical cohort study. Cats were randomized to receive either pimobendan (0.25 mg/kg PO q12h) or placebo for 4 to 7 days. Nineteen echocardiographic variables of LA size and function were evaluated. Statistical comparisons included t tests, analysis of variance, and multivariable analyses. RESULTS Peak velocity of left auricular appendage flow (LAapp peak; mean ± SD, 0.85 ± 0.20 vs 0.71 ± 0.22 m/s; P = .01), maximum LA volume (P = .03), LA total emptying volume (P = .03), peak velocity of late diastolic transmitral flow (A peak velocity; 0.77 ± 0.12 vs 0.62 ± 0.17 m/s; P = .05), and A velocity time integral (A VTI; 3.05 ± 0.69 vs 3.37 ± 0.49; P = .05) were increased after pimobendan. Mean change after pimobendan was larger in cats with HCM compared to healthy cats for LA fractional shortening (2.1% vs -2.1%; P = .05), A VTI (0.58 vs 0.01 cm; P = .01), LAapp peak (0.20 vs 0.02 m/s; P = .02), LA kinetic energy (3.51 vs -0.10 kdynes-cm; P = .05), and LA ejection force (1.93 vs -0.07 kdynes; P = .01) in the multivariable model. The stronger effect of pimobendan in cats with HCM was independent of LA size. CONCLUSIONS AND CLINICAL IMPORTANCE We identified positive, albeit minor, effects of pimobendan on LA function in cats with HCM. Whether or not treatment with pimobendan decreases the risk of cardiogenic embolism deserves further study.
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Affiliation(s)
- Samantha L Kochie
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Karsten E Schober
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Jaylyn Rhinehart
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Randolph L Winter
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - John D Bonagura
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Annie Showers
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Vedat Yildez
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
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14
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Manson KC, Woods GA, Morrison LR, Gow D, Ferreira MF, Gunn-Moore DA, Llewellyn EA. Cutaneous Vasculopathy and Pulmonary Thromboembolism in an Unstable Diabetic Cat. Top Companion Anim Med 2020; 42:100490. [PMID: 33115690 DOI: 10.1016/j.tcam.2020.100490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 09/18/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022]
Abstract
A 6-year-old, male-neutered, domestic short-haired cat was referred for further management of a 3-month history of uncontrolled diabetes mellitus. The cat visited the hospital on 3 occasions during a 3-week time period. Hyperglycemia was documented at all visits. The cat initially presented with evidence of hypovolemia, cranial abdominal pain, and dehydration. Moderate hyperglycemia, mild ketonemia, and severe hypokalemia were documented. A 3 × 2 cm skin lesion with associated alopecia and erythema was first noticed at a routine follow-up examination (visit 2) 1 week later. A diagnosis of diabetic ketoacidosis was made 6 days later. The previously identified skin lesion now measured 6 × 2.5 cm. Two episodes of respiratory distress were identified at this visit, with no evidence of cardiac or pulmonary pathology. The cat developed a moderate anemia (packed cell volume 16 %, total solids 7.9 g/dL) on the fifth day of hospitalization. Fluid therapy, electrolyte supplementation, regular insulin, anti-emetic, and analgesia medications were administered during visits 1 and 3. Due to development of anemia, suspected pulmonary thromboembolism events and progression of skin lesions, euthanasia was elected. A diagnosis of cutaneous vasculopathy with secondary ischemic necrosis was made postmortem and pulmonary thromboembolism was confirmed. To the authors' knowledge, this is the first report of cutaneous vasculopathy and pulmonary thromboembolism in a cat with confirmed diabetes mellitus, warranting further research to assess if hypercoagulability is common in this patient population, as routine thromboprophylaxis and anticoagulation may be potentially indicated.
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Affiliation(s)
- Katrina C Manson
- Cummings Veterinary Medical Center at Tufts University, Henry & Lois Foster Hospital for Small Animals, 55 Willard Street, North Grafton, MA 01536, USA.
| | - Glynn A Woods
- The University of Edinburgh, Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Linda R Morrison
- Easter Bush Pathology, Veterinary Teaching Building, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Deborah Gow
- The University of Edinburgh, Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Marisa F Ferreira
- The University of Edinburgh, Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Danielle A Gunn-Moore
- The University of Edinburgh, Royal (Dick) School of Veterinary Studies & The Roslin Institute, Hospital for Small Animals, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Efa A Llewellyn
- The University of Edinburgh, Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, Easter Bush Campus, Midlothian, EH25 9RG, UK
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15
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Rauch J, Fehr M, Beyerbach M, Hungerbuehler SO. Comparative assessment of left atrial volume in healthy cats by two-dimensional and three-dimensional echocardiography. BMC Vet Res 2020; 16:263. [PMID: 32727447 PMCID: PMC7391821 DOI: 10.1186/s12917-020-02473-6] [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: 02/11/2019] [Accepted: 07/13/2020] [Indexed: 12/03/2022] Open
Abstract
Background The left atrium (LA) is an important prognostic parameter in cardiac pathologies of cats. Its size is currently measured in one-dimensional methods, while human medicine considers two- and three-dimensional echocardiography as standard. The objectives of this study were to compare monoplane, biplane, triplane and real-time three dimensional echocardiography for volumetric measurement of the left atrium in healthy cats and establish a reference interval for further studies on cats with heart disease. Additionally, the influence of age, sex and weight on left atrial volume (LAV) was tested. Results One dimensional monoplane Simpson method of discs (SMOD) in the right parasternal four chamber view (r4) and the left apical 2 chamber view (l2) as well as biplane SMOD had no significant difference for left atrial maximum volume (LAMax). They can be used as equivalent in future studies and one common reference range was set up (1.96 ± 0.54 ml). Those three methods produced significantly higher volumes than triplane echocardiography (RTTPE) and real time three dimensional echocardiography (RT3DE) using TomTec® software. LA volumetry with RTTPE and RT3DE-TomTec™ was more feasible than expected, but low RT3DE image quality was the main reason for excluding patients. Neither age nor weight had an influence on LA volume in healthy cats. Male LAV results were only slightly, but in 2D and RTTPE significantly higher than those of female cats with a range of + 10.46% to + 19.58%. Conclusions Monoplane, biplane, triplane and real-time three dimensional echocardiography were feasible for LA volumetry in healthy cats and showed acceptable intra- and interobserver variability. One common LAMax reference range for monoplane r4, l2 and biplane SMOD was set up. Raw data can be used for LA volumes and does not need to be correlated with the cat’s weight or age. Male cats have only slightly but significantly larger atria than females in 2D and RTTPE. Therefore, under reservation, also sex related limit values were defined.
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Affiliation(s)
- Janina Rauch
- Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, D-30559, Hannover, Germany.
| | - Michael Fehr
- Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, D-30559, Hannover, Germany
| | - Martin Beyerbach
- Department of Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover, Foundation, Bünteweg 2, D-30559, Hannover, Germany
| | - Stephan O Hungerbuehler
- Tiergesundheitszentrum Hungerbühler, Tierärztliche Klinik für Kleintiere Salzgitter, Gerichtsweg 3, 38229, Salzgitter, Germany
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