Atrial natriuretic peptide vs. N-terminal-pro-atrial natriuretic peptide for the detection of left atrial dilatation in horses

Evaluation of Different Blood Parameters From Endurance Horses Competing at 160 km

The purpose of this study was to assess a change in different blood parameters before and after a 160 km endurance race and to evaluate differences in cardiac biomarkers between horses that completed the race and horses that did not. The study population consisted of 52 healthy endurance horses. Horses participating in the study were assigned to three groups: horses that successfully completed the race ("finishers"), horses that failed to qualify at the veterinary check for primarily metabolic reasons ("metabolic") and horses that failed to qualify at the veterinary check for primarily gait related reasons ("gait related"). The latter two groups were combined to form a final group of "non-finishers" that were excluded for either "gait related" or "metabolic" disorders. Venous blood samples were taken before and after the endurance race. Serum and EDTA-plasma were analyzed for cardiac troponin I (cTNI), heart fatty acid binding protein (HFABP), alpha-hydroxybutyrate dehydrogenase (α-HBDH), atrial natriuretic peptide (ANP), lactate dehydrogenase (LDH), symmetric dimethylarginine (SDMA) and asymmetric dimethylarginine (ADMA). Lactate dehydrogenase (P = .001), SDMA (P= .001) and ADMA (P= .002) increased significantly after the endurance race in the finisher group. A significant increase in cTNI and α-HBDH concentration after the endurance race compared to the values before the endurance race was detected in the finisher (P= .001, P= .001) and gait related group (P= .002, P= .007). The longer the distance completed, the more these five blood parameters increased. No differences between the groups could be found and none of the measured blood parameters showed significant differences among groups before or after racing.

Atrial fibrillation in horses Part 2: Diagnosis, treatment and prognosis

Atrial fibrillation (AF) is suspected by an irregularly irregular rhythm during auscultation at rest and should be confirmed by electrocardiography. Heart rate monitoring is potentially interesting for AF detection by horse owners, based on the disproportionally high heart rate during exercise or increased heart rate variability. Echocardiography and laboratory analysis are useful to identify underlying cardiac disease. Horses with severe cardiac disease should not undergo cardioversion due to the risk of recurrence. Cardioversion is recommended especially in horses performing high intensity exercise or showing average maximal heart rates higher than 220 beats per min or abnormal ventricular complexes during exercise or stress. Pharmacological cardioversion can be performed using quinidine sulphate administered orally, with an overall mean reported success rate around 80%. Other therapeutic drugs have been described such as flecainide, amiodarone or novel atrial specific compounds. Transvenous electrical cardioversion (TVEC) is performed by delivering a shock between two cardioversion catheters positioned in the left pulmonary artery and right atrium, with a success rate of >95%. After cardioversion, most horses return to their previous level of performance. However, the recurrence rate after pharmacological or electrical cardioversion is up to 39%. Recurrence has been related to previous unsuccessful treatment attempts, valvular regurgitation and the presence of atrial premature depolarisations or low atrial contractile function after cardioversion. Large atrial size and long AF duration have also been suggested as risk factors. Different approaches for preventing recurrence have been described such as the administration of sotalol, however, large clinical studies have not been published.

Examination of Horses with Cardiac Disease

Despite advances, increased convenience, and availability of echocardiography and other diagnostic techniques in equine cardiology, a comprehensive history and clinical examination still forms the essential first step in any cardiac evaluation. This article summarizes the approach to the cardiac examination at rest, highlighting key areas for the clinician to assess, and stressing the importance of context for assessing the significance of any abnormalities detected. Ancillary techniques, such as blood pressure measurement and the laboratory assessment of cardiac disease in the horse, are also introduced.

Measurement of plasma endothelin-1 concentration in healthy horses and horses with cardiac disease during rest and after exercise

Cardiac biomarkers are important tools for monitoring disease progress and can monitor progression of therapy. Endothelin-1 (ET-1) has been studied for its use as a cardiac biomarker in human and small animal medicine while in horses with cardiac disease it has not been evaluated yet. The objective of the present study was to determine the concentration of plasma ET-1 in healthy horses and compare it with ET-1 concentration in horses with cardiac disease during rest and after exercise. Fifty four horses admitted to the Equine Clinic of Free University of Berlin were used in the present study, of which 15 horses were clinically healthy with no evidence of cardiac disease (Group 1), 22 horses suffered from cardiac disease with normal heart dimensions (Group 2) and 17 horses with cardiac disease and enlarged heart diameters (Group 3). Clinical examination, electrocardiography and echocardiography were performed. Endothelin-1 concentration was determined using ET-1 ELISA kit. The concentration of plasma ET-1 was significantly increased in horses with cardiac disease and normal cardiac dimensions (Group 2) and in horses with cardiac disease and enlargement of the left atrium (Group 3) compared to its concentration in clinically healthy horses (Group 1). In addition, the concentration of plasma ET-1 after exercise was significantly increased in diseased horses compared to its concentration at rest. Detection of ET-1 plasma concentration in horses at rest may be useful for detecting horses with changes in left atrial cardiac dimensions.

Cardiac/Cardiovascular Conditions Affecting Sport Horses

Cardiac murmurs are not uncommonly detected in the equine athlete. Although most are benign in nature, differentiation and quantification of murmurs due to valvular regurgitation are important for prognosis and recommendations. Arrhythmias can be associated with structural disease or occur independently and may range in severity from minimal clinical effect to poor performance to presenting a safety risk to rider and horse. This article discusses commonly encountered cardiac conditions in the sport horse. Physical examination, diagnostic approach, valvular disease, and arrhythmias with an impact on performance or ridden safety are discussed.

Total plasma proANP increases with atrial dilatation in horses

Equine atrial natriuretic peptide (ANP) plasma concentrations are correlated with left atrial size. However, species-specific assays are lacking and the results from human assays are poorly reproducible. A new methodology called processing independent analysis (PIA) that measures the total proANP product in plasma has proven to be successful in human medicine, but has never been used in horses. The aims were to establish an equine proANP reference interval by measurement of the total proANP product using PIA and to examine the proANP concentrations in horses with atrial dilatation. Sample stability was studied by comparison of storage at -80°C and -20°C. Plasma samples were obtained from 23 healthy horses, 12 horses with moderate or severe valvular regurgitation without atrial dilatation and 42 horses with valvular regurgitation and atrial dilatation. The proANP concentration was significantly (P<0.001) higher in horses with atrial dilatation (761.4 (442.1-1859.1) pmol/l) than in healthy horses (491.6 (429.5-765.9) pmol/l; P<0.001) or horses with cardiac disease but without atrial dilatation (544.4 (457.0-677.6) pmol/l). A cut-off value (573.8 pmol/l) for detection of atrial dilatation was calculated. Sample storage at -80°C did not differ from sample storage at -20°C. The measurement of total proANP in plasma detects atrial dilatation in horses and may be useful for clinical evaluation in equine medicine.