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Minvielle Moncla LH, Briend M, Sokhna Sylla M, Mathieu S, Rufiange A, Bossé Y, Mathieu P. Mendelian randomization reveals interactions of the blood proteome and immunome in mitral valve prolapse. COMMUNICATIONS MEDICINE 2024; 4:108. [PMID: 38844506 PMCID: PMC11156961 DOI: 10.1038/s43856-024-00530-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Mitral valve prolapse (MVP) is a common heart disorder characterized by an excessive production of proteoglycans and extracellular matrix in mitral valve leaflets. Large-scale genome-wide association study (GWAS) underlined that MVP is heritable. The molecular underpinnings of the disease remain largely unknown. METHODS We interrogated cross-modality data totaling more than 500,000 subjects including GWAS, 4809 molecules of the blood proteome, and genome-wide expression of mitral valves to identify candidate drivers of MVP. Data were investigated through Mendelian randomization, network analysis, ligand-receptor inference and digital cell quantification. RESULTS In this study, Mendelian randomization identify that 33 blood proteins, enriched in networks for immunity, are associated with the risk of MVP. MVP- associated blood proteins are enriched in ligands for which their cognate receptors are differentially expressed in mitral valve leaflets during MVP and enriched in cardiac endothelial cells and macrophages. MVP-associated blood proteins are involved in the renewal-polarization of macrophages and regulation of adaptive immune response. Cytokine activity profiling and digital cell quantification show in MVP a shift toward cytokine signature promoting M2 macrophage polarization. Assessment of druggability identify CSF1R, CX3CR1, CCR6, IL33, MMP8, ENPEP and angiotensin receptors as actionable targets in MVP. CONCLUSIONS Hence, integrative analysis identifies networks of candidate molecules and cells involved in immune control and remodeling of the extracellular matrix, which drive the risk of MVP.
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Affiliation(s)
| | - Mewen Briend
- Genomic Medicine Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Mame Sokhna Sylla
- Genomic Medicine Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Samuel Mathieu
- Genomic Medicine Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Anne Rufiange
- Genomic Medicine Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Yohan Bossé
- Department of Molecular Medicine, Laval University, Quebec City, QC, Canada
| | - Patrick Mathieu
- Genomic Medicine Laboratory, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada.
- Department of Surgery, Laval University, Quebec City, QC, Canada.
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Kim O, Kim K, Park S, Yang H, Kim H, Ro W, Lee C. Clinical relevance of serum ionized magnesium concentration in dogs with myxomatous mitral valve disease. J Vet Intern Med 2024; 38:41-50. [PMID: 38064361 PMCID: PMC10800217 DOI: 10.1111/jvim.16963] [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: 11/03/2022] [Accepted: 11/17/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Hypomagnesemia is associated with a poor prognosis in humans with congestive heart failure (CHF), but studies in veterinary medicine are limited. HYPOTHESIS Serum ionized magnesium concentration [iMg2+ ] would decrease as CHF progresses compared with the initial diagnostic levels and that lower [iMg2+ ] would be negatively associated with prognosis in dogs with CHF. ANIMALS A total of 181 client-owned dogs with myxomatous mitral valve disease (MMVD) were included. They were classified into the preclinical stage (NO-CHF, n = 108), stage C (n = 42), and stage D (n = 31) based on the American College of Veterinary Internal Medicine MMVD classification. METHODS This is a retrospective study from 2 referral centers. The [iMg2+ ] was compared among the NO-CHF, stage C, and stage D groups. Kaplan-Meier curves and the log-rank test were used to compare the incidence of death between groups. Multivariable Cox regression analysis was used to estimate the association of hypomagnesemia with the death. RESULTS In the stage D group, the [iMg2+ ] was lower than that in the NO-CHF (P < .0001) and stage C groups (P < .003). In the Kaplan-Meier survival analysis, the 1-year cumulative survival rate in hypomagnesemic dogs was 53% compared with 91.5% in normomagnesemic dogs (log-rank test, P < .0001). In the multivariable Cox analysis, lower concentration of [K+ ] and [iMg2+ ], along with higher Evel , were associated with negative prognoses. Specifically, hypomagnesemia was associated with an approximately 4-fold increased risk of death (hazard ratio = 4.015; 95% confidence interval, 1.537-10.488; P = .005). CONCLUSIONS AND CLINICAL IMPORTANCE Assessing the [iMg2+ ] might serve as a potential marker for estimating the severity and prognosis indirectly in dogs with MMVD. Combining [iMg2+ ] measurement with other diagnostic methods, such as echocardiography, could improve the prognostic evaluation of MMVD in dogs.
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Affiliation(s)
- Ock‐Kyu Kim
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
| | - Keon Kim
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
| | - Sinwook Park
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
| | - Hayoung Yang
- Noah Animal Medical CenterGwangjuRepublic of Korea
| | - Hyunwoo Kim
- Noah Animal Medical CenterGwangjuRepublic of Korea
| | - Woong‐Bin Ro
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
| | - Chang‐Min Lee
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
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N-terminal pro-B-type natriuretic peptide levels in normotensive and hypertensive dogs with myxomatous mitral valve disease stage B. Ir Vet J 2023; 76:3. [PMID: 36755290 PMCID: PMC9906826 DOI: 10.1186/s13620-023-00233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/29/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Systemic hypertension affects the heart, and to the best of our knowledge, no study has investigated the effects of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in dogs with myxomatous mitral valve disease (MMVD) stage B and systemic hypertension. This study aimed to investigate the blood level of NT-proBNP and assess the selected echocardiographic variables in dogs with MMVD stage B according to the presence of systemic hypertension or normal blood pressure and in dogs without MMVD. RESULTS The study group comprised 37 dogs with stage B MMVD (normotensive group, n = 30; systemic hypertension group, n = 7) and 13 dogs without MMVD. We evaluated NT-proBNP, blood pressure, complete blood count (CBC), and serum chemistry in all 50 dogs. We performed electrocardiography, radiography, and echocardiography on 44 dogs (37 dogs with MMVD and 7 dogs without MMVD). The NT-proBNP concentrations showed significant intergroup differences (p < 0.001). Normotensive dogs with MMVD stage B (median [interquartile range]: 1083.5 [574.8-1912.8] pmol/L) and hypertensive dogs with MMVD stage B (2345.0 [1812.5-2533.0] pmol/L) showed significantly higher NT-proBNP concentrations than dogs without MMVD (504 [430-774] pmol/L, p = 0.009 and p < 0.001, respectively), and dogs in the systemic hypertension group showed significantly higher NT-proBNP concentrations than those in the normotensive group (p = 0.046). Mitral valve regurgitation velocity was significantly higher in dogs in the systemic hypertension group (6.11 [6.07-6.24] m/s) than in those in the normotensive group (5.53 [5.17-5.95] m/s, p = 0.006). The left atrial to aortic root ratio (LA/Ao), E-peak velocity, and left ventricular end-diastolic internal diameter corrected for body weight (LVIDDN) were significantly lower in dogs without MMVD than in dogs with MMVD stage B. CONCLUSIONS These findings suggest that NT-proBNP concentrations are higher in dogs with MMVD stage B with systemic hypertension than in normotensive dogs with MMVD stage B. Therefore, clinicians should be aware that NT-proBNP could be elevated in the presence of systemic hypertension.
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Influence of Morphometry on Echocardiographic Measurements in Cavalier King Charles Spaniels: An Inverse Probability Weighting Analysis. Vet Sci 2021; 8:vetsci8100205. [PMID: 34679035 PMCID: PMC8538534 DOI: 10.3390/vetsci8100205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 01/18/2023] Open
Abstract
The development and progression of myxomatous mitral valve disease (MMVD) in Cavalier King Charles Spaniels (CKCS) are difficult to predict. Thus, the identification of dogs with a morphotype associated with more severe mitral disease at a young age is desirable. The aims of this study were to: (1) describe the physical, morphometric, and echocardiographic features of class B1 MMVD-affected Cavalier King Charles Spaniels (CKCS) according to the American College of Veterinary Internal Medicine (ACVIM) guidelines; (2) evaluate the influence of morphometric physical measurements on murmur intensity, mitral valve prolapse (MVP), regurgitant jet size, and indexed mitral valve and annulus measurements. Fifty-two MMVD-affected CKCS were included in the ACVIM class B1. This is a prospective clinical cross-sectional study. Morphometric measurements, which included the body, thorax, and head sizes of each dog, were investigated to establish the association with heart murmur intensity, valvular and annular echocardiographic measurements, MVP, and regurgitant jet size, using inverse probability weighting (IPW) analyses to adjust for confounding. The IPW analyses showed that when the head length and nose length decreased, dogs had a more severe regurgitant jet size. Furthermore, subjects with a more pronounced head stop angle had thicker anterior mitral valve leaflets. A brachycephalic morphotype, as seen in dogs similar to the King Charles Spaniel breed in terms of cephalic morphology, is associated with a more severe regurgitant jet size and with valvular characteristics that are related to the most severe forms of MMVD.
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Echocardiographic Evaluation of the Mitral Valve in Cavalier King Charles Spaniels. Animals (Basel) 2020; 10:ani10091454. [PMID: 32825079 PMCID: PMC7552748 DOI: 10.3390/ani10091454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 11/17/2022] Open
Abstract
This prospective cross-sectional study aimed to: (1) characterize echocardiographic features of mitral valve in MMVD affected Cavalier King Charles Spaniels (CKCS), focusing on dogs classified as American College of Veterinary Internal Medicine (ACVIM) class B1; (2) compare echocardiographic data in ACVIM B1 dogs divided on the basis of age at time of MMVD diagnosis, in order to understand if different aged subjects had different echocardiographic patterns. Length (AMVL), width (AMVW) and area (AMVA) of the anterior mitral valve leaflet, mitral valve prolapse, diameters of the mitral valve annulus in diastole (MVAd) and systole (MVAs) of 90 CKCS in different ACVIM classes, 64 of which in class B1, were measured. Valvular measurements were indexed to body weight using Wesselowski's scaling exponents. The presence of heart murmur did not discriminate between A and B1 classes (p = 0.128). Heart enlargement was more frequent in males (r2 = 0.07, p = 0.013). Within class B1, older subjects showed significantly higher values of AMVA, AMVW, MVAd, MVAs and lower sphericity index (SI). Since many CKCS with MMVD have no murmur and their mitral valve has peculiarities, a specifically designed echocardiographic screening should be realized. In addition, different aged B1 dogs have different echocardiographic patterns that may imply different genetic and prognostic profiles.
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Lee CM, Song DW, Ro WB, Kang MH, Park HM. Genome-wide association study of degenerative mitral valve disease in Maltese dogs. J Vet Sci 2019; 20:63-71. [PMID: 30541184 PMCID: PMC6351756 DOI: 10.4142/jvs.2019.20.1.63] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/13/2018] [Accepted: 11/30/2018] [Indexed: 12/20/2022] Open
Abstract
Genome-wide association study (GWAS) is a powerful tool for identifying the genetic causes of various diseases. This study was conducted to identify genomic variation in Maltese dog genomes associated with degenerative mitral valve disease (DMVD) development and to evaluate the association of each biological condition with DMVD in Maltese dogs. DNA was extracted from blood samples obtained from 48 Maltese dogs (32 with DMVD and 16 controls). Genome-wide single nucleotide polymorphism (SNP) genotyping was performed. The top 30 SNPs from each association of various conditions and genetic variations were mapped to their gene locations. A total of 173,662 loci were successfully genotyped, with an overall genotype completion rate of 99.41%. Quality control analysis excluded 46,610 of these SNPs. Manhattan plots were produced using allelic tests with various candidate clinical conditions. A significant peak of association was observed between mitral valve prolapse (MVP) and SNPs on chromosome 17. The present study revealed significant SNPs in several genes associated with cardiac function, including PDZ2, Armadillo repeat protein detected in velo-cardio-facial syndrome, catenin (cadherin-associated protein) alpha 3, low-density lipoprotein receptor class A domain containing protein 4, and sterile alpha motif domain containing protein 3. To our knowledge, this is the first study of a genetic predisposition to DMVD in Maltese dogs. Although only a limited number of cases were analyzed, these data could be the basis for further research on the genetic predisposition to MVP and DMVD in Maltese dogs.
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Affiliation(s)
- Chang-Min Lee
- Department of Veterinary Laboratory Medicine, College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea
| | - Doo-Won Song
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05030, Korea
| | - Woong-Bin Ro
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05030, Korea
| | - Min-Hee Kang
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05030, Korea
| | - Hee-Myung Park
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05030, Korea
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Meurs K, Adin D, O’Donnell K, Keene B, Atkins C, DeFrancesco T, Tou S. Myxomatous mitral valve disease in the miniature poodle: A retrospective study. Vet J 2019; 244:94-97. [DOI: 10.1016/j.tvjl.2018.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/07/2018] [Accepted: 12/14/2018] [Indexed: 11/26/2022]
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Müller S, Menciotti G, Borgarelli M. Anatomic regurgitant orifice area obtained using 3D-echocardiography as an indicator of severity of mitral regurgitation in dogs with myxomatous mitral valve disease. J Vet Cardiol 2017; 19:433-440. [PMID: 28964709 DOI: 10.1016/j.jvc.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine feasibility and repeatability of measuring the anatomic regurgitant orifice area (AROA) using real-time three-dimensional transthoracic echocardiography (RT3DE) in dogs with myxomatous mitral valve disease (MMVD), and to investigate differences in the AROA of dogs with different disease severity and in different American College of Veterinary Internal Medicine (ACVIM) stages. ANIMALS Sixty privately-owned dogs diagnosed with MMVD. METHODS The echocardiographic database of our institution was retrospectively searched for dogs diagnosed with MMVD and RT3DE data set acquisition. Dogs were classified into mild, moderate, or severe MMVD according to a Mitral Regurgitation Severity Score (MRSS), and into stage B1, B2 or C according to ACVIM staging. The RT3DE data sets were imported into dedicated software and a short axis plane crossing the regurgitant orifice was used to measure the AROA. Feasibility, inter- and intra-observer variability of measuring the AROA was calculated. Differences in the AROA between dogs in different MRSS and ACVIM stages were investigated. RESULTS The AROA was measurable in 60 data sets of 81 selected to be included in the study (74%). The inter- and intra-observer coefficients of variation were 26% and 21%, respectively. The AROA was significantly greater in dogs with a severe MRSS compared with dogs with mild MRSS (p=0.045). There was no difference between the AROA of dogs in different ACVIM clinical stages. CONCLUSIONS Obtaining the AROA using RT3DE is feasible and might provide additional information to stratify mitral regurgitation severity in dogs with MMVD. Diagnostic and prognostic utility of the AROA deserves further investigation.
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Affiliation(s)
- S Müller
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - G Menciotti
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA.
| | - M Borgarelli
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA
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Menciotti G, Borgarelli M. Review of Diagnostic and Therapeutic Approach to Canine Myxomatous Mitral Valve Disease. Vet Sci 2017; 4:vetsci4040047. [PMID: 29056705 PMCID: PMC5753627 DOI: 10.3390/vetsci4040047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/09/2017] [Accepted: 09/20/2017] [Indexed: 01/11/2023] Open
Abstract
The most common heart disease that affects dogs is myxomatous mitral valve disease. In this article, we review the current diagnostic and therapeutic approaches to this disease, and we also present some of the latest technological advancements in this field.
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Affiliation(s)
- Giulio Menciotti
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, 205 Duck Pond Dr., Blacksburg, VA 24061, USA.
| | - Michele Borgarelli
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, 205 Duck Pond Dr., Blacksburg, VA 24061, USA.
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Menciotti G, Borgarelli M, Aherne M, Wesselowski S, Häggström J, Ljungvall I, Lahmers S, Abbott J. Mitral valve morphology assessed by three-dimensional transthoracic echocardiography in healthy dogs and dogs with myxomatous mitral valve disease. J Vet Cardiol 2017; 19:113-123. [DOI: 10.1016/j.jvc.2017.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 12/12/2016] [Accepted: 01/02/2017] [Indexed: 01/15/2023]
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Espiritu D, Onohara D, Kalra K, Sarin EL, Padala M. Transcatheter Mitral Valve Repair Therapies: Evolution, Status and Challenges. Ann Biomed Eng 2016; 45:332-359. [DOI: 10.1007/s10439-016-1655-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/14/2016] [Indexed: 12/21/2022]
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Sargent J, Connolly DJ, Watts V, Mõtsküla P, Volk HA, Lamb CR, Luis Fuentes V. Assessment of mitral regurgitation in dogs: comparison of results of echocardiography with magnetic resonance imaging. J Small Anim Pract 2015; 56:641-50. [DOI: 10.1111/jsap.12410] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 07/29/2015] [Accepted: 09/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J. Sargent
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - D. J. Connolly
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - V. Watts
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - P. Mõtsküla
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - H. A. Volk
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - C. R. Lamb
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - V. Luis Fuentes
- The Royal Veterinary College; University of London; Herts AL9 7TA
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Sargent J, Muzzi R, Mukherjee R, Somarathne S, Schranz K, Stephenson H, Connolly D, Brodbelt D, Fuentes VL. Echocardiographic predictors of survival in dogs with myxomatous mitral valve disease. J Vet Cardiol 2015; 17:1-12. [PMID: 25586168 DOI: 10.1016/j.jvc.2014.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 10/29/2014] [Accepted: 11/04/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To evaluate vena contracta and other echocardiographic measures of myxomatous mitral valve disease (MMVD) severity in a multivariable analysis of survival in dogs. ANIMALS 70 dogs diagnosed with MMVD from stored echocardiographic images that met study inclusion criteria. METHODS Left heart dimensions were measured as well as mitral regurgitant jet area/left atrial area (JAR), early mitral filling velocity (Evel), extent of mitral valve prolapse in right and left views (ProlR, ProlL), Prol indexed to aortic diameter (ProlR:Ao, ProlL:Ao), presence of a flail leaflet (FlailR, FlailL), and mitral regurgitation vena contracta diameter (VCR, VCL) indexed to aortic diameter (VCR:Ao, VCL:Ao). Follow-up from referring veterinarians was obtained by questionnaire or telephone to determine survival times. Inter- and intra-observer agreement was evaluated with Bland-Altman plots and weighted Kappa analysis. Survival was analyzed using Kaplan-Meier curves, logrank tests and Cox's proportional hazards. RESULTS Logrank analysis showed VCL:Ao, VCR:Ao, FlailL, ProlR:Ao, ProlL:Ao, left ventricular internal dimension in diastole indexed to aortic diameter (LVIDD:Ao) >2.87, left atrium to aorta ratio (LA/Ao) >1.6, and Evel >1.4 m/s were predictors of cardiac mortality. In a multivariable analysis, the independent predictors of cardiac mortality were Evel >1.4 m/s [hazard ratio (HR) 5.0, 95% confidence interval (CI) 2.5-10.3], FlailL (HR 3.1, 95% CI 1.3-7.9), and ProlR:Ao (HR 2.8, 95% CI 1.3-6.3). CONCLUSIONS Echocardiographic measures of mitral regurgitation severity and mitral valve pathology provide valuable prognostic information independent of chamber enlargement in dogs with MMVD.
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Affiliation(s)
- Julia Sargent
- The Royal Veterinary College, Department of Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom.
| | - Ruthnea Muzzi
- Department of Veterinary Medicine, Federal University of Lavras, Minas Gerais, Brazil
| | - Rajat Mukherjee
- Wood Street Veterinary Hospital, 74 Wood Street, Barnet EN5 4BW, United Kingdom
| | - Sharlene Somarathne
- The Royal Veterinary College, Department of Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom
| | - Katherine Schranz
- The Royal Veterinary College, Department of Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom
| | - Hannah Stephenson
- The Royal Veterinary College, Department of Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom
| | - David Connolly
- The Royal Veterinary College, Department of Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom
| | - David Brodbelt
- The Royal Veterinary College, Department of Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom
| | - Virginia Luis Fuentes
- The Royal Veterinary College, Department of Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom
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Wesselowski S, Borgarelli M, Bello NM, Abbott J. Discrepancies in identification of left atrial enlargement using left atrial volume versus left atrial-to-aortic root ratio in dogs. J Vet Intern Med 2014; 28:1527-33. [PMID: 25056960 PMCID: PMC4895582 DOI: 10.1111/jvim.12410] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/31/2014] [Accepted: 06/11/2014] [Indexed: 12/25/2022] Open
Abstract
Background Left atrial size is prognostically important in dogs with myxomatous mitral valve disease (MMVD). Hypothesis/Objectives To compare the level of agreement in identification of left atrial enlargement (LAE) between the left atrial‐to‐aortic root ratio (LA : Ao) and left atrial volume using the biplane area‐length method indexed to body weight (LA Vol/BW). Animals Sixty dogs with MMVD and 22 normal dogs were prospectively studied with 2‐dimensional echocardiography. Methods The upper limit of normal for LA Vol/BW was defined as 1.1 mL/kg. LA : Ao was deemed normal if ≤1.5. To define overall disease severity, each dog was assigned a mitral regurgitation severity score (MRSS) based on echocardiographic parameters that did not include left atrial size. ACVIM staging also was utilized. Results Of 60 affected dogs, 20 were ACVIM Stage B1, 25 were Stage B2, and 15 were Stage C. LA Vol/BW identified LAE in 12 cases in which LA : Ao was normal; 7 of these were Stage B1 and 5 were Stage B2. This diagnostic disagreement was significant (P = .00012). Of the 12 cases in which diagnostic discrepancies were identified, 5/5 of the B2 dogs and 3/7 B1 dogs had a moderate MRSS, whereas 4/7 B1 dogs had a mild MRSS. No diagnostic discrepancies between LA : Ao and LA Vol/BW were apparent in dogs with a severe MRSS. Conclusions and Clinical Importance This study shows evidence of diagnostic disagreement between LA : Ao and LA Vol/BW for assessment of LAE. LA Vol/BW may be superior to LA : Ao for identification of mild LAE.
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Affiliation(s)
- S Wesselowski
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA
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Aoki T, Fujii Y, Sunahara H, Takano H, Wakao Y. Modified loop technique in three dogs with mitral regurgitation. J Vet Med Sci 2013; 75:107-11. [PMID: 22971666 DOI: 10.1292/jvms.11-0486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mitral valvuloplasty (MVP) is used in dogs with refractory mitral regurgitation (MR); however, it is difficult to tie the artificial chord, i.e., the expanded polytetrafluoroethylene suture, at the planned height of the mitral valve, because of the slippery nature of the knot. The loop technique has resolved these difficulties in humans. Premanufactured loops (length, 8.0-15.0 mm with 1.0-mm increments) were used in the new modified loop technique. In the current study, cardiac murmurs disappeared, and the MR markedly improved or completely disappeared approximately 3 months after surgery in 3 dogs. Therefore, this new technique might be effective in dogs.
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Affiliation(s)
- Takuma Aoki
- Department of Surgery, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa 252-5201, Japan.
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Chetboul V, Tissier R. Echocardiographic assessment of canine degenerative mitral valve disease. J Vet Cardiol 2012; 14:127-48. [PMID: 22366573 DOI: 10.1016/j.jvc.2011.11.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 10/30/2011] [Accepted: 11/01/2011] [Indexed: 10/28/2022]
Abstract
Degenerative mitral valve disease (MVD), the most common acquired heart disease in small-sized dogs, is characterized by valvular degeneration resulting in systolic mitral valve regurgitation (MR). Worsening of MR leads to several combined complications including cardiac remodeling, increased left ventricular filling pressure, pulmonary arterial hypertension, and myocardial dysfunction. Conventional two-dimensional, M-mode, and Doppler examination plays a critical role in the initial and longitudinal assessment of dogs affected by MVD, providing information on mitral valve anatomy, MR severity, left ventricular (LV) size and function, as well as cardiac and vascular pressures. Several standard echocardiographic variables have been shown to be related to clinical outcome. Some of these markers (e.g., left atrium to aorta ratio, regurgitation fraction, pulmonary arterial pressure) may also help in identifying asymptomatic MVD dogs at higher risk of early decompensation, which remains a major issue in practice. However, both afterload and preload are altered during the disease course. This represents a limitation of conventional techniques to accurately assess myocardial function, as most corresponding variables are load-dependent. Recent ultrasound techniques including tissue Doppler imaging, strain and strain rate imaging, and speckle tracking echocardiography, provide new parameters to assess regional and global myocardial performance (e.g., myocardial velocities and gradients, deformation and rate of deformation, and mechanical synchrony). As illustration, the authors present new data obtained from a population of 91 dogs (74 MVD dogs, 17 age-matched controls) using strain imaging, and showing a significant longitudinal systolic alteration at the latest MVD heart failure stage.
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Affiliation(s)
- 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 général de Gaulle, 94704 Maisons-Alfort cedex, France.
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Aupperle H, Disatian S. Pathology, protein expression and signaling in myxomatous mitral valve degeneration: comparison of dogs and humans. J Vet Cardiol 2012; 14:59-71. [PMID: 22364722 DOI: 10.1016/j.jvc.2012.01.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 12/25/2011] [Accepted: 01/02/2012] [Indexed: 01/19/2023]
Abstract
Myxomatous degenerative mitral valve disease (MMVD) is a common heart disease in dogs. Although several morphological similarities occur between human and canine MMVD differences exist. However, in advanced stages the accumulation of proteoglycans is the main finding in both species. The extracellular matrix (ECM) in normal canine and human mitral valves is similar. In MMVD of both species proteoglycans is the major alteration, although specific changes in collagen distribution exists. The valvular expression pattern of matrix metalloproteinases (MMPs) and of their inhibitors (TIMPs) differs, in part, between dogs and humans. The MMPs and TIMPs expression patterns are similar in normal canine and human mitral valves, but they are quite different during degenerative progression. Valve endothelial cells (VEC) and interstitial cells (VIC) are phenotypically transformed in canine and human MMVD. Inflammation is an unlikely cause of valve degeneration in humans and dogs. There are several lines of evidence suggesting that transforming growth factor β1 (TGF β1) and serotonin signaling may mediate valve degeneration in humans and dogs. Although human and canine MMVD share structural similarities, there are some differences in ECM changes, enzyme expression and cell transformation, which may reflect a varied pathogenesis of these diseases.
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Affiliation(s)
- Heike Aupperle
- Institute of Veterinary-Pathology, University Leipzig, Germany.
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