Idiopathic dilated cardiomyopathy in dogs: survival and prognostic indicators

The Effect of Fermentation of High- or Low-Tannin Fava Bean on Glucose Tolerance, Body Weight, Cardiovascular Function, and Blood Parameters in Dogs After 7 Days of Feeding: Comparison With Commercial Diets With Normal vs. High Protein

Fava bean, which is available in high- and low-tannin varieties, is not an approved pet food ingredient and was not included in the "assumed to be safe" category based on its ability to cause favism and hemolytic anemia in susceptible humans. The effects of 7-day feeding of test canine diets containing moderate protein (~27%) were compared with two control commercial diets with normal (NP, grain-containing, ~25% protein) or high protein (HP, grain-free, ~41% protein). Fava bean diets were formulated either with or without Candida utilis fermentation processing to reduce antinutritional factors. Glucose tolerance, body weight, cardiovascular function, and blood parameters were investigated in beagles fed the NP or HP diets or a randomized, crossover, 2 × 2 Latin square design of the fava bean diets: unfermented high-tannin (UF-HT), fermented high-tannin (FM-HT), unfermented low-tannin (UF-LT), and fermented low-tannin (FM-LT). After 7 days, HP decreased red blood cells (RBC) (P < 0.05) compared with NP, while FM increased RBC compared with UF. HP increased blood bicarbonate, calcium, phosphorus, urea, cholesterol, and albumin:globulin ratio while decreasing bilirubin, liver enzymes, and total protein. Sodium:potassium ratio was increased in UF-HT, decreased in FM-HT, and intermediate in LT regardless of fermentation. Blood phosphorus was increased in HT. Blood amylase was increased in FM-HT and decreased in FM-LT, being intermediate in UF regardless of fava bean variety. Blood direct bilirubin was decreased in HT regardless of fermentation. Of note, left ventricular end-systolic volume and cardiac output were increased in NP compared with HP-fed dogs, but were normal and had no significant differences among the fava bean diets. As expected, plasma taurine, cystine, and cysteine levels were increased in HP- compared with NP-fed dogs. Plasma cysteine levels were increased in HT- compared with LT-fed dogs and in FM- compared with UF-fed dogs. Taken together, these results show that fava bean appears to be safe as a dog food ingredient at least in the short term, and its nutritional value appears improved by fermentation. Moreover, blood chemistry parameters and cardiovascular function were impacted by protein content which merits further investigation with longer term feeding trials.

Low plasma taurine levels in English cocker spaniels diagnosed with dilated cardiomyopathy

OBJECTIVES

The aims of this study were to evaluate taurine levels in English cocker spaniels with dilated cardiomyopathy and assess their survival time and natural progression of their disease.

MATERIALS AND METHODS

Retrospective comparison of English cocker spaniels with dilated cardiomyopathy phenotype with and without taurine deficiency at the cardiology department of a UK academic referral centre between 2008 and 2018.

RESULTS

Taurine plasma concentration was available in 16 English cocker spaniels with dilated cardiomyopathy phenotype; 13 of 16 had congestive heart failure and three of 16 did not. Taurine concentration was low (<50 μmol/L) in 13 of 16 and normal in three of 16. Deficient dogs received taurine supplementation in addition to conventional cardiac medications. Eight dogs were still alive at the end of this study and eight were dead. MST for all dogs included in the study was 2800 days. Left ventricular systolic function improved and left ventricular dimensions reduced in English cocker spaniels with taurine deficiency following taurine supplementation and conventional cardiac therapy, although similar results were observed in English cocker spaniels with normal taurine concentration on cardiac therapy alone.

CLINICAL SIGNIFICANCE

Based on laboratory reference intervals, low taurine concentrations were common in English cocker spaniels with dilated cardiomyopathy, showing a possible association between dilated cardiomyopathy in English cocker spaniels and taurine deficiency; supplementation with taurine was not curative.

Development of plasma and whole blood taurine reference ranges and identification of dietary features associated with taurine deficiency and dilated cardiomyopathy in golden retrievers: A prospective, observational study

INTRODUCTION

A surge in Food and Drug Administration (FDA) consumer complaints identified concerns that legume-rich, grain-free diets were associated with nutritionally-mediated dilated cardiomyopathy (DCM). Golden retrievers represent the most reported breed affected by this condition and previous studies documented the disease is responsive to dietary change and taurine supplementation. Although dietary findings across cases are compelling, prospective studies with control groups are lacking. The role of diet in developing taurine deficiency and echocardiographic changes consistent with DCM in healthy dogs is unknown.

OBJECTIVES

We hypothesized that golden retrievers eating non-traditional diets are at a higher risk of having taurine deficiency and nutritionally-mediated DCM compared with those eating traditional commercial diets. We aimed to compare taurine concentrations and echocardiographic indices of systolic function between golden retrievers in each diet group and elucidate associations between diet and these variables. Additionally, we aimed to generate breed-specific reference intervals for whole blood and plasma taurine concentrations.

ANIMALS

86 golden retrievers.

METHODS

Golden retrievers eating traditional or non-traditional diets were evaluated and diet history, taurine concentrations and echocardiographic data were collected. Dietary features, taurine concentrations and echocardiographic findings were compared between diet groups. Relative risks were calculated for the likelihood of echocardiographic abnormalities and taurine deficiency in each diet group. Breed-specific reference intervals were constructed for taurine concentrations in dogs from the traditional diet group.

RESULTS

Golden retrievers eating non-traditional diets had significantly lower taurine concentrations and more frequent systolic dysfunction. Breed specific reference intervals are higher than previously reported across breeds.

CONCLUSIONS

Non-traditional diets, which were typically grain-free and contained legumes in this study, were significantly associated with and have increased relative risk for the identification of taurine deficiency and echocardiographic abnormalities consistent with nutritionally-mediated DCM. These findings were identifiable in the absence of clinical signs and support the findings of multiple previous studies and the ongoing FDA investigation.

Functional Consequences of PDK4 Deficiency in Doberman Pinscher Fibroblasts

A splice site mutation in the canine pyruvate dehydrogenase kinase 4 (PDK4) gene has been shown to be associated with the development of dilated cardiomyopathy (DCM) in Doberman Pinchers (DPs). Subsequent studies have successfully demonstrated the use of dermal fibroblasts isolated from DPs as models for PDK4 deficiency and have shown activation of the intrinsic (mitochondrial mediated) apoptosis pathway in these cells under starvation conditions. For this study, we sought to further explore the functional consequences of PDK4 deficiency in DP fibroblasts representing PDK4^wt/wt, PDK4^wt/del, and PDK4^del/del genotypes. Our results show that starvation conditions cause increased perinuclear localization of mitochondria and decreased cell proliferation, altered expression levels of pyruvate dehydrogenase phosphatase (PDP) and pyruvate dehydrogenase (PDH), dramatically increased PDH activity, and an impaired response to mitochondrial stress in affected cells. In sum, these results show the broad impact of PDK4 deficiency and reveal mechanistic pathways used by these cells in an attempt to compensate for the condition. Our data help to elucidate the mechanisms at play in this extremely prevalent DP disorder and provide further support demonstrating the general importance of metabolic flexibility in cell health.

Renin Activity in Heart Failure with Reduced Systolic Function-New Insights

Regardless of the cause, symptomatic heart failure (HF) with reduced ejection fraction (rEF) is characterized by pathological activation of the renin–angiotensin–aldosterone system (RAAS) with sodium retention and extracellular fluid expansion (edema). Here, we review the role of active renin, a crucial, upstream enzymatic regulator of the RAAS, as a prognostic and diagnostic plasma biomarker of heart failure with reduced ejection fraction (HFrEF) progression; we also discuss its potential as a pharmacological bio-target in HF therapy. Clinical and experimental studies indicate that plasma renin activity is elevated with symptomatic HFrEF with edema in patients, as well as in companion animals and experimental models of HF. Plasma renin activity levels are also reported to be elevated in patients and animals with rEF before the development of symptomatic HF. Modulation of renin activity in experimental HF significantly reduces edema formation and the progression of systolic dysfunction and improves survival. Thus, specific assessment and targeting of elevated renin activity may enhance diagnostic and therapeutic precision to improve outcomes in appropriate patients with HFrEF.

Special topic: The association between pulse ingredients and canine dilated cardiomyopathy: addressing the knowledge gaps before establishing causation

In July 2018, the Food and Drug Administration warned about a possible relationship between dilated cardiomyopathy (DCM) in dogs and the consumption of dog food formulated with potatoes and pulse ingredients. This issue may impede utilization of pulse ingredients in dog food or consideration of alternative proteins. Pulse ingredients have been used in the pet food industry for over 2 decades and represent a valuable source of protein to compliment animal-based ingredients. Moreover, individual ingredients used in commercial foods do not represent the final nutrient concentration of the complete diet. Thus, nutritionists formulating dog food must balance complementary ingredients to fulfill the animal's nutrient needs in the final diet. There are multiple factors that should be considered, including differences in nutrient digestibility and overall bioavailability, the fermentability and quantity of fiber, and interactions among food constituents that can increase the risk of DCM development. Taurine is a dispensable amino acid that has been linked to DCM in dogs. As such, adequate supply of taurine and/or precursors for taurine synthesis plays an important role in preventing DCM. However, requirements of amino acids in dogs are not well investigated and are presented in total dietary content basis which does not account for bioavailability or digestibility. Similarly, any nutrient (e.g., soluble and fermentable fiber) or physiological condition (e.g., size of the dog, sex, and age) that increases the requirement for taurine will also augment the possibility for DCM development. Dog food formulators should have a deep knowledge of processing methodologies and nutrient interactions beyond meeting the Association of American Feed Control Officials nutrient profiles and should not carelessly follow unsubstantiated market trends. Vegetable ingredients, including pulses, are nutritious and can be used in combination with complementary ingredients to meet the nutritional needs of the dog.

An update on canine cardiomyopathies - is it all in the genes?

Dilated cardiomyopathy is the second most common cardiac disease in dogs and causes considerable morbidity and mortality. Primary dilated cardiomyopathy is suspected to be familial, and genetic loci have been associated with the disease in a number of breeds. Because it is an adult-onset disease, usually with late onset, testing breeding dogs and bitches before breeding for a genetic mutation that could lead to dilated cardiomyopathy would be helpful to prevent disease. There is growing evidence that the genetic basis may be multigenic rather than monogenic in the majority of studied breeds. This review article describes the known genetic aspects of canine dilated cardiomyopathy and the implications of genetic tests on heart testing and the future of veterinary cardiology.

Histologic Characterization of Canine Dilated Cardiomyopathy

Dilated cardiomyopathy (DCM), characterized by chamber dilatation and myocardial systolic and diastolic dysfunction, is one of the most common heart diseases in dogs. The clinical diagnosis is based on findings on echocardiographic and Doppler examinations, with the active exclusion of other acquired or congenital heart diseases. However, the echocardiographic criteria for the diagnosis of DCM are not wholly specific for the disease, and histologic examination may be necessary for final diagnosis. Review of reports on histologic findings in dogs with clinically diagnosed DCM reveals two histologically distinct forms of DCM: 1) cardiomyopathy of Boxers and Doberman Pinschers, corresponding to the “fatty infiltration-degenerative” type and 2) the form seen in many giant, large-, and medium-sized breeds, including some Boxers and Doberman Pinschers, classified as the “attenuated wavy fiber” type of DCM. The histologic changes of the attenuated wavy fiber type of DCM may precede clinical and echocardiographic signs of heart disease, thus indicating an early stage of DCM.

Dilated cardiomyopathy in a De Brazza's monkey (Cercopithecus neglectus)

BACKGROUND

Cardiomyopathies have been reported in many primates. They may result from an inflammatory response to an infectious agent, nutritional deficiency, familial-genetic inheritance or toxic agents, but in many cases they are idiopathic.

METHODS

A De Brazza's monkey (Cercopithecus neglectus) presented with weight loss and inappetence. Physical examination, blood collection and diagnostic imaging and an electrocardiogram were performed.

RESULTS

Radiographs and echocardiogram revealed pleural effusion with partially collapsed lungs, cardiomegaly, and reduced myocardial contractility from myocardial failure.

CONCLUSIONS

Necropsy revealed pulmonary infarction, subsequent to heart failure from dilated cardiomyopathy.

Relationship between glomerular filtration rate and plasma N-terminal pro B-type natriuretic peptide concentrations in dogs with chronic kidney disease

Plasma N-terminal pro B-type natriuretic peptide (NT-proBNP) concentrations increase in dogs with azotemia. However, the correlation between glomerular filtration rate (GFR) and NT-proBNP concentrations in dogs has not been evaluated. The objective of this study was to evaluate the correlation between GFR and plasma NT-proBNP concentrations in dogs with chronic kidney disease (CKD). In this retrospective cross-sectional study, plasma creatinine (Cre) and NT-proBNP concentrations, plasma iohexol clearance (PCio) values and blood pressure were measured in dogs with CKD. Dogs were classified according to PCio values into D group (dogs with decreased PCio values), and N group (dogs with normal PCio values). Dogs were further categorized on the basis of their systolic blood pressure and PCio values into NT-D group (normotensive dogs with decreased PCio values), NT-N group (normotensive dogs with normal PCio values), HT-D group (hypertensive dogs with decreased PCio values) and HT-N group (hypertensive dogs with normal PCio values). Significant correlations were observed between plasma NT-proBNP and Cre concentrations (r=0.360, P<0.05) and PCio values (r=-0.470, P<0.01). Plasma NT-proBNP concentrations were significantly higher in the D group than in the N group (P<0.001). Plasma NT-proBNP concentrations were significantly higher in the HT-D group than in the other three groups (P ≤ 0.007). No differences in plasma NT-proBNP concentrations were observed between the NT-D and HT-N groups (P=0.28). Plasma NT-proBNP concentrations were significantly lower in the NT-N group than in the other three groups (P ≤ 0.043). Our findings suggest that decreased GFR might be associated with increased plasma NT-proBNP concentrations in dogs, similar to that in humans. In addition, the complication of hypertension in CKD might be associated with further increases in plasma NT-proBNP concentrations. In conclusion, the effects of GFR and blood pressure on the plasma NT-proBNP concentration were small, but it could be necessary to consider the effects when this marker is used to evaluate canine cardiac disease.

Canine dilated cardiomyopathy: a retrospective study of signalment, presentation and clinical findings in 369 cases

OBJECTIVE

To review the clinical and diagnostic findings and survival of dilated cardiomyopathy from a large population of dogs in England.

METHODS

A retrospective study of the case records of dogs with dilated cardiomyopathy collected between January 1993 and May 2006.

RESULTS

There were 369 dogs with dilated cardiomyopathy of which all were pure-bred dogs except for four. The most commonly affected breeds were dobermanns and boxers. Over 95 per cent of dogs weighed more than 15 kg and 73 per cent were male. The median duration of signs before referral was three weeks with 65 per cent presenting in stage 3 heart failure. The most common signs were breathlessness (67 per cent) and coughing (64 per cent). The majority of dogs (89 per cent) had an arrhythmia at presentation and 74 per cent of dogs had radiographic signs of pulmonary oedema or pleural effusion. The median survival time was 19 weeks.

CLINICAL SIGNIFICANCE

Dilated cardiomyopathy occurs primarily in medium to large breed pure-bred dogs, and males are more frequently affected than females. The duration of clinical signs before referral is often short and the survival times are poor. Greater awareness of affected breeds, clinical signs and diagnostic findings may help in early recognition of this disease which often has a short clinical phase.

Monitorização eletrocardiográfica ambulatorial por 24-horas em cães com cardiomiopatia dilatada idiopática

Caracterizou-se monitorização eletrocardiográfica ambulatorial por 24 horas (ou monitorização Holter) em cães com cardiomiopatia dilatada idiopática, visando principalmente à detecção de arritmias ventriculares não detectadas pela eletrocardiografia convencional (de repouso). Para tanto, avaliaram-se 40 pacientes com diagnóstico de cardiomiopatia dilatada idiopática, por meio de exame físico e mensuração indireta da pressão arterial, além de exames eletrocardiográfico, ecocardiográfico, radiográfico de tórax e da monitorização Holter. Extra-sístoles ventriculares foram detectadas, por monitorização Holter, em 97,5% dos animais e taquicardia ventricular, em 45%. Não houve correlação entre o número de extra-sístoles ventriculares e a fração de encurtamento. Considerando as manifestações clínicas, apenas houve associação entre presença de taquicardia ventricular e histórico de síncopes. Conclui-se que a incidência de arritmias ventriculares em cães com cardiomiopatia dilatada idiopática é bastante alta, sendo a taquicardia ventricular relativamente freqüente, ocorrendo mais sob a forma não sustentada.

Taurine-deficient dilated cardiomyopathy in a family of golden retrievers

A reversible taurine-deficient dilated cardiomyopathy occurred in five related golden retrievers. An apical systolic heart murmur was the most common physical abnormality. According to fractional shortening and end-systolic diameter on echocardiography, significant improvements (P<0.005) were recorded within 3 to 6 months of starting taurine supplementation. The dogs regained substantial systolic function, and four were weaned off all cardiac medications except taurine. This response to therapy was unusual, because canine dilated cardiomyopathy is generally progressive and fatal.

Taurine and carnitine in canine cardiomyopathy

Some newer more promising therapies for dogs with dilated cardiomyopathy (DCM) are taurine and carnitine. Deficiencies of these nutrients have been shown to cause DCM in dogs, and some breeds of dogs have shown dramatic improvement in myocardial function after supplementation with one or both nutrients. Although most dogs diagnosed with DCM do not have a documented taurine or carnitine deficiency, they may still be benefit from supplementation. These nutrients are safe to administer to dogs. For some owners, the high cost of carnitine is the only deterrent to giving their dogs supplements of both nutrients.

A possible predisposition to dilated cardiomyopathy in Huntaway dogs

AIM

To compare the prevalence of dilated cardiomyopathy (DCM) in New Zealand Huntaway dogs with the prevalence of DCM in other breeds of dog.

METHODS

The necropsy database at Massey University was used to identify cases of DCM diagnosed between January 1999 and March 2006. Dogs were considered to have DCM if echocardiographic, gross necropsy, or histological findings were consistent with this diagnosis. The prevalence in Huntaways was then compared with the prevalence observed in all breeds of dog, as well as the prevalence observed in large breeds of dog.

RESULTS

Twelve dogs were identified with DCM. One was diagnosed using echocardiography, while the other 11 were diagnosed by gross necropsy examination. The gross diagnosis of DCM was confirmed histologically in 6/11 dogs. The prevalence of DCM in Huntaways was significantly higher than the prevalence seen in all breeds of dog (p=0.008), and the prevalence in large breeds of dog (p=0.025). All four Huntaways diagnosed with DCM were male, and had an average age of 4 years. Three dogs presented with symptoms attributable to impaired heart function while one presented with symptoms of chronic renal failure. The duration of clinical symptoms prior to presentation ranged between 1 day and 3 weeks.

CONCLUSIONS

The results of this study suggest that Huntaways may be predisposed to the development of DCM. Although the increased prevalence in this breed was significant, only small numbers of affected Huntaways were identified, and additional cases are required to confirm these preliminary findings.

CLINICAL RELEVANCE

Huntaways are the most common working dog in New Zealand. The premature loss of a working dog is expected to have a significant economic impact on farmers. Further investigation of DCM in Huntaways may allow measures to reduce the prevalence in this breed.

Animal models of heart failure: what is new?

Heart failure is the major cause of mortality in Western countries. Medical treatment of heart failure is associated with 50% survival at 5 years. Experimental models are required to better understand the progression of the disease and elaborate new therapy. Heart transplantation, left ventricular assist devices, artificial hearts, and cardiac bioassist techniques require animal models for testing and optimizing before they are implemented on human patients. The perfect model of heart failure that reproduces every aspect of the natural disease does not exist. Acute and chronic heart failure models have been developed to reproduce different aspect of the pathology.

Survival in dogs with dilated cardiomyopathy and congestive heart failure treated with digoxin, furosemide and propranolol: A retrospective study of 62 dogs

OBJECTIVES

To retrospectively evaluate survival and potential adverse effects in dogs with congestive heart failure (CHF) attributable to dilated cardiomyopathy (DCM) treated with propranolol, furosemide and digoxin.

BACKGROUND

The use of beta-blocking agents has been shown to improve survival in human patients with CHF, including patients with DCM.

ANIMALS, MATERIALS AND METHODS

Sixty-two dogs with DCM and CHF NYHA class IV were included in the study. All dogs were initially treated with digoxin (mean dose 0.009mg/kg per day) and furosemide (mean dose 3.6mg/kg per day). Propranolol (mean dose 2.4mg/kg per day) was added after signs of CHF had been resolved, approximately one week after initial presentation. Survival analysis was based on the Kaplan-Meier method.

RESULTS

Pulmonary edema was found at initial presentation in 60 dogs, and pleural effusion in 2 dogs. Thirty-one dogs (50%) presented with atrial fibrillation, and ventricular premature complexes were found in 9 dogs. Survival time ranged from 8 to 1335 days (median, 126 days). Nine dogs were censored in the analysis, 8 because euthanasia was performed for reasons unrelated to cardiac disease, and 1 dog was lost on follow-up. Fifty-two dogs were euthanized, 9 dogs died suddenly. Survival rate at 1 year was 34%, and 20% at 2 years.

CONCLUSIONS

The present study shows that the median survival time in dogs treated with digoxin, furosemide and propranolol was 126 days, with a survival rate at 1 year of 34%. This treatment regiment was well tolerated.

Myocardial concentrations of fatty acids in dogs with dilated cardiomyopathy

OBJECTIVE

To compare myocardial concentrations of fatty acids in dogs with dilated cardiomyopathy (DCM) with concentrations in control dogs.

SAMPLE POPULATION

Myocardial tissues from 7 dogs with DCM and 16 control dogs.

PROCEDURE

Myocardial tissues were homogenized, and total fatty acids were extracted and converted to methyl esters. Myocardial concentrations of fatty acids were analyzed by use of gas chromatography and reported as corrected percentages.

RESULTS

The amount of docosatetraenoic acid (C22:4 n-6) was significantly higher in myocardial samples from dogs with DCM (range, 0.223% to 0.774%; median, 0.451%), compared with the amount in samples obtained from control dogs (range, 0.166% to 0.621%; median, 0.280%). There were no significant differences between DCM and control dogs for concentrations of any other myocardial fatty acids.

CONCLUSIONS AND CLINICAL RELEVANCE

Although concentrations of most myocardial fatty acids did not differ significantly between dogs with DCM and control dogs, the concentration of docosatetraenoic acid was significantly higher in dogs with DCM. Additional investigation in a larger population is warranted to determine whether this is a primary or secondary effect of the underlying disease and whether alterations in fatty acids may be a target for intervention in dogs with DCM.

Tissue Doppler assessment of diastolic and systolic alterations of radial and longitudinal left ventricular motions in Golden Retrievers during the preclinical phase of cardiomyopathy associated with muscular dystrophy

OBJECTIVE

To quantify radial and longitudinal left ventricular free wall (LVFW) velocities in dogs during the preclinical phase of Golden Retriever muscular dystrophy (GRMD)-associated cardiomyopathy by use of tissue Doppler imaging (TDI).

ANIMALS

9 dogs with GRMD and 6 healthy control dogs.

PROCEDURE

All dogs (< 3 years old) were examined via conventional echocardiography and 2-dimensional color TDI. Myocardial velocities in the LVFW were recorded from right parasternal ventricular short-axis (radial motion) and left apical 4-chamber (longitudinal motion) views. Cardiac assessments via TDI included maximal systolic and early and late diastolic LVFW velocities in the endocardial and epicardial layers (for radial motion) and in the basal and apical segments (for longitudinal motion) (for longitudinal motion),

RESULTS

-No notable ventricular dilatation or alteration of inotropism was detected in dogs with GRMD via conventional echocardiography. Compared with healthy dogs, endocardial velocities were significantly decreased in dogs with GRMD, resulting in marked decreases in radial myocardial velocity gradients during systole and early and late diastole. Similarly, basal and apical velocities were significantly decreased in systole and the former also in early diastole, resulting in significant decreases in the 2 corresponding longitudinal myocardial velocity gradients. The radial epicardial and longitudinal late diastolic velocities were comparable in the 2 groups.

CONCLUSION AND CLINICAL RELEVANCE

Results indicated that GRMD-associated cardiomyopathy in dogs is associated with early marked dysfunction of both radial and longitudinal LVFW motions. These combined regional myocardial abnormalities might be useful criteria for detection of dilated cardiomyopathy at the preclinical stage of the disease in dogs.

Beta-blockade in the management of systolic dysfunction

The concept that heart failure is simply the consequence of impaired pump function is now outmoded. Congestive heart failure is a neuroendocrine syndrome in with activation of the adrenergic nervous system and specific endocrine pathways is integral to its pathogenesis. It is now clear that chronic increases in adrenergic drive associated with heart failure have detrimental effects on myocardial function. The use of BAAs is now standard therapy for people who develop heart failure caused by systolic dysfunction. Beta-blockade may have a role in the management of dogs with heart failure.

Dilated cardiomyopathy: an update

Despite many advances in he diagnosis and treatment of DCM, it continues to be an important cause of cardiovascular morbidity and mortality in large-breed dogs. In the coming years, it is hoped and anticipated tht further discoveries will be made in the areas of etiology, therapy, and assessment of prognosis, ultimately with a view to having a greater impact on the clinical management of these cases.

Taurine deficiency in dogs with dilated cardiomyopathy: 12 cases (1997-2001)

OBJECTIVE

To determine signalment, history, clinical signs, blood and plasma taurine concentrations, electrocardiographic and echocardiographic findings, treatment, and outcome of dogs with low blood or plasma taurine concentrations and dilated cardiomyopathy (DCM).

DESIGN

Retrospective study.

ANIMALS

12 client-owned dogs with low blood or plasma taurine concentrations and DCM.

PROCEDURE

Medical records were reviewed, and clinical data were obtained.

RESULTS

All 12 dogs were being fed a commercial dry diet containing lamb meal, rice, or both as primary ingredients. Cardiac function and plasma taurine concentration improved with treatment and taurine supplementation. Seven of the 12 dogs that were still alive at the time of the study were receiving no cardiac medications except taurine.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that consumption of certain commercial diets may be associated with low blood or plasma taurine concentrations and DCM in dogs. Taurine supplementation may result in prolonged survival times in these dogs, which is not typical for dogs with DCM. Samples should be submitted for measurement of blood and plasma taurine concentrations in dogs with DCM, and taurine supplementation is recommended while results of these analyses are pending.

Effect of thyroid hormone supplementation on survival of euthyroid dogs with congestive heart failure due to systolic myocardial dysfunction: a double-blind, placebo-controlled trial

Nineteen euthyroid dogs of 12 breeds with echocardiographic signs of dilated cardiomyopathy (DCM) and radiographic and clinical signs of congestive heart failure (CHF) were evaluated in a randomised, double-blind, and placebo-controlled study. The dogs received either thyroxine or placebo as an adjunct to digoxin, furosemide and propranolol. The group assignment of individual dogs and serum concentrations of thyroid hormones remained unknown to owners and investigators during the entire study period. Dogs were evaluated clinically and with electrocardiography (ECG), thoracic radiography, echocardiography and measurement of total thyroxine (tT4) and thyroid stimulating hormone (TSH) before beginning of the trial, and then one week, 2 months, 6 months and yearly after initial examination, and, when applicable, at the time of euthanasia. End-point of the study was euthanasia (n = 17) due to severe congestive heart failure or sudden death (n = 2). Survival times ranged from 17 to 1030 days (median 187 days) in the placebo group, and from 18 to 1000 days (median 73 days) in the treatment group. There was no statistically significant difference in survival times between the treatment group and the placebo group (p = 0.46). Post mortem and histopathologic examinations revealed the attenuated wavy fiber type of DCM in 11 dogs, and myocardial infarcts, arteriosclerosis and chronic valvular disease in one dog. In conclusion, there was a wide range in survival times of dogs treated with digoxin, furosemide and propranolol. Adding thyroid hormones to the treatment did not significantly influence survival.

Hypothyroidism and myocardial failure in two Great Danes

Two Great Danes were evaluated for signs of congestive heart failure. Dilated cardiomyopathy was diagnosed in each dog. Both dogs were diagnosed concurrently with primary hypothyroidism. Following appropriate supplementation with levothyroxine, both dogs showed significant improvement in myocardial contractility, as demonstrated by increased fractional shortening and reductions in left atrial size, and left ventricular end-systolic and diastolic diameters. These observations suggest that hypothyroidism may lead to myocardial failure in Great Danes that is partially or fully reversible following thyroid hormone replacement therapy, and that hypothyroidism should be considered in all Great Danes presenting with systolic failure.

Canine pleural and mediastinal effusions: a retrospective study of 81 cases

Eighty-one cases of canine pleural and/or mediastinal effusions were identified from radiography and ultrasonography records reviewed between 1992 and 2000 at the Queen's Veterinary School Hospital, University of Cambridge. All cases had a follow-up period of at least 12 months. Twenty-eight underlying disease processes were associated with pleural and/or mediastinal effusions. The most common disease was pyothorax (13 cases). Other common diseases identified were idiopathic pericardial effusion, cranial mediastinal mass, idiopathic chylothorax, secondary lung metastases and dilated cardiomyopathy. Approximately one-quarter of all cases recovered completely after initial treatment and one-third of all cases either died during, or were euthanased immediately after, completion of the initial investigations.

Evaluation of a novel doppler index of combined systolic and diastolic myocardial performance in Newfoundland dogs with familial prevalence of dilated cardiomyopathy

A Doppler index of myocardial performance (IMP) has been recently proposed in human cardiology, which is calculated from the isovolumic contraction time (ICT), isovolumic relaxation time (IRT), and the ejection time (ET) using the following formula: (ICT+IRT)/ET. In this study, IMP was measured and evaluated in Newfoundland dogs categorized in four groups: Normal dogs (n = 31), dilated cardiomyopathy (DCM) (n = 34), depressed fractional shortening (dFS) (n = 27), and left ventricular enlargement (LVE) (n = 7). IMP was found to be independent of age, sex, body surface area, and the R-R interval in the Normal group. There were significant differences in IMP between the DCM group and the Normal and dFS groups (P < 0.05) and between Newfoundlands with overt vs. occult DCM. IMP is a Doppler index which appears to correlate with severity of disease and may be of use in the early diagnosis of affected dogs during screening for the presence of DCM.

Canine idiopathic dilated cardiomyopathy. Part I: Aetiology, clinical characteristics, epidemiology and pathology

Dilated cardiomyopathy (DCM), characterized by chamber dilatation and myocardial systolic and diastolic dysfunction, is one of the most common heart diseases in dogs. The aetiology of the myocardial hypokineis is seldom known in the individual case of DCM, although several theories concerning genetic, nutritional, metabolic, inflammatory, infectious, or drug- or toxin-induced myocardial disease have been discussed. DCM is often referred to as being breed-specific for Boxers, Doberman Pinschers, English Cocker Spaniels and other breeds. Review of reports on histopathologic findings in canine DCM reveals two histologically distinct forms of DCM; (1) cardiomyopathy of boxers and of Doberman pinschers, corresponding to the "fatty infiltration-degenerative" type, and (2) the form seen in many giant, large- and medium-sized breeds, including some boxers and Doberman pinschers, which can be classified as the "attenuated wavy fiber" type of DCM. The classification of canine idiopathic DCM according to histologic findigns seems superior to classification suggesting breed-specific syndromes, as some breeds (i.e. boxers and Doberman pinschers) may be affected by both diseases. However, ante mortem aetiological diagnosis of DCM is difficult. DCM carries a poor prognosis in dogs, and few prognostic indicators have been identified.

Clinical features of dilated cardiomyopathy in Great Danes and results of a pedigree analysis: 17 cases (1990-2000)

OBJECTIVE

To determine clinical features of dilated cardiomyopathy (DCM) in Great Danes and to determine whether DCM is familial in this breed.

DESIGN

Retrospective study.

ANIMALS

17 Great Danes with DCM.

PROCEDURE

Medical records of Great Danes in which DCM was diagnosed on the basis of results of echocardiography (fractional shortening < 25%, end-systolic volume index > 30 ml/m2 of body surface area) were reviewed. Pedigrees were obtained for affected animals, as well as for other Great Danes in which DCM had been diagnosed.

RESULTS

Dilated cardiomyopathy appeared to be familial and was characterized by ventricular dilatation, congestive heart failure (left-sided or biventricular), and atrial fibrillation. Pedigree analysis suggested that DCM was inherited as an X-linked recessive trait, but the mode of inheritance could not be definitively identified.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that DCM may be an X-linked recessive trait in Great Danes. Thus, dogs with DCM probably should not be used for breeding, and female offspring of affected dogs should be used cautiously. Male offspring of affected females are at an increased risk of developing DCM and should be evaluated periodically for early signs of disease. Results of pedigree analysis were preliminary and should be used only as a guide for counseling breeders, rather than as a basis for making breeding decisions.

Evaluation of the cardiac actin gene in Doberman Pinschers with dilated cardiomyopathy

OBJECTIVE

To evaluate the coding region of the cardiac actin gene in Doberman Pinschers with dilated cardiomyopathy (DCM) for mutations that could be responsible for the development of the condition

ANIMALS

28 dogs (16 Doberman Pinschers with DCM and 12 mixed-breed control dogs).

PROCEDURE

Ten milliliters of blood was collected from each dog for DNA extraction. Polymerase chain reaction (PCR) primers were designed to amplify canine exonic regions, using the sequences of exons 2 to 6 of the cardiac actin gene. Single-stranded conformational polymorphism analysis was performed for each exon with all samples. Autoradiographs were analyzed for banding patterns specific to affected dogs. The DNA sequencing was performed on a selected group of affected and control dogs.

RESULTS

Molecular analysis of exons 2 to 6 of the cardiac actin gene did not reveal any differences in base pairs between affected dogs and control dogs selected for DNA evaluation.

CONCLUSIONS

Mutations in exons 5 and 6 of the cardiac actin gene that have been reported in humans with familial DCM do not appear to be the cause of familial DCM in Doberman Pinschers. Additionally, evaluation of exons 2 to 6 for causative mutations did not reveal a cause for inherited DCM in these Doberman Pinschers. Although there is evidence that DCM in Doberman Pinschers is an inherited problem, a molecular basis for this condition remains unresolved. Evaluation of other genes coding for cytoskeletal proteins is warranted.

Polymerase chain reaction analysis for viruses in paraffin-embedded myocardium from dogs with dilated cardiomyopathy or myocarditis

OBJECTIVE

To perform polymerase chain reaction (PCR) analysis on paraffin-embedded myocardium from dogs with dilated cardiomyopathy (DCM) and dogs with myocarditis to screen for canine parvovirus, adenovirus types 1 and 2, and herpesvirus.

SAMPLE POPULATION

Myocardial specimens from 18 dogs with an antemortem diagnosis of DCM and 9 dogs with a histopathologic diagnosis of myocarditis were evaluated.

PROCEDURE

Paraffin-embedded myocardial specimens were screened for viral genome by PCR analysis. Positive-control specimens were developed from cell cultures as well as paraffin-embedded tissue specimens from dogs with clinical and histopathologic diagnoses of viral infection with canine parvovirus, adenovirus types 1 and 2, and herpesvirus. The histologic characteristics of all myocardial specimens were classified regarding extent, location, and type of inflammation and fibrosis.

RESULTS

Canine adenovirus type 1 was amplified from 1 specimen from a dog with DCM. Canine parvovirus, adenovirus type 2, and herpesvirus were not amplified from any myocardial specimens. Histologic analysis of specimens from dogs with DCM revealed variable amounts of fibrosis; myocardial inflammation was observed in 1 affected dog. Histopathologic analysis of specimens from dogs with myocarditis disclosed variable degrees of inflammation and fibrosis.

CONCLUSIONS AND CLINICAL RELEVANCE

Viral agents canine parvovirus, adenovirus types 1 and 2, and herpesvirus are not commonly associated with DCM or active myocarditis in dogs. Additional studies evaluating for nucleic acid from viruses that less commonly affect dogs or different types of infectious agents may be warranted to gain insight into the cause of DCM and myocarditis in dogs.

Nutritional alterations and the effect of fish oil supplementation in dogs with heart failure

Alterations in body composition and nutritional status are common in humans with heart failure and are related, in part, to increases in cytokine concentrations. Cytokines have not been studied previously in dogs with naturally occurring cardiac disease nor has fish oil administration been used in this population to decrease cytokine production. The purposes of this study were to characterize nutritional and cytokine alterations in dogs with heart failure and to test the ability of fish oil to reduce cytokines and improve clinical outcome. Body composition, insulinlike growth factor-1, fatty acids, and cytokines were measured in 28 dogs with heart failure and in 5 healthy controls. Dogs with heart failure then were randomized to receive either fish oil or placebo for 8 weeks. All parameters were measured again at the end of the study period. At baseline, 54% of dogs with heart failure were cachectic and the severity of cachexia correlated with circulating tumor necrosis factor-alpha concentrations (P = .05). Cytokine concentrations at baseline, however, were not significantly increased in dogs with heart failure compared to controls. Baseline plasma arachidonic acid (P = .02), eicosapentaenoic acid (P = .03), and docosahexaenoic acid (P = .004) concentrations were lower in dogs with heart failure than in controls. Fish oil supplementation decreased interleukin-1 beta (IL-1) concentrations (P = .02) and improved cachexia (P = .01) compared to the placebo group. The mean caloric intake of the heart failure dogs as a group was below the maintenance energy requirement (P < .001), but no difference was found in food intake between the fish oil and placebo groups. Insulinlike growth factor-1 concentrations (P = .01) and reductions in circulating IL-1 concentrations over the study period (P = .02) correlated with survival. These data demonstrate that canine heart failure is associated with cachexia, alterations in fatty acids, and reduced caloric intake. Fish oil supplementation decreased IL-1 concentrations and improved cachexia. In addition, reductions in IL-1 predicted survival, suggesting that anticytokine strategies may benefit patients with heart failure.

Skeletal muscle extra-aortic counterpulsation in dogs with dilated cardiomyopathy

Skeletal muscle extra-aortic counterpulsation was performed in seven dogs with dilated cardiomyopathy. A left latissimus dorsi dynamic descending thoracic aortomyoplasty was used as the autologous counterpulsator. Pulse train stimulation in diastole was used to initiate contraction and fibre type transformation. Two of the dogs died within 48 hours of surgery. The device was successfully activated in the five remaining dogs, but in one individual it failed within 48 hours of activation. Serial echocardiographic examinations of dogs in which the device functioned successfully (n = 4) showed trends towards the decrease in the left ventricular systolic internal dimension, left ventricular diastolic internal dimension, E-point to septal separation and left atrial diameter in systole seven to 14 days following the procedure, although these changes failed to persist in the long-term. The results suggest that skeletal muscle for cardiac assistances such as extra-aortic muscle counterpulsation, might be a therapeutic option for dogs with cardiac failure due to dilated cardiomyopathy.