Peak mean myocardial velocities and velocity gradients measured by color M-mode tissue Doppler imaging in healthy cats

Comparison of two multimodal intramuscular anaesthetic protocols in uncooperative feline patients: effects on sedation and echocardiographic measurements

OBJECTIVES

The aims of this study were to compare the sedative effect, feasibility of venous angiocatheter placement and influence on heart rate (HR), systemic blood pressure (SBP) and echocardiographic variables of two multimodal anaesthetic protocols in uncooperative cats; and to compare their influence on HR, SBP and echocardiographic variables 20 mins after sedation and after elective ovariectomy.

METHODS

Eighteen stray female cats randomly received intramuscular (IM) ketamine (2 mg/kg) and methadone (0.3 mg/kg) plus dexmedetomidine (7 µg/kg; group D, n = 9) or alfaxalone (2 mg/kg; group A, n = 9). A sedation score (0-15 [from none to good sedation]) was assigned at 5 mins, 10 mins, 15 mins and 20 mins after IM injection. Venous angiocatheter placement and echocardiographic examination feasibility scores (both from 0 to 3 [from very difficult to very easy]) were recorded at 20 mins. Echocardiography, HR and blood pressure measurements (Doppler and oscillometric methods) were performed at 20 mins and at the end of surgery.

RESULTS

Sedation and angiocatheter feasibility scores did not differ significantly between groups (P >0.05); the feasibility score of echocardiographic examination was higher in cats in group D (P = 0.01). HR was higher in group A at 20 mins and after surgery (P <0.05). The systolic arterial pressure obtained with the Doppler method was statistically significantly higher in cats in group D than in group A at 20 mins (P = 0.01), while postoperatively there were no differences between groups. Cats in group D showed significantly higher atrial diameters (P <0.05) and slower atrial flows (P = 0.04) compared with group A; ventricular thickness and atrial function did not differ between groups (P >0.05). Most echocardiographic variables were not different at 20 mins vs postoperatively.

CONCLUSIONS AND RELEVANCE

Both protocols allowed for effective sedation; however, cats in group D presented alterations in some echocardiographic measurements; the use of alfaxalone, combined with ketamine and methadone, is recommended to obtain a reliable echocardiographic evaluation in uncooperative cats.

Echocardiographic Assessment of Left Ventricular Function in Healthy Horses and in Horses with Heart Disease Using Pulsed-Wave Tissue Doppler Imaging

Background

Assessment of left ventricular (LV) function by tissue Doppler imaging (TDI) is not well established in horses with heart disease.

Objectives

To describe the use of pulsed‐wave (PW) TDI for the assessment of LV function, establish reference intervals, investigate effects of mitral regurgitation (MR), aortic regurgitation (AR), and primary myocardial disease (MD), and provide proof of concept for the use of PW TDI in Warmblood horses with heart disease.

Animals

Thirty healthy horses, 38 horses with MR, 25 with AR, 8 with MD.

Methods

Echocardiograms were retrospectively analyzed. Reference intervals were calculated. PW TDI indices of healthy horses and horses with MR, AR, and MD were compared by one‐way ANOVA and Dunnett's test.

Results

A complete set of PW TDI variables could be obtained in 94 of 101 horses. Variables corresponding to isovolumic intervals were most difficult to measure. Valvular regurgitation influenced variables describing isovolumic contraction and ejection. Horses with MD had significantly shortened ET_m (−118.5 [−154.1 to −82.9] ms; mean difference [95% CI of difference of means]), increased PEP_m/ET_m (0.11 [0.05 to 0.17]), prolonged IMP_m (0.28 [0.18 to 0.37]), increased S₁ (8.9 [5.2 to 12.6] cm/s), and decreased E₁ (−2.6 [−4.7 to −0.5] cm/s), E_m (−14.2 [−19.9 to −8.5] cm/s), and E_m/A_m ratio (−1.6 [−2.6 to −0.6]).

Conclusions and Clinical Importance

Pulsed‐wave TDI might be useful for detection of LV dysfunction in horses with primary MD. The clinical value of TDI in horses with MR and AR remains uncertain.

Effects of sedation on echocardiographic variables of left atrial and left ventricular function in healthy cats

Although sedation is frequently used to facilitate patient compliance in feline echocardiography, the effects of sedative drugs on echocardiographic variables have been poorly documented. This study investigated the effects of two sedation protocols on echocardiographic indices in healthy cats, with special emphasis on the assessment of left atrial size and function, as well as left ventricular diastolic performance. Seven cats underwent echocardiography (transthoracic two-dimensional, spectral Doppler, color flow Doppler and tissue Doppler imaging) before and after sedation with both acepromazine (0.1 mg/kg IM) and butorphanol (0.25 mg/kg IM), or acepromazine (0.1 mg/kg IM), butorphanol (0.25 mg/kg IM) and ketamine (1.5 mg/kg IV). Heart rate increased significantly following acepromazine/butorphanol/ketamine (mean±SD of increase, 40±26 beats/min) and non-invasive systolic blood pressure decreased significantly following acepromazine/butorphanol (mean±SD of decrease, 12±19 mmHg). The majority of echocardiographic variables were not significantly different after sedation compared with baseline values. Both sedation protocols resulted in mildly decreased left ventricular end-diastolic dimension and mildly increased left ventricular end-diastolic wall thickness. This study therefore failed to demonstrate clinically meaningful effects of these sedation protocols on echocardiographic measurements, suggesting that sedation with acepromazine, butorphanol and/or ketamine can be used to facilitate echocardiography in healthy cats.

Advanced techniques in echocardiography in small animals

Transthoracic echocardiography has become a major imaging tool for the diagnosis and management of canine and feline cardiovascular diseases. During the last decade, more recent advances in ultrasound technology with the introduction of newer imaging modalities, such as tissue Doppler imaging, strain and strain rate imaging, and 2-dimensional speckle tracking echocardiography, have provided new parameters to assess myocardial performance, including regional myocardial velocities and deformation, ventricular twist, and mechanical synchrony. An outline of these 4 recent ultrasound techniques, their impact on the understanding of right and left ventricular function in small animals, and their application in research and clinical settings are given in this article.

Prospective echocardiographic and tissue Doppler imaging screening of a population of Maine Coon cats tested for the A31P mutation in the myosin-binding protein C gene: a specific analysis of the heterozygous status

BACKGROUND

A mutation in the sarcomeric gene coding for the myosin-binding protein C gene has been identified in a colony of Maine Coon cats with hypertrophic cardiomyopathy (MyBPC3-A31P mutation). However, the close correlation between genotype and phenotype (left ventricular hypertrophy [LVH] and dysfunction) has never been assessed in a large population, particularly in heterozygous (Hetero) cats.

OBJECTIVES

To investigate LV morphology and function with echocardiography and tissue Doppler imaging (TDI) in a population of Maine Coon cats tested for the MyBPC3-A31P mutation with focus on Hetero animals.

ANIMALS

Ninety-six Maine Coon cats.

METHODS

Prospective observational study. Cats were screened for the MyBPC3-A31P mutation and examined with both echocardiography and 2-dimensional color TDI.

RESULTS

Fifty-two out of 96 cats did not have the mutation (wild-type genotype, Homo WT), 38/96 and 6/96 were Hetero- and homozygous-mutated (Homo M) cats, respectively. Only 11% of Hetero cats (4/38) had LVH and 29% (10/34) of Hetero cats without LVH were >4 years old (4.1-11.5 years). LVH was also detected in 2 Homo WT cats (4%). A significantly decreased (P < .05) longitudinal E/A (ratio between early and late diastolic myocardial velocities) in the basal segment of the interventricular septum was observed in Hetero cats without LVH (n = 34) compared with Homo WT cats without LVH (n = 50), thus confirming that the Hetero status is associated with regional diastolic dysfunction (P < .05).

CONCLUSIONS

The heterozygous status is not consistently associated with LVH and major myocardial dysfunction. Moreover, Homo WT cats can also develop LVH, suggesting that other genetic causes might be implicated.

Quantitative assessment of velocities of the annulus of the left atrioventricular valve and left ventricular free wall in healthy cats by use of two-dimensional color tissue Doppler imaging

OBJECTIVE

To analyze velocities of the annulus of the left atrioventricular valve and left ventricular free wall (LVFW) in a large population of healthy cats by use of 2-dimensional color tissue Doppler imaging (TDI).

ANIMALS

100 healthy cats (0.3 to 12.0 years old; weighing 1.0 to 8.0 kg) of 6 breeds.

PROCEDURE

Radial myocardial velocities were recorded in an endocardial and epicardial segment, and longitudinal velocities were recorded in 2 LVFW segments (basal and apical) and in the annulus of the left atrioventricular valve.

RESULTS

LVFW velocities were significantly higher in the endocardial than epicardial layers and significantly higher in the basal than apical segments. For systole, early diastole, and late diastole, mean +/- SD radial myocardial velocity gradient (MVG), which was defined as the difference between endocardial and epicardial velocities, was 2.2 +/- 0.7, 3.3 +/- 1.3, and 1.8 +/- 0.7 cm/s, respectively, and longitudinal MVG, which was defined as the difference between basal and apical velocities, was 2.7 +/- 0.8, 3.1 +/- 1.4, and 2.1 +/- 0.9 cm/s, respectively. A breed effect was documented for several TDI variables; therefore, reference intervals for the TDI variables were determined for the 2 predominant breeds represented (Maine Coon and domestic shorthair cats).

CONCLUSIONS AND CLINICAL RELEVANCE

LVFW velocities in healthy cats decrease from the endocardium to the epicardium and from the base to apex, thus defining radial and longitudinal MVG. These indices could complement conventional analysis of left ventricular function and contribute to the early accurate detection of cardiomyopathy in cats.

Development, advances and applications of diagnostic ultrasound in animals

Ultrasound has many industrial applications but it was first introduced as a medical diagnostic aid in the 1940s with its first veterinary application, the detection of ovine pregnancy, being reported in 1966. Since then, improvements in equipment quality combined with an increased awareness of the benefits of ultrasound as an imaging technique have led to its widespread use in the veterinary field. Recent advances in computer technology have significantly influenced equipment design and the miniaturization of transducers allows intra-operative and intra-vascular applications. Software advances have improved the ability to manipulate and process data, leading to an increased amount of information being obtained from each examination and the advent of 'remote diagnosis'. Ultrasound guided interventional techniques can now be used for diagnostic or therapeutic purposes. Many of these developments have been introduced by equipment manufacturers but have found specific applications in the veterinary field. Ultrasound is currently employed in a very diverse range of situations, not just as a diagnostic tool in the routine clinical workup of a range of species, but also for disease screening, conservation projects, commercial services, herd management and clinical research.

Advances in echocardiography

Echocardiography is an exceptionally useful technique for diagnosing cardiovascular disease in small animals. It is noninvasive and provides a wealth of data concerning cardiac morphology and function. For many patients, echocardiography is the definitive diagnostic tool. A well-performed study coalesces the findings of the physical examination, electrocardiogram, and radiographs into a clearly defined diagnosis on which treatment decisions can be based. More so than other diagnostic techniques, echocardiography is highly operator dependent and relies on the proper acquisition and interpretation of results by an examiner who is familiar with the principles, capabilities, and limitations of ultrasound imaging. This article reviews the basics of echocardiography, measurement of cardiac dimensions, and assessment of cardiac function. Within these sections, emerging technologies that expand the capabilities of the echocardiographic examination are introduced.