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Ferraro A, Hartnack S, Schwarzwald CC. Diagnostic value of two-dimensional echocardiographic measurements of the pulmonary artery diameter and the pulmonary artery distensibility index to detect pulmonary hypertension in horses. J Vet Cardiol 2023; 49:52-66. [PMID: 37832424 DOI: 10.1016/j.jvc.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION/OBJECTIVES Echocardiographic diagnosis of pulmonary hypertension (PH) in horses is usually based on Doppler interrogation of tricuspid (TR) or pulmonic regurgitation (PR). This study aimed at investigating two-dimensional echocardiographic (2DE) variables, including pulmonary artery diameter (PAD) and pulmonary artery distensibility index (PADI), to diagnose PH. ANIMALS, MATERIALS AND METHODS 41 healthy horses; 82 horses with TR or PR and normal intracardiac pressure gradients; and 35 horses with TR or PR velocities indicating PH. The 2DE variables were compared between groups, cut-offs for the diagnosis of PH were determined, and conditional inference trees served to identify the variable best predicting PH in the absence of TR or PR. RESULTS Horses with PH had larger end-diastolic cross-sectional (short-axis) PAD (PADed-sx) (5.8 ± 1.0 cm; mean ± SD) and smaller PADI[/PADps] (15.4 ± 7.7%) than healthy horses (5.0 ± 0.6 cm, P<0.0001; 20.5 ± 4.4%, P<0.001) and horses with TR or PR but no PH (5.3 ± 0.6 cm, P=0.003; 18.8 ± 4.2%, P=0.005). PADed-sx predicted PH with sensitivity (Se) = 36% and specificity (Sp) = 94% (cut-off 6.0 cm, AUC = 0.668, P=0.002), while PADI[/PADps] predicted PH with Se = 43% and Sp = 92% (cut-off 13.7%, AUC = 0.662, P=0.004). In the absence of TR, PADed-sx and the end-diastolic long-axis aortic diameter-to-PADed-sx ratio (AoDed-lx/PADed-sx) were most suitable to diagnose PH. CONCLUSION Pulmonary artery crosssectional (short-axis) diameter at end-diastole measured in a right-parasternal long axis view of the left ventricular outflow tract and Pulmonary artery distensibility index were moderately specific but not very sensitive to diagnosing PH. Nonetheless, they may be used as complementary indices suggesting PH in the absence of TR or PR.
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Affiliation(s)
- A Ferraro
- Equine Department, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - S Hartnack
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - C C Schwarzwald
- Equine Department, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland.
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Reference Values and Repeatability of Pulsed Wave Doppler Echocardiography Parameters in Normal Donkeys. Animals (Basel) 2022; 12:ani12172296. [PMID: 36078016 PMCID: PMC9454746 DOI: 10.3390/ani12172296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Cardiovascular disease is underreported in donkeys, possibly related to their limited athletic posture and frequent poor performance-related examinations. Reports on treatments for cardiovascular disease are anecdotal in donkey. Normal echocardiographic parameters have been reported in healthy donkeys. The aim of the present study was to establish the reference values and repeatability for Pulsed Wave Doppler echocardiographic variables of the mitral valve, aortic valve and myocardial performance. Two-dimensional Color flow mapping and spectral Doppler modes were performed. For the mitral valve, the mean velocity, pressure gradient and duration of E-wave were 57.7 ± 12.5 cm/s, 1.4 ± 0.7 mmHg and 0.4 ± 0.13 s, respectively. The results of the present study provide the reference values of PW echocardiographic parameters measurements in normal adult donkeys. Such reference values are helpful, especially when confronted with clinical cases with cardiovascular disorders. Abstract In the present study, thirty clinically healthy donkeys were used to establish the reference values and repeatability for Pulsed Wave Doppler echocardiographic variables of the mitral valve, aortic valve and myocardial performance. 2-dimensional Color flow mapping and spectral Doppler modes were performed. For the mitral valve, the mean velocity, pressure gradient and duration of E-wave were 57.7 ± 12.5 cm/s, 1.4 ± 0.7 mmHg and 0.4 ± 0.13 s, respectively. The velocity, pressure gradient and duration of the A-wave were 32.3 ± 9.1 cm/s, 0.3 ± 0.04 mmHg and 0.3 ± 0.1 s, respectively. The mitral valve area, pressure half time, pulsatility index (PI), resistance index (RI) and velocity time integral (VTI) were 1.8 ± 0.5 cm2, 66 ± 17 ms, 2.8 ± 1.4, 0.9 ± 0.03 and 19.1 ± 5.7 cm, respectively. For the aortic valve, the mean velocity was 64.9 ± 10.4 cm/s, pressure gradient was 1.8 ± 0.4 mmHg, pulsatility index was 1.4 ± 0.3, resistance index was 0.9 ± 0.02, VTI was 25.02 ± 6.2 cm, systolic/diastolic was 19 ± 4.7 and heart rate was 95.7 ± 28.9 per minute. For Myocardial Performance Index (LV)–Tei Index, the mean ejection, isovolumic relaxation, isovolumic contraction time and myocardial performance index were 0.24 ± 0.01, 0.14 ± 0.01, 0.14 ± 0.02 and 1.2 ± 0.1 s, respectively. The results of the present study provide the reference values of PW echocardiographic parameter measurements in normal adult donkeys. Such reference values are helpful, especially when confronted with clinical cases with cardiovascular disorders.
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Premont A, Balthes S, Marr CM, Jeevaratnam K. Fundamentals of arrhythmogenic mechanisms and treatment strategies for equine atrial fibrillation. Equine Vet J 2021; 54:262-282. [PMID: 34564902 DOI: 10.1111/evj.13518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022]
Abstract
Atrial fibrillation (AF) is the most common pathological arrhythmia in horses. Although it is not usually a life-threatening condition on its own, it can cause poor performance and make the horse unsafe to ride. It is a complex multifactorial disease influenced by both genetic and environmental factors including exercise training, comorbidities or ageing. The interactions between all these factors in horses are still not completely understood and the pathophysiology of AF remains poorly defined. Exciting progress has been recently made in equine cardiac electrophysiology in terms of diagnosis and documentation methods such as cardiac mapping, implantable electrocardiogram (ECG) recording devices or computer-based ECG analysis that will hopefully improve our understanding of this disease. The available pharmaceutical and electrophysiological treatments have good efficacy and lead to a good prognosis for AF, but recurrence is a frequent issue that veterinarians have to face. This review aims to summarise our current understanding of equine cardiac electrophysiology and pathophysiology of equine AF while providing an overview of the mechanism of action for currently available treatments for equine AF.
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Affiliation(s)
- Antoine Premont
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Samantha Balthes
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Celia M Marr
- Rossdales Equine Hospital and Diagnostic Centre, Newmarket, UK
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De Silva M, Tagliavia C, Galiazzo G, Gifuni G, Caiazza M, Chiocchetti R, Grandis A. Morphological variability of the atrioventricular valve cusps in the equine heart. Equine Vet J 2021; 54:167-175. [PMID: 33555625 DOI: 10.1111/evj.13434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/28/2021] [Accepted: 02/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The morphometric studies of the atrioventricular valves are still limited in the horse. OBJECTIVES To investigate the anatomy of the atrioventricular valves in the horse, focusing on the morphometric features of the valvular leaflets and the tendinous cords. We hypothesised that accessory leaflets occur commonly and exist as independent structures in the atrioventricular valves of the horse. STUDY DESIGN Descriptive anatomical study. METHODS Twenty normal hearts from slaughtered half-bred horses were used. The cardiac weight and circumference were recorded. The atrioventricular valves were exposed by excision of the atria, and the tricuspid and mitral annular diameters and circumferences were measured; the number of leaflets and tendinous cords for each atrioventricular ostium were then counted. The atrioventricular valves were isolated and the width, height and thickness of each leaflet were measured. RESULTS In addition to the principal leaflets, accessory leaflets were identified in 39 of 40 cardiac valves, 2 to 6 accessory leaflets for the mitral valve and 1 to 4 for the tricuspid valve. All the accessory leaflets were separated from the adjacent leaflets at their insertion. They were narrower and thinner than the principal leaflets, and were attached to a single papillary muscle; 95% of the accessory leaflets had two tendinous cords shared with the adjacent leaflets while a minority (34%) had their own specific tendinous cord. MAIN LIMITATIONS Lack of signalment data from the study population. CONCLUSIONS Supernumerary leaflets occurred commonly in the atrioventricular valves of the horse and appeared as independent structures. The clinical relevance of increased numbers of commissures that result from accessory leaflets and their relationship with valvular regurgitation are currently unknown.
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Affiliation(s)
- Margherita De Silva
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Claudio Tagliavia
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Giorgia Galiazzo
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | | | | | - Roberto Chiocchetti
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Annamaria Grandis
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
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Berthoud D, Schwarzwald CC. Echocardiographic assessment of left ventricular size and systolic function in Warmblood horses using linear measurements, area-based indices, and volume estimates: A retrospective database analysis. J Vet Intern Med 2020; 35:504-520. [PMID: 33247461 PMCID: PMC7848374 DOI: 10.1111/jvim.15968] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/20/2020] [Accepted: 11/09/2020] [Indexed: 12/25/2022] Open
Abstract
Background Echocardiographic assessment of left ventricular (LV) size and function using area‐based indices and volumetric estimates is not well established in horses. Objective To report reference intervals and measurement variability for uni‐, 2‐, and 3‐dimensional echocardiographic indices of LV size and systolic function in Warmblood horses and to provide proof of concept for allometric scaling of variables to body weight. Unidimensional indices were to be compared to area‐based indices and LV volume estimates to establish their clinical use. Animals Thirty healthy Warmblood horses and 70 Warmblood horses with a primary diagnosis of mitral regurgitation or aortic regurgitation. Methods Echocardiographic indices of LV size and systolic function were measured using an existing echocardiography database. Weight‐related variables were scaled to body weight (BWT). Reference intervals and measurement variability were calculated, the influence of valvular regurgitation on LV size and function was investigated and agreement between different variables for detection of reduced, normal, and increased LV size and systolic function was assessed. Results Reference values for healthy Warmblood horses were reported. Measurement variability was sufficiently low for clinical use of all variables. Allometric scaling was effective to correct diastolic LV dimensions and cardiac output for differences in BWT. Various echocardiographic indices resulted in different conclusions regarding identification of LV enlargement and systolic dysfunction in healthy horses and horses with valvular regurgitation. Conclusions and Clinical Importance Echocardiographic assessment of LV size and systolic function should include joint assessment of multiple uni‐ and multidimensional indices. Area‐based or volumetric indices that reflect LV long‐axis motion should be included.
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Affiliation(s)
- Djamila Berthoud
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Colin C Schwarzwald
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Saadi A, Dalir-Naghadeh B, Hashemi-Asl SM, Tehrani AA, Hobbenaghi R, Mahmoudi SS, Shalizar-Jalali A. Right to left patent ductus arteriosus, acute bronchointerstitial pneumonia, pulmonary hypertension and cor pulmonale in a foal. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- A. Saadi
- Department of Clinical Pathology and Internal Medicine; Urmia University; Urmia Iran
| | - B. Dalir-Naghadeh
- Department of Clinical Pathology and Internal Medicine; Urmia University; Urmia Iran
| | - S. M. Hashemi-Asl
- Department of Surgery and Diagnostic Imaging; Urmia University; Urmia Iran
| | - A. A. Tehrani
- Department of Pathobiology; Urmia University; Urmia Iran
| | - R. Hobbenaghi
- Department of Pathobiology; Urmia University; Urmia Iran
| | - S. S. Mahmoudi
- Department of Pathobiology; Urmia University; Urmia Iran
| | - A. Shalizar-Jalali
- Department of Basic Sciences; Faculty of Veterinary Medicine; Urmia University; Urmia Iran
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Decloedt A, Van Steenkiste G, Vera L, Buhl R, van Loon G. Atrial fibrillation in horses part 1: Pathophysiology. Vet J 2020; 263:105521. [PMID: 32928494 DOI: 10.1016/j.tvjl.2020.105521] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/05/2020] [Accepted: 07/21/2020] [Indexed: 01/30/2023]
Abstract
Atrial fibrillation (AF) is the most common clinically relevant arrhythmia in horses, with a reported prevalence up to 2.5%. The pathophysiology has mainly been investigated in experimental animal models and human medicine, with limited studies in horses. Atrial fibrillation results from the interplay between electrical triggers and a susceptible substrate. Triggers consist of atrial premature depolarizations due to altered automaticity or triggered activity, or local (micro)reentry. The arrhythmia is promoted by atrial myocardial ion channel alterations, Ca2+ handling alterations, structural abnormalities, and autonomic nervous system imbalance. Predisposing factors include structural heart disease such as valvular regurgitation resulting in chronic atrial stretch, although many horses show so-called 'lone AF' or idiopathic AF in which no underlying cardiac abnormalities can be detected using routine diagnostic techniques. These horses may have underlying ion channel dysfunction or undiagnosed myocardial (micro)structural alterations. Atrial fibrillation itself results in electrical, contractile and structural remodelling, fostering AF maintenance. Electrical remodelling leads to shortening of the atrial effective refractory period, promoting reentry. Contractile remodelling consists of decreased myocardial contractility, while structural remodelling includes the development of interstitial fibrosis and atrial enlargement. Reverse remodelling occurs after cardioversion to sinus rhythm, but full recovery may take weeks to months depending on duration of AF. The clinical signs of AF depend on the aerobic demands during exercise, ventricular rhythm response and presence of underlying cardiac disease. In horses with so-called 'lone AF', clinical signs are usually absent at rest but during exercise poor performance, exercise-induced pulmonary hemorrhage, respiratory distress, weakness or rarely collapse may develop.
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Affiliation(s)
- Annelies Decloedt
- Equine Cardioteam Gent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Belgium.
| | - Glenn Van Steenkiste
- Equine Cardioteam Gent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Lisse Vera
- Equine Cardioteam Gent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Rikke Buhl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Gunther van Loon
- Equine Cardioteam Gent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Belgium
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Vernemmen I, De Clercq D, Decloedt A, Vera L, Van Steenkiste G, van Loon G. Atrial premature depolarisations five days post electrical cardioversion are related to atrial fibrillation recurrence risk in horses. Equine Vet J 2019; 52:374-378. [PMID: 31583742 DOI: 10.1111/evj.13186] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/29/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The number of atrial premature depolarisations (APDs) is a known risk factor for atrial fibrillation (AF) recurrence in humans. OBJECTIVES To evaluate if the number of APDs over a 24-h period 5 days post cardioversion predicts AF recurrence within 1 year in horses, taking the multifactorial nature of AF into account. STUDY DESIGN Retrospective case series. METHODS Eighty horses met these inclusion criteria: first AF episode, no AF recurrence within 5 days post cardioversion, cardioversion by transvenous electrical cardioversion (TVEC), 24-h ECG recording and echocardiographic examination 5 days post cardioversion, no antiarrhythmic treatment during the ECG recording and follow-up of minimum 1 year. To compare the APD burden between the recurrence and non-recurrence group a Mann-Whitney U test was used. A multivariable survival model was built to identify additional risk factors for AF recurrence. RESULTS The patient population mainly consisted of Warmbloods (93%). Twenty-six horses (33%) experienced AF recurrence within 1 year. The number of APDs (median [range]) was significantly higher (P = 0.01) in the recurrence group (15 [1-152]) compared with the non-recurrence group (7 [0-304]). In the multivariable survival model, APDs ≥25/24 h (hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.2-6.8, P = 0.02), mitral regurgitation (HR 8.6, 95% CI 2.6-28.9, P<0.001), left atrial active fractional area change ≤9.6% (HR 2.6, 95% CI 1.0-6.5, P = 0.04) and lower body weight (HR 0.99, 95% CI 0.98-0.99, P = 0.001) were significantly associated with AF recurrence. MAIN LIMITATIONS This study did not evaluate early AF recurrence within 5 days. The results cannot necessarily be extrapolated to other treatment methods, as only horses converted by TVEC were included. CONCLUSIONS The APD burden 5 days post cardioversion could be a useful predictive value for AF recurrence within 1 year in horses. However, other factors such as mitral regurgitation and atrial contractile function must also be taken into account.
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Affiliation(s)
- I Vernemmen
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - D De Clercq
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - A Decloedt
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - L Vera
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - G Van Steenkiste
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - G van Loon
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Hesselkilde EZ, Carstensen H, Flethøj M, Fenner M, Kruse DD, Sattler SM, Tfelt-Hansen J, Pehrson S, Braunstein TH, Carlson J, Platonov PG, Jespersen T, Buhl R. Longitudinal study of electrical, functional and structural remodelling in an equine model of atrial fibrillation. BMC Cardiovasc Disord 2019; 19:228. [PMID: 31638896 PMCID: PMC6805623 DOI: 10.1186/s12872-019-1210-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 09/26/2019] [Indexed: 06/06/2024] Open
Abstract
Background Large animal models are important in atrial fibrillation (AF) research, as they can be used to study the pathophysiology of AF and new therapeutic approaches. Unlike other animal models, horses spontaneously develop AF and could therefore serve as a bona fide model in AF research. We therefore aimed to study the electrical, functional and structural remodelling caused by chronic AF in a horse model. Method Nine female horses were included in the study, with six horses tachypaced into self-sustained AF and three that served as a time-matched sham-operated control group. Acceleration in atrial fibrillatory rate (AFR), changes in electrocardiographic and echocardiographic variables and response to medical treatment (flecainide 2 mg/kg) were recorded over a period of 2 months. At the end of the study, changes in ion channel expression and fibrosis were measured and compared between the two groups. Results AFR increased from 299 ± 33 fibrillations per minute (fpm) to 376 ± 12 fpm (p < 0.05) and atrial function (active left atrial fractional area change) decreased significantly during the study (p < 0.05). No changes were observed in heart rate or ventricular function. The AF group had more atrial fibrosis compared to the control group (p < 0.05). No differences in ion channel expression were observed. Conclusion Horses with induced AF show signs of atrial remodelling that are similar to humans and other animal models.
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Affiliation(s)
- Eva Zander Hesselkilde
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Højbakkegaard Allé 5, 2630, Taastrup, Denmark
| | - Helena Carstensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Højbakkegaard Allé 5, 2630, Taastrup, Denmark
| | - Mette Flethøj
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Højbakkegaard Allé 5, 2630, Taastrup, Denmark
| | - Merle Fenner
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Højbakkegaard Allé 5, 2630, Taastrup, Denmark
| | - Ditte Dybvald Kruse
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark
| | - Stefan M Sattler
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Medicine I, University Hospital Munich, Campus Grosshadern, Ludwig-Maximilians University Munich (LMU), Munich, Germany
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Frederik V's vej 11, 2100, Copenhagen, Denmark
| | - Steen Pehrson
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Thomas Hartig Braunstein
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark
| | - Jonas Carlson
- Department of Cardiology, Clinical Sciences, Arrhythmia Clinic, Skåne University Hospital, Lund University, 21185, Lund, Sweden
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Arrhythmia Clinic, Skåne University Hospital, Lund University, 21185, Lund, Sweden
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark
| | - Rikke Buhl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Højbakkegaard Allé 5, 2630, Taastrup, Denmark.
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10
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Boegli J, Schwarzwald CC, Mitchell KJ. Diagnostic value of noninvasive pulse pressure measurements in Warmblood horses with aortic regurgitation. J Vet Intern Med 2019; 33:1446-1455. [PMID: 30938891 PMCID: PMC6524107 DOI: 10.1111/jvim.15494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 03/21/2019] [Indexed: 12/21/2022] Open
Abstract
Background Noninvasive blood pressures (NIBP) and pulse pressures (PP) have not been published in horses with aortic and mitral regurgitation (AR or MR). Objectives To investigate NIBP and PP in healthy Warmblood horses and horses with AR and MR and propose PP cutoffs to identify and stage AR severity. Animals Seventy‐three Warmblood horses (healthy, 10; AR, 31; MR, 32). Methods Retrospective study. All horses had NIBP and an echocardiogram recorded. Cases were categorized based on severity of regurgitation. Pulse pressures were compared among healthy, MR, and AR groups and among AR severity groups. Cutoffs were determined by receiver operating characteristic curve analyses. Results Horses with AR had higher PP than horses with MR (mean difference [95% confidence interval (CI)], +17 [9‐26] mm Hg, P < .001) and controls (+17 [5‐30] mm Hg; P =.004). Horses with severe AR had higher PP compared those with mild (+38 [20‐54] mm Hg; P < 0.001) and moderate AR (+33 [18‐47] mm Hg; P < .001). The PP cutoffs to distinguish AR from MR and controls were 38 mm Hg (sensitivity [Sn], 100%; specificity [Sp], 19%) for maximal Sn and 61 mm Hg (Sn, 43%; Sp, 100%) for maximal Sp. The PP cutoffs to distinguish severe AR from mild and moderate AR were 57 mm Hg (Sn, 100%; Sp, 70%) for maximal Sn and 77 mm Hg (Sn, 75%; Sp, 100%) for maximal Sp. Conclusions and Clinical Importance Horses with AR have increased PP. Noninvasive PP measurements interpreted with provided cutoffs may aid clinicians in diagnosing and staging severity of AR in horses.
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Affiliation(s)
- Julia Boegli
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Colin C Schwarzwald
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Katharyn J Mitchell
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Pericardial Disease, Myocardial Disease, and Great Vessel Abnormalities in Horses. Vet Clin North Am Equine Pract 2019; 35:139-157. [PMID: 30871834 DOI: 10.1016/j.cveq.2018.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pericardial, myocardial, and great vessel diseases are relatively rare in horses. The clinical signs are often nonspecific and vague, or related to the underlying cause. Physical examination usually reveals tachycardia, fever, venous distension or jugular pulsation, a weak or bounding arterial pulse, ventral edema, and abnormal cardiac auscultation such as arrhythmia, murmur, or muffled heart sounds. The prognosis depends on the underlying cause and the disease progression, and ranges from full recovery to poor prognosis for survival. This article focuses on the etiology, diagnosis, prognosis, and treatment of pericarditis, pericardial mass lesions, myocarditis, cardiomyopathy, and great vessel aneurysm or rupture.
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12
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Assessment of the Cardiovascular System in Horses During Prepurchase and Insurance Examinations. Vet Clin North Am Equine Pract 2019; 35:191-204. [PMID: 30871830 DOI: 10.1016/j.cveq.2018.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Arrhythmias detected on prepurchase examination should be confirmed with an ECG. Exercising ECG determines if the arrhythmia is overdriven during exercise or is a safety concern. An echocardiogram is needed in all horses with a grade 3/6 or louder mid to late systolic, holosystolic, or pansystolic murmur or any holodiastolic decrescendo murmur to identify the cardiac abnormality and its hemodynamic impact. Most horses with arrhythmias and murmurs have a normal performance career and life expectancy and are insurable. Risks for sudden death and congestive heart failure associated with the common murmurs and arrhythmias are identified, because these horses cannot be insured.
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Abstract
Degenerative myxomatous disease is common and is associated with aging. Poor prognostic indicators for equine aortic regurgitation specifically include ventricular ectopy, increased pulse pressure, and hyperkinetic pulses. Valvular prolapse is a functional abnormality diagnosed echocardiographically, about which knowledge is limited. A better understanding of its role in valvular regurgitation is needed. Infective endocarditis presents with fever and other systemic signs accompanying valvular regurgitation. The prognosis is poor, warranting aggressive therapy. Other forms of valvular disease occur rarely, but often presenting with severe regurgitation. Management of horses with valvular disease is focused on assessment of severity and regular clinical, echocardiographic, and electrocardiographic monitoring.
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Abstract
Equine heart diseases can be categorized with morphologic, etiologic, and physiologic diagnoses and classified anatomically as diseases of the pericardium, myocardium, valves (endocardium), and great vessels. An appreciation of normal and pathologic physiology is a key to understanding diagnosis and therapy of heart disease. Pathophysiologic diagnoses include arrhythmias, congestive heart failure, and pulmonary hypertension. Heart rhythm disturbances can occur in isolation or with structural disease. Heart failure stems from arterial filling owing to insufficient cardiac output. Pulmonary hypertension is associated with strenuous exercise, left heart failure, bronchopulmonary diseases, and pulmonary arteriopathies. The etiopathogenesis of these disorders are incompletely understood.
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Affiliation(s)
- John D Bonagura
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27606, USA; Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA.
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Vezzosi T, Schober KE. Doppler-derived echocardiographic evidence of pulmonary hypertension in cats with left-sided congestive heart failure. J Vet Cardiol 2019; 23:58-68. [PMID: 31174730 DOI: 10.1016/j.jvc.2019.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 01/21/2019] [Accepted: 01/28/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Pulmonary hypertension (PH) caused by left-sided congestive heart failure (L-CHF) is common in dogs and contributes to clinical signs and outcome. The aim of this study was to evaluate the prevalence of Doppler echocardiography-derived PH in a population of cats with L-CHF. ANIMALS The study involved 131 cats with L-CHF and 56 control cats. METHODS The study design is retrospective, observational study. Tricuspid regurgitation velocity, right atrial dimension, right ventricular (RV) dimension and function, RV wall thickness, pulmonary artery (PA) dimension, Doppler-derived systolic time intervals of PA flow, and presence of septal flattening were evaluated. Pulmonary hypertension was considered if tricuspid regurgitation velocity was >2.7 m/s. RESULTS Tricuspid regurgitation was present in 57/131 (44%) of cats with L-CHF and 24/56 (43%) in control cats based on color flow Doppler. Doppler-derived of PH was identified in 22/131 cats with L-CHF (17%). In 15/22 cats, PH was associated with cardiomyopathy, in 5/22 cases with congenital heart disease, and in 2/22 cases with other causes. Cats with Doppler-derived PH more often had chronic L-CHF, as opposed to acute L-CHF (p<0.05). All cats with Doppler-derived PH had subjectively-assessed right-sided heart enlargement, with larger right atrial and RV diameters (p<0.001), increased RV wall thickness (p<0.05), and higher prevalence of septal flattening (<0.001) and PA enlargement (p<0.05). CONCLUSIONS Pulmonary hypertension identified by Doppler echocardiography is not a common finding in cats with L-CHF. Right-sided heart enlargement, more frequently observed, may raise the suspicion of PH in cats with L-CHF.
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Affiliation(s)
- T Vezzosi
- Department of Veterinary Sciences, University of Pisa, via Livornese, 56122, San Piero a Grado, Pisa, Italy.
| | - K E Schober
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon L Tharp Street, Columbus, OH, 43210, USA
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Zuber N, Zuber M, Schwarzwald CC. Assessment of systolic and diastolic function in clinically healthy horses using ambulatory acoustic cardiography. Equine Vet J 2018; 51:391-400. [DOI: 10.1111/evj.13014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 08/21/2018] [Indexed: 12/13/2022]
Affiliation(s)
- N. Zuber
- Clinic for Equine Internal Medicine, Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - M. Zuber
- Division of Cardiology University of Zurich Zurich Switzerland
| | - C. C. Schwarzwald
- Clinic for Equine Internal Medicine, Vetsuisse Faculty University of Zurich Zurich Switzerland
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17
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Al-Haidar A, Moula N, Leroux A, Farnir F, Deleuze S, Sandersen C, Amory H. Reference values of two-dimensional and M-mode echocardiographic measurements as a function of body size in various equine breeds and in ponies. J Vet Cardiol 2017; 19:492-501. [DOI: 10.1016/j.jvc.2017.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 08/04/2017] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
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18
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Afonso T, Giguère S, Brown SA, Barton MH, Rapoport G, Barba M, Dembek KA, Toribio RE, Coleman AE. Preliminary investigation of orally administered benazepril in horses with left-sided valvular regurgitation. Equine Vet J 2017; 50:446-451. [PMID: 29044678 DOI: 10.1111/evj.12773] [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: 04/11/2017] [Accepted: 10/11/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the paucity of data available, orally administered angiotensin-converting enzyme (ACE) inhibitors are empirically used in horses with valvular regurgitation. OBJECTIVE Evaluate the echocardiographic and hormonal changes in response to oral benazepril in horses with left-sided valvular regurgitation. STUDY DESIGN Prospective, randomised double-blind, placebo-controlled trial. METHODS Horses with mitral valve (MR) and/or aortic valve regurgitation (AR) received oral benazepril (n = 6) at a dosage of 1 mg/kg q 12 h or a placebo (n = 5) for 28 days. Echocardiography was performed before drug administration and after 28 days of treatment. Plasma renin activity, serum ACE activity, angiotensin II concentration, aldosterone concentration and biochemical variables were measured before drug administration and after 7 and 28 days of treatment. RESULTS Relative to baseline, horses treated with benazepril had statistically significant reduction in left ventricular internal diameter in systole (mean difference between groups = -0.97 cm; 95% CI = -1.5 to -0.43 cm), aortic sinus diameter (-0.31 cm; -0.54 to -0.07 cm), and percentage of the aortic annulus diameter occupied by the base of the AR jet (-17.05%; -31.17 to -2.93%) compared with horses receiving a placebo. In addition, horses treated with benazepril had a significantly greater increase in cardiac output (11.95 L/min; 1.17-22.73 L/min) and fractional shortening (7.59%; 3.3-11.88%) compared with horses receiving a placebo. Despite profound serum ACE inhibition, renin activity and concentrations of angiotensin II and aldosterone were not significantly different between treatment groups or among time points. MAIN LIMITATIONS Very small sample size and short treatment period. CONCLUSIONS Treatment with oral benazepril resulted in statistically significant echocardiographic changes that might indicate reduced cardiac afterload in horses with left-sided valvular regurgitation. Additional studies with a larger sample size will be necessary to determine if administration of benazepril is beneficial in horses with valvular regurgitation. The Summary is available in Spanish - see Supporting Information.
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Affiliation(s)
- T Afonso
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - S Giguère
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - S A Brown
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - M H Barton
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - G Rapoport
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - M Barba
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | - K A Dembek
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - R E Toribio
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - A E Coleman
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
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Wijnberg I, Franklin S. The heart remains the core: cardiac causes of poor performance in horses compared to human athletes. COMPARATIVE EXERCISE PHYSIOLOGY 2017. [DOI: 10.3920/cep170012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cardiac remodelling occurs in response to exercise and is generally beneficial for athletic performance due to the increase in cardiac output. However, this remodelling also may lead to an increased prevalence of cardiac murmurs and arrhythmias. In most cases, these are not considered to be significant. However, in some cases, there may be potentially deleterious consequences. Whilst sudden cardiac death (SCD) is a rare occurrence, the consequences are catastrophic for both the horse and potentially the rider or driver. Furthermore, the sudden death of a horse in the public arena has negative connotations in regards to public perception of welfare during equestrian sports. Prediction of which individuals might be susceptible to potential deleterious effects of exercise is a focus of interest in both human and equine athletes but remains a challenge because many athletes experience cardiac murmurs and exercise-induced arrhythmias that are clinically irrelevant. This review summarises the effects of exercise on cardiac remodelling in the horse and the potential effects on athletic performance and SCD. The use of biomarkers and their future potential in the management of athletic horses is also reviewed.
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Affiliation(s)
- I.D. Wijnberg
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, 3584 CM, Utrecht, the Netherlands
| | - S.H. Franklin
- Equine Health and Performance Centre, School of Animal and Veterinary Science, University of Adelaide, SA 5005, Australia
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Miller SM, Spargo KE. Science-in-brief: Clinical highlights from 50th Congress of the South African Equine Veterinary Association 2017. Equine Vet J 2017; 49:266-268. [DOI: 10.1111/evj.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 11/26/2022]
Affiliation(s)
- S. M. Miller
- Summerveld Equine Hospital; Summerveld South Africa
- Section Diagnostic Imaging; Department of Companion Animal Clinical Studies, Faculty of Veterinary Science; University of Pretoria, Onderstepoort; Pretoria South Africa
| | - K. E. Spargo
- Section Diagnostic Imaging; Department of Companion Animal Clinical Studies, Faculty of Veterinary Science; University of Pretoria, Onderstepoort; Pretoria South Africa
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Huesler IM, Mitchell KJ, Schwarzwald CC. Echocardiographic Assessment of Left Atrial Size and Function in Warmblood Horses: Reference Intervals, Allometric Scaling, and Agreement of Different Echocardiographic Variables. J Vet Intern Med 2016; 30:1241-52. [PMID: 27362277 PMCID: PMC5108425 DOI: 10.1111/jvim.14368] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 04/19/2016] [Accepted: 05/26/2016] [Indexed: 11/30/2022] Open
Abstract
Background Echocardiographic assessment of left atrial (LA) size and function in horses is not standardized. Objectives The aim of this study was to establish reference intervals for echocardiographic indices of LA size and function in Warmblood horses and to provide proof of concept for allometric scaling of variables and for the clinical use of area‐based indices. Animals Thirty‐one healthy Warmblood horses and 91 Warmblood horses with a primary diagnosis of mitral regurgitation (MR) or aortic regurgitation (AR). Methods Retrospective study. Echocardiographic indices of LA size and function were measured and scaled to body weight (BWT). Reference intervals were calculated, the influence of BWT, age, and valvular regurgitation on LA size and function was investigated and agreement between different measurements of LA size was assessed. Results Allometric scaling of variables of LA size allowed for correction of differences in BWT. Indices of LA size documented LA enlargement with moderate and severe MR and AR, whereas most indices of LA mechanical function were not significantly altered by valvular regurgitation. Different indices of LA size were in fair to good agreement but still lead to discordant conclusions with regard to assessment of LA enlargement in individual horses. Conclusions and Clinical Importance Allometric scaling of echocardiographic variables of LA size is advised to correct for differences in BWT among Warmblood horses. Assessment of LA dimensions should be based on an integrative approach combining subjective evaluation and assessment of multiple measurements, including area‐based variables. The clinical relevance of indices of LA mechanical function remains unclear when used in horses with mitral or aortic regurgitation.
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Affiliation(s)
- I M Huesler
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - K J Mitchell
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - C C Schwarzwald
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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22
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Abstract
Respiratory and cardiac diseases are common in older horses. Advancing age is a specific risk factor for cardiac murmurs and these are more likely in males and small horses. Airway inflammation is the most common respiratory diagnosis. Recurrent airway obstruction can lead to irreversible structural change and bronchiectasis; with chronic hypoxia, right heart dysfunction and failure can develop. Valvular heart disease most often affects the aortic and/or the mitral valve. Management of comorbidity is an essential element of the therapeutic approach to cardiac and respiratory disease in older equids.
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23
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Decloedt A, Schwarzwald CC, De Clercq D, Van Der Vekens N, Pardon B, Reef VB, van Loon G. Risk factors for recurrence of atrial fibrillation in horses after cardioversion to sinus rhythm. J Vet Intern Med 2015; 29:946-53. [PMID: 25917409 PMCID: PMC4895430 DOI: 10.1111/jvim.12606] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 02/13/2015] [Accepted: 03/31/2015] [Indexed: 11/29/2022] Open
Abstract
Background Although atrial fibrillation (AF) can be successfully treated in horses, recurrence occurs frequently. In humans, atrial function after cardioversion can predict recurrence. Objectives To examine the prognostic value of atrial mechanical function at 24 hours after cardioversion and other potential predictor variables for AF recurrence in horses. Animals 117 horses treated for AF at 4 referral centers. Methods Retrospective study. Inclusion criteria were successful cardioversion, echocardiography at 24 hours after cardioversion and ≥4 months follow‐up. To determine factors associated with AF recurrence, a multivariable survival model was built. Results 133 AF episodes in 117 horses were included. AF recurred in 36/100 horses with a first AF episode and in 57/133 AF episodes overall. Factors associated with recurrence in horses with a first episode were previous unsuccessful treatment attempt (hazard ratio HR 2.36, 95% confidence interval CI 1.11–4.99, P = .025) and mild or moderate mitral regurgitation (HR 2.70, 95% CI 1.23–5.91, P = .013). When the last AF episode of all horses was included, previous AF (HR 2.53, 1.33–4.82, P = .005) and active left atrial fractional area change ≤9.6% (HR 3.43, 1.22–9.67, P = .020) were significant predictors. Conclusions and Clinical Importance The only echocardiographic variable of left atrial function with significant prognostic value for recurrence was low active left atrial fractional area change. Further research is necessary to evaluate whether echocardiography at a later timepoint could provide more prognostic information.
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Affiliation(s)
- A Decloedt
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - C C Schwarzwald
- Clinic for Equine Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, 8057, Switzerland.,Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, 43210
| | - D De Clercq
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - N Van Der Vekens
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - B Pardon
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - V B Reef
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, 19348
| | - G van Loon
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
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24
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Reef VB, Bonagura J, Buhl R, McGurrin MKJ, Schwarzwald CC, van Loon G, Young LE. Recommendations for management of equine athletes with cardiovascular abnormalities. J Vet Intern Med 2014; 28:749-61. [PMID: 24628586 PMCID: PMC4895474 DOI: 10.1111/jvim.12340] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 01/28/2014] [Accepted: 01/28/2014] [Indexed: 11/29/2022] Open
Abstract
Murmurs and arrhythmias are commonly detected in equine athletes. Assessing the relevance of these cardiovascular abnormalities in the performance horse can be challenging. Determining the impact of a cardiovascular disorder on performance, life expectancy, horse and rider or driver safety relative to the owner's future expectations is paramount. A comprehensive assessment of the cardiovascular abnormality detected is essential to determine its severity and achieve these aims. This consensus statement presents a general approach to the assessment of cardiovascular abnormalities, followed by a discussion of the common murmurs and arrhythmias. The description, diagnosis, evaluation, and prognosis are considered for each cardiovascular abnormality. The recommendations presented herein are based on available literature and a consensus of the panelists. While the majority of horses with cardiovascular abnormalities have a useful performance life, periodic reexaminations are indicated for those with clinically relevant cardiovascular disease. Horses with pulmonary hypertension, CHF, or complex ventricular arrhythmias should not be ridden or driven.
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Affiliation(s)
- V B Reef
- Department of Clinical Studies-New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA
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25
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Leroux A, Detilleux J, Sandersen C, Borde L, Houben R, Al Haidar A, Art T, Amory H. Prevalence and Risk Factors for Cardiac Diseases in a Hospital-Based Population of 3,434 Horses (1994-2011). J Vet Intern Med 2013; 27:1563-70. [DOI: 10.1111/jvim.12197] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 07/18/2013] [Accepted: 08/13/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- A.A. Leroux
- Equine Teaching Hospital; Department of Clinical Sciences; Faculty of Veterinary Medicine; University of Liege; Sart-Tilman Liege Belgium
| | - J. Detilleux
- Quantitative Genetics Section; Department of Animal Production; Faculty of Veterinary Medicine; University of Liege; Sart-Tilman Liege Belgium
| | - C.F. Sandersen
- Equine Teaching Hospital; Department of Clinical Sciences; Faculty of Veterinary Medicine; University of Liege; Sart-Tilman Liege Belgium
| | - L. Borde
- Equine Teaching Hospital; Department of Clinical Sciences; Faculty of Veterinary Medicine; University of Liege; Sart-Tilman Liege Belgium
| | - R.M.A.C. Houben
- Equine Teaching Hospital; Department of Clinical Sciences; Faculty of Veterinary Medicine; University of Liege; Sart-Tilman Liege Belgium
| | - A. Al Haidar
- Equine Teaching Hospital; Department of Clinical Sciences; Faculty of Veterinary Medicine; University of Liege; Sart-Tilman Liege Belgium
| | - T. Art
- Equine Sports Medicine Centre; Department of Functional Sciences (Art); Faculty of Veterinary Medicine; University of Liege; Sart-Tilman Liege Belgium
| | - H. Amory
- Equine Teaching Hospital; Department of Clinical Sciences; Faculty of Veterinary Medicine; University of Liege; Sart-Tilman Liege Belgium
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Cardiac Arrhythmias in Standardbreds During and After Racing—Possible Association Between Heart Size, Valvular Regurgitations, and Arrhythmias. J Equine Vet Sci 2013. [DOI: 10.1016/j.jevs.2012.09.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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27
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Coleman AE. Pathophysiological consequences of atrioventricular valve insufficiency in the equine patient. EQUINE VET EDUC 2013. [DOI: 10.1111/eve.12035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. E. Coleman
- University of Georgia College of Veterinary Medicine; Georgia; USA
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28
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Trachsel DS, Schwarzwald CC, Bitschnau C, Grenacher B, Weishaupt MA. Atrial natriuretic peptide and cardiac troponin I concentrations in healthy Warmblood horses and in Warmblood horses with mitral regurgitation at rest and after exercise. J Vet Cardiol 2013; 15:105-21. [DOI: 10.1016/j.jvc.2012.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 11/30/2012] [Accepted: 12/30/2012] [Indexed: 11/16/2022]
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29
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Bowser JE, Woodington MK, Boggs JJ. What is your diagnosis? Vegetative valvular endocarditis of the mitral valve. J Am Vet Med Assoc 2013; 242:921-3. [PMID: 23517202 DOI: 10.2460/javma.242.7.921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jacquelyn E Bowser
- Equine Internal Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762, USA.
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Seddighi R, Doherty TJ. Anesthesia of the geriatric equine. VETERINARY MEDICINE-RESEARCH AND REPORTS 2012; 3:53-64. [PMID: 30101084 DOI: 10.2147/vmrr.s34162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Advancements in veterinary medicine have resulted in an increased number of geriatric horses being presented for medical or surgical procedures that require general anesthesia. Due to the physiological changes associated with aging and the likelihood of concurrent disease conditions, the geriatric equine is at an increased risk during anesthesia. The main physiological changes associated with aging, and their impact on anesthesia, are discussed in this review.
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Affiliation(s)
- Reza Seddighi
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Veterinary Medical Center, University of Tennessee, Knoxville, TN, USA,
| | - Thomas J Doherty
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Veterinary Medical Center, University of Tennessee, Knoxville, TN, USA,
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31
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Duz M, Philbey AW, Hughes KJ. Mitral valve and tricuspid valve dysplasia in a 9-week-old Standardbred colt. EQUINE VET EDUC 2012. [DOI: 10.1111/j.2042-3292.2012.00392.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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32
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Patteson M. Prepurchase examination in horses: detection and significance of heart murmurs. IN PRACTICE 2010. [DOI: 10.1136/inp.c5312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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33
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Guglielmini C, Giuliani A, Testoni S, Corletto F, Bernardini D. Use of an ACE inhibitor (ramipril) in a horse with congestive heart failure. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2002.tb00193.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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34
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Rovira S, Muñoz A, Rodilla V. Allometric scaling of echocardiographic measurements in healthy Spanish foals with different body weight. Res Vet Sci 2009; 86:325-31. [DOI: 10.1016/j.rvsc.2008.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Revised: 06/02/2008] [Accepted: 08/03/2008] [Indexed: 11/24/2022]
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35
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Doppler-derived evidence of severe pulmonary arterial hypertension in a pony with recurrent airway obstruction. Vet Rec 2009; 164:340-1. [DOI: 10.1136/vr.164.11.340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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36
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Imhasly A, Tschudi PR, Lombard CW, Gerber V. Clinical and echocardiographic features of mild mitral valve regurgitation in 108 horses. Vet J 2009; 183:166-71. [PMID: 19272821 DOI: 10.1016/j.tvjl.2009.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 01/02/2009] [Accepted: 01/17/2009] [Indexed: 10/21/2022]
Abstract
The clinical and echocardiographic characteristics of 108 horses with echocardiographically confirmed mild mitral valve regurgitation (MR) were investigated along with its clinical progression. Follow-up consisted of a re-examination of 28 horses and questionnaires were used to obtain information on a further 43 cases. Thirty-seven horses with mild MR were lost to follow-up. Horses with mild MR were re-examined between 2 and 9 years (3.8+/-1.8 years) following first presentation, with mild MR still present and a small, but statistically significant (P=0.049) increase of left ventricular diameter in end-diastole. These results suggested that mild MR has a good mid-term prognosis in sport and pleasure horses.
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Affiliation(s)
- Alexandra Imhasly
- Equine Hospital, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty of the University of Berne, 3012 Berne, Switzerland.
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37
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Stevens KB, Marr CM, Horn JNR, Pfeiffer DU, Perkins JD, Bowen IM, Allan EJ, Campbell J, Elliott J. Effect of left-sided valvular regurgitation on mortality and causes of death among a population of middle-aged and older horses. Vet Rec 2009; 164:6-10. [DOI: 10.1136/vr.164.1.6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- K. B. Stevens
- Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA
| | - C. M. Marr
- Rossdales Equine Hospital; Cotton End Road, Exning Newmarket Suffolk CB8 7NN
| | | | - D. U. Pfeiffer
- Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA
| | - J. D. Perkins
- Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA
| | - I. M. Bowen
- School of Veterinary Medicine; University of Nottingham; Sutton Bonington Campus, Sutton Bonington Leicestershire LE12 5RD
| | - E. J. Allan
- Davison Veterinary Surgeons; 65 Ilkeston Road Nottingham NG7 3GR
| | - J. Campbell
- Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA
| | - J. Elliott
- Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA
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Menzies-Gow NJ. Effects of sedation with acepromazine on echocardiographic measurements in eight healthy thoroughbred horses. Vet Rec 2008; 163:21-5. [PMID: 18603631 DOI: 10.1136/vr.163.1.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Eight normal thoroughbred horses were examined by echocardiography before and 10 minutes after they had been sedated by the intravenous administration of 0.03 mg/kg acepromazine. There were significant (P<0.025) increases in the diameters of the pulmonary artery and the aorta, measured at end-systole, and in the thickness of the interventricular septum, measured at end-systole and end-diastole. In addition, there was a significant (P<0.001) decrease in the diameter of the left atrium measured at end-diastole. The remaining cardiac dimensions, all the indices of cardiac function, and the occurrence and severity of valvular regurgitation were not affected by sedation.
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Affiliation(s)
- N J Menzies-Gow
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hawkshead Lane, Hatfield AL9 7TA, UK
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Johansson AM, Gardner SY, Atkins CE, LaFevers DH, Breuhaus BA. Cardiovascular Effects of Acute Pulmonary Obstruction in Horses with Recurrent Airway Obstruction. J Vet Intern Med 2007. [DOI: 10.1111/j.1939-1676.2007.tb02964.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Sage AM, Valberg S, Hayden DW, Firshman AM, Jacob K. Echocardiography in a Horse with Cor Pulmonale from Recurrent Airway Obstruction. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb02918.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Gehlen H, Marnette S, Rohn K, Stadler P. Echocardiographic analysis of segmental left ventricular wall motion at rest and after exercise in horses with and without heart disease. J Equine Vet Sci 2005. [DOI: 10.1016/j.jevs.2005.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Marr CM. Advances in equine ultrasonography. Vet Clin North Am Equine Pract 2005; 17:305-17, vii. [PMID: 15658178 DOI: 10.1016/s0749-0739(17)30064-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The digital storage and transfer of images coupled with the development of the Internet have revolutionized diagnostic imaging. With the press of a button, practitioners can exploit the diagnostic skills of specialists anywhere in the world and enlist their help with challenging cases. This easy transfer of images and digital data should stimulate a greater number of multicenter studies so that the sensitivity and specificity of ultrasonographic techniques can be established in larger and more meaningful cohorts of patients. There is now no doubt that we can identify a plethora of conditions of the horse with ultrasonography; however, there is a continuing need to look critically at how we use such information to improve patient management and outcome.
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Affiliation(s)
- C M Marr
- Equine Division, Department of Farm Animal and Equine Medicine and Surgery, Royal Veterinary College, North Mymms, Hertfordshire, United Kingdom.
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Gehlen H, Bubeck K, Stadler P. Pulmonary artery wedge pressure measurement in healthy warmblood horses and in warmblood horses with mitral valve insufficiencies of various degrees during standardised treadmill exercise. Res Vet Sci 2004; 77:257-64. [PMID: 15276778 DOI: 10.1016/j.rvsc.2004.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2004] [Indexed: 10/26/2022]
Abstract
In 12 healthy warmblood horses and 10 horses with mitral valve insufficiencies (MVI) of various degrees heart rate and pulmonary artery wedge pressure (PWP) was measured at rest and during standardised exercise on a high speed treadmill. There was a significant increase in PWP with each change in speed of the treadmill (p < 0.01). The PWP of horses with mild mitral valve regurgitation under working conditions was not significantly different compared to the healthy horses. The horses with moderate mitral valve regurgitation showed a significant higher pulmonary artery wedge pressure at rest and during exercise compared to the healthy horses (p < 0.01) at rest and during treadmill velocity. The tendencies were seen that mild mitral valve regurgitation results only in mild hemodynamic changes during exercise, while moderate MVI have an important influence on haemodynamics.
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Affiliation(s)
- H Gehlen
- Equine Clinic, School of Veterinary Medicine, Bischofsholer Damm 15, 30173 Hannover, Germany.
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Häggström J, Duelund Pedersen H, Kvart C. New insights into degenerative mitral valve disease in dogs. Vet Clin North Am Small Anim Pract 2004; 34:1209-26, vii-viii. [PMID: 15325478 DOI: 10.1016/j.cvsm.2004.05.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Degenerative mitral valve disease (DMVD) is the most common cardiac disease in dogs. Although the disease is frequently described in the veterinary literature, many aspects are still unknown or controversial. Based on recent research findings, this article addresses the etiology, pathogenesis, inheritance, diagnosis of early DMVD, diagnosis of mild decompensated heart failure, and efficacy of early medical intervention in clinically compensated dogs.
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Affiliation(s)
- Jens Häggström
- Department of Small Animal Medicine and Surgery, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, PO Box 7045, S-75007 Uppsala, Sweden.
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Gehlen H, Stadler P. Comparison of systolic cardiac function before and after treatment of atrial fibrillation in horses with and without additional cardiac valve insufficiencies. Vet Res Commun 2004; 28:317-29. [PMID: 15222736 DOI: 10.1023/b:verc.0000026672.25856.0a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Clinical, electrocardiographic and echocardiographic examinations were conducted before therapy and 4 days after conversion to normal sinus rhythm in 15 horses with a history of atrial fibrillation of 2-6 months duration. Seven horses showed no other signs of cardiac disease. Four horses suffered additionally from mitral valve insufficiency, while six horses had aortic valve insufficiency, including two of the four horses with mitral valve insufficiency, but none had signs of congestive heart failure. Doppler echocardiographic estimates of various variables were made for assessment of systolic heart function. These included heart rate, stroke volume, cardiac output and cardiac output per kg of body weight (heart index). After conversion to normal sinus rhythm, the horses without heart valve insufficiency showed a statistically significantly decreased heart rate (-24%) and cardiac output (-3%), but an increase in stroke volume (+8.4%) and heart index (+9%). The horses with heart valve insufficiency experienced a statistically significant decrease in heart rate (-21%) after conversion to normal sinus rhythm, but showed an increase in all other variables. Cardiac output increased statistically significantly by 20%, stroke volume by 54% and heart index by 58%.
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Affiliation(s)
- H Gehlen
- Clinic for Horses, School of Veterinary Medicine Hannover, Bischofsholer Damm 12, D-30173 Hannover, Germany.
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Abstract
Cardiac disease and dysfunction can occur as a primary disorder(ie, with pathology situated in one or more of the cardiac structures) or can be classified as a secondary problem when it occurs in patients with another primary problem that has affected the heart either directly or indirectly. Primary cardiac problems are encountered in horses presented to emergency clinics; however,this occurs much less frequently in equine critical patients than cardiac problems arising secondary to other conditions. Nevertheless,if primary or secondary cardiac problems are not identified and addressed, they certainly contribute to the morbidity and mortality of critical care patients.
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Affiliation(s)
- Celia M Marr
- Beaufort Cottage Equine Hospital, Cotton End Road, Exning, Newmarket, Suffolk, CB8 7NN, UK.
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Corcoran BM, Black A, Anderson H, McEwan JD, French A, Smith P, Devine C. Identification of surface morphologic changes in the mitral valve leaflets and chordae tendineae of dogs with myxomatous degeneration. Am J Vet Res 2004; 65:198-206. [PMID: 14982036 DOI: 10.2460/ajvr.2004.65.198] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe structural changes in the left atrioventricular (mitral) valve complex of dogs with endocardiosis by use of scanning electron microscopy. ANIMALS 5 clinically normal dogs and 4 dogs with mitral valve endocardiosis. PROCEDURE The mitral valve complex from each dog was fixed and prepared for examination via scanning electron microscopy. Findings in valves from clinically normal and affected dogs were compared to identify surface changes associated with endocardiosis. RESULTS Compared with findings in valves from clinically normal dogs, endocardiosis-affected mitral valve complexes had several morphologic abnormalities. Tissue swelling on the edge of valve leaflets, chordae tendineae, and the chordal-papillary muscle junction was evident. Damage to the valve complex endothelium was unevenly distributed; in some areas, denudation of endothelial cells had exposed the basement membrane or subendothelial valve collagen matrix. This damage was most noticeable on the leaflet edges and extended more to the ventricular aspect of the valve than the atrial side. Cell loss also extended to the chordae tendineae but was less apparent at the chordal-papillary muscle junction. The remaining endothelial cells on affected valves were arranged in less-ordered rows and had more plasmalemmal microappendages, compared with cells on unaffected valves. CONCLUSIONS AND CLINICAL RELEVANCE Morphologic changes associated with mitral valve endocardiosis in dogs were similar to those observed in humans with mitral valve prolapse. In dogs with mitral valve endocardiosis, gross changes in the valve complex may affect hemodynamics in the heart; alterations in the leaflet and chordal endothelium may contribute to pathogenesis of this disease.
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Affiliation(s)
- Brendan M Corcoran
- Hospital for Small Animals, Division of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush Veterinary Centre, Roslin, Mid Lothian, Scotland, UK EH25 9RG
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Gehlen H, Vieht JC, Stadler P. Effects of the ACE Inhibitor Quinapril on Echocardiographic Variables in Horses with Mitral Valve Insufficiency. ACTA ACUST UNITED AC 2004; 50:460-5. [PMID: 15109241 DOI: 10.1046/j.1439-0442.2003.00580.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Twenty horses with mitral valve insufficiency, but without signs of congestive heart failure, and five horses without signs of heart disease were examined before and after medication with an angiotensin-converting enzyme (ACE) inhibitor. The examination included echocardiography assessment as well as heart catheterization. The echocardiographic examination included B-mode, M-mode, conventional and colour Doppler techniques. For 8 weeks, all horses were treated with Accupro 20 (active substance: Quinapril) at an oral dose rate of 120 mg/horse/day. A follow-up of the horses with mitral valve insufficiency after 8 weeks revealed a statistically significant increase in the stroke volume and the cardiac output as well as a decrease in regurgitation velocity time integral (VTI). The regurgitation blood velocity remained the same. The severity of mitral valve insufficiencies revealed a moderate improvement in five horses, from moderate to mild, after therapy. Significant changes of cardiac dimension (B-mode) and shortening fraction (M-mode) before and after treatment could not be observed. The owners' judgement of the horses' performance was that of a minor improvement. In the horses without clinical findings the results of examination before and after treatment remained the same.
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Affiliation(s)
- H Gehlen
- Equine Clinic, School of Veterinary Medicine Hannover, Hannover, Germany.
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