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Li CC, Chan IP, Chang CC, Hsueh T, Yang CC, Lin SL. Potential prognostic indicators in dogs with advanced heart failure secondary to myxomatous mitral valve disease. Vet Rec 2024; 195:e4393. [PMID: 38959211 DOI: 10.1002/vetr.4393] [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: 07/04/2023] [Revised: 05/12/2024] [Accepted: 05/24/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Advanced heart failure (AHF) secondary to myxomatous mitral valve disease (MMVD) in dogs has unclear predictive variables and survival time. METHODS This retrospective study included 38 dogs with AHF and 38 with stable congestive heart failure (CHF), both due to MMVD. Predictive variables for AHF were analysed, and survival times were calculated using logistic regression and the Kaplan-Meier method. RESULTS Left atrium to aortic root ratio, normalised left ventricular dimension at the end-diastole and end-systole, isovolumic relaxation time (IVRT) and early transmitral inflow velocity to IVRT ratio were associated with AHF progression. The median survival times were significantly longer in the stable group than in the AHF group. After AHF diagnosis, the median survival times for all-cause and cardiogenic mortality were 194 and 354 days, respectively. LIMITATIONS This was a single-centre retrospective observational study. The study population was small, with breed bias (overrepresentation of Maltese dogs). Additionally, the treatment plans depended on clinical experience. CONCLUSIONS AHF in dogs with CHF secondary to MMVD is linked to left heart chamber enlargement and increased left ventricular dimensions, significantly reducing survival time to around six months post-diagnosis. Early recognition and appropriate management may improve outcomes, highlighting the importance of advanced treatment strategies.
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Affiliation(s)
- Chuan-Chuan Li
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - I-Ping Chan
- Veterinary Medical Teaching Hospital, National Chung Hsing University, Taichung, Taiwan
| | - Chao-Chin Chang
- Graduate Institute of Microbiology and Public Health, National Chung Hsing University, Taichung, Taiwan
| | - Tung Hsueh
- Veterinary Medical Teaching Hospital, National Chung Hsing University, Taichung, Taiwan
| | - Chung-Chun Yang
- Veterinary Medical Teaching Hospital, National Chung Hsing University, Taichung, Taiwan
| | - Shiun-Long Lin
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
- Veterinary Medical Teaching Hospital, National Chung Hsing University, Taichung, Taiwan
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Thomovsky E, Ilie L. Basic triage in dogs and cats: Part I. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2024; 65:162-172. [PMID: 38304479 PMCID: PMC10783570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Background Emergency cases can present at any time of the day or night. All small animal practitioners need to have the skills to triage and stabilize common emergency cases even if they ultimately aim to refer the patient to another facility. Objectives and procedures The first part of this 3-part review article series covers respiratory distress and seizures. A stepwise approach to categorize and stabilize these cases is outlined, along with helpful tips to optimize the referral experience, if indicated. Results Having a strong methodical approach to animals in respiratory distress optimizes treatment. Similarly, achieving cessation of seizures, along with having a good understanding of the causes of seizures, allows for patient stabilization. Conclusion and clinical relevance Do NOT refer emergent cases before completing basic stabilization. Many emergency cases do not require emergent referral and can be worked up by the primary veterinarian or sent to a referral clinic on an appointment basis after appropriate stabilization steps are completed.
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Affiliation(s)
- Elizabeth Thomovsky
- Veterinary Clinical Sciences, Purdue University, 625 Harrison Street, West Lafayette, Indiana 47907, USA (Thomovsky); Emergency and Critical Care, VCA Arboretum View Animal Hospital, 2551 Warrenville Road, Downers Grove, Illinois 60515, USA (Ilie)
| | - Laura Ilie
- Veterinary Clinical Sciences, Purdue University, 625 Harrison Street, West Lafayette, Indiana 47907, USA (Thomovsky); Emergency and Critical Care, VCA Arboretum View Animal Hospital, 2551 Warrenville Road, Downers Grove, Illinois 60515, USA (Ilie)
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Koster L, Vogel J, Springer CM, Hecht S. Radiographic lung congestion scores in dogs with acute congestive heart failure caused by myxomatous mitral valve disease. J Vet Intern Med 2023; 37:1983-1991. [PMID: 37694988 PMCID: PMC10658542 DOI: 10.1111/jvim.16850] [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: 08/09/2022] [Accepted: 08/23/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND In humans, lung congestion scores are predictive of recurrence of acute congestive heart failure (CHF) and are superior to cardiac biomarkers in predicting survival. OBJECTIVES The primary aim of this retrospective study was to determine if a modified lung congestion score (LCS) in dogs diagnosed with acute CHF because of myxomatous mitral valve disease was associated with time until recurrence or death. ANIMALS Complete medical records were available for a total of 94 dogs between 2010 and 2019, but only 35 dogs fulfilled the criteria for inclusion. METHODS This retrospective study used descriptive statistics to describe the cumulative and corrected LCS. Correlations were used to examine the association of the corrected LCS and time until recurrence or death, selected echocardiographic variables, and timing of furosemide administration. RESULTS The mean LCS was 8.4 (SD 3.3) and corrected LCS was 0.48 (SD 0.19). The pattern was predominantly symmetric (40% of dogs) and focal (caudal) but more commonly right-sided when asymmetric (40% vs 20%). The median number of days after initial diagnosis of acute CHF to readmission and death was 150 days (range 4-572), and 266 days (range 5-965), respectively. No significant association between the dog's corrected LCS and number of days until readmission (r = .173, P = .42) nor survival (r = .109, P = .56) was found. There was a negative significant correlation (r = -.71, P < .001) between the time interval of furosemide administration and corrected LCS.
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Affiliation(s)
- Liza Koster
- Department of Small Animal Clinical SciencesUniversity of Tennessee College of Veterinary MedicineKnoxvilleTennesseeUSA
| | - Jenna Vogel
- Department of Small Animal Clinical SciencesUniversity of Tennessee College of Veterinary MedicineKnoxvilleTennesseeUSA
| | - Cary M. Springer
- Office of Information TechnologyUniversity of TennesseeKnoxvilleTennesseeUSA
| | - Silke Hecht
- Department of Small Animal Clinical SciencesUniversity of Tennessee College of Veterinary MedicineKnoxvilleTennesseeUSA
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Pennington C, Kurosawa TA, Navarro-Cubas X, Bristow P. Use of the Functional Evaluation of Cardiac Health questionnaire to assess health-related quality of life before and after mitral valve repair in dogs with myxomatous mitral valve disease. J Am Vet Med Assoc 2022; 260:1806-1812. [PMID: 35594202 DOI: 10.2460/javma.22.02.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine changes in health-related quality of life up to 12 months after surgery in dogs with myxomatous mitral valve disease that undergo mitral valve repair. ANIMALS 54 dogs that underwent mitral valve repair at a United Kingdom referral hospital. PROCEDURES Health-related quality of life was assessed with a previously validated, owner-completed questionnaire before and 1, 3, 6, and 12 months after surgery. Results There was a significant decrease in total score (corresponding to reduced negative impact of cardiac disease on quality of life) between the preoperative timepoint and all postoperative timepoints. A significant decrease in total score was also demonstrated between the 1- and 3-month timepoints, but no additional significant changes in total score between adjacent timepoints were identified beyond 3 months after surgery. Significant improvements in individual question scores were found up to 12 months after surgery. CLINICAL RELEVANCE Health-related quality of life was significantly improved following mitral valve repair in dogs with myxomatous mitral valve disease and this improvement persisted for up to a year after surgery. These results may be useful when counseling owners of dogs considered candidates for this procedure.
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Affiliation(s)
- Catrina Pennington
- 1Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Wirral, UK
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Udomkiattikul J, Kirdratanasak N, Siritianwanitchakul P, Worapunyaanun W, Surachetpong SD. Factors related to survival time in dogs with pulmonary hypertension secondary to degenerative mitral valve disease stage C. Int J Vet Sci Med 2022; 10:25-32. [PMID: 35573138 PMCID: PMC9068001 DOI: 10.1080/23144599.2022.2067630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/05/2022] [Accepted: 04/09/2022] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hypertension (PH) is a common complication in dogs with degenerative mitral valve disease (DMVD). The aim of this study was to determine the survival time and to determine factors related to the survival time of dogs with PH secondary to DMVD stage C. A retrospective study was conducted in 37 dogs with PH secondary to DMVD stage C to analyse the median survival time and associated factors such as age, sex, breed, body weight, the presence of syncope, heart rate, systolic blood pressure, manifestation of congestive heart failure (CHF), vertebral heart score (VHS), the presence of left or right heart enlargement, probability of PH and medication. Data were analysed using the Log-Rank test and plotted with the Kaplan-Meier curve. The results showed that the median survival time of dogs with PH secondary to DMVD stage C was 368 days, and factors that shortened the median survival time of dogs with PH secondary to DMVD stage C were mixed breeds, VHS > 11.5, the presence of right heart enlargement, ascites and high probability of PH. Factors associated with an increased hazard of death were mixed breed dogs, dogs with right heart enlargement and ascites. These findings may be useful for the prognosis and management of dogs with PH secondary to DMVD stage C.
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Affiliation(s)
- Jutamas Udomkiattikul
- Department of Veterinary Medicine, Faculty of Veterinary Science, Chulalongkorn University,Pathumwan, Thailand
| | - Noppasorn Kirdratanasak
- Department of Veterinary Medicine, Faculty of Veterinary Science, Chulalongkorn University,Pathumwan, Thailand
| | | | - Wasaporn Worapunyaanun
- Department of Veterinary Medicine, Faculty of Veterinary Science, Chulalongkorn University,Pathumwan, Thailand
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Noordin N, Khor KH, Khor KS, Lim YJ, Lee YC. Dog Owners’ Perspectives on Canine Heart Disease in Klang Valley, Malaysia. Animals (Basel) 2022; 12:ani12080985. [PMID: 35454232 PMCID: PMC9032639 DOI: 10.3390/ani12080985] [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: 12/19/2021] [Revised: 02/23/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Heart disease is a common chronic illness among dogs that often requires long-term treatment. This study investigated owners’ awareness and knowledge about canine heart disease, followed by their intention to treat with respect to the Theory of Planned Behavior. The attitude, subjective norm, and perceived behavioral control (PBC) in predicting dog owners’ intention to treat canine heart disease, with empathy as moderator, was analyzed. The majority of dog owners have a high awareness of the disease denoted by their ability to identify 5 to 8 out of 12 common clinical signs. Although seeking treatment is a common effort by dog owners, the cost was the barrier that curtailed their intention. If dog owners improve their attitudes, receive support from spouses and other family members, and increase their confidence in managing their pets, this can increase the pursuance of heart disease treatment. Owners with low empathic concern can be motivated to treat by cultivating perceived behavioral control. Therefore, continuous education may improve owners’ preconceived ability to provide care, and veterinarians may play an essential role in encouraging treatment in dogs diagnosed with heart disease. Abstract Canine heart disease often requires long-term treatment, which involves a continuous commitment from the dog owners. In addition to investigating their awareness and knowledge, the Theory of Planned Behavior was applied to also analyze attitude, subjective norm, and perceived behavioral control (PBC) of the dog owners, with empathic concern as a moderator in predicting intention to treat canine heart disease. Through a convenience sampling approach, 261 respondents, who were clients of University Veterinary Hospital, Universiti Putra Malaysia (UVH-UPM), with experience in owning or caring for dogs, were recruited. While the majority of the respondents (83.5%) claimed that they were aware of canine heart disease, most respondents (45.6%) could only identify 5 to 8 (Fair) out of 12 of the salient clinical signs. Most dog owners (92.3%) were willing to seek treatment if the pet dogs were affected, although the intent is deterred by cost (39.5%). In this study, attitude, subjective norms, and perceived behavioral control were significant predictors for the intention to treat. Dog owners with low empathic concern can be motivated to treat affected dogs by cultivating perceived behavioral control. Therefore, continual education may improve dog owners’ preconceived ability to provide care, and veterinarians may play an important role to encourage treatment in dogs diagnosed with heart disease.
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Affiliation(s)
- Norhidayah Noordin
- Faculty of Veterinary Medicine, Universiti Malaysia Kelantan, City Campus Pengkalan Chepa, Kota Bharu 16100, Kelantan, Malaysia;
- Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, Universiti Putra Malaysia, UPM, Serdang 43400, Selangor, Malaysia; (Y.J.L.); (Y.C.L.)
| | - Kuan Hua Khor
- Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, Universiti Putra Malaysia, UPM, Serdang 43400, Selangor, Malaysia; (Y.J.L.); (Y.C.L.)
- Correspondence: ; Tel.: +603-9769-3926; Fax: +603-8947-1971
| | - Kuan Siew Khor
- Department of Management, Sunway University Business School, Petaling Jaya 47500, Selangor, Malaysia;
| | - Yi Jun Lim
- Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, Universiti Putra Malaysia, UPM, Serdang 43400, Selangor, Malaysia; (Y.J.L.); (Y.C.L.)
| | - Yong Chong Lee
- Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, Universiti Putra Malaysia, UPM, Serdang 43400, Selangor, Malaysia; (Y.J.L.); (Y.C.L.)
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Bagardi M, Zamboni V, Locatelli C, Galizzi A, Ghilardi S, Brambilla PG. Management of Chronic Congestive Heart Failure Caused by Myxomatous Mitral Valve Disease in Dogs: A Narrative Review from 1970 to 2020. Animals (Basel) 2022; 12:ani12020209. [PMID: 35049831 PMCID: PMC8773235 DOI: 10.3390/ani12020209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Myxomatous mitral valve disease (MMVD) is the most common acquired cardiovascular disease in dogs. The progression of the disease and the increasing severity of valvular regurgitation cause a volume overload of the left heart, leading to left atrial and ventricular remodeling and congestive heart failure (CHF). The treatment of chronic CHF secondary to MMVD in dogs has not always been the same over time. In the last fifty years, the drugs utilized have considerably changed, as well as the therapeutic protocols. Some drugs have also changed their intended use. An analysis of the literature concerning the therapy of chronic heart failure in dogs affected by this widespread degenerative disease is not available; a synthesis of the published literature on this topic and a description of its current state of art are needed. To the authors’ knowledge, a review of this topic has never been published in veterinary medicine; therefore, the aim of this study is to overview the treatments of chronic CHF secondary to MMVD in dogs from 1970 to 2020 using the general framework of narrative reviews. Abstract The treatment of chronic congestive heart failure (CHF), secondary to myxomatous mitral valve disease (MMVD) in dogs, has considerably changed in the last fifty years. An analysis of the literature concerning the therapy of chronic CHF in dogs affected by MMVD is not available, and it is needed. Narrative reviews (NRs) are aimed at identifying and summarizing what has been previously published, avoiding duplications, and seeking new study areas that have not yet been addressed. The most accessible open-access databases, PubMed, Embase, and Google Scholar, were chosen, and the searching time frame was set in five decades, from 1970 to 2020. The 384 selected studies were classified into categories depending on the aim of the study, the population target, the pathogenesis of MMVD (natural/induced), and the resulting CHF. Over the years, the types of studies have increased considerably in veterinary medicine. In particular, there have been 43 (24.29%) clinical trials, 41 (23.16%) randomized controlled trials, 10 (5.65%) cross-over trials, 40 (22.60%) reviews, 5 (2.82%) comparative studies, 17 (9.60%) case-control studies, 2 (1.13%) cohort studies, 2 (1.13%) experimental studies, 2 (1.13%) questionnaires, 6 (3.40%) case-reports, 7 (3.95%) retrospective studies, and 2 (1.13%) guidelines. The experimental studies on dogs with an induced form of the disease were less numerous (49–27.68%) than the studies on dogs affected by spontaneous MMVD (128–72.32%). The therapy of chronic CHF in dogs has considerably changed in the last fifty years: in the last century, some of the currently prescribed drugs did not exist yet, while others had different indications.
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Giraud L, Rodrigues NF, Lekane M, Farnir F, Kennedy C, Gommeren K, Merveille AC. Caudal vena cava point-of-care ultrasound in dogs with degenerative mitral valve disease without clinically important right heart disease. J Vet Cardiol 2022; 41:18-29. [DOI: 10.1016/j.jvc.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/25/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
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DeProspero DJ, O'Donnell KA, DeFrancesco TC, Keene BW, Tou SP, Adin DB, Atkins CE, Meurs KM. Myxomatous mitral valve disease in Miniature Schnauzers and Yorkshire Terriers: 134 cases (2007-2016). J Am Vet Med Assoc 2021; 259:1428-1432. [PMID: 34757932 DOI: 10.2460/javma.20.05.0291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize features of myxomatous mitral valve disease (MMVD) in Miniature Schnauzers and Yorkshire Terriers. ANIMALS 69 Miniature Schnauzers and 65 Yorkshire Terriers, each with MMVD. PROCEDURES Medical record data for each dog were collected; the study period was January 2007 through December 2016. If available, radiographic data were evaluated, and a vertebral heart scale score was assigned for each dog. Statistical analysis was performed with Student t and Fisher exact tests. RESULTS Compared with Yorkshire Terriers, the prevalence of MMVD was significantly higher in Miniature Schnauzers and affected dogs were significantly younger at the time of diagnosis. Miniature Schnauzers were significantly more likely to have mitral valve prolapse and syncope, compared with Yorkshire Terriers. Yorkshire Terriers were significantly more likely to have coughing and have had previous or current treatment with cardiac medications, compared with Miniature Schnauzers. There was no statistical difference between breeds with regard to abnormally high vertebral heart scale scores or radiographic evidence of congestive heart failure. CONCLUSIONS AND CLINICAL RELEVANCE With regard to MMVD, features of the disease among Miniature Schnauzers and Yorkshire Terriers were similar, but there were also a few discernable differences between these 2 breeds and from historical findings for dogs with MMVD of other breeds. Clinical signs at the time of diagnosis differed between the 2 breeds, which may have reflected concurrent breed-specific conditions (sick sinus syndrome or airway disease [eg, tracheal collapse]). Future work should include prospective studies to provide additional information regarding the natural progression of MMVD in these dog breeds.
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Affiliation(s)
- Dylan J DeProspero
- From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695
| | - Kerry A O'Donnell
- From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695
| | - Teresa C DeFrancesco
- From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695
| | - Bruce W Keene
- From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695
| | - Sandra P Tou
- From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695
| | - Darcy B Adin
- From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695
| | - Clarke E Atkins
- From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695
| | - Kathryn M Meurs
- From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695
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Adin D, Atkins C, Londoño L, Del Nero B. Correction of serum chloride concentration in dogs with congestive heart failure. J Vet Intern Med 2020; 35:51-57. [PMID: 33305873 PMCID: PMC7848309 DOI: 10.1111/jvim.15998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 12/03/2022] Open
Abstract
Background Hypochloremia associated with congestive heart failure (CHF) in dogs is likely multifactorial. Loop diuretics cause 1:2 sodium [Na+]:chloride [Cl−] loss, whereas water retention causes a 1:1 [Na+]:[Cl−] dilution. Mathematical [Cl−] correction separates these effects on [Cl−]. Hypothesis We hypothesized that corrected [Cl−] (c[Cl−]) would not differ from measured [Cl−] (m[Cl−]) in dogs with controlled CHF because of loop diuretics, and dogs with refractory CHF would have higher c[Cl−] than m[Cl−], indicating relative water excess. Animals Seventy‐one client‐owned dogs with acquired heart disease, without CHF (NO‐CHF), 76 with Stage C CHF and 24 with Stage D CHF. Methods Clinicopathological data from a previous study were retrospectively analyzed. Corrected [Cl−], m[Cl−], and differences were compared among NO‐CHF, Stage C CHF, and Stage D CHF, using the formula: c[Cl−] = (mid‐reference range [Na+]/measured [Na+]) × m[Cl−]. Results Corrected [Cl−] and m[Cl−] were lower in Stage D vs Stage C and NO‐CHF (all P < .0001). The c[Cl−] was higher than m[Cl−] in Stage D (P < .0001) but not Stage C or NO‐CHF. Median difference between c[Cl−] and m[Cl−] was higher for Stage D vs Stage C (P = .0003). No hypochloremic Stage D dogs had normal c[Cl−], but 11/24 had [Cl−] that was increased by >2 mmol/L. Conclusions and Clinical Importance Serum [Cl−] increased after mathematical correction in Stage D CHF dogs but not in Stage C and NO‐CHF dogs. Although c[Cl−] was higher than m[Cl−] in Stage D dogs supportive of relative water excess, hypochloremia persisted, consistent with concurrent loop diuretic effects on electrolytes. Future study correlating c[Cl−] to antidiuretic hormone concentrations is warranted.
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Affiliation(s)
- Darcy Adin
- University of Florida, College of Veterinary Medicine, Gainesville, Florida, USA
| | - Clarke Atkins
- North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Leonel Londoño
- University of Florida, College of Veterinary Medicine, Gainesville, Florida, USA
| | - Bruna Del Nero
- University of Florida, College of Veterinary Medicine, Gainesville, Florida, USA
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Rubio CP, Saril A, Kocaturk M, Tanaka R, Koch J, Ceron JJ, Yilmaz Z. Changes of inflammatory and oxidative stress biomarkers in dogs with different stages of heart failure. BMC Vet Res 2020; 16:433. [PMID: 33167963 PMCID: PMC7654180 DOI: 10.1186/s12917-020-02650-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/28/2020] [Indexed: 12/22/2022] Open
Abstract
Background Heart failure (HF) is associated with changes in inflammatory and oxidative stress biomarkers. This study aimed to evaluate the changes of a panel of inflammatory and oxidative stress biomarkers in dogs with different stages of HF and its relation with the severity of the disease and echocardiographic changes. A total of 29 dogs with HF as a result of myxomatous mitral valve degeneration or dilated cardiomyopathy were included and classified as stage-A (healthy), B (asymptomatic dogs), C (symptomatic dogs) and D (dogs with end-stage HF) according to the ACVIM staging system. In these dogs an ecnhocardiographic examination was performed and cytokines, and inflammatory and oxidative stress markers were evaluated in serum. Results KC-like was significantly increased in dogs of stage-C (P < 0.01) and -D (P < 0.05) compared with stage-A and -B. Stage-D dogs showed significantly higher serum CRP and Hp (P < 0.05) but lower serum antioxidant capacity (PON1, TEAC, CUPRAC, and thiol) compared to stage-A and -B (P < 0.05). After the treatment, serum levels of CRP, Hp and KC-like decreased and serum antioxidant levels increased compared to their pre-treatment values. Left ventricular dimension and LA/Ao ratio correlated positively with CRP, MCP-1, and KC-like but negatively with PON1, GM-CSF, IL-7 and antioxidant biomarkers (P < 0.01). Conclusion Our results showed that dogs with advanced HF show increases in positive acute-phase proteins and selected inflammatory cytokines such as KC-like, and decreases in antioxidant biomarkers, indicating that inflammation and oxidative stress act as collaborative partners in the pathogenesis of HF. Some of these biomarkers of inflammation and oxidative stress could have the potential to be biomarkers to monitor the severity of the disease and the effect of treatment.
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Affiliation(s)
- Camila Peres Rubio
- Interdisciplinary Laboratory of Clinical Pathology, Interlab-UMU, University of Murcia, 30100, Murcia, Spain
| | - Ahmet Saril
- Department of Internal Medicine, Faculty of Veterinary Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Meriç Kocaturk
- Department of Internal Medicine, Faculty of Veterinary Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Ryou Tanaka
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, 183-8509, Japan
| | - Jorgen Koch
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg - Copenhagen, Denmark
| | - Jose Joaquin Ceron
- Interdisciplinary Laboratory of Clinical Pathology, Interlab-UMU, University of Murcia, 30100, Murcia, Spain
| | - Zeki Yilmaz
- Department of Internal Medicine, Faculty of Veterinary Medicine, Bursa Uludag University, 16059, Bursa, Turkey.
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Sasaki K, Yamamoto S, Mutoh T. Noninvasive assessment of fluid responsiveness for emergency abdominal surgery in dogs with pulmonary hypertension: Insights into high-risk companion animal anesthesia. PLoS One 2020; 15:e0241234. [PMID: 33095826 PMCID: PMC7584187 DOI: 10.1371/journal.pone.0241234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/11/2020] [Indexed: 11/19/2022] Open
Abstract
Objective Optimizing cardiac stroke volume during high-risk surgical anesthesia is of particular interest with regard to a therapeutic target to reduce the incidence of postoperative complications. However, intensive fluid management in critically ill small animals with pulmonary hypertension (PH) has been empirically performed, and thus it can be challenging. Stroke volume variation (SVV) has been used as a dynamic preload predictor of fluid responsiveness. We hypothesized that if SVV exhibited robust reliability in the setting of hemodynamically unstable condition, it would provide more precise information on fluid resuscitation to translate it into veterinary anesthesia. Thus the aim of this study was to investigate the utility of SVV measured by the electrical velocimetry (EV) method for predicting fluid responsiveness in dogs with PH. Methods Sixteen dogs undergoing emergency abdominal surgery and diagnosed with PH secondary to myxomatous mitral valve disease (MMVD) on preoperative transthoracic echocardiogram were included. Dogs were randomly assigned to 2 groups with and without inotropic cardiac support with dobutamine. Hemodynamic measurements including stroke volume and SVV derived from the EV device were performed under general anesthesia before (baseline) and after surgery (fluid challenge with a colloid solution defined by a SV increase of ≥ 10%). Results In both groups, SVV elevated significantly after abdominal surgery compared with baseline. In dobutamine infused group, the SVV values decreased significantly after fluid challenge (P < 0.05) with a greater number of responders than saline infused control group (P < 0.01). Receiver operating curve analysis of SVV confirmed high positive predictive value for dogs during dobutamine infusion (P < 0.05; cut-off value of 15%; specificity 90%, sensitivity 82%). Conclusions Noninvasive EV monitoring may be useful for the prediction of fluid responsiveness in critically ill dogs with left-sided heart failure-related PH. This normalization of dynamic preload indices, which could be achieved more precisely under inotropic support, may prevent further detrimental consequence of fluid loading.
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Affiliation(s)
- Kazumasu Sasaki
- Small Animal Emergency and Critical Care Service, Sendai Animal Care and Research Center, Sendai, Japan
- Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Shuzo Yamamoto
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Tatsushi Mutoh
- Small Animal Emergency and Critical Care Service, Sendai Animal Care and Research Center, Sendai, Japan
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
- * E-mail:
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13
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Santiago SL, Freeman LM, Rush JE. Cardiac cachexia in cats with congestive heart failure: Prevalence and clinical, laboratory, and survival findings. J Vet Intern Med 2019; 34:35-44. [PMID: 31837182 PMCID: PMC6979101 DOI: 10.1111/jvim.15672] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/13/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cardiac cachexia is common in people and dogs with congestive heart failure (CHF). However, the prevalence and effects of cardiac cachexia in cats are unknown. OBJECTIVES To determine the prevalence of cachexia and its associations with clinical laboratory and survival data in cats with CHF. ANIMALS One hundred twenty-five cats with CHF. METHODS Medical records of cats evaluated during a 40-month period were retrospectively reviewed to identify cats with cardiac cachexia using 7 different definitions. Clinical, laboratory, and survival data were compared between cats with and without cachexia. RESULTS Prevalence of cachexia ranged from 0 to 66.7% for the 7 definitions, with a prevalence of 41.6% using muscle condition score (MCS). Cats with cachexia (determined by MCS) were older (P < .001), more likely to have pleural effusion (P = .003), had significantly higher blood urea nitrogen (P < .001) and neutrophil concentrations (P = .01), and significantly lower body condition score (P < .001), body weights (P < .001), hematocrit (P = .007), and hemoglobin concentrations (P = .009). Survival time for cats with cachexia (determined by MCS) was significantly shorter than for cats without cachexia (P = .03). Cats that were underweight (P = .002) and cats with dilated cardiomyopathy (DCM) also had shorter survival times (P = .04). CONCLUSIONS AND CLINICAL IMPORTANCE The association between cachexia and reduced survival time emphasizes the importance of identifying and addressing this common problem in cats with CHF.
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Affiliation(s)
- Sasha L Santiago
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - Lisa M Freeman
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - John E Rush
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
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14
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Adin D, Kurtz K, Atkins C, Papich MG, Vaden S. Role of electrolyte concentrations and renin-angiotensin-aldosterone activation in the staging of canine heart disease. J Vet Intern Med 2019; 34:53-64. [PMID: 31769114 PMCID: PMC6979094 DOI: 10.1111/jvim.15662] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 10/29/2019] [Indexed: 11/28/2022] Open
Abstract
Background Refractory congestive heart failure (CHF) and associated diuretic resistance are not well defined. Objectives To characterize renal function, electrolyte concentrations, indices of diuretic efficacy, and renin‐angiotensin‐aldosterone system (RAAS) activation in dogs with naturally occurring heart disease (HD) in American College of Veterinary Internal Medicine stages B1, B2, C, and D and to determine their usefulness in defining HD stages. Animals Group 1:149 dogs with HD stages B1, B2, C, and D. Group 2:22 dogs with HD stages C and D. Methods Group 1: Renal parameters, serum and urine electrolyte and diuretic concentrations, and urine aldosterone concentrations were measured. Medication dosages and measured variables were compared among stages. Correlation of furosemide dosages to serum concentrations was explored. Group 2: Angiotensin‐converting enzyme activity and RAAS components were measured and compared among CHF stages. Results Serum chloride concentration was the best differentiator of HD stage. Furosemide PO dosages (≤6 mg/kg/day) were weakly correlated with serum furosemide concentrations, whereas higher dosages were not significantly correlated. Angiotensin‐converting enzyme inhibitor dosage and RAAS inhibition were greater in stage D, compared to stage C dogs. Conclusions and Clinical Importance Hypochloremia is a useful marker for stage D HD in dogs. Poor furosemide dosage correlation to serum concentration may indicate variable and poor absorption, especially at higher dosages, advanced disease, or both. A small number of stage D dogs met proposed criteria for diuretic resistance. Greater RAAS inhibition in stage D versus stage C indicates effectiveness of RAAS‐suppressive treatments in this group of dogs with refractory CHF.
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Affiliation(s)
- Darcy Adin
- College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Kari Kurtz
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Clarke Atkins
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Mark G Papich
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Shelly Vaden
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
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15
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Ineson DL, Freeman LM, Rush JE. Clinical and laboratory findings and survival time associated with cardiac cachexia in dogs with congestive heart failure. J Vet Intern Med 2019; 33:1902-1908. [PMID: 31317600 PMCID: PMC6766489 DOI: 10.1111/jvim.15566] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 07/01/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiac cachexia, loss of muscle mass associated with congestive heart failure (CHF), is associated with increased morbidity and shorter survival times in people, but an association between cardiac cachexia and survival has not been reported in dogs. OBJECTIVES To determine the prevalence of cachexia and its associations with clinical, laboratory, and survival data in dogs with CHF. ANIMALS Two hundred sixty-nine dogs with CHF. METHODS Retrospective cohort study. Cachexia was defined by 1 of 2 definitions: (1) mild, moderate, or severe muscle loss or (2) weight loss of ≥5% in 12 months or less. Variables were compared between dogs with and without cachexia. RESULTS One hundred thirty of 269 dogs (48.3%) had cardiac cachexia based on muscle loss, whereas 67 of 159 dogs (42.1%) with pre-evaluation body weights had cachexia based on weight loss. Dogs with cachexia (based on muscle loss) were significantly older (P = .05), more likely to have a cardiac arrhythmia (P = .02), had higher chloride concentrations (P = .04), and had a lower body condition score (P < .001), hematocrit (P = .006), hemoglobin (P = .006), and albumin (P = .004) concentrations. On multivariable analysis, cachexia (P = .05), clinically important tachyarrhythmias (P < .001), azotemia (P < .001), and being under- or overweight (both P = .003) were associated with shorter survival times. CONCLUSIONS AND CLINICAL IMPORTANCE Cardiac cachexia in common in dogs with CHF and is associated with significantly shorter survival. This emphasizes the importance of preventing, diagnosing, and treating muscle loss in dogs with CHF.
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Affiliation(s)
- Deanna L Ineson
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - Lisa M Freeman
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - John E Rush
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
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16
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Beaumier A, Rush JE, Yang VK, Freeman LM. Clinical findings and survival time in dogs with advanced heart failure. J Vet Intern Med 2018; 32:944-950. [PMID: 29635788 PMCID: PMC5980388 DOI: 10.1111/jvim.15126] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 02/21/2018] [Accepted: 03/05/2018] [Indexed: 12/02/2022] Open
Abstract
Background Dogs with advanced heart failure are a clinical challenge for veterinarians but there are no studies reporting clinical features and outcome of this population. Hypothesis/Objectives To describe clinical findings and outcome of dogs with advanced heart failure caused by degenerative mitral valve disease (DMVD). Animals Fifty‐four dogs with advanced heart failure because of DMVD. Methods For study purposes, advanced heart failure was defined as recurrence of congestive heart failure signs despite receiving the initially prescribed dose of pimobendan, angiotensin‐converting‐enzyme inhibitor (ACEI), and furosemide >4 mg/kg/day. Data were collected for the time of diagnosis of Stage C heart failure and time of diagnosis of advanced heart failure. Date of death was recorded. Results At the diagnosis of advanced heart failure, doses of pimobendan (n = 30), furosemide (n = 28), ACEI (n = 13), and spironolactone (n = 4) were increased, with ≥1 new medications added in most dogs. After initial diagnosis of advanced heart failure, 38 (70%) dogs had additional medications adjustments (median = 2 [range, 0‐27]), with the final total medication number ranging from 2‐10 (median = 5). Median survival time after diagnosis of advanced heart failure was 281 days (range, 3‐885 days). Dogs receiving a furosemide dose >6.70 mg/kg/day had significantly longer median survival times (402 days [range, 3‐885 days] versus 129 days [range 9‐853 days]; P = .017). Conclusions and Clinical Importance Dogs with advanced heart failure can have relatively long survival times. Higher furosemide dose and non‐hospitalization were associated with longer survival.
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Affiliation(s)
- Amelie Beaumier
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - John E Rush
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Vicky K Yang
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Lisa M Freeman
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
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