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Välimäki E, Leppänen H, Turunen H, Raekallio M, Honkavaara J. The impact of intravenous medetomidine and vatinoxan on echocardiographic evaluation of dogs with stage B1 mitral valve disease. J Vet Cardiol 2024; 54:7-17. [PMID: 38838577 DOI: 10.1016/j.jvc.2024.04.003] [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: 05/07/2023] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION/OBJECTIVE The purpose of this study was to investigate the echocardiographic effects of intravenous medetomidine and vatinoxan in dogs with stage B1 mitral valve disease. We hypothesised medetomidine-vatinoxan would reduce the need for manual restraint during echocardiography without producing detrimental cardiovascular effects or echocardiographic changes. ANIMALS Twelve client-owned dogs with stage B1 mitral valve disease. METHODS A transthoracic echocardiographic examination was performed before and after sedation with intravenous medetomidine (10 μg/kg) and vatinoxan (200 μg/kg). Vital parameters were also recorded, and the level of sedation was assessed subjectively. The data were analysed with Student's t-tests with an alpha level of <0.05. RESULTS End-systolic volume and left ventricular systolic diameter increased (from 0.89 ± 0.19 mL/kg to 1.13 ± 0.29 mL/kg and 0.96 ± 0.12 cm to 1.10 ± 0.10 cm, respectively) and ejection fraction (from 66.33 ± 4.0% to 56.23 ± 9.54%) and fractional shortening (from 36.13 ± 5.42% to 27.24 ± 5.6%) decreased significantly after sedation. End diastolic volume, left ventricular diastolic diameter, and left atrial size remained statistically unchanged, while aortic (from 1.34 ± 0.2 m/s to 0.99 ± 0.14 m/s) and pulmonic (from 0.94 ± 0.16 m/s to 0.66 ± 0.15 m/s) velocities decreased significantly. No dogs had a mean arterial pressure below 65 mmHg. Sedation enabled echocardiographic examination without manual restraint. No adverse effects were observed with the dose studied. CONCLUSIONS Echocardiographic parameters were not completely comparable with the baseline values, which should be taken into consideration when evaluating dogs sedated with intravenous medetomidine-vatinoxan.
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Affiliation(s)
- E Välimäki
- Evidensia Animal Hospital Tammisto, Tammiston Kauppatie 29, 01510 Vantaa, Finland.
| | - H Leppänen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, PO Box 57, 00014, Finland
| | - H Turunen
- Vetcare Ltd, Liedontie 45 (PL 26) 04601 Mäntsälä, Finland
| | - M Raekallio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, PO Box 57, 00014, Finland
| | - J Honkavaara
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, PO Box 57, 00014, Finland
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Huh T, Achilles EJ, Massey LK, Loughran KA, Larouche‐Lebel É, Convey V, McKaba VF, Crooks A, Kraus MS, Gelzer AR, Oyama MA. Utility of focused cardiac ultrasonography training in veterinary students to differentiate stages of subclinical myxomatous mitral valve disease in dogs. J Vet Intern Med 2024; 38:1325-1333. [PMID: 38532734 PMCID: PMC11099716 DOI: 10.1111/jvim.17056] [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: 10/13/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Differentiation of the subclinical phases of myxomatous mitral valve disease (MMVD) in dogs relies heavily on echocardiography. Focused cardiac ultrasonography (FCU) is a point-of-care technique that can assess heart size. HYPOTHESIS/OBJECTIVES Veterinary students trained in FCU can differentiate dogs with subclinical MMVD based on left ventricular (LV) and left atrial (LA) dimensions. ANIMALS Forty-eight dogs with subclinical MMVD. METHODS Veterinary students were trained to measure LV dimension and LA-to-aortic root dimension ratio (LA : Ao) using FCU. Dogs were categorized into 2 cohorts based on whether or not the LV normalized internal diastolic dimension was ≥1.7 and LA : Ao was ≥1.6. Agreement between FCU and echocardiographic studies performed by cardiologists was evaluated. RESULTS One-hundred and forty-six FCU examinations were performed by 58 veterinary students on 48 dogs. Overall agreement between students and cardiologists was moderate (Fleiss' kappa, 0.54; 95% confidence interval [CI], 0.39-0.69; P < .001). Percentage accuracy in observations with heart dimensions less than the cutoffs (86/89, 97%) was significantly higher than in observations in with larger hearts (31/57, 54%; P < .001). Agreement increased from moderate to good as heart sizes became more extreme. Degree of confidence by students in performing FCU was significantly higher at the end vs start of the study. CONCLUSIONS AND CLINICAL IMPORTANCE Categorization of dogs with subclinical MMVD by veterinary students using FCU was associated with moderate to good agreement with echocardiography. Focused cardiac ultrasonography is a point-of-care method that can help assess clinical stage in dogs with subclinical MMVD.
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Affiliation(s)
- Terry Huh
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Erin J. Achilles
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Laura K. Massey
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kerry A. Loughran
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Éva Larouche‐Lebel
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Victoria Convey
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Victoria F. McKaba
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Alexandra Crooks
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Marc S. Kraus
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Anna R. Gelzer
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Mark A. Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Chetboul V, Poissonnier C, Foulex P, Alvarado MP, Trehiou-Sechi É, Saponaro V, Passavin P, Desquilbet L. Volumetric quantification identifies some left atrial dilations undetected by left atrium:aorta ratio measurements: A prospective echocardiographic study in 155 Cavalier King Charles Spaniels with and without degenerative mitral valve disease. PLoS One 2024; 19:e0300827. [PMID: 38547236 PMCID: PMC10977888 DOI: 10.1371/journal.pone.0300827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/05/2024] [Indexed: 04/01/2024] Open
Abstract
INTRODUCTION Degenerative mitral valve disease (DMVD) is the most common canine heart disease with a high predisposition in Cavalier King Charles Spaniels (CKCSs). Mitral regurgitation related to DMVD can lead to left atrial (LA) dilation, which is associated with survival time. Left-atrial-to-aortic (LA:Ao) ratio assessed by two-dimensional echocardiography is commonly used to evaluate LA size. The objectives of this prospective observational study were therefore 1) to compare different echocardiographic methods (i.e., monoplane and biplane Simpson's methods of discs (SMOD) and area-length methods (ALM)) in evaluating LA volume (LAvol) in CKCSs, 2) to assess LA volumes according to DMVD severity and, 3) compare the ability of LAvol and LA:Ao ratio to identify LA enlargement in CKCSs with subclinical DMVD (i.e., American College of Veterinary Internal Medicine (ACVIM) stage B). MATERIALS AND METHODS 155 CKCSs, either healthy or affected by DMVD, were recruited. Variability and concordance between volumetric methods were evaluated. Values were analyzed according to 2019 ACVIM stages. RESULTS All Lin's concordance correlation coefficients regarding intra- and inter-observer variability were considered as very good to excellent. Monoplane methods and ALM produced higher values of LAvol than biplane methods and SMOD, respectively. The upper limit of normal end-systolic LAvol/body weight (LASvol/BW) was defined as 0.90 mL/kg. Left atrial volumes significantly increased with ACVIM stages. Additionally, 37% of stage B1 CKCSs demonstrated LA enlargement using LASvol/BW assessment, with significantly lower LASvol/BW values in dogs with regurgitation fraction ≤30% than in others (p<0.01). CONCLUSION In CKCSs, LAvol methods are not interchangeable. In ACVIM stage B CKCSs, LAvol quantification is more effective to detect LA enlargement than LA linear measurements.
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Affiliation(s)
- Valérie Chetboul
- École Nationale Vétérinaire d’Alfort, CHUVA, Unité de Cardiologie d’Alfort (UCA), Maisons-Alfort, France
- INSERM, IMRB, Univ Paris Est Créteil, Créteil, France
| | - Camille Poissonnier
- École Nationale Vétérinaire d’Alfort, CHUVA, Unité de Cardiologie d’Alfort (UCA), Maisons-Alfort, France
| | - Pierre Foulex
- École Nationale Vétérinaire d’Alfort, CHUVA, Unité de Cardiologie d’Alfort (UCA), Maisons-Alfort, France
| | - Maria Paz Alvarado
- École Nationale Vétérinaire d’Alfort, CHUVA, Unité de Cardiologie d’Alfort (UCA), Maisons-Alfort, France
| | - Émilie Trehiou-Sechi
- École Nationale Vétérinaire d’Alfort, CHUVA, Unité de Cardiologie d’Alfort (UCA), Maisons-Alfort, France
| | - Vittorio Saponaro
- École Nationale Vétérinaire d’Alfort, CHUVA, Unité de Cardiologie d’Alfort (UCA), Maisons-Alfort, France
| | - Peggy Passavin
- École Nationale Vétérinaire d’Alfort, CHUVA, Unité de Cardiologie d’Alfort (UCA), Maisons-Alfort, France
| | - Loïc Desquilbet
- INSERM, IMRB, Univ Paris Est Créteil, Créteil, France
- Department of Biostatistics and Clinical Epidemiology, École Nationale Vétérinaire d’Alfort, Maisons-Alfort, France
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Zhou Q, Cui X, Zhou H, Guo S, Wu Z, Li L, Zhang J, Feng W, Guo Y, Ma X, Chen Y, Qiu C, Xu M, Deng G. Differentially expressed platelet activation-related genes in dogs with stage B2 myxomatous mitral valve disease. BMC Vet Res 2023; 19:271. [PMID: 38087280 PMCID: PMC10717932 DOI: 10.1186/s12917-023-03789-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Peripheral blood carries a reservoir of mRNAs that regulate cardiac structure and function potential. Although it is well recognized that the typical symptoms of Myxomatous Mitral Valve Disease (MMVD) stage B2 are long-standing hemodynamic disorder and cardiac structure remodeling caused by mitral regurgitation, the transcriptomic alterations in blood from such dogs are not understood. RESULTS In the present study, comparative high-throughput transcriptomic profiling of blood was performed from normal control (NC) and naturally-occurring MMVD stage B2 (MMVD) dogs. Using Weighted Gene Co-expression Network Analyses (WGCNA), Gene Ontology (GO), and Kyoto Encyclopedia of Gene and Genomes (KEGG), we identified that the turquoise module was the most highly correlated with echocardiographic features and found 64 differentially expressed genes (DEGs) that were significantly enriched in platelet activation related pathways. Therefore, from the turquoise module, we selected five DEGs (MDM2, ROCK1, RIPK1, SNAP23, and ARHGAP35) that, according to real-time qPCR, exhibited significant enrichment in platelet activation related pathways for validation. The results showed that the blood transcriptional abundance of MDM2, ROCK1, RIPK1, and SNAP23 differed significantly (P < 0.01) between NC and MMVD dogs. On the other hand, Correlation Analysis revealed that MDM2, ROCK1, RIPK1, and SNAP23 genes negatively regulated the heart structure parameters, and followed the same trend as observed in WGCNA. CONCLUSION We screened four platelet activation related genes, MDM2, ROCK1, RIPK1, and SNAP23, which may be considered as the candidate biomarkers for the diagnosis of MMVD stage B2. These findings provided new insights into MMVD pathogenesis.
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Affiliation(s)
- Qingqing Zhou
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Xiang Cui
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Han Zhou
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Shuai Guo
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Zhimin Wu
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Liyang Li
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Jinxin Zhang
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Wen Feng
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Yingfang Guo
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Xiaofei Ma
- Department of Clinical Animal Medicine, College of Veterinary Medicine, Gansu Agricultural University, Lanzhou, 730070, China
| | - Yu Chen
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Changwei Qiu
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Ming Xu
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China.
| | - Ganzhen Deng
- Department of Clinical Animal Medicine, College of Animal Medicine, Huazhong Agricultural University, Wuhan, 430070, China.
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Ghilardi S, Pradelli D, Rizzi R, Polli M, Bagardi M, Santilli RA, Brambilla PG, Bussadori CM. A study of the inter- and intra-operator variability on selected echocardiographic measurements in dogs. Vet Res Commun 2023; 47:2323-2331. [PMID: 37351815 DOI: 10.1007/s11259-023-10154-6] [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: 04/26/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
Standard transthoracic echocardiography is considered the non-invasive gold standard for the diagnosis of most cardiac diseases. Defining reproducibility, repeatability, and reliability of this exam is imperative to reduce errors in clinical evaluations. The present study aimed at: (1) evaluating the reproducibility and repeatability of 15 echocardiographic parameters in dogs by analyzing measurements obtained from several operators with different levels of experience and comparing them to the ones obtained from two board-certified operators (gold standards - GSs); (2) assessing whether different formative paths have an influence on the variability of the echocardiographic measurements. Fifty-one operators have been included in this study, along with two diplomates of the European College of Veterinary Internal Medicine - Cardiology. Ten dogs were enrolled, 5 Golden Retrievers and 5 Cavalier King Charles Spaniels. Echocardiographic examination was performed on each dog by one GS and several operators on the same day. Results show the highest deviation from the GS and a poor inter-operator reproducibility for the M-mode measurements of the interventricular septum and the left ventricular free wall. Differently, M-mode-obtained internal diameters of the left ventricle in systole and diastole, and measurements of the aortic annulus and root show moderate to excellent intra- and inter-operator reliability and a good concordance with the GSs, demonstrating that all the operators correctly assess left ventricular systolic function and dilation, and evaluate the aortic valve. Furthermore, a specialist clinical activity, more than the acquired theoretical knowledge, affects the reliability of the echocardiographic examination by reducing the difference from the GS' measurements.
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Affiliation(s)
- Sara Ghilardi
- Department of Veterinary Medicine and Animal Sciences - DIVAS, University of Milan, Lodi, LO, 26900, Italy
- Department of Cardiology, Clinica Veterinaria Gran Sasso, Milan, MI, 20131, Italy
| | - Danitza Pradelli
- Department of Veterinary Medicine and Animal Sciences - DIVAS, University of Milan, Lodi, LO, 26900, Italy
- Department of Cardiology, Clinica Veterinaria Gran Sasso, Milan, MI, 20131, Italy
| | - Rita Rizzi
- Department of Veterinary Medicine and Animal Sciences - DIVAS, University of Milan, Lodi, LO, 26900, Italy
| | - Michele Polli
- Department of Veterinary Medicine and Animal Sciences - DIVAS, University of Milan, Lodi, LO, 26900, Italy.
| | - Mara Bagardi
- Department of Veterinary Medicine and Animal Sciences - DIVAS, University of Milan, Lodi, LO, 26900, Italy
| | - Roberto A Santilli
- Anicura Clinica Veterinaria Malpensa, Samarate, VA, 21017, Italy
- Department of Clinical Sciences, Cornell University, Ithaca, NY, 14853, USA
| | - Paola G Brambilla
- Department of Veterinary Medicine and Animal Sciences - DIVAS, University of Milan, Lodi, LO, 26900, Italy
| | - Claudio M Bussadori
- Department of Cardiology, Clinica Veterinaria Gran Sasso, Milan, MI, 20131, Italy
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6
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Oyama MA, Scansen BA, Boswood A, Goldfeder G, Rosenthal S, Cober R, LaFauci K, Friese RC, Gomes M, Chang YR, Li Q. Effect of a specially formulated diet on progression of heart enlargement in dogs with subclinical degenerative mitral valve disease. J Vet Intern Med 2023; 37:1323-1330. [PMID: 37392086 PMCID: PMC10365052 DOI: 10.1111/jvim.16796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/06/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Previous studies in dogs with degenerative mitral valve disease (DMVD) have identified altered myocardial energy metabolism and oxidation, which might contribute to cardiac hypertrophy. Diets rich in medium chain fatty acids and antioxidants are a potential means of treatment. A previous clinical study found significantly smaller left atrial diameter (LAD) and left atrium-to-aorta diameter ratio (LA : Ao) in dogs with subclinical DMVD fed a specially formulated diet vs control diet for 6 months. HYPOTHESIS/OBJECTIVES A specially formulated diet will slow or arrest left heart enlargement in dogs with subclinical DMVD over 365 days. ANIMALS One hundred twenty-seven dogs with unmedicated subclinical DMVD; 101 dogs in the per protocol cohort. METHODS Randomized double-blinded controlled multicenter clinical trial. RESULTS The study's primary composite outcome measure was the sum of percentage change in LAD and left ventricular internal dimension at end-diastole (LVIDd) at day 365. In the per protocol cohort, the outcome measure increased by 8.0% (95% confidence interval [CI], 2.9%-13.1%) in dogs receiving the test diet vs 8.8% (95% CI, 5.1%-12.5%) in dogs receiving control diet (P = .79). Neither component of the primary outcome measure was significantly different between groups (LAD, P = .65; LVIDd, P = .92). No difference was found in mitral valve E wave velocity (P = .36) or the proportion of dogs withdrawn from the study because of worsening DMVD and heart enlargement (P = .41). CONCLUSIONS AND CLINICAL IMPORTANCE Feeding a specially formulated diet for 365 days was not associated with a significantly different rate of change of left heart size in dogs with subclinical DMVD as compared to control.
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Affiliation(s)
- Mark A. Oyama
- School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Brian A. Scansen
- College of Veterinary Medicine & Biomedical SciencesColorado State UniversityFort CollinsColoradoUSA
| | | | | | | | | | | | - Ryan C. Friese
- College of Veterinary MedicineUniversity of IllinoisUrbana‐ChampaignIllinoisUSA
| | - Márcia Gomes
- School of Veterinary MedicineUniversity of São PauloSão PauloBrazil
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Ellis-Reis RE, Visser LC, Hsue W, Sharpe AN, Kaplan JL. Echocardiographic evaluation of regurgitant fraction in dogs with subclinical myxomatous mitral valve disease: Method comparison, effects of pimobendan, and reproducibility. J Vet Cardiol 2023; 45:27-40. [PMID: 36630740 DOI: 10.1016/j.jvc.2022.12.002] [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: 02/10/2022] [Revised: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION/OBJECTIVES To evaluate regurgitant fraction (RF) using Simpson's method of discs to estimate total stroke volume (RFSMOD_TSV) and using Motion-mode to estimate total stroke volume (RFM-modeTSV) in dogs with subclinical myxomatous mitral valve disease (MMVD). We also sought to evaluate the effects of pimobendan on RF, and to determine the reproducibility of RFSMOD_TSV and RFM-modeTSV. ANIMALS, MATERIALS, AND METHODS Echocardiography was performed on 57 dogs with MMVD (30 stage B1 and 27 stage B2). Ten dogs received pimobendan for 7-10 days and had a second echocardiogram. Nine dogs underwent six repeated echocardiographic examinations by two operators on three nonconsecutive days within one week for reproducibility analysis. RESULTS Both RFSMOD_TSV and RFM-modeTSV exhibited a curvilinear relationship with left atrium-to-aortic root ratio. Both RFSMOD_TSV and RFM-modeTSV varied considerably within stage B1 (minimum-maximum: -9.1%-58.2% and -35.7%-66.2%, respectively) and B2 (13.6%-76.2% and 20.1%-85.7%, respectively). Method comparison showed RFSMOD_TSV and RFM-modeTSV were not interchangeable with proportional bias. Pimobendan significantly reduced RFSMOD_TSV (-32.0% ± 23.3%) and RFM-modeTSV (-19.2% ± 10.9%) within the same dog and relative to controls. Good inter-day and between-operator reproducibility was observed for RFSMOD_TSV and RFM-modeTSV based on intraclass correlation coefficients 0.86-0.90 and 0.83-0.90, respectively. Reproducibility coefficients were 19.6%-24.1% and 24.1%-27.0%, respectively. CONCLUSIONS Use of RF using the total stroke volume method to aid the assessment of dogs with subclinical MMVD might be of clinical value. However, further study is warranted. Based on response to pimobendan and reproducibility analysis, RF SMOD_TSV might be a more reliable technique to quantify RF.
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Affiliation(s)
- R E Ellis-Reis
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - L C Visser
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Ave, Davis, CA 95616, USA.
| | - W Hsue
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - A N Sharpe
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - J L Kaplan
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
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Vila BDCP, Vanhoni MS, Sousa MG. QT interval instability and variability in dogs with naturally-occurring hypercortisolism. Vet Res Commun 2023; 47:121-130. [PMID: 35575953 DOI: 10.1007/s11259-022-09936-1] [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: 03/31/2022] [Accepted: 05/04/2022] [Indexed: 01/27/2023]
Abstract
Hypercortisolism is one of the most common endocrine diseases in dogs. In humans, it is clearly associated with a higher risk of cardiovascular events, but studies in dogs are scarce. To investigate the arrhythmogenic risk of dogs with naturally-occurring hypercortisolism (NOHC), indices of variability and instability of the QT interval were retrospectively studied in 38 dogs with NOHC and prospectively studied in 12 healthy dogs: variance (QTv), total instability (TI), short-term (STI) and long-term (LTI), and mean (QTm). Except for QTm, all parameters studied were higher in the NOHC group than in the control group. In addition, STI and QTv showed moderate positive correlation with left ventricle wall thickness. The NOHC group was subdivided according to cortisol suppression pattern in the low-dose dexamethasone suppression test. All electrocardiographic indices of partial and absent suppression patterns were numerically higher than healthy dogs. QTv and TI were lower in the control group than in both NOHC subgroups. LTI and STI were lower in the CG than in the group with the partial suppression pattern. There was no statistical difference between sex groups in any of the electrocardiographic parameters studied. This result might indicate that the etiology of NOHC, and its consequent influence on hypothalamus-pituitary-adrenal axis could interfere on the heterogeneity of ventricular repolarization parameters in different ways, especially in the short-term and the long-term stability; however further studies are necessary to understand the role of cortisol on electrical instability in dogs.
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Affiliation(s)
- Beatriz de Carvalho Pato Vila
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários, 1540, Curitiba, PR, 80035-050, Brazil.
| | - Marcela Sigolo Vanhoni
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários, 1540, Curitiba, PR, 80035-050, Brazil
| | - Marlos Gonçalves Sousa
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários, 1540, Curitiba, PR, 80035-050, Brazil
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Performance of Different Echocardiographic Measurements of Left Atrial Size in Dogs by Observers with Different Levels of Experience. Animals (Basel) 2022; 12:ani12050625. [PMID: 35268194 PMCID: PMC8909604 DOI: 10.3390/ani12050625] [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: 01/02/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/27/2022] Open
Abstract
Simple Summary Assessing enlargement of the left atrium (one of the four cardiac chambers) is extremely important for gaining information about dogs’ heart disease, their prognosis, and directing treatment. However, people with different levels of experience may be required to make this assessment, and we don’t know how observers with different experiences perform in making this assessment. In this study, five observers with different levels of experience evaluated the left atrium of 36 dogs in a blinded fashion (i.e., unaware of each other measurements, or of the identity of the dog), compared to two cardiologists. We then used statistical analysis to evaluate repeatability, reproducibility, accuracy of the measurements, and the capacity of correctly identifying left atrial enlargement. We found that the measurements performed by observers with more experience where more similar to the cardiologists’ measurements, and that combining more than one technique for measuring the left atrium can improve accuracy of the identification of left atrial enlargement. Abstract Assessment of left atrial (LA) sizes in dogs informs clinical staging, risk assessment, treatment decisions, and prognosis. The objective of this study was to assess the diagnostic performance of observers with different levels of experience measuring the LA with three different techniques. Echocardiographic images from 36 dogs with different degrees of left atrial enlargement (LAE) were retrospectively retrieved, anonymized and measured in a blinded fashion by a veterinary student, a first-year cardiology resident, a third-year cardiology resident, and two board-certified veterinary cardiologists. The LA to aortic root ratio (LA:Ao), LA antero-postero diameter indexed to body weight (LAiAPD) and left atrial area were measured. Inter- and intra-observer intraclass correlation coefficients (ICCs) were calculated for all three variables. Bland–Altman plots and accuracy in identification of LAE were calculated for the three least experienced observers using LA:Ao and LAiAPD. Intra- and interobserver ICCs were greater than 0.9 for every variable. The observer with least experience had significant positive bias and a tendency to overestimate larger measurements using LA:Ao, but not using LAiAPD. The accuracy of identification of LAE also increased with the increasing level of experience and was higher for LAiAPD compared to LA:Ao. Combining both methods for identification of LAE, further increased accuracy.
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Kruckman L, Fries RC, Kadotani S, Stack JP, Wallace LG. Comparison of three two-dimensional echocardiographic methods of assessing left ventricular size in Doberman Pinschers. J Vet Cardiol 2021; 40:110-118. [PMID: 34238699 DOI: 10.1016/j.jvc.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Compare three methods of obtaining linear left ventricular dimensions within the same Doberman Pinscher (DP). ANIMALS One hundred and thirty-nine client-owned DP. MATERIALS AND METHODS Linear left ventricular dimensions were measured using two-dimensional short-axis (Sx-2D), motion-mode short-axis (Sx-MM), and motion-mode long-axis (Lx-MM) methods, then left ventricular volumes were obtained using monoplane Simpson's method of discs (SMOD). A Friedman test with Dunn's multiple comparisons was used to compare differences between methods. Bias and correlation were evaluated via Bland-Altman and Spearman's correlation. Sensitivity and specificity for diagnosing occult dilated cardiomyopathy (DCM) compared to SMOD were determined. Coefficients of variation (CVs) were calculated for intra- and inter-observer measurement variability. RESULTS There were significant differences between all linear dimensions in diastole and systole. Short-axis 2D measurements had significant bias compared with Sx-MM (diastole +1.19 mm, systole +1.65 mm) and Lx-MM (diastole +4.36 mm, systole +3.87 mm) as did Sx-MM compared with Lx-MM (diastole +3.17 mm, systole +2.22 mm). All linear dimensions had a moderate positive correlation with SMOD. The sensitivity and specificity of linear measurements to detect DCM were: Sx-2D (sensitivity 72.0%, specificity 88.5%), Sx-MM (sensitivity 52.0%, specificity 92.0%), and Lx-MM (sensitivity 37.5%, specificity 99.1%). All methods had acceptably low CV for intra- and inter-observer measurement variability. CONCLUSIONS Results of this study suggest that linear measurements are repeatable and correlate with reference standard; however, there is a significant bias between measurements, and they should not be used interchangeably.
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Affiliation(s)
- L Kruckman
- Department of Veterinary Clinical Medicine, University of Illinois, 1008 W. Hazelwood Dr, Urbana, IL, 61801, United States
| | - R C Fries
- Department of Veterinary Clinical Medicine, University of Illinois, 1008 W. Hazelwood Dr, Urbana, IL, 61801, United States.
| | - S Kadotani
- Department of Veterinary Clinical Medicine, University of Illinois, 1008 W. Hazelwood Dr, Urbana, IL, 61801, United States
| | - J P Stack
- Department of Veterinary Clinical Medicine, University of Illinois, 1008 W. Hazelwood Dr, Urbana, IL, 61801, United States
| | - L G Wallace
- Department of Veterinary Clinical Medicine, University of Illinois, 1008 W. Hazelwood Dr, Urbana, IL, 61801, United States
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Vezzosi T, Puccinelli C, Citi S, Tognetti R. Two radiographic methods for assessing left atrial enlargement and cardiac remodeling in dogs with myxomatous mitral valve disease. J Vet Cardiol 2021; 34:55-63. [PMID: 33581663 DOI: 10.1016/j.jvc.2021.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Two radiographic measures of the left atrial (LA) size, the vertebral left atrial size (VLAS) and the radiographic left atrial dimension (RLAD), have been described in dogs. The aim of this study was to determine their feasibility and diagnostic value in the prediction of LA enlargement and clinical stage in dogs with myxomatous mitral valve disease (MMVD). ANIMALS 111 client-owned dogs affected by MMVD. METHODS Retrospective study. In each dog, VLAS, RLAD, vertebral heart score (VHS), and left atrium-to-aorta-ratio (LA/Ao) were measured. The correlation between VLAS, RLAD, and LA/Ao was evaluated. The diagnostic accuracy of VLAS and RLAD was assessed for the detection of LA enlargement and clinical staging using the receiver operating characteristic curve analysis. RESULTS A positive correlation was observed between VLAS, RLAS, and LA/Ao (r = 0.816 and r = 0.855, respectively; p<0.0001). Both VLAS (area under the curve [AUC], 0.93; p<0.0001) and RLAD (AUC, 0.98; p<0.0001) showed high diagnostic accuracy in the detection of LA enlargement. In the stage B, the RLAD (AUC, 0.99; cutoff, ≥1.8; sensitivity, 100%; specificity 93%) performed better than VLAS (AUC, 0.90; cutoff, ≥2.4; sensitivity, 66%; specificity 100%) and VHS (AUC, 0.89; cutoff, ≥10.7; sensitivity, 88%; specificity 83%) in the detection of dogs fulfilling the echocardiographic criteria for stage B2. CONCLUSIONS VLAS and RLAD represent useful radiological tools for the detection of LA enlargement in dogs with MMVD. In asymptomatic dogs, the RLAD performs better than VLAS and VHS in the prediction of those fulfilling the echocardiographic criteria for stage B2.
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Affiliation(s)
- T Vezzosi
- Department of Veterinary Sciences, University of Pisa, Via Livornese lato monte, 56122 San Piero a Grado, Pisa, Italy
| | - C Puccinelli
- Department of Veterinary Sciences, University of Pisa, Via Livornese lato monte, 56122 San Piero a Grado, Pisa, Italy
| | - S Citi
- Department of Veterinary Sciences, University of Pisa, Via Livornese lato monte, 56122 San Piero a Grado, Pisa, Italy.
| | - R Tognetti
- Department of Veterinary Sciences, University of Pisa, Via Livornese lato monte, 56122 San Piero a Grado, Pisa, Italy
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Hsue W, Visser LC. Reproducibility of echocardiographic indices of left atrial size in dogs with subclinical myxomatous mitral valve disease. J Vet Intern Med 2020; 34:1779-1786. [PMID: 32644291 PMCID: PMC7517857 DOI: 10.1111/jvim.15850] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/19/2020] [Accepted: 06/26/2020] [Indexed: 11/27/2022] Open
Abstract
Background Reliability of echocardiographic measurements of left atrial (LA) size, an important marker of disease severity, has not been reported in dogs with myxomatous mitral valve disease (MMVD). Objectives To define and compare reliability of left atrial dimension/diameter (LAD), LAD indexed to aortic valve diameter (LAD/AoD), left atrium‐to‐aortic root ratio (LA/Ao), left atrial volume acquired from a right parasternal long‐axis (LAVRPLx), and left apical view (LAVLAP) in dogs with subclinical MMVD. Animals Nine dogs with subclinical MMVD. Methods Prospective reproducibility study. Dogs underwent 12 echocardiographic examinations by 2 operators on the mornings and afternoons of 3 nonconsecutive days within 1 week. Reliability (measurement variability) was quantified using coefficients of variation (CV) and 95% repeatability/reproducibility coefficients (95% RC). A mixed‐model analysis of variance (ANOVA) was used to determine if time of day, day, and operator were significant sources of variability for each index. Results Linear measurements (LAD, LAD/AoD, and LA/Ao) exhibited less within‐day, between‐day, and interoperator variability (CVs, 3.9%‐12.5%) than did volume estimate measurements (LAVRPLx and LAVLAP; CVs, 11.8%‐17.9%). Of the linear measurements, LA/Ao exhibited greater variability (CVs, 9.9%‐12.5%) compared to LAD and LAD/AoD (CVs, 3.9%‐4.9%). Operator was a significant (P = .005) source of variability for LA/Ao. Conclusions and Clinical Importance Compared to other linear measurements, LA/Ao was the least reproducible and most dependent on operator. The 95% RC for each LA size index are provided to help identify clinically relevant changes (beyond intraoperator or interoperator variability) during serial echocardiographic examinations of dogs with subclinical MMVD.
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Affiliation(s)
- Weihow Hsue
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Lance C Visser
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
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