1
|
Wesselowski S, Gordon SG, Fries R, Saunders AB, Sykes KT, Vitt J, Boutet B, Häggström J, Kadotani S, Stack J, Barnett BG. Use of physical examination, electrocardiography, radiography, and biomarkers to predict echocardiographic stage B2 myxomatous mitral valve disease in preclinical Cavalier King Charles Spaniels. J Vet Cardiol 2023; 50:1-16. [PMID: 37913604 DOI: 10.1016/j.jvc.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Cavalier King Charles Spaniels (CKCS) are predisposed to developing myxomatous mitral valve disease (MMVD). Dogs with stage B2 MMVD benefit from medication. OBJECTIVES To develop (1) breed-specific cut-offs for individual screening tests and (2) predictive models utilizing physical examination (PE), ECG, radiograph, and blood-based biomarker variables in combination for identification of echocardiographic stage B2 MMVD in preclinical CKCS. ANIMALS Adult, preclinical CKCS not receiving cardiac medications (N = 226). MATERIALS AND METHODS Prospective, cross-sectional study. Enrolled CKCS underwent PE, ECG, radiography, Doppler blood pressure measurement, echocardiography, and biomarker testing. Dogs were grouped by MMVD stage using echocardiography only. The discriminatory ability of individual tests to identify stage B2 was assessed, and prediction models were developed using variables derived from four 'tests' (PE, ECG, radiography, and biomarkers). RESULTS N-terminal pro-B-type natriuretic peptide (NT-proBNP) and radiographic vertebral heart size (VHS) had the best discriminatory ability of individual diagnostic tests to differentiate stage A/B1 CKCS from stage B2, with an area under the curve (AUC) of 0.855 and 0.843, respectively. An NT-proBNP ≥1138 pmol/L or a VHS ≥11.5 had high specificity for predicting stage B2 (90.1% and 90.6%, respectively). Prediction models incorporating variables from multiple tests had better discriminatory ability than single tests. The four-test prediction model had an AUC of 0.971. Three and two-test models had AUCs ranging between 0.925-0.959 and 0.895-0.949, respectively. CONCLUSIONS Both NT-proBNP and VHS have good utility for predicting echocardiographic stage B2 MMVD in CKCS as individual tests. Prediction models incorporating multiple test variables have superior discriminatory ability.
Collapse
Affiliation(s)
- S Wesselowski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA.
| | - S G Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - R Fries
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, 1008 Hazelwood Drive, Urbana, IL, USA
| | - A B Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - K T Sykes
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - J Vitt
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, 1008 Hazelwood Drive, Urbana, IL, USA
| | - B Boutet
- VETMED emergency and specialty veterinary hospital, 20610 N Cave Creek Rd, Phoenix, AZ, USA
| | - J Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Box 7045, 7507 Uppsala, Sweden
| | - S Kadotani
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, 1008 Hazelwood Drive, Urbana, IL, USA
| | - J Stack
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, 1008 Hazelwood Drive, Urbana, IL, USA
| | - B G Barnett
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| |
Collapse
|
2
|
Yun H, Koo Y, Yun T, Chae Y, Lee D, Cha S, Kim J, Kim H, Yang MP, Kang BT. Evaluation of progression of chronic kidney disease in dogs with myxomatous mitral valve disease. Front Vet Sci 2023; 10:1200653. [PMID: 37691634 PMCID: PMC10484475 DOI: 10.3389/fvets.2023.1200653] [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: 04/05/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Cardiovascular and renal diseases are known to affect each other in the cardiovascular renal axis disorder (CvRD). Although CvRD, which includes myxomatous mitral valve disease (MMVD) and chronic kidney disease (CKD), has been described in dogs, there are only a few reports on the progression of CKD in accordance with the severity of MMVD. The aim of this study was to evaluate whether the presence of MMVD is associated with the rate of progression of CKD in dogs. The time from the initial diagnosis to the worsening of the International Renal Interest Society (IRIS) stage and the time for the occurrence of hyperphosphatemia and isosthenuria were evaluated. Materials and methods In this retrospective study, CKD progression was determined as an increase in the IRIS stage by at least one level and the development of hyperphosphatemia or isosthenuria. The CKD progression was compared in dogs with and without comorbid MMVD. Results Dogs with CKD were divided into two groups: dogs with and without MMVD (n = 63, concurrent group; n = 52, CKD group, respectively). The concurrent group was further divided into two subgroups based on the American College of Veterinary Internal Medicine guidelines (B1 group, n = 24; B2 group, n = 39). The time for progression of CKD from IRIS stage 1 to IRIS stage 2 was significantly shorter in the concurrent group than in the CKD group (log-rank test, p < 0.001). MMVD was associated with an increased risk of progression from stage 1 to stage 2 (hazard ratio, 6.442; 95% confidence interval (CI), 2.354 to 18.850; p < 0.001). The timing of the onset of hyperphosphatemia or isosthenuria in the concurrent group and the CKD group was not significantly different. Conclusion The results of this study suggest that MMVD could be a risk factor for the progression of CKD. Our findings may help predict the prognosis of dogs with both CKD and MMVD compared to CKD only.
Collapse
Affiliation(s)
- Hyejin Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Yoonhoi Koo
- College of Veterinary Medicine, Kyungpook National University, Daegu, South Korea
| | - Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Dohee Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Sijin Cha
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Jeeyune Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Mhan Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Byeong Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| |
Collapse
|
3
|
Valente C, Guglielmini C, Baron Toaldo M, Romito G, Artusi C, Brugnolo L, Contiero B, Poser H. Plasmatic Dimethylarginines in Dogs With Myxomatous Mitral Valve Disease. Front Vet Sci 2021; 8:738898. [PMID: 34604374 PMCID: PMC8481685 DOI: 10.3389/fvets.2021.738898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022] Open
Abstract
Plasmatic dimethylarginines, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are considered biomarkers of endothelial and renal dysfunction, respectively, in humans. We hypothesize that plasmatic concentration of dimethylarginines in dogs with myxomatous mitral valve disease (MMVD) is influenced by heart disease stage. Eighty-five client-owned dogs with MMVD, including 39, 19, and 27 dogs in ACVIM stages B1, B2, and C+D, respectively, and a control group of 11 clinically healthy dogs were enrolled. A prospective, multicentric, case-control study was performed. Each dog underwent a complete clinical examination, arterial blood pressure measurement, thoracic radiography, six-lead standard electrocardiogram, transthoracic echocardiography, CBC, biochemical profile, and urinalysis. Plasmatic concentration of dimethylarginines was determined through high-performance liquid chromatography coupled with tandem mass spectrometry. Median ADMA was significantly increased in dogs of group C+D (2.5 μmol/L [2.1–3.0]) compared to those of group B1 (1.8 μmol/L [1.6–2.3]; p < 0.001) and healthy dogs (1.9 μmol/L [1.7–2.3]; p = 0.02). Median SDMA was significantly increased in dogs of group C+D (0.7 μmol/L [0.5–0.9]) compared to those of groups B1 (0.4 μmol/L [0.3–0.5]; p < 0.001), B2 (0.4 μmol/L [0.3–0.6]; p < 0.01), and the control group (0.4 μmol/L [0.35–0.45]; p = 0.001). In the final multivariable analysis, ADMA and SDMA were significantly associated with left atrium to aorta ratio (p < 0.001), and creatinine (p < 0.001), respectively. Increased plasmatic concentrations of dimethylarginines suggest a possible role as biomarkers of disease severity in dogs with decompensated MMVD.
Collapse
Affiliation(s)
- Carlotta Valente
- Department of Animal Medicine, Production and Health, University of Padua, Padua, Italy
| | - Carlo Guglielmini
- Department of Animal Medicine, Production and Health, University of Padua, Padua, Italy
| | - Marco Baron Toaldo
- Department of Veterinary Medical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Giovanni Romito
- Department of Veterinary Medical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Carlo Artusi
- Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy
| | - Laura Brugnolo
- Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy
| | - Barbara Contiero
- Department of Animal Medicine, Production and Health, University of Padua, Padua, Italy
| | - Helen Poser
- Department of Animal Medicine, Production and Health, University of Padua, Padua, Italy
| |
Collapse
|
4
|
Prieto Ramos J, Corda A, Swift S, Saderi L, De La Fuente Oliver G, Corcoran B, Summers KM, French AT. Clinical and Echocardiographic Findings in an Aged Population of Cavalier King Charles Spaniels. Animals (Basel) 2021; 11:ani11040949. [PMID: 33800666 PMCID: PMC8065390 DOI: 10.3390/ani11040949] [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: 03/08/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
Myxomatous mitral valve disease (MMVD) is the most common cardiac disease in dogs. It varies from dogs without clinical signs to those developing left-sided congestive heart failure, leading to death. Cavalier King Charles Spaniels (CKCSs) are particularly susceptible to MMVD. We hypothesised that within the elderly CKCS population, there is a sub-cohort of MMVD-affected dogs that do not have cardiac remodelling. The objectives of the present study were (i) to determine the prevalence and the degree of cardiac remodelling associated with MMVD; and (ii) assess the effect of age, gender, and body weight on echocardiographic status in a population of aged CKCSs. A total of 126 CKCSs ≥ 8 years old were prospectively included. They all had a physical and echocardiographic examination. A systolic murmur was detected in 89% of dogs; the presence of clinical signs was reported in 19% of them; and echocardiographic evidence of MMVD was described in 100%. Despite the high prevalence, 44.4% of the dogs were clear of echocardiographic signs of cardiac remodelling. Age was significantly associated with the presence and severity of cardiac remodelling and mitral valve prolapse. Our results showed that a proportion of elderly CKCS with confirmed MMVD did not undergo advanced stages of this pathology.
Collapse
Affiliation(s)
| | - Andrea Corda
- Department of Veterinary Medicine, University of Sassari, 07100 Sassari, Italy
- Correspondence: ; Tel.: +39-3494381468
| | - Simon Swift
- College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA;
| | - Laura Saderi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | | | - Brendan Corcoran
- Royal (Dick) School of Veterinary Medicine, Easter Bush Campus, University of Edinburgh, Midlothian EH25 9RG, UK;
| | - Kim M. Summers
- Translational Research Institute, Mater Research Institute-University of Queensland, 37 Kent St, Wooloongabba, QLD 4102, Australia;
| | - Anne T. French
- School of Veterinary Medicine, Ross University, Two mile hill st., Michael BB11093, Barbados;
| |
Collapse
|
5
|
Red Cell Distribution Width Has a Negative Prognostic Role in Dogs with Myxomatous Mitral Valve Disease. Animals (Basel) 2021; 11:ani11030778. [PMID: 33799710 PMCID: PMC7998152 DOI: 10.3390/ani11030778] [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: 01/29/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 12/05/2022] Open
Abstract
Simple Summary The red cell distribution width (RDW) is a simple and inexpensive laboratory parameter that reflects the difference in size of the red blood cells (also known as anisocytosis) and is conventionally used in a clinical setting for the differential diagnosis of anemias. Nonetheless, recent studies have demonstrated that anisocytosis is commonplace in many non-hematological human disorders and an increased RDW has been associated with a negative prognosis in patients with different cardiovascular diseases. In dogs, no studies have evaluated the prognostic role of RDW with myxomatous mitral valve disease (MMVD). The present study evaluates clinical, echocardiographic, and laboratory parameters, including RDW, with a cohort of dogs with MMVD and followed up on for more than one year. We sought to evaluate if RDW acts as an independent prognostic marker for negative outcomes in dogs with MMVD with or without concurrent non-cardiac diseases. Abstract Red cell distribution width (RDW) is a quantitative measurement of anisocytosis. This hematological parameter is an important prognostic biomarker for different cardiovascular disorders in humans but its influence on survival has been poorly investigated in dogs with cardiovascular disease. The RDW and various clinical, complete blood count, serum biochemical and echocardiographic variables were retrospectively investigated in 146 client-owned dogs with myxomatous mitral valve disease (MMVD) at various disease stages, with or without concurrent diseases and treatment. Laboratory variables, including RDW, urea, and white blood cell (WBC), in addition to the echocardiographic variable left atrium to aorta ratio were found to be independent predictors of all-cause mortality at six months in a multivariable Cox proportional hazards regression model. In particular, the hazard ratio of RDW was 1.203 (95% confidence interval = 1.045–1.384; p = 0.010). The negative effect of increased RDW on outcome was confirmed using Kaplan–Meier curve analysis. The results of this study indicate that RDW acted as an independent predictor of negative outcome in dogs with MMVD.
Collapse
|