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van Staveren MDB, Muis E, Szatmári V. Self-Reported Utilization of International (ACVIM Consensus) Guidelines and the Latest Clinical Trial Results on the Treatment of Dogs with Various Stages of Myxomatous Mitral Valve Degeneration: A Survey among Veterinary Practitioners. Animals (Basel) 2024; 14:772. [PMID: 38473157 DOI: 10.3390/ani14050772] [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: 02/08/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Myxomatous mitral valve degeneration is the most common canine heart disease. Several clinical trials have investigated various treatments. The latest recommendations are published in the ACVIM consensus guidelines (2019). Our study aimed to investigate how closely veterinary practitioners apply the treatment recommendations of these guidelines and the latest clinical trials. METHODS An online survey was sent to Dutch and Belgian veterinary practices via digital channels. RESULTS The data from 363 fully completed surveys were analyzed. For stage B1 disease, 93% recommended, correctly, no treatment. For stage B2 disease, 67% of the respondents recommended starting pimobendan as monotherapy. For chronic treatment of stage C disease, 16 different drug combinations were mentioned, but nobody recommended surgery. Only 48% of the respondents recommended the only evidence-based drug combination: a loop diuretic with pimobendan. A concerning finding was the simultaneous prescription of two loop diuretics, by 19% of the respondents. CONCLUSIONS Treatment recommendations showed an increasing variation with more advanced disease stages from B1 through B2 to C. This reflects the increasing disagreement among the panelists who prepared the ACVIM consensus guidelines. Practitioners of our study seem to practice more evidence-based medicine than veterinary cardiologists, as it was reported in a recent survey-based study.
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Affiliation(s)
- Marie D B van Staveren
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - Esther Muis
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - Viktor Szatmári
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
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Vereb M, Atkins CE, Adin D, Blondel T, Coffman M, Lee S, Guillot E, Ward JL. Efficacy of a mitral regurgitation severity index to predict long-term outcome in dogs with myxomatous mitral valve disease. J Vet Intern Med 2024; 38:51-60. [PMID: 37909399 PMCID: PMC10800232 DOI: 10.1111/jvim.16923] [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: 05/11/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Predicting progression of myxomatous mitral valve disease (MMVD) in dogs can be challenging. HYPOTHESIS/OBJECTIVES The mitral regurgitation severity index (MRSI) will predict time to congestive heart failure (CHF) and all-cause death in dogs with MMVD. ANIMALS Eight hundred sixty-nine client-owned dogs. METHODS Retrospective study pooling data from 4 previous samples including dogs with MMVD stage B2 or C. MRSI was calculated as: (heart rate [HR]/120) × left atrium-to-aorta ratio (LA:Ao) × (age in years/10) × 100. Alternative MRSI formulas substituting radiographic measures of left atrial size were also calculated. Cox proportional hazard modeling and time-dependent receiver-operator characteristic curves quantified prognostic performance. RESULTS For Stage B2 pooled samples, MRSI > 156 was predictive of time to CHF (median 407 vs 1404 days; area under the curve [AUC] 0.68; hazard ratio 3.02 [95% CI 1.9-4.9]; P < .001). MRSI > 173 was predictive of all-cause death (median survival 868 vs 1843 days; AUC 0.64; hazard ratio 4.26 [95% CI 2.4-7.5]; P < .001). MRSI showed superior predictive value compared to the individual variables of HR, LA:Ao, and age. Variations of the MRSI equation substituting radiographic vertebral left atrial size for LA:Ao were also significantly predictive of outcome in stage B2. MRSI was not consistently predictive of outcome in Stage C. CONCLUSIONS AND CLINICAL IMPORTANCE MRSI was predictive of outcome (onset of CHF and all-cause death) in MMVD Stage B2, demonstrating utility as a useful prognostic tool. Echocardiographic LA:Ao can be effectively replaced by radiographically determined LA size in the MRSI formula.
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Affiliation(s)
- Michelle Vereb
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineIowa State UniversityAmesIowaUSA
| | - Clarke E. Atkins
- Department of Clinical Sciences, College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Darcy Adin
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | | | | | | | | | - Jessica L. Ward
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineIowa State UniversityAmesIowaUSA
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Ames MK, Adin DB, Wood J. Beyond Angiotensin-Converting Enzyme Inhibitors: Modulation of the Renin-Angiotensin-Aldosterone System to Delay or Manage Congestive Heart Failure. Vet Clin North Am Small Anim Pract 2023; 53:1353-1366. [PMID: 37423846 DOI: 10.1016/j.cvsm.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
The renin-angiotensin-aldosterone system (RAAS) consists of bioactive angiotensin peptides, enzymatic pathways, receptors, and the steroid hormone aldosterone. The RAAS regulates blood pressure, sodium, and electrolyte homeostasis and mediates pathologic disease processes. Within this system is an alternative arm that counterbalances the vasoconstrictive, sodium and water retentive, and pro-fibrotic and inflammatory effects of the classical arm. Improved biochemical methodologies in RAAS quantification are elucidating how this complex system changes in health and disease. Future treatments for cardiovascular and kidney disease will likely involve a more nuanced manipulation of this system rather than simple blockade.
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Affiliation(s)
- Marisa K Ames
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California - Davis, 1 Shields Avenue, Davis, CA 95616, USA.
| | - Darcy B Adin
- University of Florida, College of Veterinary Medicine, 2015 Southwest 16th Avenue, Gainesville, FL 32608, USA
| | - James Wood
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California - Davis, 1 Shields Avenue, Davis, CA 95616, USA
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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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Rešetar Maslov D, Farkaš V, Rubić I, Kuleš J, Beletić A, Beer Ljubić B, Šmit I, Mrljak V, Torti M. Serum Proteomic Profiles Reflect the Stages of Myxomatous Mitral Valve Disease in Dogs. Int J Mol Sci 2023; 24:ijms24087142. [PMID: 37108311 PMCID: PMC10138901 DOI: 10.3390/ijms24087142] [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: 02/22/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Canine myxomatous mitral valve disease (MMVD) is similar to Barlow's form of MMVD in humans. These valvulopathies are complex, with varying speeds of progression. We hypothesized that the relative abundances of serum proteins would help identify the consecutive MMVD stages and discover new disease pathways on a systemic level. To identify distinction-contributing protein panels for disease onset and progression, we compared the proteomic profiles of serum from healthy dogs and dogs with different stages of naturally occurring MMVD. Dogs were divided into experimental groups on the basis of the left-atrium-to-aorta ratio and normalized left ventricular internal dimension in diastole values. Serum was collected from healthy (N = 12) dogs, dogs diagnosed with MMVD in stages B1 (N = 13) and B2 (N = 12) (asymptomatic), and dogs diagnosed with MMVD in chronic stage C (N = 13) (symptomatic). Serum biochemistry and selected ELISAs (galectin-3, suppression of tumorigenicity, and asymmetric dimethylarginine) were performed. Liquid chromatography-mass spectrometry (LC-MS), tandem mass tag (TMT) quantitative proteomics, and statistical and bioinformatics analysis were employed. Most of the 21 serum proteins with significantly different abundances between experimental groups (p < 0.05, FDR ˂ 0.05) were classified as matrix metalloproteinases, protease inhibitors, scaffold/adaptor proteins, complement components, anticoagulants, cytokine, and chaperone. LC-MS TMT proteomics results obtained for haptoglobin, clusterin, and peptidase D were further validated analytically. Canine MMVD stages, including, for the first time, asymptomatic B1 and B2 stages, were successfully distinguished in dogs with the disease and healthy dogs on the basis of the relative abundances of a panel of specific serum proteins. Most proteins with significantly different abundances were involved in immune and inflammatory pathways. Their role in structural remodeling and progression of canine MMVD must be further investigated. Further research is needed to confirm the resemblance/difference with human MMVD. Proteomics data are available via ProteomeXchange with the unique dataset identifier PXD038475.
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Affiliation(s)
- Dina Rešetar Maslov
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Vladimir Farkaš
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Ivana Rubić
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Josipa Kuleš
- Department of Chemistry and Biochemistry, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Anđelo Beletić
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Blanka Beer Ljubić
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Iva Šmit
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Vladimir Mrljak
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Marin Torti
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
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Sotillo S, Ward JL, Guillot E, Domenig O, Yuan L, Smith JS, Gabriel V, Iennarella-Servantez CA, Mochel JP. Dose-response of benazepril on biomarkers of the classical and alternative pathways of the renin-angiotensin-aldosterone system in dogs. Sci Rep 2023; 13:2684. [PMID: 36792677 PMCID: PMC9932142 DOI: 10.1038/s41598-023-29771-x] [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: 07/14/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Angiotensin-converting enzyme inhibitors (ACEI) such as benazepril are commonly prescribed in both humans and dogs with heart disease to mitigate the renin-angiotensin-aldosterone system (RAAS); however, the dose-dependent effects of benazepril on comprehensive RAAS components remain unknown. In this study, nine purpose-bred healthy dogs received three different dosages of oral benazepril (0.125 mg/kg, 0.25 mg/kg, or 0.5 mg/kg) in a randomized crossover design following induction of RAAS activation by consuming a low-sodium diet. Blood samples were collected at serial time intervals after benazepril dosing to measure plasma benazeprilat (active metabolite of benazepril) and serum RAAS biomarkers. Blood pressure and echocardiogram were performed at baseline and after each benazepril administration. Time-weighted averages for RAAS biomarkers for 12 h post-dose and hemodynamic variables were compared between dosing groups using Wilcoxon rank-sum testing. Compared to the lowest dosage of benazepril (0.125 mg/kg), the highest dosage (0.5 mg/kg) resulted in lower time-weighted average values of angiotensin (Ang) II (- 38%, P = 0.004), Ang1-5 (- 53%, P = 0.001), ACE-S (surrogate for ACE activity; - 59%, P = 0.0002), and ALT-S (surrogate for alternative RAAS activity; - 22%, P = 0.004), and higher values of AngI (+ 78%, P = 0.014) and PRA-S (surrogate for plasma renin activity; + 58%, P = 0.040). There were no relevant differences between dosing groups for blood pressure or echocardiographic variables. Knowledge of dose-dependent alterations in biomarkers of the classical and alternative RAAS pathways could help inform clinical trials for dosage optimization in both dogs and humans.
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Affiliation(s)
- Samantha Sotillo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, USA.
| | - Emilie Guillot
- Ceva Santé Animale, Companion Animal Franchise, Libourne, France
| | | | - Lingnan Yuan
- Department of Veterinary Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Joseph S Smith
- Department of Veterinary Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Vojtech Gabriel
- Department of Veterinary Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | | | - Jonathan P Mochel
- Department of Veterinary Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
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7
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Adin DB, Hernandez JA. Influence of sex on renin-angiotensin-aldosterone system metabolites and enzymes in Doberman Pinschers. J Vet Intern Med 2022; 37:22-27. [PMID: 36412252 PMCID: PMC9889697 DOI: 10.1111/jvim.16589] [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: 05/28/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Estrogen modulates the renin-angiotensin-aldosterone system (RAAS) in women, but sex differences have not been fully explored in dogs. OBJECTIVE We hypothesized that the RAAS profile of intact female (IF) Doberman Pinschers (DP) would differ from spayed female (SF) and intact male (IM) DP. ANIMALS Eighteen healthy DP (6 IF, 6 SF, 6 IM). METHODS Absolute and indexed RAAS metabolites, angiotensin-converting enzyme (ACE) and ACE2 activities, and genotypes (pyruvate kinase dehydrogenase 4, titin, and ACE variants) were compared among sex groups using Kruskal-Wallis or chi-square tests, and linear regression controlling for age. Data are expressed as median (minimum, maximum) and P < .05 was considered significant. RESULTS The ACE activity was higher in IF DP (656 pmol/L; 436, 784) compared to SF DP (411 pmol/L; 287, 451; P = .01) and IM DP (365 pmol/L; 276, 1200; P = .04) after controlling for age. Angiotensin II, angiotensin I, and plasma renin activity marker (PRA-S) were higher in IF DP compared to SF DP, but not significantly (P ≤ .25). After controlling for age, angiotensin 1-7/angiotensin I was lower in IF DP compared to SF DP (P = .01). Genotypes did not differ among groups. Most DP (94%) were ACE variant positive. CONCLUSIONS AND CLINICAL SIGNIFICANCE Sex and reproductive status influenced the RAAS of DP, with IF DP showing genotype-independent higher ACE activity. These findings hold implications for sterilization practices in female dogs, and support sex and reproductive status as a source of variability in RAAS studies. Additionally, the frequency of the ACE gene variant was very high in this group of DP.
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Affiliation(s)
- Darcy B. Adin
- Department of Small Animal Clinical SciencesUniversity of Florida, College of Veterinary MedicineGainesvilleFloridaUSA
| | - Jorge A. Hernandez
- Department of Small Animal Clinical SciencesUniversity of Florida, College of Veterinary MedicineGainesvilleFloridaUSA
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8
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Giorgi ME, Mochel JP, Yuan L, Adin DB, Ward JL. Retrospective evaluation of risk factors for development of kidney injury after parenteral furosemide treatment of left-sided congestive heart failure in dogs. J Vet Intern Med 2022; 36:2042-2052. [PMID: 36254646 DOI: 10.1111/jvim.16571] [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: 11/13/2021] [Accepted: 10/07/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Kidney injury (KI) has been documented in dogs treated with furosemide for left-sided congestive heart failure (CHF). HYPOTHESIS/OBJECTIVES Determine risk factors for development of KI in furosemide-treated dogs and determine the effect of KI on survival. ANIMALS Seventy-nine client-owned dogs receiving parenteral furosemide for CHF. METHODS Serum creatinine (sCr) and electrolyte concentrations were determined during hospitalization and at first outpatient reevaluation to detect and stage KI (increase in sCr ≥0.3 mg/dL). Furosemide dosage administered between timepoints was calculated. Multivariable modeling was performed to identify predictors of KI and percent change in serum biochemistry results over time. RESULTS Kidney injury was identified in 38/79 (48%) dogs and mostly occurred during hospitalization. Kidney injury was Grade I in 25 dogs, Grade II in 9 dogs, and Grade III in 4 dogs. Higher blood pressure was associated with acute KI during hospitalization (odds ratio, 1.03; 95% confidence interval [95% CI] 1.01-1.07; P = .03) whereas PO furosemide dosage was associated with KI after hospital discharge (odds ratio, 7.77; 95% CI, 2.05-68.6; P = .02). Baseline sCr and use of a furosemide continuous rate infusion were not associated with increased risk of KI. Kidney injury was not associated with long-term outcome. Of 13 dogs with Grade II-III KI, azotemia was reversible in 9 dogs, and 6 dogs survived >1 year after KI. CONCLUSIONS AND CLINICAL IMPORTANCE In this cohort of dogs receiving parenteral furosemide for CHF, KI was common, mostly nonazotemic (Grade I), and did not impact survival.
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Affiliation(s)
- Maria E Giorgi
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Jonathan P Mochel
- Department of Biomedical Sciences, SMART Pharmacology, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Lingnan Yuan
- Department of Biomedical Sciences, SMART Pharmacology, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Darcy B Adin
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
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The ACVIM consensus statement definition of LV enlargement in myxomatous mitral valve disease does not always represent LV enlargement. J Vet Cardiol 2022; 42:92-102. [DOI: 10.1016/j.jvc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022]
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Gordon SG, Saunders AB, Wesselowski SR. Asymptomatic Canine Degenerative Valve Disease. Vet Clin North Am Small Anim Pract 2022; 52:819-840. [DOI: 10.1016/j.cvsm.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Franchini A, Borgarelli M, Abbott JA, Menciotti G, Crosara S, Häggström J, Lahmers S, Rosenthal S, Tyrrell W. The Longitudinal Outcome Of Canine (K9) myxomatous mitral valve disease (LOOK-Mitral) registry: baseline treatment characteristics. J Vet Cardiol 2022; 41:99-120. [DOI: 10.1016/j.jvc.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
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Donati P, Tarducci A, Zanatta R, Verdier N, Belerenian G, Cordero I, Villalta C, Franco J, Tarragona L. Angiotensin-converting enzyme inhibitors in preclinical myxomatous mitral valve disease in dogs: systematic review and meta-analysis. J Small Anim Pract 2021; 63:362-371. [PMID: 34905219 DOI: 10.1111/jsap.13461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/28/2021] [Accepted: 10/31/2021] [Indexed: 12/09/2022]
Abstract
To determine the efficacy and adverse events of the administration of angiotensin-converting enzyme inhibitors for the management of preclinical myxomatous mitral valve disease in dogs. A comprehensive search using Pubmed/MEDLINE, LILACS and CAB abstracts databases was performed. Randomised clinical trials that assessed efficacy and adverse events of angiotensin-converting enzyme inhibitors for the management of preclinical myxomatous mitral valve disease in dogs were included. Certainty of evidence was rated using GRADE methods. Four randomised clinical trials were included. While safe, angiotensin-converting enzyme inhibitors administration to dogs with myxomatous mitral valve disease and cardiomegaly results in little to no difference in the risk of development congestive heart failure (high certainty of evidence; relative risk: 1.03; 95% confidence interval: 0.87 to 1.23) and may result in little to no difference in cardiovascular-related (low certainty of evidence; relative risk: 1.01; 95% confidence interval: 0.54 to 1.89) and all-cause mortality (low certainty of evidence; relative risk: 0.93; 95% confidence interval: 0.63 to 1.36). Administration of angiotensin-converting enzyme inhibitors to dogs with myxomatous mitral valve disease without cardiomegaly may result in a reduced risk of congestive heart failure development. However, the range in which the actual effect for this outcome may be, the "margin of error," indicates it might also increase the risk of congestive heart failure development (low certainty of evidence; relative risk: 0.86; 95% confidence interval: 0.54 to 1.35). Administration of angiotensin-converting enzyme inhibitors to dogs with preclinical myxomatous mitral valve disease and cardiomegaly results in little to no difference in the risk of the development of congestive heart failure and may result in little to no difference in cardiovascular-related and all-cause mortality. The certainty of evidence of the efficacy of angiotensin-converting enzyme inhibitors administration to dogs without cardiomegaly was low.
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Affiliation(s)
- P Donati
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Anestesiología y Algiología, Av. Chorroarín 280, CP, 1427, Ciudad Autónoma de Buenos Aires, Argentina
| | - A Tarducci
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini 2-5, 10095, Grugliasco Turin, Italy
| | - R Zanatta
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini 2-5, 10095, Grugliasco Turin, Italy
| | - N Verdier
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Anestesiología y Algiología, Av. Chorroarín 280, CP, 1427, Ciudad Autónoma de Buenos Aires, Argentina.,Department of Anesthesiology and Perioperative Intensive Care, University of Veterinary Medicine, Veterinärplatz 1, 1220, Vienna, Austria
| | - G Belerenian
- Luis Pasteur Zoonosis Institute, Av. Díaz Vélez 482, CP, 1405, Ciudad Autónoma de Buenos Aires, Argentina
| | - I Cordero
- Clinica Veterinaria VET'S, Suecia 3580, Providencia, Ñuñoa, Región Metropolitana, Chile
| | - C Villalta
- Clinica Veterinaria VET'S, Suecia 3580, Providencia, Ñuñoa, Región Metropolitana, Chile
| | - J Franco
- Instituto Universitario Hospital Italiano, Argentine Cochrane Centre, Potosi 4234, CP, 1199, Ciudad Autónoma de Buenos Aires, Argentina
| | - L Tarragona
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Anestesiología y Algiología, Av. Chorroarín 280, CP, 1427, Ciudad Autónoma de Buenos Aires, Argentina
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Analysis of canine cardiovascular therapeutic agent prescriptions using electronic health records in primary care veterinary practices in the United Kingdom. J Vet Cardiol 2021; 39:35-45. [PMID: 34968989 DOI: 10.1016/j.jvc.2021.11.003] [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: 02/25/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION/OBJECTIVES Canine cardiovascular (CV) diseases are often managed in primary care settings. The objectives were to describe CV therapeutic agent (CVTA) prescribing patterns in primary care practices in the United Kingdom (UK) and to evaluate recorded clinical signs, diagnostic tests and justifications for use of torasemide, a recently marketed and authorised loop-diuretic in the UK. ANIMALS, MATERIALS AND METHODS Electronic health records (EHRs) describing 3,579,420 consultations (1,043,042 unique dogs) were collated (1 April 2014 and 31 December 2018) by the Small Animal Veterinary Surveillance Network from 270 veterinary practices. Consultations prescribing at least one CVTA were identified. Annual variation in individual CVTA prescriptions was analysed using mixed-effects binomial regression models. Free-text clinical narratives were manually read to determine the first-prescribing event for torasemide. RESULTS Twenty-nine thousand and seven consultations (0.81% of all consultations, 95% confidence interval [CI], 0.76-0.86) prescribed CVTA in 14,148 (1.36%) dogs. Furosemide (52.8% of CV-prescribing consultations, 95% CI 50.7-54.9) and pimobendan (51.9%, 95% CI 50.1-53.7) were most prescribed. Longitudinal analysis (2014-2018) showed a significant negative temporal trend for angiotensin-converting enzyme inhibitors (p < 0.001), and furosemide (p = 0.003) and a positive temporal trend for pimobendan (p = 0.020) and torasemide (p < 0.001). First prescriptions of torasemide were identified in 16.5% of torasemide-prescribing consultations. Where justification for prescription of torasemide was identified (32.5%), furosemide resistance was the most common (92.0%). CONCLUSIONS EHRs can be used to temporally monitor prescribing habits, including responses to market authorisations. Despite authorisation in the UK for torasemide use as a first-line diuretic, it was most commonly prescribed after furosemide resistance.
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14
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Ward JL, Chou YY, Yuan L, Dorman KS, Mochel JP. Retrospective evaluation of a dose-dependent effect of angiotensin-converting enzyme inhibitors on long-term outcome in dogs with cardiac disease. J Vet Intern Med 2021; 35:2102-2111. [PMID: 34387901 PMCID: PMC8478030 DOI: 10.1111/jvim.16236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background Angiotensin‐converting enzyme inhibitors (ACEIs) are commonly prescribed in dogs, but the ideal dosage is unknown. Hypothesis/Objectives In dogs with cardiac disease, a dose‐response relationship exists for ACEIs with respect to long‐term outcome. Animals One hundred forty‐four dogs with cardiac disease, 63 with current or prior congestive heart failure. Methods Retrospective medical record review. Cox proportional hazards models were used to determine variables associated with 2‐year survival or survival from first‐onset congestive heart failure (CHF). Results Median initial ACEI dosage was 0.84 (interquartile range [IQR], 0.56‐0.98) mg/kg/day, and 108/144 (75%) of dogs received q12h dosing. No clinically relevant changes in renal function test results, serum electrolyte concentrations, or blood pressure occurred between initial prescription of ACEI and first reevaluation (median, 14 days later). In univariable analysis, higher ACEI dose was associated with increased survival from first‐onset CHF (P = .005), and within the subgroup of dogs in CHF at the time of ACEI prescription, higher ACEI dose was associated with improved survival at 2 years (P = .04). In multivariable analysis, q12h dose frequency of ACEI (hazard ratio [HR], 0.30; 95% CI, 0.10‐0.88; P = .03) and higher serum potassium concentration at visit 1 (HR, 0.39; 95% CI, 0.16‐0.97; P = .04) were predictive of 2‐year survival. The ACEIs were well‐tolerated, with only 8/144 (5.6%) dogs having ACEI dose decreased or discontinued because of adverse effects. Conclusions and Clinical Importance Twice daily dose frequency might optimize the cardioprotective benefit of ACEIs.
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Affiliation(s)
- Jessica L Ward
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, USA
| | - Yen-Yu Chou
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, USA
| | - Lingnan Yuan
- Department of Statistics, Iowa State University, Ames, Iowa, USA.,Department of Biomedical Sciences, SMART Pharmacology, Iowa State University, Ames, Iowa, USA
| | - Karin S Dorman
- Department of Statistics, Iowa State University, Ames, Iowa, USA.,Department of Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa, USA
| | - Jonathan P Mochel
- Department of Biomedical Sciences, SMART Pharmacology, Iowa State University, Ames, Iowa, USA
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15
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Adin DB, Atkins CE, Friedenberg SG, Stern JA, Meurs KM. Prevalence of an angiotensin-converting enzyme gene variant in dogs. Canine Med Genet 2021; 8:6. [PMID: 34256860 PMCID: PMC8276509 DOI: 10.1186/s40575-021-00105-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/07/2021] [Indexed: 12/04/2022] Open
Abstract
Background Genetic heterogeneity of the canine angiotensin converting enzyme (ACE) gene is functionally important because the degree of aldosterone breakthrough with ACE-inhibitor therapy is greater in variant positive dogs compared to variant negative dogs, but the prevalence of the variant is not known. The purpose of this study was to determine ACE gene variant-positive prevalence in a population of 497 dogs of different breeds. Results Overall variant-positive prevalence was 31%, with 20% of dogs heterozygous and 11% of dogs homozygous. The variant was overrepresented in Irish Wolfhounds (prevalence 95%; P < .001), Dachshunds (prevalence 90%; P < .001), Cavalier King Charles Spaniels (prevalence 85%; P < .001), Great Danes (prevalence 84%; P < .001), and Bull Mastiffs (prevalence 58%; P = .02). Irish Wolfhounds were more likely to be homozygous than heterozygous (P < .001). Conclusions Nearly one-third of dogs in this study were positive for a functionally important ACE gene variant, with wide prevalence variability between breeds. The clinical importance of high ACE gene variant-positive prevalence in some breeds requires further study because the highest prevalences were found in breeds that are predisposed to heart disease and therefore may be treated with ACE-inhibitors. Genetic differences in the angiotensin converting enzyme (ACE) have been shown to affect the way dogs respond to ACE-inhibitors, a class of medication which is used to treat dogs with heart disease. Dogs that have a genetic mutation of the ACE gene show less benefit with ACE-inhibitor medications than dogs without the mutation, but it is not known how common the mutation is in dogs. The purpose of this study was to determine the prevalence of this mutation (variant) in a large population of dogs of different breeds. The overall variant-positive prevalence in this population of 497 dogs was 31%. The variant was overrepresented in Irish Wolfhounds (prevalence 95%), Dachshunds (prevalence 90%), Cavalier King Charles Spaniels (prevalence 85%), Great Danes (prevalence 84%), and Bull Mastiffs (prevalence 58%). Irish Wolfhounds were more likely than other breeds to have 2 copies of the mutation (homozygous) than 1 copy of the mutation (heterozygous). The clinical importance of high ACE gene variant-positive prevalence in some breeds will require additional studies because some breeds are predisposed to heart disease, for which treatment with ACE-inhibitor medication might be recommended.
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Affiliation(s)
- D B Adin
- University of Florida, College of Veterinary Medicine, Gainesville, FL, USA.
| | - C E Atkins
- North Carolina State University, College of Veterinary Medicine, Raleigh, NC, USA
| | - S G Friedenberg
- University of Minnesota, College of Veterinary Medicine, Saint Paul, MN, USA
| | - J A Stern
- University of California, Davis, Davis, CA, USA
| | - K M Meurs
- North Carolina State University, College of Veterinary Medicine, Raleigh, NC, USA
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16
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O'Brien MJ, Beijerink NJ, Wade CM. Genetics of canine myxomatous mitral valve disease. Anim Genet 2021; 52:409-421. [PMID: 34028063 DOI: 10.1111/age.13082] [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] [Accepted: 05/03/2021] [Indexed: 12/26/2022]
Abstract
Myxomatous mitral valve disease (MMVD) is the most common heart disease and cause of cardiac death in domestic dogs. MMVD is characterised by slow progressive myxomatous degeneration from the tips of the mitral valves onwards with subsequent mitral valve regurgitation, and left atrial and ventricular dilatation. Although the disease usually has a long asymptomatic period, in dogs with severe disease, mortality is typically secondary to left-sided congestive heart failure. Although it is not uncommon for dogs to survive long enough in the asymptomatic period to die from unrelated causes; a proportion of dogs rapidly advance into congestive heart failure. Heightened prevalence in certain breeds, such as the Cavalier King Charles Spaniel, has indicated that MMVD is under a genetic influence. The genetic characterisation of the factors that underlie the difference in progression of disease is of strong interest to those concerned with dog longevity and welfare. Advanced genomic technologies have the potential to provide information that may impact treatment, prevalence, or severity of MMVD through the elucidation of pathogenic mechanisms and the detection of predisposing genetic loci of major effect. Here we describe briefly the clinical nature of the disorder and consider the physiological mechanisms that might impact its occurrence in the domestic dog. Using results from comparative genomics we suggest possible genetic approaches for identifying genetic risk factors within breeds. The Cavalier King Charles Spaniel breed represents a robust resource for uncovering the genetic basis of MMVD.
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Affiliation(s)
- M J O'Brien
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
| | - N J Beijerink
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, NSW, 2006, Australia.,Veterinaire Specialisten Vught, Reutsedijk 8a, Vught, 5264 PC, The Netherlands
| | - C M Wade
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
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17
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Wess G, Glaus T. Response to letter to the editor regarding "Efficacy of adding ramipril (VAsotop) to the combination of furosemide (Lasix) and pimobendan (VEtmedin) in dogs with mitral valve degeneration: The VALVE trial". J Vet Intern Med 2021; 35:700-702. [PMID: 33496046 PMCID: PMC7995423 DOI: 10.1111/jvim.16033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Gerhard Wess
- Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tony Glaus
- University of Zurich, Zurich, Switzerland
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18
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Duler L, Visser LC, Jackson KN, Phillips KL, Pollard RE, Wanamaker MW. Evaluation of radiographic predictors of left heart enlargement in dogs with known or suspected cardiovascular disease. Vet Radiol Ultrasound 2021; 62:271-281. [PMID: 33439529 DOI: 10.1111/vru.12949] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 11/27/2022] Open
Abstract
Radiographic assessment of heart size is important for clinical management of dogs with cardiovascular disease (CVDz). We sought to compare the ability of vertebral heart size (VHS), vertebral left atrial size (VLAS), and radiologists' assessment of left atrial size (RadLAE) to predict echocardiographic left atrial size (EchoLAE), an important marker of left heart disease severity. We also compared the ability of VHS and VLAS to predict echocardiographic criteria for ACVIM stage B2 (EchoB2) in dogs with myxomatous mitral valve disease (MMVD). This prospective observational study enrolled 183 dogs with known or suspected CVDz that had an echocardiographic examination and thoracic radiographs obtained within 24 h. Compared to increased VHS, VLAS >2.3 was a more accurate predictor of EchoLAE (P = .002). VLAS >2.3 and RadLAE (both P <.0001) were independently associated with EchoLAE but VHS was not (P = .45). Optimal cutoffs for VLAS and VHS to predict EchoLAE were >2.3 vertebrae (sensitivity [Sn] = 90.3%, specificity [Sp] = 73.6%) and >11.1 vertebrae (Sn = 75.8%, Sp = 76.0%), respectively. Diagnostic accuracy of VLAS (AUC 0.84, 95% CI 0.73-0.92) and VHS (AUC 0.78, 95% CI 0.66-0.88) to predict EchoB2 in dogs with subclinical MMVD (n = 64) were not significantly different (P = .17). Results demonstrate that VLAS and RadLAE were superior indicators of EchoLAE compared to VHS in dogs with known or suspected CVDz. Both VLAS and VHS are useful predictors of EchoB2 in dogs with subclinical MMVD. When echocardiography is unavailable, VLAS represents a useful radiographic measurement to aid clinical management of dogs with known or suspected CVDz.
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Affiliation(s)
- Laetitia Duler
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Lance C Visser
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Kristina N Jackson
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Kathryn L Phillips
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Rachel E Pollard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Mason W Wanamaker
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, California, USA
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19
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Bagardi M, Manfredi M, Zani DD, Brambilla PG, Locatelli C. Interobserver variability of radiographic methods for the evaluation of left atrial size in dogs. Vet Radiol Ultrasound 2020; 62:161-174. [PMID: 33226167 DOI: 10.1111/vru.12930] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/20/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Abstract
The objectives of this retrospective, observer agreement study were to (a) test variability of radiographic left atrial dimension (RLAD) and vertebral left atrial size (VLAS) measurements among observers with different levels of expertise in thoracic radiology and cardiology, (b) assess whether one method is better than the other in detecting left atrial enlargement (LAE), and (c) assess the agreement among RLAD, VLAS, and American College of Veterinary Internal Medicine (ACVIM) classes. Seventy-four dogs (eight healthy and 66 with mitral valve disease) with thoracic radiographs and echocardiography performed on the same day were reviewed. Thirty showed echocardiographic LAE. Left atrial dimension was quantified using RLAD and VLAS by six different operators with three levels of clinical experience in veterinary cardiology/radiology. Vertebral heart score and fourth thoracic vertebra (T4) were also measured. Differences in T4, vertebral heart score (VHS), RLAD, and VLAS measurements were found among six operators and among the three levels of clinical expertise as well as between veterinary cardiology readers and veterinary radiology readers (P < .05). The area under the receiver operating characteristic (AUC) curve for VHS showed good performances for all observers and level and type of expertise; the AUC for RLAD and VLAS was suboptimal only for the radiology student. Our RLAD and VLAS cutoffs (1.9 and 2.43 v, respectively) were better related to qualitative radiographic than quantitative echocardiographic LAE evaluation. Radiographic LA dimension and VLAS showed an increase proportional to the worsening of the ACVIM class. In conclusion, these results allow us to affirm that RLAD and VLAS are reproducible measurements for detecting LAE. Better performances are associated with clinical expertise and background.
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Affiliation(s)
- Mara Bagardi
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Lodi, Italy
| | - Martina Manfredi
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Lodi, Italy
| | - Davide D Zani
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Lodi, Italy
| | - Paola G Brambilla
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Lodi, Italy
| | - Chiara Locatelli
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Lodi, Italy
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20
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Symmetric dimethylarginine in dogs with myxomatous mitral valve disease at various stages of disease severity. PLoS One 2020; 15:e0238440. [PMID: 32870923 PMCID: PMC7462265 DOI: 10.1371/journal.pone.0238440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022] Open
Abstract
Symmetric dimethylarginine (SDMA) is a serum biomarker of renal damage in dogs. Moreover, SDMA concentration is an independent predictor of development of severe heart failure (HF) in humans with cardiac disease. This study evaluates whether the serum concentration of SDMA in dogs with myxomatous mitral valve disease (MMVD) is influenced by the severity of heart disease, pulmonary hypertension (PH) and treatment of HF. A total of 99 client-owned dogs were included in this retrospective case-control study; 78 dogs were affected by MMVD and classified according to the American College of Veterinary Internal Medicine (ACVIM) guidelines, and 21 were healthy controls. For each dog, history, physical examination, complete blood count, biochemical profile, thoracic radiography, 6-lead standard electrocardiogram and trans-thoracic echocardiography were available. Comparisons were performed between groups of dogs belonging to different ACVIM stages and between dogs with and without PH. The median SDMA concentration was neither significantly different among groups of dogs in different disease stages (overall P = 0.010), nor among dogs with MMVD, nor between those with [14.5 μg/dl (10.5–18.8)] and without PH [13 μg/dl (9–17.2)] (P = 0.295). The concentration of SDMA did not differ between dogs when considering the combined effect of the ACVIM group and cardiac treatment (overall P = 0.486). Furthermore, no correlation was found between SDMA concentration and radiographic and echocardiographic parameters associated with increased MMVD severity. In conclusion, this study failed to demonstrate the presence of renal impairment in dogs with MMVD, and the increase in renal parameters in some dogs in the more advanced stage of MMVD could be attributed to pre-renal azotemia.
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21
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Li S, Wang Z, Visser LC, Wisner ER, Cheng H. Pilot study: Application of artificial intelligence for detecting left atrial enlargement on canine thoracic radiographs. Vet Radiol Ultrasound 2020; 61:611-618. [PMID: 32783354 PMCID: PMC7689842 DOI: 10.1111/vru.12901] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 12/15/2022] Open
Abstract
Although deep learning has been explored extensively for computer‐aided medical imaging diagnosis in human medicine, very little has been done in veterinary medicine. The goal of this retrospective, pilot project was to apply the deep learning artificial intelligence technique using thoracic radiographs for detection of canine left atrial enlargement and compare results with those of veterinary radiologist interpretations. Seven hundred ninety‐two right lateral radiographs from canine patients with thoracic radiographs and contemporaneous echocardiograms were used to train, validate, and test a convolutional neural network algorithm. The accuracy, sensitivity, and specificity for determination of left atrial enlargement were then compared with those of board‐certified veterinary radiologists as recorded on radiology reports. The accuracy, sensitivity, and specificity were 82.71%, 68.42%, and 87.09%, respectively, using an accuracy driven variant of the convolutional neural network algorithm and 79.01%, 73.68%, and 80.64%, respectively, using a sensitivity driven variant. By comparison, accuracy, sensitivity, and specificity achieved by board‐certified veterinary radiologists was 82.71%, 68.42%, and 87.09%, respectively. Although overall accuracy of the accuracy driven convolutional neural network algorithm and veterinary radiologists was identical, concordance between the two approaches was 85.19%. This study documents proof‐of‐concept for application of deep learning techniques for computer‐aided diagnosis in veterinary medicine.
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Affiliation(s)
- Shen Li
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
| | - Zigui Wang
- Department of Animal SciencesUniversity of CaliforniaDavisCaliforniaUSA
| | - Lance C. Visser
- Department of Medicine and Epidemiology, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
| | - Erik R. Wisner
- Department of Surgical and Radiological Sciences, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
| | - Hao Cheng
- Department of Animal SciencesUniversity of CaliforniaDavisCaliforniaUSA
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22
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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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23
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Adin D, Atkins C, Domenig O, DeFrancesco T, Keene B, Tou S, Stern JA, Meurs KM. Renin-angiotensin aldosterone profile before and after angiotensin-converting enzyme-inhibitor administration in dogs with angiotensin-converting enzyme gene polymorphism. J Vet Intern Med 2020; 34:600-606. [PMID: 32112596 PMCID: PMC7097578 DOI: 10.1111/jvim.15746] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND An angiotensin-converting enzyme (ACE) gene polymorphism occurs in dogs; however, functional importance is not well studied. HYPOTHESIS We hypothesized that dogs with the polymorphism would show alternative renin-angiotensin aldosterone system (RAAS) pathway activation and classical RAAS pathway suppression before and after ACE-inhibitor administration, as compared to dogs without the polymorphism that would show this pattern only after ACE-inhibitor administration. ANIMALS Twenty-one dogs with mitral valve disease that were genotyped for the ACE gene polymorphism. METHODS This retrospective study utilized stored samples from 8 ACE gene polymorphism-negative (PN) dogs and 13 ACE gene polymorphism-positive (PP) dogs before and after enalapril administration. Equilibrium analysis was performed to evaluate serum RAAS metabolites and enzyme activities. Results were compared before and after enalapril, and between groups. RESULTS The classical RAAS pathway was suppressed and the alternative RAAS pathway was enhanced for both genotypes after administration of enalapril, with no differences before enalapril administration. Aldosterone breakthrough occurred in both PN (38%) and PP (54%) dogs despite angiotensin II suppression. Aldosterone was significantly higher (P = .02) in ACE gene PP dogs (median, 92.17 pM; IQR, 21.85-184.70) compared to ACE gene PN dogs (median, 15.91 pM; IQR, <15.00-33.92) after enalapril. CONCLUSIONS AND CLINICAL IMPORTANCE The ACE gene polymorphism did not alter baseline RAAS activity. Aldosterone breatkthrough in some dogs suggests nonangiotensin mediated aldosterone production that might be negatively influenced by genotype. These results support the use of aldosterone receptor antagonists with ACE-inhibitors when RAAS inhibition is indicated for dogs, especially those positive for the ACE gene polymorphism.
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Affiliation(s)
- Darcy Adin
- College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Clarke Atkins
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | | | - Teresa DeFrancesco
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Bruce Keene
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Sandra Tou
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Joshua A Stern
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Kathryn M Meurs
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
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24
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Reinero C, Visser LC, Kellihan HB, Masseau I, Rozanski E, Clercx C, Williams K, Abbott J, Borgarelli M, Scansen BA. ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs. J Vet Intern Med 2020; 34:549-573. [PMID: 32065428 PMCID: PMC7097566 DOI: 10.1111/jvim.15725] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/30/2020] [Indexed: 01/01/2023] Open
Abstract
Pulmonary hypertension (PH), defined by increased pressure within the pulmonary vasculature, is a hemodynamic and pathophysiologic state present in a wide variety of cardiovascular, respiratory, and systemic diseases. The purpose of this consensus statement is to provide a multidisciplinary approach to guidelines for the diagnosis, classification, treatment, and monitoring of PH in dogs. Comprehensive evaluation including consideration of signalment, clinical signs, echocardiographic parameters, and results of other diagnostic tests supports the diagnosis of PH and allows identification of associated underlying conditions. Dogs with PH can be classified into the following 6 groups: group 1, pulmonary arterial hypertension; group 2, left heart disease; group 3, respiratory disease/hypoxia; group 4, pulmonary emboli/pulmonary thrombi/pulmonary thromboemboli; group 5, parasitic disease (Dirofilaria and Angiostrongylus); and group 6, disorders that are multifactorial or with unclear mechanisms. The approach to treatment of PH focuses on strategies to decrease the risk of progression, complications, or both, recommendations to target underlying diseases or factors contributing to PH, and PH‐specific treatments. Dogs with PH should be monitored for improvement, static condition, or progression, and any identified underlying disorder should be addressed and monitored simultaneously.
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Affiliation(s)
- Carol Reinero
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri
| | - Lance C Visser
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Heidi B Kellihan
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin
| | - Isabelle Masseau
- Department of Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, Medford, Massachusetts
| | - Cécile Clercx
- Department of Clinical Sciences of Companion Animals and Equine, University of Liège, Liège, Belgium
| | - Kurt Williams
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Jonathan Abbott
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Michele Borgarelli
- Department of Small Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Brian A Scansen
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
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25
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Borgarelli M, Ferasin L, Lamb K, Bussadori C, Chiavegato D, D'Agnolo G, Migliorini F, Poggi M, Santilli RA, Guillot E, Garelli-Paar C, Toschi Corneliani R, Farina F, Zani A, Dirven M, Smets P, Guglielmini C, Oliveira P, Di Marcello M, Porciello F, Crosara S, Ciaramella P, Piantedosi D, Smith S, Vannini S, Dall'Aglio E, Savarino P, Quintavalla C, Patteson M, Silva J, Locatelli C, Baron Toaldo M. DELay of Appearance of sYmptoms of Canine Degenerative Mitral Valve Disease Treated with Spironolactone and Benazepril: the DELAY Study. J Vet Cardiol 2020; 27:34-53. [PMID: 32032923 DOI: 10.1016/j.jvc.2019.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Efficacy of renin-angiotensin-aldosterone system (RAAS) blockade using angiotensin-converting enzyme inhibitors (ACEi) in dogs with preclinical myxomatous mitral valve disease (MMVD) is controversial. HYPOTHESIS Administration of spironolactone (2-4 mg q 24 h) and benazepril (0.25-0.5 mg q 24 h) in dogs with preclinical MMVD, not receiving any other cardiac medications, delays the onset of heart failure (HF) and cardiac-related death. Moreover, it reduces the progression of the disease as indicated by echocardiographic parameters and level of cardiac biomarkers N-terminal pro brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI). ANIMALS 184 dogs with pre-clinical MMVD and left atrium-to-aortic root ratio (LA:Ao) ≥1.6 and normalized left ventricular end-diastolic diameter (LVEDDn) ≥1.7. METHODS This is a prospective, randomized, multicenter, single-blinded, placebo-controlled study. Primary outcome variable was time-to-onset of first occurrence of HF or cardiac death. Secondary end points included effect of treatment on progression of the disease based on echocardiographic and radiographic parameters, as well as variations of NT-proBNP and cTnI concentrations. RESULTS The median time to primary end point was 902 days (95% confidence interval (CI) 682-not available) for the treatment group and 1139 days (95% CI 732-NA) for the control group (p = 0.45). Vertebral heart score (p = 0.05), LA:Ao (p < 0.001), LVEDDn (p < 0.001), trans-mitral E peak velocity (p = 0.011), and NT-proBNP (p = 0.037) were lower at the end of study in the treatment group. CONCLUSIONS This study failed in demonstrating that combined administration of spironolactone and benazepril delays onset of HF in dogs with preclinical MMVD. However, such treatment induces beneficial effects on cardiac remodeling and these results could be of clinical relevance.
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Affiliation(s)
- M Borgarelli
- Department Small Animal Clinical Science, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA, USA.
| | - L Ferasin
- Lumbry Park Veterinary Specialists, Alton, Hampshire, UK
| | - K Lamb
- Lamb Statiscal Consulting and Scientific Writing LLC, West St. Paul, MN, USA
| | - C Bussadori
- Clinica Veterinaria Gran Sasso, Milan, Italy
| | | | | | | | - M Poggi
- Centro Veterinario Imperiese, Imperia, Italy
| | - R A Santilli
- Clinica Veterinaria Malpensa, Samarate Varese, Italy
| | - E Guillot
- Ceva Santé Animale, Libourne, France
| | | | | | - F Farina
- Ambulatorio Veterinario Del Parco Margherita, Naples, Italy
| | - A Zani
- Clinica Cardiovet, Livorno, Italy
| | - M Dirven
- Dierenkliniek Rijen, Rijen the Netherlands
| | - P Smets
- Dierenkliniek Rijen, Rijen the Netherlands
| | - C Guglielmini
- Dipartimento di Medicina Animale, Produzione e Salute, Università di Padova, Legnaro Padova, Italy
| | - P Oliveira
- Davies Veterinary Specialists Ltd, Higham Gobion, Hertfordshire, UK
| | - M Di Marcello
- Centro Veterinario Cellatica, Cellatica, Brescia, Italy
| | - F Porciello
- Dipartimento di Medicina Veterinaria, Università Degli Studi di Perugia, Perugia, Italy
| | - S Crosara
- Clinica Veterinaria CMV, Varese, Italy
| | - P Ciaramella
- Dipartimento di Medicina Veterinaria e Produzioni Animali, Università Degli Studi di Napoli Federico II, Naples, Italy
| | - D Piantedosi
- Dipartimento di Medicina Veterinaria e Produzioni Animali, Università Degli Studi di Napoli Federico II, Naples, Italy
| | - S Smith
- Sarah Smith Cardiology Ivy Court, Willington, UK
| | - S Vannini
- Clinica Veterinaria Gran Sasso, Milan, Italy
| | - E Dall'Aglio
- Clinica Veterinaria Milano Sud, Peschiera Borromeo, Milano, Italy
| | - P Savarino
- Facoltà di Medicina Veterinaria di Torino, Ospedale Didattico Veterinario Della Facoltà, Sezione Clinica Medica, Grugliasco, Turin, Italy
| | - C Quintavalla
- Dipartimento di Scienze Mediche Veterinarie, Università di Parma, Parma, Italy
| | - M Patteson
- Heartvets, The Animal Hospital Stinchcombe, Dursley, UK
| | - J Silva
- Clinica Veterinaria Gran Sasso, Milan, Italy
| | - C Locatelli
- Dipartimento di Medicina Veterinaria, Università Degli Studi di Milano, Milan, Italy
| | - M Baron Toaldo
- Dipartimento di Scienze Mediche Veterinarie, Alma Mayor Studiorum, Università di Bologna, Ozzano Emilia, Italy
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26
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Visser LC, Ciccozzi MM, Sintov DJ, Sharpe AN. Echocardiographic quantitation of left heart size and function in 122 healthy dogs: A prospective study proposing reference intervals and assessing repeatability. J Vet Intern Med 2019; 33:1909-1920. [PMID: 31313382 PMCID: PMC6766555 DOI: 10.1111/jvim.15562] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/01/2019] [Indexed: 12/21/2022] Open
Abstract
Background Broadly applicable reference intervals (RIs) for measurements of left atrial (LA) and left ventricular (LV) size and function generated prospectively using statistically appropriate methods are limited. Objectives To generate body size‐independent RIs for linear, area, and volume measurements of LA size and LV size and function. Animals Healthy adult dogs (n = 122) of variable size and somatotype. Methods Prospective study. All dogs underwent an echocardiogram performed by the same examiner. Effects of body weight, sex, age, and heart rate were evaluated by regression and correlation analyses. Scaling exponents and prediction intervals were generated for linear measurements using the allometric equation. After normalization to body weight, 95% RIs were determined using nonparametric methods with 2.5 and 97.5 percentiles serving as the lower and upper limits (each with 90% confidence intervals), respectively. Results Linear LA and LV measurements were strongly correlated (R2 ≥ 0.79) with body weight. Scaling exponents were close to the expected 1/3 (0.299‐0.392). Prediction intervals for linear measurements of LV chamber size were considerably narrower than previously reported. Weak correlations (r = −0.42 to −0.50) among LV fractional shortening, fractional area change, and ejection fraction and body weight were identified. No other meaningful relationships were identified between the measurements and sex, age, and heart rate. Conclusions and Clinical Importance Body size‐independent RIs for several linear, area, and volume measurements of LA and LV size and function were generated prospectively from a large and diverse reference population and are available for clinical use.
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Affiliation(s)
- Lance C Visser
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Marisa M Ciccozzi
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Daniel J Sintov
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Ashley N Sharpe
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California
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27
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Keene BW, Atkins CE, Bonagura JD, Fox PR, Häggström J, Fuentes VL, Oyama MA, Rush JE, Stepien R, Uechi M. ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. J Vet Intern Med 2019; 33:1127-1140. [PMID: 30974015 PMCID: PMC6524084 DOI: 10.1111/jvim.15488] [Citation(s) in RCA: 340] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/13/2019] [Indexed: 01/25/2023] Open
Abstract
This report, issued by the ACVIM Specialty of Cardiology consensus panel, revises guidelines for the diagnosis and treatment of myxomatous mitral valve disease (MMVD, also known as endocardiosis and degenerative or chronic valvular heart disease) in dogs, originally published in 2009. Updates were made to diagnostic, as well as medical, surgical, and dietary treatment recommendations. The strength of these recommendations was based on both the quantity and quality of available evidence supporting diagnostic and therapeutic decisions. Management of MMVD before the onset of clinical signs of heart failure has changed substantially compared with the 2009 guidelines, and new strategies to diagnose and treat advanced heart failure and pulmonary hypertension are reviewed.
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Affiliation(s)
- Bruce W Keene
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Clarke E Atkins
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - John D Bonagura
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina.,Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio
| | - Philip R Fox
- The Elmer and Mamdouha Bobst Hospital, The Animal Medical Center, New York, New York
| | - Jens Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Virginia Luis Fuentes
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Mark A Oyama
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John E Rush
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - Rebecca Stepien
- Department of Medical Sciences, University of Wisconsin, Madison, Wisconsin
| | - Masami Uechi
- Jasmine Veterinary Cardiovascular Medical Center, Yokohama, Japan
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28
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Abstract
Many cardiac therapeutics lack significant evidence of benefit in the horse, and in many cases their use is based on extrapolation of evidence from other species. In recent years there has been a push to develop a better understanding of both the pharmacodynamics and pharmacokinetics of these drugs. Recent data have described the use of antiarrhythmic agents including sotalol, flecainide, and amiodarone. Data about the use of ACE inhibitors in the management of congestive heart failure are encouraging and support their use in certain cases, wheras evidence for other medicines, such as pimobendan, remain speculative.
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Affiliation(s)
- Adam Redpath
- Oakham Veterinary Hospital, University of Nottingham, School of Veterinary Medicine and Science, Sutton Bonington, LE12 5RD, UK.
| | - Mark Bowen
- Oakham Veterinary Hospital, University of Nottingham, School of Veterinary Medicine and Science, Sutton Bonington, LE12 5RD, UK
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Ames MK, Atkins CE, Pitt B. The renin-angiotensin-aldosterone system and its suppression. J Vet Intern Med 2019; 33:363-382. [PMID: 30806496 PMCID: PMC6430926 DOI: 10.1111/jvim.15454] [Citation(s) in RCA: 208] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 01/30/2019] [Indexed: 12/11/2022] Open
Abstract
Chronic activation of the renin-angiotensin-aldosterone system (RAAS) promotes and perpetuates the syndromes of congestive heart failure, systemic hypertension, and chronic kidney disease. Excessive circulating and tissue angiotensin II (AngII) and aldosterone levels lead to a pro-fibrotic, -inflammatory, and -hypertrophic milieu that causes remodeling and dysfunction in cardiovascular and renal tissues. Understanding of the role of the RAAS in this abnormal pathologic remodeling has grown over the past few decades and numerous medical therapies aimed at suppressing the RAAS have been developed. Despite this, morbidity from these diseases remains high. Continued investigation into the complexities of the RAAS should help clinicians modulate (suppress or enhance) components of this system and improve quality of life and survival. This review focuses on updates in our understanding of the RAAS and the pathophysiology of AngII and aldosterone excess, reviewing what is known about its suppression in cardiovascular and renal diseases, especially in the cat and dog.
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Affiliation(s)
- Marisa K Ames
- Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado
| | - Clarke E Atkins
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
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30
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Sudunagunta S, Green D, Christley R, Dukes-McEwan J. The prevalence of pulmonary hypertension in Cavalier King Charles spaniels compared with other breeds with myxomatous mitral valve disease. J Vet Cardiol 2019; 23:21-31. [PMID: 31174726 DOI: 10.1016/j.jvc.2019.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 01/01/2019] [Accepted: 01/04/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pulmonary hypertension (PH) is a common consequence of myxomatous mitral valve disease (MMVD). Cavalier King Charles spaniels (CKCS) are frequently affected with MMVD and appear to have different disease progression compared to other dogs. This study aimed to determine if CKCS are more likely to develop PH as a result of MMVD than dogs of other breeds. A secondary aim was to explore whether breed or PH impacted survival. ANIMALS A total of 187 dogs diagnosed with MMVD, 94 CKCS and 93 non-CKCS, were included in this study. METHODS This is a retrospective review of dogs with MMVD. Data were analyzed for presence of PH, congestive heart failure (CHF) and echocardiographic variables including the ratio between mitral E wave velocity (E vel) and isovolumic relaxation time (E/IVRT) and were compared between CKCS/non-CKCS and dogs with/without PH. Survival analysis was also performed. RESULTS American College of Veterinary Internal Medicine (ACVIM) stage (p < 0.001), CKCS (p = 0.005), left atrium-to-aortic ratio (LA/Ao) (p < 0.001), E vel (p < 0.001) and log10(E/IVRT) (p < 0.001) were significant at the univariate level for PH development. At the multivariate level, only ACVIM stage remained significant (p = 0.044), suggesting that worsening MMVD was the predominant determinant of PH development in this study. Pulmonary hypertension was associated with greater likelihood of CHF (p < 0.001) and death (both cardiac [p < 0.001] and all-cause mortality [p = 0.011]). Cavalier King Charles spaniels were more likely to experience cardiac death than non-CKCS (p = 0.004). CONCLUSIONS In this study, development of PH was associated with worse MMVD, according to ACVIM stage.
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Affiliation(s)
- S Sudunagunta
- Cardiology Service, Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK.
| | - D Green
- Waikanae Beach, Wellington, 5036, New Zealand
| | - R Christley
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, CH64 7TE, UK
| | - J Dukes-McEwan
- Cardiology Service, Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
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31
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Larouche-Lebel É, Loughran KA, Oyama MA. Echocardiographic indices and severity of mitral regurgitation in dogs with preclinical degenerative mitral valve disease. J Vet Intern Med 2019; 33:489-498. [PMID: 30793808 PMCID: PMC6430891 DOI: 10.1111/jvim.15461] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/06/2019] [Indexed: 12/03/2022] Open
Abstract
Background Describing severity of mitral regurgitation (MR) in dogs with degenerative mitral valve disease (DMVD) is challenging. Hypothesis/Objectives Mitral regurgitant fraction (RF), effective regurgitant orifice area (EROA), and the ratio of mitral regurgitant to aortic flow (QMR:QAo) can be calculated from routine echocardiographic measurements and provide additional information regarding MR severity. Animals Fifty‐seven dogs with preclinical DMVD including 36 without and 21 with cardiomegaly. Methods Prospective observational study. The expected relationships among RF, EROA, and QMR:QAo and 1‐dimensional measurements including left atrium to aortic root diameter ratio (LA:Ao) and normalized left ventricular internal dimension at end‐diastole (LVIDdN) were mathematically derived and calculated using echocardiographic data from the study population. Nonlinear goodness of fit was determined by calculation of the root mean standard error. The correlations between 1‐dimensional and multidimensional indices were analyzed using receiver operating characteristic curves. Results The relationships among RF, EROA, QMR:QAo, and both LA:Ao and LVIDdN were curvilinear, and the multidimensional indices differentiated MR of variable severity. By contrast, 1‐dimensional measurements were insensitive to MR severity until RF equaled or exceeded 50%. Regurgitant fraction ≥50%, EROA to body surface area ≥0.347 and QMR:QAo ≥0.79 were strongly associated with LA:Ao ≥1.6 and LVIDdN ≥1.7. Conclusions and Clinical Importance Regurgitant fraction, EROA, and QMR:QAo quantify MR severity in dogs with preclinical DMVD in a manner that 1‐dimensional measurements do not.
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Affiliation(s)
- Éva Larouche-Lebel
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kerry A Loughran
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark A Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Mattin MJ, Boswood A, Church DB, Brodbelt DC. Prognostic factors in dogs with presumed degenerative mitral valve disease attending primary-care veterinary practices in the United Kingdom. J Vet Intern Med 2018; 33:432-444. [PMID: 30357909 PMCID: PMC6430873 DOI: 10.1111/jvim.15251] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/19/2018] [Accepted: 05/31/2018] [Indexed: 11/28/2022] Open
Abstract
Background Prognostic risk factors were identified for dogs with degenerative mitral valve disease (DMVD) monitored by veterinary cardiologists. The value of these measurements has not been determined in the wider primary care setting. Objectives To evaluate whether plasma cardiac biomarkers and data obtained from routine history‐taking and physical examination are predictive of survival in dogs with DMVD attending primary care practice. Animals Eight‐hundred and ninety‐three dogs with a presumptive diagnosis of DMVD recruited from 79 primary care veterinary practices in the United Kingdom. Methods Prospective cohort study. Primary care veterinary practitioners recorded clinical data. Plasma N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) and cardiac troponin I (cTnI) were measured at presentation. Cox regression models evaluated associations between risk factor variables and hazard of death (all‐cause mortality and cardiac‐related death). Flexible parametric models generated predicted survival probabilities for dogs with different combinations of prognostic risk factor variable values. Results Dogs with higher NT‐proBNP and cTnI concentrations, higher heart rates, older dogs, females, and those reported to be exercise intolerant, dyspneic, and diagnosed with selected comorbidities had an increased hazard of death due to any cause. Dogs with higher concentrations of plasma biomarkers, higher heart rates, and heart murmur intensities, those with exercise intolerance and those receiving potent diuretics had a higher hazard of cardiac‐related death. Conclusions and Clinical Importance Cardiac biomarkers and key clinical findings identified in this study can help primary care veterinary practitioners identify dogs with DMVD that are at highest risk of death.
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Affiliation(s)
- M J Mattin
- Royal Veterinary College, University of London, London, The United Kingdom
| | - A Boswood
- Royal Veterinary College, University of London, London, The United Kingdom
| | - D B Church
- Royal Veterinary College, University of London, London, The United Kingdom
| | - D C Brodbelt
- Royal Veterinary College, University of London, London, The United Kingdom
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33
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Malcolm EL, Visser LC, Phillips KL, Johnson LR. Diagnostic value of vertebral left atrial size as determined from thoracic radiographs for assessment of left atrial size in dogs with myxomatous mitral valve disease. J Am Vet Med Assoc 2018; 253:1038-1045. [DOI: 10.2460/javma.253.8.1038] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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34
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Two-dimensional, long-axis echocardiographic ratios for assessment of left atrial and ventricular size in dogs. J Vet Cardiol 2018; 20:330-342. [DOI: 10.1016/j.jvc.2018.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 11/18/2022]
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35
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Angiotensin-converting enzyme activity in Cavalier King Charles Spaniels with an ACE gene polymorphism and myxomatous mitral valve disease. Pharmacogenet Genomics 2018; 28:37-40. [PMID: 29200408 DOI: 10.1097/fpc.0000000000000322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Myxomatous mitral valve disease (MMVD) is the most common heart disease in the dog. It is particularly common in the Cavalier King Charles Spaniel (CKCS) breed and affected dogs are frequently managed with angiotensin-converting enzyme inhibitors (ACE-I). We have previously identified a canine ACE gene polymorphism associated with a decrease in angiotensin-converting enzyme (ACE) activity. The aim of this study was to evaluate for the prevalence of the ACE polymorphism in CKCS with mitral valve disease and to determine whether the presence of the polymorphism is associated with alterations in ACE activity at different stages of cardiac disease. METHODS Seventy-three dogs with a diagnosis of mitral valve disease were evaluated and a blood sample was drawn for ACE polymorphism genotyping and ACE activity measurement. RESULTS Forty-three dogs were homozygous for the ACE polymorphism; five were heterozygous and 25 were homozygous wild type. The mean age and the median severity of disease were not different for dogs with the polymorphism and dogs with the wild-type sequence. The median baseline ACE activity was significantly lower for the ACE polymorphism (27.0 U/l) than the wild-type sequence dogs (31.0 U/l) (P=0.02). Dogs with more severe disease and the ACE polymorphism had significantly lower levels of ACE activity than dogs with the wild-type sequence (P=0.03). CONCLUSION The CKCS appears to have a high prevalence of the ACE variant. Dogs with the ACE variant had lower levels of ACE activity even in more advanced mitral valve disease than dogs without the variant. The clinical significance of this finding and its impact on the need for ACE-I in dogs with the polymorphism and heart disease deserves further study.
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Hori Y, Nakamura K, Kanno N, Hitomi M, Yamashita Y, Hosaka S, Isayama N, Mimura T. Effects of the angiotensin-converting enzyme inhibitor alacepril in dogs with mitral valve disease. J Vet Med Sci 2018; 80:1212-1218. [PMID: 29937457 PMCID: PMC6115264 DOI: 10.1292/jvms.17-0557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Alacepril is a relatively novel angiotensin-converting enzyme inhibitor; however, the safety, tolerance, and efficacy of alacepril in terms of cough suppression in dogs with mitral valve disease (MVD) remain unknown. The aim of this study was to investigate the safety, tolerance, and cough suppression efficacy of alacepril in dogs with MVD. This was a multi-center, prospective study. Forty-two dogs with echocardiographic or radiographic evidence of cardiac enlargement in addition to cough were enrolled. Dogs were treated with alacepril (1.0-3.0 mg/kg/day) for at least 4 weeks. One dog (2.4%) developed complications, including appetite loss, lethargy, and vomiting. Thirty-six dogs were re-evaluated after 4 weeks of treatment. Cough resolved or improved in 20 dogs (55.6%) after treatment. Based on the efficacy of alacepril, the dogs were divided into an effective group (n=20) and an ineffective group (n=16). After treatment, the left ventricular end-diastolic internal diameter corrected for body weight was significantly increased from baseline in the ineffective group but was significantly decreased in the effective group. Univariate binomial logistic regression analyses showed that high atrial natriuretic peptide level, N-terminal pro-B-type natriuretic peptide level, and E wave velocity at baseline were significantly correlated with alacepril inefficacy. Alacepril as treatment for MVD is well tolerated in most dogs, and different conditions of cardiac loading may influence the effect of the drug. Alacepril is expected to improve the quality of life of dogs with early stage MVD.
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Affiliation(s)
- Yasutomo Hori
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midori-machi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan
| | - Kensuke Nakamura
- University of Miyazaki, 1-1 Gakuenkibanadai-nishi, Miyazaki 889-2192 Japan
| | - Nobuyuki Kanno
- Veterinary Internal Medicine, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa 252-8510, Japan
| | - Makoto Hitomi
- Hitomi Animal Hospital, 37-7 Yoshidakamiadachicho, Sakyo, Kyoto 606-8307, Japan
| | - Yohei Yamashita
- Ebisu Animal Hospital, 3-3-43 Nishitaga, Taihaku, Sendai, Miyagi 982-0034, Japan.,Laboratory of Small Animal Internal Medicine II, School of Veterinary Medicine, Kitasato University, 23-35-1 Higashi, Towada, Aomori 034-8628, Japan
| | - Satoshi Hosaka
- Hosaka Animal Hospital, 4-17-1 Nihonmatsu Midori, Sagamihara, Kanagawa 252-0137, Japan
| | - Noriko Isayama
- Uenonomori Animal Clinic, 1-5-11 Yanaka Taito, Tokyo 110-0001, Japan
| | - Takahiro Mimura
- Olieve Animal Medical Center, 12-5 Shinomiyakandacho, Yamashina, Kyoto 607-8035, Japan
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Clinical use of submaximal treadmill exercise testing and assessments of cardiac biomarkers NT-proBNP and cTnI in dogs with presymptomatic mitral regurgitation. PLoS One 2018; 13:e0199023. [PMID: 29902265 PMCID: PMC6002043 DOI: 10.1371/journal.pone.0199023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 05/30/2018] [Indexed: 12/15/2022] Open
Abstract
Exercise intolerance is the first symptom of heart disease. Yet an objective and standardised method in canine cardiology to assess exercise capacity in a clinical setting is lacking. In contrast, exercise testing is a powerful diagnostic tool in humans, providing valuable information on prognosis and impact of therapeutic intervention. To investigate whether an exercise test reveals differences between dogs with early stage mitral regurgitation (MR) and dogs without cardiac disease, 12 healthy beagles (healthy group, HG) and 12 dogs with presymptomatic MR (CHIEF B1 / B2, patient group, PG) underwent a six-stage submaximal exercise test (ET) on a motorised treadmill. They trotted in their individual comfort speed for three minutes per stage, first without incline, afterwards increasing it by 4% for every subsequent stage. Blood samples were taken at rest and during two 3-minute breaks in the course of the test. Further samples were taken after the completion of the exercise test and again after a 3-hour recovery period. Measured parameters included heart rate, lactate and the cardiac biomarkers N-terminal pro-B-Type natriuretic peptide and cardiac Troponin I. The test was performed again under the same conditions in the same dogs three weeks after the first trial to evaluate individual repeatability. Cardiac biomarkers increased significantly in both HG and PG in the course of the test. The increase was more pronounced in CHIEF B1 / B2 dogs than in the HG. N-terminal pro-B-Type natriuretic peptide increased from 435 ± 195 to 523 ± 239 pmol/L (HG) and from 690 to 815 pmol/L (PG). cTnI increased from 0.020 to 0.024 ng/mL (HG) and from 0.06 to 0.08 ng/ml (PG). The present study provides a method to assess exercise-induced changes in cardiac biomarkers under clinical conditions. The increase of NT-proBNP and cTnI is more pronounced in dogs with early-stage MR than in healthy dogs. Results indicate that measuring the parameters before and after exercise is adequate and taking blood samples between the different stages of the ET does not provide additional information. Also, stress echocardiography was inconclusive. It can be concluded that exercise testing, especially in combination with measuring cardiac biomarkers, could be a helpful diagnostic tool in canine cardiology.
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Affiliation(s)
- Adrian Boswood
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldHertfordshireUK
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Meurs KM, Stern JA, Atkins CE, Adin D, Aona B, Condit J, DeFrancesco T, Reina-Doreste Y, Keene BW, Tou S, Ward J, Woodruff K. Angiotensin-converting enzyme activity and inhibition in dogs with cardiac disease and an angiotensin-converting enzyme polymorphism. J Renin Angiotensin Aldosterone Syst 2017; 18:1470320317737184. [PMID: 29069972 PMCID: PMC5843865 DOI: 10.1177/1470320317737184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 09/19/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate angiotensin-converting enzyme (ACE) activity in dogs and with and without an ACE polymorphism in the canine ACE gene, before and after treatment with an ACE inhibitor. METHODS Thirty-one dogs (20 wild-type, 11 ACE polymorphism) with heart disease were evaluated with ACE activity measurement and systolic blood pressure before and after administration of an ACE inhibitor (enalapril). RESULTS Median pre-treatment ACE activity was significantly lower for ACE polymorphism dogs than for dogs with the wild-type sequence ( P=0.007). After two weeks of an ACE inhibitor, ACE activity was significantly reduced for both genotypes (wild-type, P<0.0001; ACE polymorphism P=0.03); mean post-therapy ACE activity was no different between the groups. CONCLUSION An ACE polymorphism is associated with lower levels of ACE activity. Dogs with the polymorphism still experience suppression of ACE activity in response to an ACE inhibitor. It is possible that the genetic status and ACE activity of dogs may impact the response of dogs with this variant to an ACE inhibitor.
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Affiliation(s)
- Kathryn M Meurs
- Department of Veterinary Clinical Sciences, North Carolina State University, USA
| | - Joshua A Stern
- Department of Veterinary Clinical Sciences, North Carolina State University, USA
| | - Clarke E Atkins
- Department of Veterinary Clinical Sciences, North Carolina State University, USA
| | - Darcy Adin
- Department of Veterinary Clinical Sciences, North Carolina State University, USA
| | - Brent Aona
- Department of Veterinary Clinical Sciences, North Carolina State University, USA
| | - Julia Condit
- Department of Veterinary Clinical Sciences, North Carolina State University, USA
| | - Teresa DeFrancesco
- Department of Veterinary Clinical Sciences, North Carolina State University, USA
| | - Yamir Reina-Doreste
- Department of Veterinary Clinical Sciences, North Carolina State University, USA
| | - Bruce W Keene
- Department of Veterinary Clinical Sciences, North Carolina State University, USA
| | - Sandy Tou
- Department of Veterinary Clinical Sciences, North Carolina State University, USA
| | - Jessica Ward
- Department of Veterinary Clinical Sciences, North Carolina State University, USA
| | - Kathleen Woodruff
- Department of Veterinary Clinical Sciences, North Carolina State University, USA
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Menciotti G, Borgarelli M. Review of Diagnostic and Therapeutic Approach to Canine Myxomatous Mitral Valve Disease. Vet Sci 2017; 4:vetsci4040047. [PMID: 29056705 PMCID: PMC5753627 DOI: 10.3390/vetsci4040047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/09/2017] [Accepted: 09/20/2017] [Indexed: 01/11/2023] Open
Abstract
The most common heart disease that affects dogs is myxomatous mitral valve disease. In this article, we review the current diagnostic and therapeutic approaches to this disease, and we also present some of the latest technological advancements in this field.
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Affiliation(s)
- Giulio Menciotti
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, 205 Duck Pond Dr., Blacksburg, VA 24061, USA.
| | - Michele Borgarelli
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, 205 Duck Pond Dr., Blacksburg, VA 24061, USA.
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Pirintr P, Saengklub N, Limprasutr V, Sawangkoon S, Kijtawornrat A. Sildenafil improves heart rate variability in dogs with asymptomatic myxomatous mitral valve degeneration. J Vet Med Sci 2017; 79:1480-1488. [PMID: 28717064 PMCID: PMC5627316 DOI: 10.1292/jvms.17-0016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Myxomatous mitral valve degeneration (MMVD) causes an imbalance of sympathovagal activity resulted in poor cardiac outcomes. Phosphodiesterase-5 inhibitors have been revealed cardioprotective effect in patients with heart diseases. This study aimed to 1) compare the heart rate variability (HRV) between asymptomatic MMVD and healthy dogs and 2) assess long-term effects of sildenafil and enalapril on time- and frequency-domains analyzes. Thirty-four dogs with MMVD stage B1 or B2 and thirteen healthy dogs were recruited into the study. MMVD dogs were divided into 3 subgroups: control (n=13), sildenafil (n=12) and enalapril (n=9). HRV was analyzed from 1-hr Holter recording at baseline (D0) in all dogs and at 30, 90 and 180 days after treatment. The results showed that MMVD dogs had significant higher heart rate (HR), systemic blood pressures, the ratio of low to high frequency (LF/HF) and had significant decreased standard deviation of all normal to normal RR intervals (SDNN) and the percentage of the number of normal-to-normal sinus RR intervals with differences >50 msec computed over the entire recording (pNN50) when compared with healthy dogs (P<0.05). Neither time nor frequency domain parameters were different among subgroups of MMVD dogs at D0. After treatment with sildenafil for 90 days, both time- and frequency-domain parameters were significantly increased when compared with control and enalapril groups. This study demonstrated that sildenafil improves HRV in asymptomatic MMVD dogs suggesting that sildenafil should be used in the MMVD dogs to restore the sympathovagal balance.
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Affiliation(s)
- Prapawadee Pirintr
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand.,Department of Veterinary Bioscience and Veterinary Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Mae Hia, Muang, Chiang Mai 50100, Thailand
| | - Nakkawee Saengklub
- Department of Physiology, Faculty of Pharmacy, Mahidol University, Sri Ayudhya Road, Rajathevi, Bangkok 10400, Thailand
| | - Vudhiporn Limprasutr
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
| | - Suwanakiet Sawangkoon
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
| | - Anusak Kijtawornrat
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand.,Research Clusters: Research Study and Testing of Drug's Effect Related to Cardiovascular System in Laboratory Animal, Chulalongkorn University, Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
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Markby GR, Summers KM, MacRae VE, Corcoran BM. Comparative Transcriptomic Profiling and Gene Expression for Myxomatous Mitral Valve Disease in the Dog and Human. Vet Sci 2017; 4:vetsci4030034. [PMID: 29056693 PMCID: PMC5644653 DOI: 10.3390/vetsci4030034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/02/2017] [Accepted: 06/06/2017] [Indexed: 12/28/2022] Open
Abstract
Myxomatous mitral valve disease is the single most important mitral valve disease in both dogs and humans. In the case of the dog it is ubiquitous, such that all aged dogs will have some evidence of the disease, and for humans it is known as Barlow's disease and affects up to 3% of the population, with an expected increase in prevalence as the population ages. Disease in the two species show many similarities and while both have the classic myxomatous degeneration only in humans is there extensive fibrosis. This dual pathology of the human disease markedly affects the valve transcriptome and the difference between the dog and human is dominated by changes in genes associated with fibrosis. This review will briefly examine the comparative valve pathology and then, in more detail, the transcriptomic profiling and gene expression reported so far for both species.
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Affiliation(s)
- Greg R Markby
- Roslin Institute, The University of Edinburgh, Easterbush Veterinary Centre, Roslin, Scotland EH25 9RG, UK.
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easterbush Veterinary Centre, Roslin, Scotland EH25 9RG, UK.
| | - Kim M Summers
- Roslin Institute, The University of Edinburgh, Easterbush Veterinary Centre, Roslin, Scotland EH25 9RG, UK.
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easterbush Veterinary Centre, Roslin, Scotland EH25 9RG, UK.
| | - Vicky E MacRae
- Roslin Institute, The University of Edinburgh, Easterbush Veterinary Centre, Roslin, Scotland EH25 9RG, UK.
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easterbush Veterinary Centre, Roslin, Scotland EH25 9RG, UK.
| | - Brendan M Corcoran
- Roslin Institute, The University of Edinburgh, Easterbush Veterinary Centre, Roslin, Scotland EH25 9RG, UK.
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easterbush Veterinary Centre, Roslin, Scotland EH25 9RG, UK.
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Swift S, Baldin A, Cripps P. Degenerative Valvular Disease in the Cavalier King Charles Spaniel: Results of the UK Breed Scheme 1991-2010. J Vet Intern Med 2017; 31:9-14. [PMID: 28054393 PMCID: PMC5259630 DOI: 10.1111/jvim.14619] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/10/2016] [Accepted: 11/01/2016] [Indexed: 11/28/2022] Open
Abstract
Background Cavalier King Charles spaniels (CKCSs) are predisposed to degenerative mitral valve disease (DMVD) and studies have indicated a genetic cause. Animals A total of 8,860 CKCSs were examined at shows or private clinics from 1991 to 2010. Objectives To analyze the effects of a breed scheme for CKCS on the age at which a murmur consistent with DMVD was first detected. Methods The presence or absence of a murmur consistent with mitral regurgitation was noted and age a murmur was first detected recorded. Results A total of 16,887 examinations were performed on 8,860 dogs. The median age dogs developed a murmur were slightly younger in male than female dogs (7.8 versus 8.3 years, 95% confidence interval [CI] 7.4–8.1 versus 8.0–8.4, P < .001) and cardiologists detected murmurs in younger dogs than did general practitioner (GP) veterinary surgeons (7.2 versus 8.6 years, 95% CI 7.0–7.4 versus 8.3–8.7 P < .001). In bitches examined by GP vets during the study, there was a significantly increased age of detection of murmurs over time (8.6–9.2 years, 95% CI 8.3–9.1 and 8.5–10.9, P = .001) but not for male dogs examined by GP vets or dogs of either sex examined by cardiologists. Conclusions and Clinical Importance This study suggests that the age incidence of murmurs associated with DMVD might be increased by application of breeding guidelines based on auscultation alone. This benefit was only seen in a subgroup and compliance of breeders with this voluntary scheme was poor.
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Affiliation(s)
- S Swift
- College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - A Baldin
- Eastcott Veterinary Clinic, Swindon, UK
| | - P Cripps
- Department of Epidemiology and Population Health, University of Liverpool, School of Veterinary Science, Leahurst Campus, Neston, UK
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Boswood A, Häggström J, Gordon SG, Wess G, Stepien RL, Oyama MA, Keene BW, Bonagura J, MacDonald KA, Patteson M, Smith S, Fox PR, Sanderson K, Woolley R, Szatmári V, Menaut P, Church WM, O'Sullivan ML, Jaudon JP, Kresken JG, Rush J, Barrett KA, Rosenthal SL, Saunders AB, Ljungvall I, Deinert M, Bomassi E, Estrada AH, Fernandez Del Palacio MJ, Moise NS, Abbott JA, Fujii Y, Spier A, Luethy MW, Santilli RA, Uechi M, Tidholm A, Watson P. Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly: The EPIC Study-A Randomized Clinical Trial. J Vet Intern Med 2016; 30:1765-1779. [PMID: 27678080 PMCID: PMC5115200 DOI: 10.1111/jvim.14586] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/08/2016] [Accepted: 08/23/2016] [Indexed: 11/27/2022] Open
Abstract
Background Pimobendan is effective in treatment of dogs with congestive heart failure (CHF) secondary to myxomatous mitral valve disease (MMVD). Its effect on dogs before the onset of CHF is unknown. Hypothesis/Objectives Administration of pimobendan (0.4–0.6 mg/kg/d in divided doses) to dogs with increased heart size secondary to preclinical MMVD, not receiving other cardiovascular medications, will delay the onset of signs of CHF, cardiac‐related death, or euthanasia. Animals 360 client‐owned dogs with MMVD with left atrial‐to‐aortic ratio ≥1.6, normalized left ventricular internal diameter in diastole ≥1.7, and vertebral heart sum >10.5. Methods Prospective, randomized, placebo‐controlled, blinded, multicenter clinical trial. Primary outcome variable was time to a composite of the onset of CHF, cardiac‐related death, or euthanasia. Results Median time to primary endpoint was 1228 days (95% CI: 856–NA) in the pimobendan group and 766 days (95% CI: 667–875) in the placebo group (P = .0038). Hazard ratio for the pimobendan group was 0.64 (95% CI: 0.47–0.87) compared with the placebo group. The benefit persisted after adjustment for other variables. Adverse events were not different between treatment groups. Dogs in the pimobendan group lived longer (median survival time was 1059 days (95% CI: 952–NA) in the pimobendan group and 902 days (95% CI: 747–1061) in the placebo group) (P = .012). Conclusions and Clinical Importance Administration of pimobendan to dogs with MMVD and echocardiographic and radiographic evidence of cardiomegaly results in prolongation of preclinical period and is safe and well tolerated. Prolongation of preclinical period by approximately 15 months represents substantial clinical benefit.
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Affiliation(s)
- A Boswood
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - J Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, SE
| | - S G Gordon
- Small Animal Clinical Science, Texas A&M University, College Station, TX
| | - G Wess
- Clinic of Small Animal Medicine, University of Munich, Munich, Germany
| | - R L Stepien
- Medical Sciences, University of Wisconsin Madison School of Veterinary Medicine, Madison, WI
| | - M A Oyama
- Clinical Studies-Philadelphia, MJR-VHUP-Cardiology, University of Pennsylvania, Philadelphia, PA
| | - B W Keene
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, NC
| | - J Bonagura
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH
| | | | - M Patteson
- HeartVets @ Vale Referrals, The Animal Hospital, Dursley, Gloucestershire, UK
| | - S Smith
- Sarah Smith Cardiology, Derby, UK
| | - P R Fox
- Animal Medical Center, New York, NY
| | - K Sanderson
- Rocky Mountain Veterinary Cardiology, Boulder, CO
| | - R Woolley
- Cardio Respiratory Pet Referrals Victoria, Mordialloc, Vic, Australia
| | - V Szatmári
- Faculty of Veterinary Medicine, Clinical Sciences of Companion Animals, Utrecht University, Utrecht, Utrecht, Netherlands
| | - P Menaut
- Internal Medicine and Cardiology, Clinique Vétérinaire Aquivet, Eysines, France
| | - W M Church
- Desert Veterinary Medical Specialists, Phoenix, AZ
| | - M L O'Sullivan
- Deptartment of Clinical Studies, University of Guelph, Ontario Veterinary College, Guelph, ON, Canada
| | - J-P Jaudon
- Clinique Veterinaire Des Etangs, Villars Les Dombes, France
| | - J-G Kresken
- Clinic for Small Animals Kaiserberg, Duisburg, Germany
| | - J Rush
- Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA
| | - K A Barrett
- Cardiology, VCA West Los Angeles, Los Angeles, CA
| | | | - A B Saunders
- Small Animal Clinical Science, Texas A&M University, College Station, TX
| | - I Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, SE
| | - M Deinert
- Tierklinik am Sandpfad, Wiesloch, Germany
| | - E Bomassi
- Cardiology, Centre Hospitalier Vétérinaire des Cordeliers, Meaux, France
| | - A H Estrada
- Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL
| | | | - N S Moise
- Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - J A Abbott
- Department of Small Animal Clinical Sciences, Virginia Tech, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA
| | - Y Fujii
- Azabu University, Chuo-ku, Sagamihara, Kanagawa, Japan
| | - A Spier
- Blue Pearl Veterinary Partners, Tampa, FL
| | - M W Luethy
- Chicago Veterinary Emergency and Specialty Center, Chicago, IL
| | - R A Santilli
- Cardiology, Clinica Veterinaria Malpensa, Viale Marconi, Varese, Italy
| | - M Uechi
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., Yokohama, Japan
| | - A Tidholm
- Djursjukhuset Albano, Danderyd, Sweden
| | - P Watson
- Boehringer Ingelheim, Animal Health, Ingelheim am Rhein, Germany
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Vollmar AC, Fox PR. Long-term Outcome of Irish Wolfhound Dogs with Preclinical Cardiomyopathy, Atrial Fibrillation, or Both Treated with Pimobendan, Benazepril Hydrochloride, or Methyldigoxin Monotherapy. J Vet Intern Med 2016; 30:553-9. [PMID: 26936799 PMCID: PMC4913600 DOI: 10.1111/jvim.13914] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/10/2016] [Accepted: 02/02/2016] [Indexed: 11/28/2022] Open
Abstract
Background Dilated cardiomyopathy (DCM) is a common cause of morbidity and mortality in the Irish Wolfhound (IW). However, the benefit of medical treatment in IW dogs with preclinical DCM, atrial fibrillation (AF), or both has not been demonstrated. Objectives Compare the time to develop congestive heart failure (CHF) or sudden death in IW dogs with preclinical DCM, AF, or both receiving monotherapy with pimobendan, methyldigoxin, or benazepril hydrochloride. Animals Seventy‐five client‐owned IW dogs. Methods Irish Wolfhound dogs were prospectively randomized to receive pimobendan (Vetmedin®)1, benazepril HCl (Fortekor®)2, or methyldigoxin (Lanitop®)3 monotherapy in a 1:1:1 ratio in a blinded clinical trial. The prospectively defined composite primary endpoint was onset of CHF or sudden death. To assure stringent evaluation of treatment effect, data from dogs complying with the study protocol were analyzed. Results Sixty‐six IW fulfilling the study protocol included 39 males, 27 females; median (interquartile range) age, 4.0 years (3.0–5.0 years) and weight, 70.0 kg (63.0–75.0 kg). Primary endpoint was reached in 5 of 23 (21.7%) IW receiving pimobendan, 11 of 22 (50.0%) receiving benazepril HCl, and 9 of 21 (42.9%) receiving methyldigoxin. Median time to primary endpoint was significantly longer for pimobendan (1,991 days; 65.4 months) compared to methyldigoxin (1,263 days; 41.5 months; P = .031) or benazepril HCl‐(997 days; 32.8 months; P = .008) treated dogs. Conclusions and Clinical Importance In IW dogs with preclinical DCM, AF or both, pimobendan monotherapy significantly prolonged time to onset of CHF or sudden death than did monotherapy with benazepril HCl or methyldigoxin.
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Affiliation(s)
- A C Vollmar
- Small Animal Clinic (Wissen and Bonn Germany), New York, NY
| | - P R Fox
- The Animal Medical Center, New York, NY
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Dickson D, Caivano D, Patteson M, Rishniw M. The times they are a-changin': Two-dimensional aortic valve measurements differ throughout diastole. J Vet Cardiol 2016; 18:15-25. [PMID: 26810488 DOI: 10.1016/j.jvc.2015.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Diastolic aortic valve measurements are used to obtain weight-independent cardiac ratiometric indices. However, whether clinically important variations in valve measurements occur during diastole remains undetermined. ANIMALS One hundred sixty-three dogs and 40 cats; a mixture of healthy animals and patients with heart disease. MATERIALS AND METHODS Aortic valve diameter and area were measured at three time-points: early diastole {AoMAX}, during the P-wave {AoP} and at end-diastole {AoMIN}. Measurement beat-to-beat variability was determined. Difference plots were generated for each measurement pair. Aortic measurements were compared by repeated measures analysis of variance. RESULTS In dogs, normalised aortic diameters showed a fixed bias of approximately 14% for AoMAX-AoMIN, 6% for AoMAX-AoP and 8% for AoP-AoMIN. In cats, the aortic diameter and area biases were all less than 2.5% and less than 7% respectively. AoMAX was the largest measurement in 78% patients and AoMIN was the smallest measurement in 73% patients. In dogs, AoMAX > AoP > AoMIN (p < 0.0001). Median within-patient measurement variability was 5% for linear dimensions and 8% for area measurements in dogs and 4.5% for linear and 10.4% for area in cats. DISCUSSION Aortic measurements in dogs differ significantly throughout diastole, with Ao(A)MAX > Ao(A)P > Ao(A)MIN. These differences could clinically impact cardiac ratiometric indices. The difference in cats is less than the within-patient measurement variability and unlikely to be of clinical significance. CONCLUSIONS Operators should adopt a single diastolic time-point for measurement of the aorta to ensure consistency in measuring and reporting in echocardiography.
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Affiliation(s)
- D Dickson
- HeartVets, The Animal Hospital, Dursley, Gloucestershire, GL11 6AJ, UK.
| | - D Caivano
- Department of Clinical Sciences, School of Veterinary Medicine, University of Perugia, Perugia, Italy
| | - M Patteson
- HeartVets, The Animal Hospital, Dursley, Gloucestershire, GL11 6AJ, UK
| | - M Rishniw
- Department of Clinical Sciences, Cornell University, Ithaca, NY, USA
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Nakamura K, Osuga T, Morishita K, Suzuki S, Morita T, Yokoyama N, Ohta H, Yamasaki M, Takiguchi M. Prognostic value of left atrial function in dogs with chronic mitral valvular heart disease. J Vet Intern Med 2014; 28:1746-52. [PMID: 25327889 PMCID: PMC4895618 DOI: 10.1111/jvim.12441] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/26/2014] [Accepted: 07/23/2014] [Indexed: 11/28/2022] Open
Abstract
Background A strong correlation between left atrial (LA) dysfunction and the severity of cardiac disease has been described in human patients with various cardiac diseases. The role of LA dysfunction in dogs with chronic mitral valvular heart disease (CMVHD) has not been addressed. Objectives To investigate the correlation between LA function and the prognosis of dogs with CMVHD. Animals Thirty‐eight client‐owned dogs with CMVHD. Methods Prospective clinical cohort study. Dogs were divided into 2 groups (survivors and nonsurvivors) based on the onset of cardiac‐related death within 1 year. Physical examination and echocardiographic variables were compared between the groups. For the assessment of the comparative accuracy in identifying patients with cardiac‐related death, receiver operating characteristic (ROC) curves and multivariate logistic analysis were used. Results The highest accuracy was obtained for the LA active fractional area change (LA‐FACact), with an area under the ROC curve (AUC) of 0.95, followed by the left atrial to aortic root ratio (LA/Ao), with an AUC of 0.94; peak early diastolic mitral inflow velocity (E), with an AUC of 0.85; and LA total fractional area change (LA‐FACtotal), with an AUC of 0.85. In the multivariate logistic regression analysis, LA‐FACact emerged as the only independent correlate of cardiac‐related death within 1 year (odds ratio = 1.401, P = .002). Conclusions and Clinical Importance Regarding both the size and function, the LA has a strong correlation with the prognosis of dogs with CMVHD. The most significant independent predictor of mortality in this study was LA‐FACact.
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Affiliation(s)
- K Nakamura
- Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Veterinary Teaching Hospital, Sapporo, Hokkaido, Japan
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Pharmacokinetics and pharmacodynamics of enalapril and its active metabolite, enalaprilat, at four different doses in healthy horses. Res Vet Sci 2014; 97:105-10. [PMID: 24972864 DOI: 10.1016/j.rvsc.2014.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 05/02/2014] [Accepted: 06/08/2014] [Indexed: 11/23/2022]
Abstract
Pharmacokinetic and pharmacodynamic of IV enalapril at 0.50 mg/kg, PO placebo and PO enalapril at three different doses (0.50, 1.00 and 2.00 mg/kg) were analyzed in 7 healthy horses. Serum concentrations of enalapril and enalaprilat were determined for pharmacokinetic analysis. Angiotensin-converting enzyme (ACE) activity, serum ureic nitrogen (SUN), creatinine and electrolytes were measured, and blood pressure was monitored for pharmacodynamic analysis. The elimination half-lives of enalapril and enalaprilat were 0.67 and 2.76 h respectively after IV enalapril. Enalapril concentrations after PO administrations were below the limit of quantification (10 ng/ml) in all horses and enalaprilat concentrations were below the limit of quantification in 4 of the 7 horses. Maximum mean ACE inhibitions from baseline were 88.38, 3.24, 21.69, 26.11 and 30.19% for IV enalapril at 0.50 mg/kg, placebo and PO enalapril at 0.50, 1.00 and 2.00 mg/kg, respectively. Blood pressures, SUN, creatinine and electrolytes remained unchanged during the experiments.
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Chompoosan C, Buranakarl C, Chaiyabutr N, Chansaisakorn W. Decreased sympathetic tone after short-term treatment with enalapril in dogs with mild chronic mitral valve disease. Res Vet Sci 2014; 96:347-54. [DOI: 10.1016/j.rvsc.2014.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 11/28/2013] [Accepted: 01/26/2014] [Indexed: 10/25/2022]
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