Short-term hemodynamic and neuroendocrine effects of pimobendan and benazapril in dogs with myxomatous mitral valve disease and congestive heart failure

BACKGROUND

Pimobendan and benazepril are frequently used with diuretics to treat dogs in congestive heart failure (CHF) caused by myxomatous mitral valve disease (MMVD).

AIM

To compare the short-term effects of pimobendan versus benazepril on pump function, heart size, and neuroendocrine profile in dogs with CHF caused by MMVD.

ANIMALS

Sixteen client-owned dogs.

MATERIAL AND METHODS

Seven-day prospective single-blinded study of dogs stabilized on furosemide monotherapy, randomized to pimobendan (0.4-0.6 mg/kg/day) or benazepril (0.25-1.0 mg/kg/day). Dogs had first-pass radionuclide angiocardiography, and heart size was measured by radiography and echocardiography. Circulating neuroendocrine hormones were measured.

RESULTS

Baseline variables did not differ between treatment groups. Greater decreases in the pimobendan than in the benazepril group were found for heart rate (P = .001), heart rate-normalized pulmonary transit time (P = .02), left atrial size (P = .03), and systolic and diastolic left ventricular diameters (P < .001 and P = .03, respectively) and volumes (P < .001 and P = .02, respectively), whereas ejection fraction increased more (P = .02) in the pimobendan group. Of the neuroendocrine hormones, only N-terminal proatrial natriuretic peptide (NT-ProANP) differed (P = .04) between groups. Within groups, plasma aldosterone increased (P = .01), and NT-proANP (P = .01) and NT-proB-type (P = .02) natriuretic peptide decreased in the pimobendan group, and NT-proANP (P = .02) and plasma vasopressin (P = .01) decreased in the benazepril group.

CONCLUSIONS AND CLINICAL IMPORTANCE

Pimobendan improves short-term cardiac function more than benazepril in dogs with CHF caused by MMVD. Pimobendan treatment enables the heart to work at smaller end-systolic and diastolic dimensions while maintaining adequate forward stroke volume. Some of the treatment responses found in neuroendocrine profile might have therapeutic relevance.

Longitudinal analysis of quality of life, clinical, radiographic, echocardiographic, and laboratory variables in dogs with myxomatous mitral valve disease receiving pimobendan or benazepril: the QUEST study

BACKGROUND

Myxomatous mitral valve disease (MMVD) is an important cause of morbidity and mortality in dogs.

OBJECTIVES

To compare, throughout the period of follow-up of dogs that had not yet reached the primary endpoint, the longitudinal effects of pimobendan versus benazepril hydrochloride treatment on quality-of-life (QoL) variables, concomitant congestive heart failure (CHF) treatment, and other outcome variables in dogs suffering from CHF secondary to MMVD.

ANIMALS

A total of 260 dogs in CHF because of MMVD.

METHODS

A prospective single-blinded study with dogs randomized to receive pimobendan (0.4-0.6 mg/kg/day) or benazepril hydrochloride (0.25-1.0 mg/kg/day). Differences in outcome variables and time to intensification of CHF treatment were compared.

RESULTS

A total of 124 dogs were randomized to pimobendan and 128 to benazepril. No difference was found between groups in QoL variables during the trial. Time from inclusion to 1st intensification of CHF treatment was longer in the pimobendan group (pimobendan 98 days, IQR 30-276 days versus benazepril 59 days, IQR 11-121 days; P = .0005). Postinclusion, dogs in the pimobendan group had smaller heart size based on VHS score (P = .013) and left ventricular diastolic (P = .035) and systolic (P = .0044) dimensions, higher body temperature (P = .030), serum sodium (P = .0027), and total protein (P = .0003) concentrations, and packed cell volume (P = .030). Incidence of arrhythmias was similar in treatment groups.

CONCLUSIONS AND CLINICAL IMPORTANCE

Pimobendan versus benazepril resulted in similar QoL during the study, but conferred increased time before intensification of CHF treatment. Pimobendan treatment resulted in smaller heart size, higher body temperature, and less retention of free water.

Radiographic heart size and its rate of increase as tests for onset of congestive heart failure in Cavalier King Charles Spaniels with mitral valve regurgitation

BACKGROUND

In canine mitral regurgitation (MR) the rate of heart enlargement increases in the last year before congestive heart failure (CHF). Measurement of heart size and its rate of increase may be useful tests for CHF in MR.

OBJECTIVES

To determine the value of vertebral heart scale (VHS) and its rate of increase (∆VHS units/month) for diagnosing the presence and predicting the onset of CHF.

ANIMALS

Longitudinal study of 94 Cavalier King Charles Spaniels (CKCS).

METHODS

VHS was measured at intervals before CHF. ∆VHS/month was calculated from sequential pairs of VHS measurements and the interval between them. Diagnostic accuracy and utility were determined by the areas under receiver operating characteristic plots (AUROC), and likelihood ratios (LR).

RESULTS

AUROC for VHS at the onset of CHF was 0.93 (95% CI, 0.96-0.90), to predict CHF 1-12 months before CHF was 0.74 (95% CI, 0.81-0.66), and for ∆VHS/month at CHF was 0.98 (95% CI, 0.99-0.96). Interval LRs and their cutoff values for CHF were for VHS: 13 (95% CI, 20-7.3) at ≥12.7; 1.2 (95% CI, 2.0-0.68) between 12.7 and 12.0; 0.04 (95% CI, 0.18-0.01) at ≤12.0, and for ∆VHS/month: 15 (95% CI, 30-7.7) at ≥0.08; 0.72 (95% CI, 2.0-0.25) between 0.08 and 0.06; and 0.05 (95% CI, 0.13-0.02) at ≤0.06.

CONCLUSIONS AND CLINICAL IMPORTANCE

Under the conditions of this study, VHS and particularly ∆VHS/month are useful measurements for detecting onset of CHF in CKCS with MR.

Plasma aldosterone concentration and cardiovascular response to low sodium intake in horses in training

REASON FOR PERFORMING THE STUDY

Horses in training lose large amounts of sodium but little is known about the cardiovascular response to low sodium intake.

OBJECTIVES

To investigate the effect of low sodium intake on plasma aldosterone (pAldo) concentrations and the cardiovascular system of athletic horses, and to identify markers of low sodium intake.

METHODS

Seven Standardbred geldings in training (trained twice a week) were randomly offered a standardised diet supplemented (NaS, 58 mg Na/kg bwt) and not supplemented (NaN, 3 mg Na/kg bwt) with NaCl for 5 weeks in a changeover design. Blood samples were taken once a week and in Week 5, before and following an exercise test until 22.30 h and analysed for blood sodium (bNa), total plasma protein (TPP), pAldo, troponin I and packed cell volume (PCV). Blood pressure (BP) was measured and pulse wave recorded at rest with high definition oscillometric-technique (HDO). ECG and echocardiography were recorded. Water intake was measured before and on the day of exercise and voluntary saline intake was measured for 2 days after each period. Faecal samples were taken weekly and analysed for sodium and potassium content.

RESULTS

The pAldo and the PCV was higher in NaN compared to NaS. There were no differences between diets in BP, ECG, plasma troponin I and echocardiogram but HDO pulse amplitude tended to be smaller on diet NaN. Water intake was lower on diet NaN and saline intake higher. The response to exercise in bNa, pAldo, PCV and TPP was different on the 2 diets. Faecal potassium/sodium ratio was higher on NaN than on NaS.

CONCLUSION

This study shows that 5 weeks of low sodium intake increased plasma aldosterone concentration and PCV but no alterations in heart function was observed. Faecal potassium/sodium ratio could be used to assess sodium status in horses.

A prospective study of systolic ejection murmurs and left ventricular outflow tract in boxers

OBJECTIVES

To investigate the prevalence and progression of murmurs and the development of the left ventricular outflow tract (LVOT) and flow velocities in the great arteries in boxer puppies through adolescence until three years of age.

METHODS

Nineteen boxer puppies with or without a low-intensity murmur, but without evidence of congenital heart disease, were studied prospectively. Examinations were carried out at 7 weeks, 3, 4, 6, 9, 12 and 36 months of age by cardiac auscultation and Doppler echocardiography.

RESULTS

Presence and intensity of heart murmurs varied in the same dog and between dogs, but flow velocities did not change. Estimated effective orifice diameter (EOD) and indexed EOD was significantly narrower than measured subvalvular and valvular diameters.

CLINICAL SIGNIFICANCE

The variability in presence and intensity of low-intensity ejection murmurs is high during growth in boxers.

Reader performance in radiographic diagnosis of signs of mitral regurgitation in cavalier King Charles spaniels

OBJECTIVES

To measure accuracy and variability of diagnosis by radiography of heart enlargement (HE) and heart failure (HF) in mitral regurgitation (MR).

METHODS

Sixteen readers representing four levels of experience evaluated 50 sets of radiographs with varying severity of MR for presence or absence of HE, left atrial enlargement (LAE) and HF. The performance of the readers was compared with a reference standard, using area under the curve (AUC) of receiver operating characteristic (ROC) curves. The interreader agreement value kappa (K) was calculated. A subset of difficult cases of HF was analysed before and after removing an outlying reader from each group.

RESULTS

AUC for HE was 0.89, for LAE it was 0.93 and for HF it was 0.92. Experience increased certainty of diagnosis but not accuracy. K ranges were HE, 0.53 to 0.67; LAE, 0.61 to 0.69 and HF, 0.49 to 0.58. When only difficult cases of HF were read, accuracy decreased and experienced readers performed better than inexperienced. When outlying readers were excluded, the differences between experienced and inexperienced readers increased.

CLINICAL SIGNIFICANCE

LAE, not HE, should be used to evaluate the heart size and indirectly the severity of MR on radiographs. For HF, agreement among individual readers was only moderate. Studies of reader accuracy should consider the effects of interreader variability.

Assessing aortic stenosis using sample entropy of the phonocardiographic signal in dogs

In aortic valve stenosis (AS), heart murmurs arise as an effect of turbulent blood flow distal to the obstructed valves. With increasing AS severity, the flow becomes more unstable, and the ensuing murmur becomes more complex. We hypothesize that these hemodynamic flow changes can be quantified based on the complexity of the phonocardiographic (PCG) signal. In this study, sample entropy (SampEn) was investigated as a measure of complexity using a dog model. Twenty-seven boxer dogs with various degrees of AS were examined with Doppler echocardiography, and the peak aortic flow velocity ( V(max)) was used as a reference of AS severity. SampEn correlated to V(max) with R = 0.70 using logarithmic regression. In a separate analysis, significant differences were found between physiologic murmurs and murmurs caused by AS ( p << 0.05), and the area under a receiver operating characteristic curve was calculated to 0.96. Comparison with previously presented PCG measures for AS assessment showed improved performance when using SampEn, especially for differentiation between physiological murmurs and murmurs caused by mild AS. Studies in patients will be needed to properly assess the technique in humans.

Effect of pimobendan or benazepril hydrochloride on survival times in dogs with congestive heart failure caused by naturally occurring myxomatous mitral valve disease: the QUEST study

BACKGROUND

Myxomatous mitral valve disease (MMVD) continues to be an important cause of morbidity and mortality in geriatric dogs despite conventional therapy.

HYPOTHESIS

Pimobendan in addition to conventional therapy will extend time to sudden cardiac death, euthanasia for cardiac reasons, or treatment failure when compared with conventional therapy plus benazepril in dogs with congestive heart failure (CHF) attributable to MMVD.

ANIMALS

Two hundred and sixty client-owned dogs in CHF caused by MMVD were recruited from 28 centers in Europe, Canada, and Australia.

METHODS

A prospective single-blinded study with dogs randomized to PO receive pimobendan (0.4-0.6 mg/kg/d) or benazepril hydrochloride (0.25-1.0 mg/kg/d). The primary endpoint was a composite of cardiac death, euthanized for heart failure, or treatment failure.

RESULTS

Eight dogs were excluded from analysis. One hundred and twenty-four dogs were randomized to pimobendan and 128 to benazepril. One hundred and ninety dogs reached the primary endpoint; the median time was 188 days (267 days for pimobendan, 140 days for benazepril hazard ratio = 0.688, 95% confidence limits [CL]=0.516-0.916, P= .0099). The benefit of pimobendan persisted after adjusting for all baseline variables. A longer time to reach the endpoint was also associated with being a Cavalier King Charles Spaniel, requiring a lower furosemide dose, and having a higher creatinine concentration. Increases in several indicators of cardiac enlargement (left atrial to aortic root ratio, vertebral heart scale, and percentage increase in left ventricular internal diameter in systole) were associated with a shorter time to endpoint, as was a worse tolerance for exercise.

CONCLUSIONS AND CLINICAL IMPORTANCE

Pimobendan plus conventional therapy prolongs time to sudden death, euthanasia for cardiac reasons, or treatment failure in dogs with CHF caused by MMVD compared with benazepril plus conventional therapy.

Low intensity heart murmurs in boxer dogs: inter-observer variation and effects of stress testing

Inter-observer variation in the detection and grading of low intensity heart murmurs in boxer dogs was investigated. Six veterinarians with different levels of experience examined 27 boxers by cardiac auscultation. The dogs were auscultated before and after exercise, and the results were compared with phonocardiographic and echocardiographic examinations performed at rest and during two different stress tests. A subvalvular aortic ridge was identified in six dogs on two-dimensional echocardiography. Using dogs with low intensity murmurs or dogs free of heart murmurs, inter-observer agreement was positively correlated to the level of experience at rest (weighted kappa [kappa] 0.14 to 0.75), while the agreement was poor after exercise (weighted kappa 0.01 to 0.36). The presence of a subvalvular aortic ridge was associated with higher aortic flow velocities (P<0.002) and higher auscultatory murmur grading (P<0.001). There was an increase in murmur duration during one kind of stress test (P<0.001) and in aortic flow velocity during the other (P=0.001).

Prevalence of murmurs consistent with aortic stenosis among boxer dogs in Norway and Sweden

The prevalence and severity of cardiac murmurs consistent with subclinical or clinically detectable aortic stenosis among purebred boxer dogs in Norway and Sweden were evaluated. Two hundred and thirty-one boxers, randomly selected or investigated at dog shows, were examined by phonocardiography by two veterinarians and classified on the basis of the characteristics of their murmurs into categories 0 to 4. No murmur was detected in 23 per cent of the dogs, murmurs classified as category 1 were diagnosed in 25 per cent of the dogs, as category 2 in 46 per cent, as category 3 in 7 per cent cent, and two dogs had category 4 murmurs. In 55 per cent of the dogs, primarily those with very soft murmurs, there was some variation in the intensity of the murmur from beat to beat. The prevalence of cardiac murmurs among Norwegian and Swedish boxers was high and similar to the prevalence reported in Great Britain.

Analysis of murmur intensity, duration and frequency components in dogs with aortic stenosis

A study was undertaken to investigate the relationship between murmur intensity, murmur duration, duration to peak intensity and frequency components with degree of aortic stenosis in boxers. Measurements were made from phonocardiograms obtained from 35 boxers with ejection-type murmurs, and values were compared with those obtained for aortic flow velocity measured by Doppler echocardiography. Murmur intensity graded by auscultation was significantly correlated with aortic flow velocity (P < 0.001), and murmur duration, expressed as a percentage of systole was significantly correlated with aortic flow velocity (P < 0.001), independent of heart rate. Dogs with early systolic murmurs not exceeding 50 per cent of systole had aortic flow velocities of less than 1.5 m/second and no echocardiographic abnormalities, in contrast with dogs with murmurs of longer duration. Dogs with only high frequency components had lower aortic velocities than those that also had components in the medium frequency range (P < 0.01).

Effects of naturally acquired decompensated mitral valve regurgitation on the renin-angiotensin-aldosterone system and atrial natriuretic peptide concentration in dogs

OBJECTIVE

To investigate activity of the renin-angiotensin-aldosterone system and N-terminal pro-atrial natriuretic peptide (NT-proANP) during development of clinical signs of decompensated mitral valve regurgitation (MR).

ANIMALS

11 Cavalier King Charles Spaniels with advanced MR attributable to chronic valvular disease.

PROCEDURE

Dogs were subjected to repeated examinations at 6-month intervals until signs of decompensation had developed (end point). Data acquired at end point were compared with data obtained from examinations 1 year and 1 to 6 months before decompensation. Each examination included physical examination, collection of venous blood, thoracic radiography, and echocardiography.

RESULTS

Echocardiographic measurements of left atrial-to-aortic root ratio and left ventricular end diastolic diameter increased considerably during the study, whereas left ventricular end systolic diameter remained unchanged. The increase in cardiac size was associated with increased plasma concentration of NT-proANP. In contrast, plasma concentrations of aldosterone and angiotensin II were reduced at decompensation (aldosterone compared with the 2 earlier examinations and angiotensin II compared with values obtained 1 to 6 months before), despite decreased plasma protein concentration and hematocrit, suggesting fluid retention. The urine-to-plasma creatinine ratio was reduced at end point.

CONCLUSION AND CLINICAL IMPLICATIONS

Early decompensated MR in dogs was not associated with increased circulating renin-angiotensin-aldosterone system activity, which may be caused by increased activity of ANP, and may be important for future therapeutic strategies of MR.

Effects of long-term treatment with enalapril or hydralazine on the renin-angiotensin-aldosterone system and fluid balance in dogs with naturally acquired mitral valve regurgitation

OBJECTIVE

To study long-term effects of enalapril, an angiotensin-converting enzyme inhibitor, and hydralazine, an arteriodilator, on renin-angiotensin-aldosterone system and fluid balance before and after administration of furosemide.

ANIMALS

22 dogs with clinical signs of congestive heart failure (CHF) attributable to mitral regurgitation.

PROCEDURE

After initial examination, 12 dogs received enalapril and 10 received hydralazine. Dogs were re-examined 3 weeks and 6 months after initial examination. Furosemide was added after the 3-week examination, and at 6 months, dogs had received furosemide for at least 4 months.

RESULTS

Angiotensin II and aldosterone plasma concentrations were low before treatment, and only aldosterone became significantly decreased after enalapril monotherapy. Concentrations of both hormones and heart rate increased in dogs receiving hydralazine monotherapy, and fluid retention was evident. After long-term treatment with either of the 2 drugs together with furosemide, angiotensin II and aldosterone values increased in both groups. Natriuresis and kaliuresis developed in all dogs, with greatest effect in those receiving enalapril and furosemide. These dogs had decreased plasma sodium concentration, whereas potassium concentration was equally decreased in both groups. After 6 months, the enalapril group, but not the hydralazine group, had increased cardiac size. All dogs had moderate reduction of weight and were azotemic, although changes were more pronounced in those of the hydralazine group.

CONCLUSION

The 2 drugs have different effects on the renin-angiotensin-aldosterone system and fluid balance in dogs with CHF.

Relationship between parental cardiac status in Cavalier King Charles spaniels and prevalence and severity of chronic valvular disease in offspring

OBJECTIVE

To study the relationship between parental cardiac status in Cavalier King Charles Spaniels and development of chronic valvular disease (CVD) in offspring.

DESIGN

Historical cohort.

ANIMALS

54 female and 53 male Cavalier King Charles Spaniel offspring.

PROCEDURE

7 sires, selected on the basis of their liability to develop CVD, were screened for clinical signs of CVD and assigned to 1 of 3 groups (late, intermediate, and early onset of CVD). The mates of these sires (30 dams) were selected and classified likewise, and 107 offspring produced in 1988 from matings between these parents were screened for clinical signs of CVD at a mean age of 5.3 +/- 0.3 years.

RESULTS

55% of the offspring were free from clinical signs of CVD, whereas 45% had cardiac murmurs of low or moderate intensity. The proportion of offspring with heart murmurs and the intensity of murmurs were significantly greater with increased parental classification. More males than females had developed murmurs, and murmurs of moderate intensity also were more prevalent in males. Results of multiple-regression analysis indicated that mean parental classification and sex had significant effects on proportion of offspring with murmurs and their intensity. Additionally, age affected disease prevalence and severity, despite the narrow range in age of offspring examined.

CLINICAL IMPLICATIONS

Parental CVD status is an important factor influencing the probability of heart murmurs and their intensity in offspring. The results of this study indicate that CVD development is a polygenic threshold trait and that sex of the offspring influences threshold levels.

Heart rate variability in relation to severity of mitral regurgitation in Cavalier King Charles spaniels

Heart rate variability was measured in 81 Cavalier King Charles spaniels to investigate if it could be used to evaluate the severity of mitral regurgitation and to predict decompensation. Heart rate variability was assessed by the natural logarithm of the variance of the R-R intervals for 20 consecutive beats obtained from electrocardiographic recordings. Twenty-two of the dogs were clinically normal and 59 had mitral regurgitation caused by chronic valvular disease. The severity of mitral regurgitation was evaluated by echocardiography and thoracic radiography. Heart rate variability was found to be reduced (P < 0.001) among dogs with severe left atrial and ventricular dilatation and clinical signs of congestion. No significant differences in heart rate variability were found among normal dogs, dogs with only cardiac murmur, and dogs with echoradiographic evidence of slight to moderate left atrial and ventricular dilatation. Overall, an association was found between heart rate variability and left atrial to aortic root ration and left ventricular end diastolic diameters (r = 0.72 and 0.64, respectively, P < 0.001), as well as heart and respiratory rate (r = 0.80 and 0.69, respectively, P < 0.001). Multiregression analysis showed that, in order of importance, heart rate, left atrial diameter and respiratory rate had significant effects on heart rate variability. Among these parameters, heart rate variability and left atrial diameter were found to be most efficient in separating decompensated dogs from compensated. It is concluded that heart rate variability may provide the clinician with valuable information when assessing the severity of mitral regurgitation caused by chronic valvular disease.

Heart sounds and murmurs: changes related to severity of chronic valvular disease in the Cavalier King Charles spaniel

Auscultatory, phonocardiographic (PCG), radiographic, and echocardiographic evidence of chronic valvular disease (CVD) were studied in 79 Cavalier King Charles Spaniels with a mean age of 7.6 years (SD 2.6). Cardiac murmurs were present in 59 of the dogs and the intensity of the systolic cardiac murmur, assessed by auscultation (grade 1-6), was correlated (P < .001) to the severity of CVD (heart failure class) and to the echocardiographic dimensions of the heart (left atrial ratio, La/Ao-d, and left ventricular end diastolic diameter, LVEDD) (both P < .001). The heart sounds and duration of electromechanical systole (Q-S2) were investigated in all dogs using measurements obtained from PCG recordings. Normal regression equations describing the relation between heart rate and systolic intervals (Q-S1, Q-S2 and S1-S2) were established based on observations in 11 normal control Cavalier King Charles Spaniels. The total electromechanical systole (Q-S2), Q-S1, and S1-S2 intervals in the 59 dogs were related to the corresponding normal regression equation. A shortening of Q-S2 and S1-S2 intervals were found in dogs belonging to heart failure class I (Q-S2; P < .01 and S1-S2; P < .05), class II, and classes III and IV (both P < .001). The ratio of the amplitudes of the first (S1) and second heart sounds (S2) measured on the PCG recordings was found to be increased in dogs belonging to class I (P < .01), class II, and classes III and IV (both P < .001). The relationship between cardiac dimensions (LVEDD and La/Ao-d) and S1a/S2a ratio was described by quadratic regression and found to be significant for both parameters (LVEDD; P < .001, R2 = .54 and La/Ao-d; P < .001, R2 = .63). The presence of a third heart sound (S3) was detected, using PCG, in 21 of the 68 dogs. The proportion of dogs exhibiting S3 increased with heart failure class (and increasing cardiac dimensions) (P < .001). These findings were confirmed by observations in 13 Cavalier King Charles Spaniels with cardiac failure progressing from heart failure class I to class II (Mean LVEDD from 30.2 to 35.2 mm and mean La/Ao-d from 1.09 to 1.43). An increase in intensity of the heart murmur, assessed by auscultation, increase in the ratio of the amplitudes of S1 and S2, as well as a shortening in Q-S2 and S1-S2 intervals (all P < .01) were found in these dogs.(ABSTRACT TRUNCATED AT 400 WORDS)

Plasma concentration of atrial natriuretic peptide in relation to severity of mitral regurgitation in Cavalier King Charles Spaniels

Plasma concentration of immunoreactive atrial natriuretic peptide (ir-ANP) was investigated in 83 Cavalier King Charles Spaniels with variable severity of mitral regurgitation caused by chronic valvular disease (CVD). Severity of mitral incompetence was assessed by echocardiography. Significant differences in plasma concentrations of ir-ANP were not found between clinically normal dogs (New York Heart Association functional class O), dogs with only cardiac murmur (class I), and dogs with echocardiographic evidence of slight to moderate left atrial and ventricular dilatation (class II). Dogs with severe left atrial and ventricular dilatation and clinical signs of congestion (classes III and IV) were found to have significantly (P < 0.001) increased plasma concentration of ir-ANP. Overall, moderate degree of association was found between plasma concentration of ir-ANP and left atrial and left ventricular diameters (Pearson's r = 0.65, 0.60, respectively, P < 0.001), as well as heart rate (r = 0.47, P < 0.01). However, left atrial enlargement was found to have the predominant effect on plasma ir-ANP concentration. It is concluded that the plasma concentration of ir-ANP did not become markedly increased before decompensation of chronic mitral regurgitation associated with severe enlargement of the left atrium and ventricle in Cavalier King Charles Spaniels.

Chronic valvular disease in the cavalier King Charles spaniel in Sweden

The prevalence of chronic valvular disease was studied in 494 cavalier King Charles spaniels with a mean (+/- sd) age of 3.0 +/- 2.7 years. Cardiac murmurs were detected in 65 (13.2 per cent) of the dogs. Among 61 cavalier King Charles spaniels with a mean age of 6.4 +/- 2.8 years, cardiac murmurs were detected in 32 (52 per cent). In both groups of dogs the prevalence of cardiac murmurs was low among dogs younger than three years (1.9 per cent) but increased with age (P < 0.001). The estimated ages at which 50 per cent of the dogs had developed murmurs were 7.5 and 6.2 years, respectively. When 39 of the 61 dogs were re-examined three years later, cardiac murmurs were detected in 28 (72 per cent), and the intensities of the murmurs had generally increased (P < 0.05). Nine (28 per cent) of the dogs which had previously had murmurs had been euthanased for signs of congestive heart failure whereas none of the dogs which had been free of murmurs had died from congestive heart failure. Animal insurance statistics from 1982 to 1990 (1983 excluded) for dogs less than 10 years old showed that claims for veterinary care or death or euthanasia were five times more common in the cavalier King Charles spaniel than in dachshunds (P < 0.001) and eight times more common than the mean for all other insured breeds (P < 0.001).

Pulmonary gas exchange correlated to clinical signs and lung pathology in horses with chronic bronchiolitis

Eight horses (mean weight 438 kg) with chronic obstructive pulmonary disease (COPD) were studied for clinical signs, ventilation/perfusion relationships (VA/Q) and lung morphology. Four horses were killed and necropsied after the study. In horses with COPD, minute ventilation was almost twice as high as normal, whereas PaO2 was significantly decreased. Cardiac output was normal, but pulmonary artery pressure and pulmonary vascular resistance were significantly increased. The VA/Q distribution was abnormal with an increased scatter of VA/Q ratios. However, shunt (VA/Q = 0) was increased in one horse only. Ventilation of dead space and high VA/Q regions (VA/Q greater than 10) were increased markedly and comprised 74 per cent of minute ventilation. On lung biopsy, all horses showed chronic bronchiolitis with epithelial hyperplasia and metaplasia. Diffuse acinar hyperinflation also was evident at necropsy. There was a significant inverse correlation between the respiratory rate and the fractional ventilation of normal VA/Q regions. Also, there was a significant agreement between the extent of bronchiolar epithelial hyperplasia in necropsy specimens of lungs and the degree of ventilation of high VA/Q regions and dead space. The findings suggest that hyperinflation of the lung due to obstructed airways may be the common denominator of increased ventilation of high VA/Q regions and dead space ventilation and of elevated pulmonary artery pressure in horses with COPD from chronic bronchiolitis.

Atelectasis causes gas exchange impairment in the anaesthetised horse

The anatomical basis of gas exchange impairment in the anaesthetised horse was studied by computerised tomography (CT; three shetland ponies) and morphological analysis (one pony and three horses). By means of CT, densities were seen in dependent lung regions early during anaesthesia, both with spontaneous breathing and with mechanical ventilation. The densities remained for some time where they had initially been created when the animal was turned from dorsal to sternal recumbency. Deep insufflation of the lungs reduced the dense area. Gas exchange was impaired roughly in proportion to the dense area. On histological analysis, the densities were atelectatic and congested with blood. Gravimetry showed no more extravascular water per unit lung tissue in the atelectatic than in the 'normal' regions, and the blood content was increased only slightly. It is concluded that the horse develops atelectasis in dependent lung regions early during anaesthesia in dorsal recumbency, and that atelectasis is the most likely explanation for the large shunt and impaired arterial oxygenation regularly seen during anaesthesia.

Cardiorespiratory and sedative effects of a combination of acepromazine, xylazine and methadone in the horse

Cardiorespiratory and sedative effects of a combination of acepromazine, xylazine and methadone were studied in the horse. Acepromazine and xylazine produced cardiovascular effects whereas methadone mainly affected respiratory rate. Decreases in heart rate, arterial blood pressure and respiratory rate were seen. Sedation was superior to that of acepromazine, xylazine or a combination of these. No serious side effects were seen.

Ventilation-perfusion relationships in the standing horse: an inert gas elimination study

The multiple inert gas elimination technique was adapted for use in the conscious standing horse. The modifications included increased infusion rate of the inert gases (30 ml/min), extended infusion time (60 mins) in order to reach steady state, and construction of a nose mask mixing box system for collection of expired gas. Eight adult horses with a mean weight of 454 kg and a mean age of 6.1 years were studied while standing under resting conditions. Ventilation was 65.2 liters/min and cardiac output measured by thermodilution 40.2 liters/min. Systemic and pulmonary artery mean pressures were 114 and 26 mmHg, respectively. Three horses showed a unimodal VA/Q distribution centred upon a mean VA/Q of one. Five horses had a bimodal distribution with an additional high VA/Q mode comprising 2 to 18 per cent of ventilation. The mean logarithmic standard deviation of perfusion was 0.41. There was no perfusion of 'low' VA/Q regions, but minor shunting on an average of 1 per cent was noted. Inert gas dead space (minus apparatus dead space) averaged 38 per cent of total ventilation. Arterial oxygen tension varied from 11 to 14 kPa and the mean arterial CO2 tension was 5.7 kPa. It is concluded that the standing horse in general has a good match between ventilation and perfusion but that some individuals display high VA/Q regions, possibly explained by poor perfusion of upper lung regions.

Selective mechanical ventilation of dependent lung regions in the anaesthetized horse in dorsal recumbency

The effect of selective mechanical ventilation of dependent lung regions were studied in anaesthetized horses (mean weight 486 kg) in dorsal recumbency. Blood-gas measurements were performed with the horse in the lateral position during spontaneous breathing (before selective intubation) and in dorsal recumbency during spontaneous breathing, general mechanical ventilation, and spontaneous breathing + selective mechanical ventilation. Arterial oxygen tension (PaO2) was 32.3 kPa in the lateral position during spontaneous breathing with a high inspired oxygen fraction (FlO2 greater than 92%). In dorsal recumbency PaO2 decreased to 10.9 kPa during spontaneous breathing and was not significantly affected by general mechanical ventilation (PaO2 12.6 kPa). The institution of selective mechanical ventilation with a selective positive end-expiratory pressure (PEEP) of 20 cm H2O caused a marked increase in PaO2 to an average of 35.3 kPa. It is concluded that selective intubation of dependent regions in the diaphragmatic lobes is a feasible procedure and that selective mechanical ventilation with PEEP markedly improves arterial oxygenation in the anaesthetized horse in dorsal recumbency.

Systemic and centrally mediated angiotensin II effects in the horse

The primary aim of the study was to evaluate the potential value of intravenous (i.v.) infusion of angiotensin II (AII) for phonocardiographic differential diagnosis of equine valvular insufficiency. Ten-minute AII infusions at 4.5-33 pmol kg-1 min-1 induced clear-cut dose-dependent rises in systemic arterial blood pressure (aBP), whereas the pulmonary aBP remained largely unaffected. It implies that i.v. infusion of AII at about 10 pmol kg-1 min-1 could be a valuable tool for the acoustic differentiation between mitral and tricuspid valvular dysfunction in the horse. The infusion at, and above 9 pmol kg-1 min-1 caused increased heart rate. This chronotrophic effect was not strictly dose-dependent and exhibited significant tachyphylaxis. Angiotensin II administration at, or above 9 pmol kg-1 min-1 was needed to induce an urge to drink, suggesting that angiotensin-induced thirst does not appear in the euhydrated horse until the octapeptide reaches supraphysiological blood concentration. Determinations of plasma aldosterone concentration (PA) revealed comparatively high morning control values (269 +/- 46 pmol-1). Three consecutive AII infusions with 10-min intervals and at increasing dosages caused a cumulative, almost fourfold elevation of PA. The PA pattern indicated that AII-induced hypersecretion of aldosterone continued for several minutes after the end of the infusions, but also showed that the metabolic clearance of the hormone took precedency of the secretion within 20 min post-infusion. In two of the horses a fall in PA occurred during a fourth, final infusion, indicating that in these instances the previous AII administration had impoverished the store of aldosterone available for release from the adrenal cortex.

Diagnostic value of contrast echocardiography in the horse

M-mode echocardiography is a safe and practical means of using ultrasound to evaluate the dynamic movements of cardiac structures. The technique can be refined by using a simple contrast medium in the form of carbon dioxide mixed with heparinised blood to provide a strong echogenic result. This technique was employed in a series of 15 normal conscious standing horses and in three animals with specific cardiac defects. In the clinical cases it was possible to confirm the diagnosis and differentiate between a congenital septal defect and mitral regurgitation. The method was found to be safe and relatively simple to perform using percutaneous insertion of catheters. The intracardiac catheterisation was trouble free and no clinical side effects to direct injection of the carbon dioxide contrast medium into the heart were demonstrated.

Effect of E. coli ectotoxin on calcium and phosphate concentration in serum of dairy cows

The injection of E. coli ectotoxin into eight healthy cows of the SRB breed induced a significant hypocalcemia and hypophosphatemia. A clinical profile similar to that normally seen in paresis puerperalis was also observed. These results confirm earlier observations that toxaemia can give rise to paralytic symptoms.

Method of selective and non-selective angiocardiography for the horse

A practical and safe method of angiocardiography for the horse is described. The technique involved the rapid injection of 50 to 150 ml contrast agent via catheters in the right and left heart, pulmonary artery and aorta. The examination was carried out with the horse in the standing position or under general anaesthesia. Angiocardiograms were performed on 10 normal horses and satisfactory pictures of the right and left ventricles, pulmonary arteries, aorta and coronary circulation were obtained. The technique was also used in a foal with severe congenital heart disease. The most practical methods of recording the images in the standing position were cinefilm or video taperecording. In the recumbent position both cinefilm and radiographs were taken. No damage to the heart was inflicted by the catheters and only a few ventricular premature contractions (less than five) were produced by the pressure of injection. No signs of toxicity were recorded using repeated injections of contrast material (ie, less than 600 ml).

Hypocalcaemia and Q-oTc interval in cows with parturient paresis

The degree of hypocalcaemia was determined from serum total, and serum ionized calcium concentrations in 27 cows with parturient paresis. Electrocardiographic recordings were made just before the start of the intravenous calcium treatment. The T-oTc interval was determined, but could only be adequately measured in 16 cases because of inherent difficulties in recording from paretic animals. No significant correlation was found between the degree of hypocalcaemia and Q-oTc interval, whether the hypocalcemia was determined from serum total or serum ionized calcium concentrations. This study indicated that measurement of the Q-oTc interval was of very little value as a clinical test for detection of hypocalcaemia and indication of the degree of hypocalcaemia in parturient paresis.

Parturient paresis in the cow. Serum ionized calcium concentrations before and after treatment with different calcium solutions--classification of different degrees of hypo- and hypercalcemia

Serum ionized calcium concentrations (CaF) were determined in 87 Swedish red-and-white cows and 10 Swedish Friesian cows with clinical signs of parturient paresis. All cows were in the week prior to or after parturition. A classification of the severity of hypocalcemia in terms of serum ionized calcium was devised. Eight cows had normal serum ionized calcium concentrations (Cap 1.06–1.26 mmol/1); 15 had slight (CaF 0.80–1.05 mmol/1); 43 a moderate (CaF 0.50–0.79 mmol/1), and 31 asevere (CaF < 0.50 mmol/1) hypocalcemia.

All cows were given 8 or 8.3 g of calcium intravenously. Of 8 normocalcemic cows 7 (87.5 %) reached a maximum posttreatment serum ionized calcium concentration > 1.80 mmol/1 (severe hypercalcemia). This was also found in 13 of 15 (86.7 %) slightly hypocalcemic cows and in 31 of 43 (72.1 %) moderately hypocalcemic cows. In the severe hypocalcemia group 14 of 31 (45.2 %) had maximum posttreatment Cap > 1.80 mmol/1).

These findings emphazise the need of a rapid pretreatment evaluation of the degree of hypocalcemia. The present study also underlined the difficulty in predicting serum ionized calcium from serum total calcium concentrations.

Studies on ionized calcium in serum and plasma from normal cows. Its relation to total serum calcium and the effects of sample storing

Ionized calcium has been determined with a new improved instrument on serum samples from 111 Swedish red-and-white cows. Simultaneous sampling of plasma and serum was performed in 32 cows for comparison of the ionized calcium level. Multiple sampling of plasma and serum from seven cows was performed to evaluate the effect of storage at 4°C and room temperature.

The normal range for ionized calcium found in this study implies that the ionized calcium fraction comprises for 43.4 ± 3.0 % (mean ± 2 s) of the total serum calcium. Simultaneous analyses on plasma and serum revealed that the plasma level of ionized calcium was generally 0.ι05 mιmol/1 lower than the serum value. pH changes in stored blood samples have a direct effect on the ionized calcium levels and is therefore to be avoided. Storing samples in vacutainers for five days at 4°C or for two days at room temperature was accompanied by only small decreases of serum or plasma ionized calcium.

The new instrument used in this study enables rapid analyses, and most of earlier drawbacks with calcium-ion-selective analyzers have been eliminated.