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Borgarelli M, Ferasin L, Lamb K, Chiavegato D, Bussadori C, 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. The predictive value of clinical, radiographic, echocardiographic variables and cardiac biomarkers for assessing risk of the onset of heart failure or cardiac death in dogs with preclinical myxomatous mitral valve disease enrolled in the DELAY study. J Vet Cardiol 2021; 36:77-88. [PMID: 34118562 DOI: 10.1016/j.jvc.2021.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify the predictive value on time to onset of heart failure (HF) or cardiac death of clinical, radiographic, and echocardiographic variables, as well as cardiac biomarkers N-terminal pro brain natriuretic peptide (NT-proBNP) and cardiac troponin I in dogs with preclinical myxomatous mitral valve disease (MMVD). ANIMALS One hundred sixty-eight dogs with preclinical MMVD and left atrium to aortic root ratio ≥1.6 (LA:Ao) and normalized left ventricular end-diastolic diameter ≥1.7 were included. METHODS Prospective, randomized, multicenter, single-blinded, placebo-controlled study. Clinical, radiographic, echocardiographic variables and plasma cardiac biomarkers concentrations were compared at different time points. Using receiving operating curves analysis, best cutoff for selected variables was identified and the risk to develop the study endpoint at six-month intervals was calculated. RESULTS Left atrial to aortic root ratio >2.1 (hazard ratio [HR] 3.2, 95% confidence interval [95% CI] 1.9-5.6), normalized left ventricular end-diastolic diameter > 1.9 (HR: 6.3; 95% CI: 3.3-11.8), early transmitral peak velocity (E peak) > 1 m/sec (HR: 3.9; 95% CI: 2.3-6.7), and NT-proBNP > 1500 ρmol/L (HR: 5.7; 95% CI: 3.3-9.5) were associated with increased risk of HF or cardiac death. The best fit model to predict the risk to reach the endpoint was represented by the plasma NT-proBNP concentrations adjusted for LA:Ao and E peak. CONCLUSIONS Logistic and survival models including echocardiographic variables and NT-proBNP can be used to identify dogs with preclinical MMVD at higher risk to develop HF or cardiac death.
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Affiliation(s)
- M Borgarelli
- Department Small Animal Clinical Science, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA, USA.
| | - L Ferasin
- Specialist Veterinary Cardiology Consultancy Ltd, 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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Menegazzo L, Bussadori C, Chiavegato D, Piccinini P, Sturaro E, Gallo L, Carnier P, Bittante G. A study on the risk of subaortic and pulmonic stenosis and on genetic aspects of echocardiography measurements in the Italian Boxer dog. Italian Journal of Animal Science 2016. [DOI: 10.4081/ijas.2005.2s.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Borgarelli M, Abbott J, Braz-Ruivo L, Chiavegato D, Crosara S, Lamb K, Ljungvall I, Poggi M, Santilli RA, Haggstrom J. Prevalence and prognostic importance of pulmonary hypertension in dogs with myxomatous mitral valve disease. J Vet Intern Med 2015; 29:569-74. [PMID: 25818210 PMCID: PMC4895522 DOI: 10.1111/jvim.12564] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 12/08/2014] [Accepted: 01/28/2015] [Indexed: 12/31/2022] Open
Abstract
Background Pulmonary hypertension (PH) is common in dogs with myxomatous mitral valve disease (MMVD) but its effect on clinical outcome has not been investigated. Hypothesis/objectives The presence of PH worsens the outcome in dogs with MMVD. To compare survival times of dogs with MMVD and PH to those without PH. Animals Two hundred and twelve client‐owned dogs. Methods Case review study. Medical records of dogs diagnosed with ACVIM stage B2 and C MMVD between January 2010 and December 2011 were retrospectively reviewed. Long‐term outcome was determined by telephone interview or from the medical record. End of the observation period was March 2013. PH was identified if tricuspid regurgitation peak velocity was >3 m/s. Results Two hundred and twelve were identified. Eighty‐three dogs (39%) had PH. PH was more commonly identified in stage C compared to B2 (P < .0001). One hundred and five (49.5%) dogs died during the observation period. Median survival time for the entire study population was 567 days (95% CI 512–743). Stage C (P = .003), the presence of PH (P = .009), left atrial to aortic root ratio (LA/Ao) >1.7 (P = .0002), normalized left‐ventricular end‐diastolic diameter (LVEDn) >1.73 (P = .048), and tricuspid regurgitation pressure gradient (TRPG) >55 mmHg (P = .009) were associated with worse outcomes in the univariate analyses. The presence of TRPG >55 mmHg (HR 1.8 95% CI 1–2.9; P = .05) and LA/Ao > 1.7 (HR 2 95% CI 1.2–3.4; P = .01) remained significant predictors of worse outcome in the multivariate analysis. Conclusions and Clinical Importance In dogs with MMVD, moderate to severe PH worsens outcome.
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Affiliation(s)
- M Borgarelli
- Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
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Menegazzo L, Bussadori C, Chiavegato D, Quintavalla C, Bonfatti V, Guglielmini C, Sturaro E, Gallo L, Carnier P. The relevance of echocardiography heart measures for breeding against the risk of subaortic and pulmonic stenosis in Boxer dogs1. J Anim Sci 2012; 90:419-28. [DOI: 10.2527/jas.2011-4018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L. Menegazzo
- Department of Animal Science, University of Padova, viale dell'Università 16, 35020 Legnaro (PD), Italy
| | - C. Bussadori
- Istituto di Medicina Cardiovascolare, Ospedale Maggiore IRCCS, University of Milan, Italy
| | - D. Chiavegato
- La Clinica Veterinaria, Via Callegari 48, 35010 Padova, Italy
| | - C. Quintavalla
- Department of Animal Health, Parma University, Via del Taglio, 8, 43100 Parma, Italy
| | - V. Bonfatti
- Department of Animal Science, University of Padova, viale dell'Università 16, 35020 Legnaro (PD), Italy
| | - C. Guglielmini
- Department of Veterinary Clinical Sciences, University of Padova, viale dell'Università 16, 35020 Legnaro (PD), Italy
| | - E. Sturaro
- Department of Animal Science, University of Padova, viale dell'Università 16, 35020 Legnaro (PD), Italy
| | - L. Gallo
- Department of Animal Science, University of Padova, viale dell'Università 16, 35020 Legnaro (PD), Italy
| | - P. Carnier
- Department of Animal Science, University of Padova, viale dell'Università 16, 35020 Legnaro (PD), Italy
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Borgarelli M, Savarino P, Crosara S, Santilli RA, Chiavegato D, Poggi M, Bellino C, La Rosa G, Zanatta R, Haggstrom J, Tarducci A. Survival Characteristics and Prognostic Variables of Dogs with Mitral Regurgitation Attributable to Myxomatous Valve Disease. J Vet Intern Med 2008; 22:120-8. [DOI: 10.1111/j.1939-1676.2007.0008.x] [Citation(s) in RCA: 232] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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