Left Ventricular Radial and Circumferential Wall Motion Analysis in Horses Using Strain, Strain Rate, and Displacement by 2D Speckle Tracking

Background: Noninvasive assessment of left-ventricular (LV) function is clinically relevant, but is incompletely studied in horses.
Objectives: To document the feasibility, describe the techniques, and determine the reliability of 2D speckle tracking (2DST) for characterization of LV radial and circumferential wall motion in horses.
Animals: Three Standardbreds, 3 Thoroughbreds; age 8–14 years; body weight 517–606 kg.
Methods: Observational study. Repeated 2-dimensional echocardiographic examinations were performed in unsedated horses by 2 observers and subsequently analyzed by 2DST. Test reliability was determined for segmental and for averaged 2DST indices (including strain, strain rate, displacement, and rotation) by estimating measurement variability, within-day interobserver variability, between-day interobserver variability, and between-day intraobserver variability. Variability was expressed as coefficient of variation (percent) and the absolute value below which the difference between 2 measurements will lie with 95% probability.
Results: 2DST analyses were feasible in 16 of 18 echocardiographic studies. The automated tracking was accurate during systole but inaccurate during diastole. Reliability was higher for radial compared to circumferential measurements. For radial strain, radial systolic strain rate, and radial systolic displacement, the test-retest variabilities ranged between 2.4 and 33.1% for segmental and between 4.1 and 16.1% for averaged measurements.
Conclusions and Clinical Importance: Systolic radial motion of the LV at the chordal level could be reliably characterized in horses by 2DST. Circumferential measurements were less reliable. Diastolic measurements were invalid because of inaccurate tracking. The clinical value of LV wall motion analysis by 2DST in horses requires further investigation.     

Quantification of left ventricular longitudinal strain, strain rate, velocity, and displacement in healthy horses by 2-dimensional speckle tracking

Background: The quantification of equine left ventricular (LV) function is generally limited to short‐axis M‐mode measurements. However, LV deformation is 3‐dimensional (3D) and consists of longitudinal shortening, circumferential shortening, and radial thickening. In human medicine, longitudinal motion is the best marker of subtle myocardial dysfunction. Objectives: To evaluate the feasibility and reliability of 2‐dimensional speckle tracking (2DST) for quantifying equine LV longitudinal function. Animals: Ten healthy untrained trotter horses; 9.6 ± 4.4 years; 509 ± 58 kg. Methods: Prospective study. Repeated echocardiographic examinations were performed by 2 observers from a modified 4‐chamber view. Global, segmental, and averaged peak values and timing of longitudinal strain (SL), strain rate (SrL), velocity (VL), and displacement (DL) were measured in 4 LV wall segments. The inter‐ and intraobserver within‐ and between‐day variability was assessed by calculating the coefficients of variation for repeated measurements. Results: 2DST analysis was feasible in each exam. The variability of peak systolic values and peak timing was low to moderate, whereas peak diastolic values showed a higher variability. Significant segmental differences were demonstrated. DL and VL presented a prominent base‐to‐midwall gradient. SL and SrL values were similar in all segments except the basal septal segment, which showed a significantly lower peak SL occurring about 60 ms later compared with the other segments. Conclusions and Clinical Importance: 2DST is a reliable technique for measuring systolic LV longitudinal motion in healthy horses. This study provides preliminary reference values, which can be used when evaluating the technique in a clinical setting.     

Quantitative Analysis of Stress Echocardiograms in Healthy Horses with 2‐Dimensional (2D) Echocardiography,Anatomical M‐Mode,Tissue Doppler Imaging,and 2D Speckle Tracking

Background: Stress echocardiography is used to diagnose myocardial dysfunction in horses, but current methods are not well standardized. The influence of heart rate (HR) on measurements is largely unknown. Objectives: To investigate the use of 2‐dimensional echocardiography (2DE), anatomical M‐mode (AMM), tissue Doppler imaging (TDI), and 2D speckle tracking (2DST) at rest and after exercise for quantification of regional and global left‐ventricular (LV) function. Animals: Five athletic Warmblood horses; 11.6 ± 3.6 years; 529 ± 48 kg. Methods: Prospective study. Three separate echocardiographic examinations were performed before (baseline) and over 5 minutes after treadmill exercise with 2DE (1st, short‐axis view; 2nd, long‐axis view) and pulsed‐wave TDI (3rd examination). Offline analyses were performed at baseline and after exercise at HR 120, 110, 100, 90, and 80 minute^?1. Global and segmental measurements were compared by analysis of variance. Results: Quantitative analyses of stress echocardiograms were feasible in all horses. None of the AMM indices changed significantly after exercise. Stroke volume and ejection fraction by 2DE and strain by 2DST decreased, whereas strain rate by 2DST increased significantly at HR > 100 minute^?1. TDI analyses were technically difficult and provided little additional information. Conclusions and Clinical Importance: Volumetric indices by 2DE and strain and strain rate by 2DST are applicable for quantitative assessment of stress echocardiograms. In healthy horses, they are significantly altered at a HR > 100 minute^?1 and need to be evaluated in view of the instantaneous HR. Further investigations are needed to define the clinical value of stress echocardiography in horses with cardiac disease.     

Feasibility of radial and circumferential strain analysis using 2D speckle tracking echocardiography in cats

The purpose of the present study is to investigate the feasibility of strain analysis using speckle tracking echocardiography (STE) in cats and to evaluate STE variables in cats with hypertrophic cardiomyopathy (HCM). Sixteen clinically healthy cats and 17 cats with HCM were used. Radial and circumferential strain and strain rate variables in healthy cats were measured using STE to assess the feasibility. Comparisons of global strain and strain variables between healthy cats and cats with HCM were performed. Segmental assessments of left ventricle (LV) wall for strain and strain rate variables in cats with HCM were also performed. As a result, technically adequate images were obtained in 97.6% of the segments for STE analysis. Sedation using buprenorphine and acepromazine did not affect any global strain nor strain rate variable. In LV segments of cats with HCM, reduced segmental radial strain and strain rate variables had significantly related with segmental LV hypertrophy. It is concluded that STE analysis using short axis images of LV appeared to be clinically feasible in cats, having the possibility to be useful for detecting myocardial dysfunctions in cats with diseased heart.     

Methods and Reliability of Tissue Doppler Imaging for Assessment of Left Ventricular Radial Wall Motion in Horses

Background: Noninvasive assessment of left ventricular (LV) function is incompletely studied in horses.
Objectives: The goals of this study were to investigate the feasibility, techniques, and reliability of tissue Doppler imaging (TDI) for characterization of LV radial wall motion in healthy horses.
Animals: Three Standardbreds, 3 Thoroughbreds; age 8–14 years; body weight 517–606 kg.
Methods: Repeated echocardiographic examinations were performed by 2 observers in unsedated horses using TDI. Test reliability was determined by estimating measurement variability, within-day interobserver variability, and between-day interobserver and intraobserver variability of all echocardiographic variables. Variability was expressed as coefficient of variation (CV) and the absolute value below which the difference between 2 measurements will lie with 95% probability.
Results: Assessment of LV radial wall motion by TDI was feasible in all horses. Measurement variabilities were very low (CV < 5%) to low (CV 5–15%) for most variables. Within-day interobserver variability as well as between-day interobserver and intraobserver variabilities were low to moderate (CV 16–25%) for most variables. All pulsed-wave TDI variables of systolic LV function showed very low to low variability, whereas some of the variables of LV diastolic and LA function showed moderate to high (CV > 25%) variability. Pulsed-wave TDI variables appeared more reliable than color TDI variables.
Conclusions and Clinical Importance: Measurement of TDI indices of LV function is feasible and reliable in adult Standardbred and Thoroughbred horses. The clinical relevance of LV function assessment by TDI remains to be determined.     

Tissue Doppler Imaging and Two-Dimensional Speckle Tracking of Left Ventricular Function in Healthy Horses After Clenbuterol Application

The cardiac effects of high dosages of the ß²-adrenergic agent clenbuterol have been the focus of several histological, biochemical and echocardiographic studies in the past. Possible effects of a therapeutic dosage on myocardial contractility and velocities have not been evaluated using tissue Doppler imaging (TDI) and two-dimensional speckle tracking (2DST) in equine medicine. Twenty-five healthy horses were treated over 14 days with clenbuterol in a normal dosage (0.8 μg/kg every 12 hours). Before and after the treatment, an echocardiographic examination was performed using B-mode, M-mode, color flow Doppler, and tissue Doppler imaging (TDI). In all horses, the radial and circumferential myocardial functions were recorded in the right parasternal short-axis view (SAX). Pulsed-wave (PW) and color TDI were used for evaluation of peak and mean myocardial velocities; myocardial deformation was documented in 2DST. An improvement of diastolic function after clenbuterol treatment was demonstrated by a significant increase of the early diastolic radial wall motion velocity (E_m) in all myocardial sections except the right ventricular free wall (RVFW) in TDI, as well as an increase of the E/A quotient in the left ventricular free wall (LVFW) and the interventricular septum (IVS). Shortened time intervals, in particular in the LVFW and a tendency of increase of all deformation parameters showed improved relaxation characteristics of the cardiac muscle after treatment. The results can be interpreted as beginning physiologic cardiac hypertrophy due to clenbuterol treatment. No signs of increased rigidity or reduced compliance of the heart muscle could be found at the applied dosage. This study demonstrates the sensitivity of TDI and 2DST in equine cardiology to detect myocardial remodeling before the appearance of obvious findings in conventional echocardiographic techniques. This technique can be used to detect pharmacologic effects on myocardial function.     

Precision-controlled echocardiographic left ventricular function parameters by repeated measurement on three consecutive days in trained and untrained warmblood horses

Echocardiographic measurements have to be reliable and reproducible with only a low day to day variability for detecting pathological changes of left ventricular myocardial function in horses. The day dependent fluctuation margin represents an important indicator for the reproducibility of a method. To find out the day to day variability of echocardiographic parameter in healthy warmblood horses, in the present study repeated echocardiographic measurements at three consecutive days were carried out (at the same time and by the same examiner) at 11 untrained and 7 trained warmblood horses. The horses were examined from the right hemithorax, in five different B- and M-Mode views in the long and short heart axis. The echocardiographic measurements in the three-day examination interval showed with coefficient of variation between 3.4 and 25.8% a good reproducibility. In order to calculate the precision of echocardiographic parameters (reproducibility from day to day) statistical analysis was carried out by means of a linear model with random effects. Herefor the variation between repeated measurements over three days and within the horses (day to day intraindividual variation) as well as the variation between the horses (interindividual variation) were taken into account. In dependency of the echocardiographic parameters 46.2-95.7% (median 85.7%) of the variation is caused by the difference between the horses (intraclass correlation) and 4.3-53.8% (median 14.3%) of the variation is caused by the repeated measurements on different days. With a coefficient of variance from 6.6% and an intraclass correlation of 0.957 the left ventricular diastolic diameter at the level of the papillary muscles showed the lowest variation between repeated measurements on different days. The heart rate with a coefficient of variance of 10.3% and an intraclass correlation of 0.462 showed the highest variation with 53.8% between the repeated measurements on different days. The precision of single echocardiographic measurements is confirmed. All parameters were also tested for differences between trained and untrained horses. Significant differences (p<0.05) could be found in the left ventricular diameter at the level of the apex cordis and under the mitral valves as well as in the systolic left ventricular area.     

Magnetic resonance imaging and histological findings in the proximal aspect of the suspensory ligament of forelimbs in nonlame horses

Reasons for performing study: Detailed magnetic resonance imaging (MRI) and histological appearances of the proximal aspect of the suspensory ligament (PSL) in the forelimb of nonlame horses have not been previously documented. Objectives: 1) to describe detailed anatomy of the PSL, 2) describe high‐ and low‐field MRI and histological appearances of the PSL and surrounding structures in the forelimb of horses with no carpal or proximal metacarpal pain, 3) assess the relationship between age, breed, gender, height, bodyweight and MRI findings and 4) describe the histological appearance of the PSL and compare this with MRI findings. Methods: High‐ and low‐field MR images of the PSL and related structures from 30 cadaver limbs of nonlame horses were analysed subjectively and objectively. Univariable and multivariable linear regression analyses were used to assess the association of age, breed, gender, height and bodyweight with MRI findings. Histological and MRI findings of the PSL of 9 limbs were compared subjectively. Results: The collagenous tissue of the PSL had low to intermediate signal intensity depending on the pulse sequence. There was a large variation among horses in the amount, shape and signal intensity of the muscle and adipose tissue within the PSL. Comparison of MR images with histological slides revealed that the high signal intensity areas corresponded to adipose tissue and intermediate signal intensity areas to muscle tissue. The medial lobe of the PSL had a smaller cross sectional area (CSA) than the lateral lobe; there was a positive association between CSA of the PSL and both horse height and bodyweight (P<0.001). Conclusions and potential relevance: The large variability in the MRI appearance of the PSL in nonlame horses should be borne in mind when interpreting MR images of lame horses.     

Myocardial Function of Horses Under Sedation with Romifidine Using Two-Dimensional Speckle Tracking

Two-dimensional speckle tracking echocardiography (2DST) provides the assessment of the left ventricle deformation parameters strain (St) and strain rate (SR). The objective of this study was to evaluate St and SR under the influence of romifidine in healthy horses and horses affected with heart disease. The study subjects were 45 privately owned horses. Valvular insufficiencies were identified by color Doppler in 21 out of 45 horses. Dimensional changes were identified in 13 of these 21 horses. These dimensional changes included dilatations of the left ventricle (130 ± 8.95 mm) and/or the left atrium (141 ± 4.8 mm). The other 24 horses were without echocardiographic findings and had normal heart dimensions. Based on clinical signs, echo-, and electrocardiographic examinations, 24 horses were categorized as group 1 (healthy), 13 as group 2 (heart disease without dimensional changes), and 8 as group 3 (heart disease with dimensional changes). The radial St and SR were assessed in the left ventricular free wall and the interventricular septum using 2DST. After application of romifidine, a significant reduction of St and the systolic peak of SR were found in all three groups. Group 3 showed the most significant reduction of these parameters (41.5%). The reduction of St and SR under romifidine showed a reduced myocardial function, which is more obvious in horses with cardiac dilatation. It can be assumed that heart disease with myocardial dilatation leads to decreasing myocardial function, which becomes more obvious after romifidine application and of clinical importance in horses with severe heart disease and cardiac dilatation.     

Echocardiographic analysis of segmental left ventricular wall motion at rest and after exercise in horses with and without heart disease

An echocardiography was performed on 23 healthy warmblood horses and on 12 warmblood horses with cardiac diseases at rest and after treadmill or lungeing exercise. The B-mode technique was used, and the left ventricular wall motion was analyzed visually. The left ventricle was divided into 6 equally sized myocardial segments, 3 of them in the region of the interventricular septum, and the other 3 in the region of the left ventricular rear wall (“6-segment model”). The kinetic of each segment was determined using a kinetic score system. A normokinetic wall motion was defined with a kinetic index of 1. To the authors' knowledge, the current study is the first to present a visual qualitative method for assessment of the healthy equine heart with regard to the myocardial left ventricular wall motion at rest and after exercise under standardized conditions. First, reference values for the left ventricular myocardial kinetics were established in healthy horses. Subsequently, horses with cardiac diseases of differing severity were examined, and the diagnostic value of the method was evaluated. In contrast with human cardiology, the healthy equine heart is characterized by several deviating wall motion patterns. The majority of the healthy horses (52%) showed a normokinetic wall motion of all 6 segments at rest and a normokinetic concentrically increased hypertrophy after exercise. In 9 healthy horses, however, the middle septal segment (at the papillary muscle level) was characterized by a hypokinesia (kinetics index = 2) at rest. In 5 of these horses, the hypokinesia was not observed after exercise. The kinetic wall motion score was 1.1 ± 0.2 at rest in the healthy horses. In the horses with cardiac disorders, the score was 1.5 ± 0.4 at rest. In all healthy horses, the middle septal segment (at the papillary muscle level) was characterized by a hypokinesia (kinetics index = 2; n = 5) or akinesia (kinetics index = 3; n = 3) at rest.After standardized treadmill exercise, the wall motion score of the healthy horses was 1.12 ± 0.16 and the score of the horses with cardiac disorders was 1.52 ± 0.4. In contrast to human cardiology, the mid-septal segment showed a hypokinesia (kinetics index: 2) and an akinesia (kinetics index: 3) in two healthy horses after exercise. In all horses with low-grade and moderate cardiac disorder, an atypical wall motion pattern was observed after exercise. In all horses with high-grade cardiac disorder, an atypical motion pattern was documented in 5 out of 6 segments. An exercise test was not performed on the latter group.     

Changes over time in echocardiographic measurements in young Standardbred racehorses undergoing training and racing and association with racing performance

OBJECTIVE: To evaluate changes over time in echocardiographic measurements in young Standardbred racehorses undergoing training and racing and determine whether there was any relationship between cardiac dimensions and racing performance. DESIGN: Longitudinal observational study. ANIMALS: 103 horses. PROCEDURE: 2-dimensional and M-mode echocardiography was performed 4 times at 6-month intervals. RESULTS: Significant cardiac enlargement took place during the study period as indicated by increases in left ventricular internal diameter in diastole (LVIDd), estimated left ventricular muscle mass (LV mass), and mean wall thickness attributable to eccentric left ventricular hypertrophy. Estimated body weight was positively correlated with left ventricular size, and males had significantly larger LVIDd and LV mass than did females. Horses that were racing regularly had larger LVIDd and LV mass than did unraced horses. A significant relationship between left ventricular size and racing performance was observed. The relationship was strongest at the time of the fourth examination. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that age must be taken into account when interpreting results of echocardiography in young Standardbred racehorses because significant cardiac enlargement takes place with age and training. A larger heart was found in horses that were racing, and size of the heart was correlated with athletic performance of the horse.     

Contrast‐enhanced computed tomography may be helpful for characterizing and staging canine gastric tumors

In humans, computed tomography (CT) is a widely performed technique for the diagnosis and staging of gastric tumors. The purpose of this retrospective case series study was to describe CT findings in a group of dogs with confirmed gastric tumors. For each included dog, the following CT parameters were recorded: gastric tumor location, tumor shape, gastric involvement pattern, tumor enhancement pattern in early and late phases, presence and location of lymphadenopathy, gastric tumor attenuation values, attenuation values of enlarged lymph nodes, maximum short‐axis diameter (mm) of enlarged lymph node, maximum long‐axis diameter (mm) of enlarged lymph node, and short‐axis diameter to long‐axis diameter ratio (short axis/long axis). A total of 16 dogs met inclusion criteria and had the following final diagnoses: five lymphoma, six adenocarcinoma, three inflammatory polyps, and two leiomyoma. In the early‐ and delayed‐phase postcontrast images, the mean CT attenuation value for lymphoma was lower than that of other gastric tumors. Lymphadenopathy was widespread in lymphomas and regional in adenocarcinomas. Lymphadenopathy was not detected in leiomyomas. Lymph node measurements in lymphoma were larger than lymph node measurements in adenocarcinoma. Although there were overlapping findings for the different types of gastric tumors, contrast‐enhanced CT provided helpful information for characterizing gastric tumors based on the following criteria: early and late enhancement patterns, the site of origin of the mass lesion, and extent of local invasion and distant metastases. Lymphoma should be considered for canine gastric tumors with low mean attenuation values during early‐ and delayed‐phase postcontrast images, and widespread, bulky, and rounded lymphadenopathy.     

INTRA‐ AND INTEROBSERVER VARIABILITY OF ULTRASONOGRAPHIC MEASUREMENTS OF THE ADRENAL GLANDS IN HEALTHY BEAGLES

The aim of the present study was to establish which adrenal gland measurement was characterized by the least variations. To do this, we quantified the variability of seven different size measurements of the canine adrenal gland (maximal length, maximal height at the cranial and caudal poles on longitudinal and transverse images, and maximal width of the cranial and caudal poles) within observer, between observer, and between dogs based on three different measurements made by each of the three observers in six healthy Beagle dogs. The height of the caudal pole of both adrenal glands measured on longitudinal images had the lowest intra‐ and interobserver variability, while measurements of the length had the highest intra‐ and interobserver variability. Other measurements that were characterized by low intra‐ and interobserver variability were: height and width of the caudal pole on transverse images and height of the cranial pole on longitudinal images only. These results provide a basis for further study of the changes in adrenal gland size in dogs with pituitary‐dependent hyperadrenocorticism.     

The proximal aspect of the suspensory ligament in the horse: How precise are ultrasonographic measurements?

Reasons for performing study: To evaluate intra‐ and interobserver variability in ultrasonographic measurements of the proximal aspect of the suspensory ligament (PSL) in the horse. Hypothesis: A minimum difference of ≥20% is required to differentiate reliably between physiological and pathological alterations related to dimensions. Materials and methods: Two operators examined the PSL in all 4 limbs of 14 horses twice using different techniques and different probes with and without standoff pads. Measurements were taken from the longitudinal and transverse images. Inter‐ and intraoperator variability was evaluated using agreement indices (AI) and the 95% limits of agreement (LOA). Results: On the longitudinal scan the mean inter‐ and intraoperator AIs for dorsopalmar/‐plantar thickness were both ≥0.89 and the 95% LOA were within target values for almost all intra‐ and interoperator comparisons. Similar mean AIs and 95% LOA were calculated for the dorsopalmar/‐plantar thickness on the transverse image. For lateromedial width, cross‐sectional area and circumference on the transverse scan, the mean inter‐ and intraoperator AIs ranged between 0.81 and 0.95 and the 95% LOA were higher than target values regardless of the imaging technique used. In general, better values for AIs and 95% LOA were achieved in the fore‐ compared with the hindlimb. Conclusion and clinical relevance: Acceptable precision was identified within and between operators only for the dorsopalmar/‐plantar thickness in longitudinal and in transverse scanning directions. For the lateromedial width, cross‐sectional area and circumference, a relatively large variability was identified. This aspect has to be considered if these parameters are to be used for objective measurement of the PSL from the transverse ultrasound image.     

In vitro measurement of internal hoof strain

REASONS FOR PERFORMING STUDY: Strains during stance on the hoof wall surface have been measured by a number of authors in vitro and in vivo. Histological structure and mechanical properties vary through the wall thickness (radially); radial strain measurements may therefore aid the understanding of mechanical function of the capsule and adjacent tissues. OBJECTIVES: To develop instrumentation capable of measuring internal hoof strain, and to carry out a preliminary comparison of normal and laminitic hooves. METHODS: Six forelimbs from 4 horses, including 2 with laminitis from the same horse, were tested using an Instron test rig designed to simulate the walk at impact, midstance and breakover. Internal strains were measured at a dorsal site using strain gauges moulded into a plug made of 007 fast-set structural adhesive. In addition, kinetic and kinematic data were collected from each specimen. RESULTS: When simulating the walk, a significant (P<0.0001) increase in gradient of radial tensile strain was found in a normal hoof wall, from 5.6 +/- 73.9 microepsilon at the outer gauge to 418.5 +/- 170.6 microepsilon at the inner gauge. However, radial strains measured at the inner gauge site in limbs with laminitis were found to be significantly (P<0.0001) compressive, with values of -406.7 +/- 156.3 and -109.9 +/- 72.4 microepsilon for Specimens 1 and 2, respectively. CONCLUSIONS AND POTENTIAL RELEVANCE: These preliminary data indicate that a marked redistribution may well occur in the wall of laminitic hooves. With a larger sample size, the results should have relevance to the treatment and management of laminitis.     

Variability of resting endoscopic grading for assessment of recurrent laryngeal neuropathy in horses

Reasons for performing study: The extent to which variability affects endoscopic grading of arytenoid cartilage movement is uncertain. Objective: To determine the observer and within horse variability of grading arytenoid cartilage movement in horses during resting endoscopic examination, using a 7‐grade system. Methods: Endoscopic recordings of the upper respiratory tract made at rest in 270 draught horses were reviewed independently by 2 veterinarians to assess interobserver variability when scoring horses' laryngeal function with a 7‐grade system. Grading was repeated by both examiners in 80 randomly selected recordings in order to assess intraobserver variability. In 120 horses, endoscopy was repeated after 24–48 h, with videos graded by both veterinarians to assess intrahorse variability. Results: The mean weighted κ statistic for concordance within examiners was 0.867, with a mean intraobserver agreement of 76.3%. The weighted κ statistic for concordance between the 2 examiners was 0.765, with an interobserver agreement of 63.1%. Of the horses receiving 2 endoscopic examinations, the same grade was assigned to 57.1% of horses at the second examination, when effects resulting from interobserver variability were removed. The mean weighted κ statistic for concordance between the grade assigned at first vs. second examinations was 0.588, indicating only moderate agreement. Conclusions and potential relevance: Intra‐ and interobserver reliability of resting endoscopic grading of arytenoid cartilage movement using a 7‐grade system was high when examinations were conducted by experienced veterinarians. However, there was moderate daily intrahorse variability, suggesting that results of resting endoscopic examinations performed on a single day should be interpreted with caution.     

Left ventricular volume determination in the horse by two-dimensional echocardiography: an in vitro study

This study was designed to evaluate the accuracy of two-dimensional echocardiography (2DE) in determining the left ventricular volume (LVV) of the horse in vitro. After examining the shape of the left ventricular silicon rubber casts of four equine hearts, two modified Simpson's rule methods (Model A and Model B) as combinations of conical shapes and one biplane area-length method as a single cone (Model C) were chosen for volume calculations. One long axis and three short axis planes were used for linear and area 2DE measurements, respectively. The ventricular length (L) was calculated from the chordal length (CL) by using a linear regression equation (L = 5.54 + 1.83 CL) obtained by anatomical measurement of these two parameters on 40 normal hearts. The LVV was calculated in 15 formalin-fixed hearts from 2DE measurements with the three geometric models. Left ventricular casts were then made using silicon rubber, and their volumes were determined by water displacement. The calculated volumes were plotted against cast volumes with linear regression analysis. All calculated LVVs correlated well with the cast LVVs (R = 0.921 to 0.957; P less than 0.001). The highest correlation was provided by Model A which best represented the shape of the left ventricle. This model consisted of a truncated cone bordered by the area at the level of the mitral valve and by the area at the level of the chordae tendineae, plus a cone the base of which was the area at the level of the papillary muscles. The results demonstrate the applicability of 2DE for equine LVV determinations in vitro, similar to other species.(ABSTRACT TRUNCATED AT 250 WORDS)     

Observer agreement study of cervical-vertebral ratios in horses

Reason for performing study: Different examiners or the same examiner were observed at different times producing slightly different results when obtaining cervical‐vertebral ratios. If the difference is substantial, then measurement variability would have an important impact of radiographic interpretation. Objective: To quantify agreement and repeatability of these measurements. Methods: An observer agreement study was performed using 75 horses. Measurements were made at C3–4 and C6–7 by a board‐certified radiologist and an imaging resident. Intra‐ and interobserver agreement was quantified using Bland‐Altman plots. Repeatability was assessed as the percentage of differences between duplicate measurements by the radiologist that were within ± 2 s.d. of the differences. Results: At C3–4, the limits of agreement for the intra‐vertebral ratio were between ‐5 and 4% for the intra‐ and ‐5 and 6% for interobserver comparison. For the intervertebral ratio, they were between ‐9 and 8% for the intra‐ and ‐10 and 10% for interobserver comparison. At C6–7, the limits of agreement for the intra‐vertebral ratio were between ‐6 and 5% for the intra‐ and ‐6 and 8% for interobserver comparison. For the intervertebral ratio, they were between ‐7 and 7% for the intra‐ and ‐6 and 13% for interobserver comparison. At C3–4, all measurements were 95% repeatable (differences typically ≤4% and always ≤8%) for the intra‐vertebral ratio and 96% repeatable (differences typically ≤8% and always ≤11%) for the intervertebral ratio. At C6–7, all measurements were 98% repeatable (differences typically ≤6% and always ≤7%) for the intravertebral ratio and 92% repeatable (differences typically ≤6% and always ≤10%) for the intervertebral ratio. Conclusions: Cervical‐vertebral ratios typically varied by 5–10% within and between examiners. Potential relevance: When using cervical‐vertebral ratios in practice, the impact of measurement agreement should be factored into the interpretation of the test result because measurement variability may lead to misdiagnosis and limit the clinical usefulness of these tests.     

Seasonal changes in plasma adrenocorticotropic hormone and α-melanocyte-stimulating hormone in response to thyrotropin-releasing hormone in normal, aged horses

Background: Results of diagnostic tests for equine pituitary pars intermedia dysfunction (PPID), including endogenous ACTH concentration and the overnight dexamethasone suppression test (DST), are affected by season. New and potentially more sensitive diagnostic tests for equine PPID, such as thyrotropin‐releasing hormone (TRH)‐stimulated ACTH response, have been developed, but have had limited evaluation of seasonality. Objective: Our purpose was to evaluate seasonal changes in plasma ACTH and alpha‐melanocyte‐stimulating hormone (α‐MSH) responses to TRH administration. Animals: Nine, healthy, aged horses with normal DST results. Methods: Synthetic TRH (1 mg) was administered IV. Plasma ACTH and α‐MSH concentrations were measured at 0, 5, 10, 15, 20, 25, 30, 45, 60, and 180 minutes. Testing was performed in February, July, August, September, October, and November. Mean TRH‐stimulated ACTH and α‐MSH concentrations were compared across months and time by repeated measures analysis of variance. Significance was set at the P < .05 level. Results: Concentrations of ACTH and α‐MSH significantly increased after TRH administration. Endogenous and TRH‐stimulated ACTH and α‐MSH concentrations were significantly different across months with higher concentrations in the summer and fall compared with February. Conclusions and Clinical Importance: Plasma ACTH and α‐MSH responses to TRH administration experience seasonal variation, with TRH‐stimulated ACTH and α‐MSH concentrations increasing from summer through fall. These results support previous evidence of a seasonal influence on the equine pituitary‐adrenal axis. More research is warranted with a larger number of horses to determine if seasonal reference ranges for TRH stimulation testing need to be defined.     

Evaluation of Intra‐ and Interobserver Variability and Repeatability of Tibial Plateau Angle Measurements with Digital Radiography Using a Novel Digital Radiographic Program

Objective— To compare the intra‐ and interobserver variability occurring when observers with differing experience levels measure tibial plateau angles (TPAs) with a novel digital radiographic projection program (tibial plateau leveling osteotomy [TPLO] planning program), the Kodak Picture Archiving and Communications System (PACS), and standard sized printed films (SF). Study Design— Cross‐sectional study. Sample Population— Dogs (n=36) with cranial cruciate ligament (CCL) rupture that had a TPLO. Methods— Six observers, divided into 3 equal groups based on experience level, measured TPA on 36 digitally captured radiographic images of tibiae of dogs clinically affected with CCL rupture. Each observer used 3 methods of measuring TPA and repeated the measurements 3 times with each method. The intra‐ and interobserver variability was compared using the coefficient of variation. Results— Averaged over all replications and images, there was no significant difference (P>.05) in the average variability occurring with each method for all but 1 observer. There was no effect of experience level on measurement variability; however, interobserver variability was significantly less with measurements made with the PACS and TPLO planning program compared with measurements made from SF (P<.05). Conclusions— Repeated measurements of TPA made using digital images and computer‐based measurement programs were significantly less variable between observers than those made from images printed on standard radiographic films. Clinical Relevance— Digital radiography and computer‐based measurement programs are effective for determining the TPA, allowing less variability in measurements compared with SF. The ability to manipulate the image may allow better identification of anatomic landmarks.