Usefulness of Conventional and Tissue Doppler Echocardiography to Predict Congestive Heart Failure in Dogs with Myxomatous Mitral Valve Disease

Background

Systolic and diastolic functions have been evaluated to predict outcome in congestive heart failure (CHF). Recently, tissue Doppler imaging (TDI) has become useful for the estimation of myocardial function in cardiac diseases of humans and animals.

Objective

This study was designed to assess whether myocardial function as assessed by TDI is associated with the occurrence of CHF in dogs with myxomatous mitral valve disease (MMVD) and whether additional information is gained over conventional Doppler variables.

Animals

Forty‐one privately owned dogs (15 healthy dogs and 26 dogs with MMVD) were included. Dogs with MMVD were divided into non‐CHF (n = 10) and CHF groups (n = 16).

Methods

Conventional echocardiographic examinations were performed. In addition, TDI‐derived variables, including radial and longitudinal velocities, strain, and strain rate were assessed.

Results

Several (12 of 47, 26%) conventional and tissue Doppler echocardiography variables were significant predictors of CHF in a univariate analysis (P < .05). However, TDI‐derived E/E _{m sept} was the only load‐independent significant predictor of CHF (P < .05) after multivariate logistic regression analysis. The E/E _{m sept} cut‐off value of >18.7 had a sensitivity of 56% and specificity of 90% in predicting CHF in dogs with MMVD.

Conclusions and Clinical Importance

The combination of TDI of the mitral annulus and mitral inflow velocity provided better estimates of diastolic dysfunction in dogs with MMVD and CHF. Additional study is warranted to assess TDI‐derived E/E _{m sept}, an index of diastolic function that could contribute to the management of dogs with MMVD and CHF.     

Change of Vertebral Left Atrial Size in Dogs With Preclinical Myxomatous Mitral Valve Disease Prior to the Onset of Congestive Heart Failure

Introduction/objectivesIt has been proposed that vertebral left atrial size (VLAS) on thoracic radiographs can be used to assess the left atrial enlargement in dogs with myxomatous mitral valve disease (MMVD). However, it remains unclear whether VLAS can be used to distinguish dogs between pre-clinical MMVD that are at a greater risk of developing congestive heart failure (CHF) from those at a lower risk. We investigated this possibility.Animals, materials and methodsForty-one dogs with MMVD were retrospectively classified into one of two groups, a group that developed CHF (group CHF, n = 17) or remained CHF-free (group no-CHF, n = 24). The value of vertebral heart scale (VHS) and VLAS at three time-points, change in VHS and VLAS at a specific time interval (ΔVHS, ΔVLAS) and rate of change in the values per month (ΔVHS/month, ΔVLAS/month) were compared.ResultsAt the first visit, there were no significant differences in VLAS between the groups. At the median of 105 (interquartile ranges 83–155) days prior to the onset of CHF (group CHF) or the last visit (group no-CHF), VLAS was significantly higher in group CHF (mean, 2.9; standard deviation ± 0.4) than in group no-CHF (2.6 ± 0.3) (p = 0.028). ΔVLAS/month (area under the curve, 0.91; p<0.001) showed high diagnostic accuracy in distinguishing which dogs would develop CHF within 180 days and which would not.ConclusionsVLAS and ΔVLAS/month in dogs with pre-clinical MMVD may be useful to identify dogs at risk of developing CHF within the next 180 days.     

Tissue Doppler and Strain Imaging in Dogs with Myxomatous Mitral Valve Disease in Different Stages of Congestive Heart Failure

Background: Tissue Doppler imaging (TDI) including strain and strain rate (SR) assess systolic and diastolic myocardial function.
Hypothesis: TDI, strain, and SR variables of the left ventricle (LV) and the interventricular septum (IVS) differ significantly between dogs with myxomatous mitral valve disease (MMVD) with and without congestive heart failure (CHF).
Animals: Sixty-one dogs with MMVD with and without CHF. Ten healthy control dogs.
Methods: Prospective observational study.
Results: Radial motion : None of the systolic variables were altered and 3 of the diastolic velocities were significantly increased in dogs with CHF compared with dogs without CHF and control dogs. Longitudinal motion : 2 systolic velocities and 3 diastolic velocities were significantly increased in dogs with CHF compared with dogs without CHF and control dogs. Difference in systolic velocity time-to-peak between LV and IVS was significantly increased in dogs with MMVD with and without CHF compared with control dogs. In total, 11 (23%) of 48 TDI and strain variables differed significantly between groups. Left atrial to aortic ratio was positively correlated to early diastolic velocities, percentage increase in left ventricular internal diameter in systole was positively correlated to systolic and diastolic velocities, and mitral E wave to peak early diastolic velocity in the LV basal segment (E/Em) was positively correlated to radial strain and SR.
Conclusions and Clinical Importance: Few TDI and strain variables were changed in dogs with MMVD with and without CHF. Intraventricular dyssynchrony may be an early sign of MMVD or may be an age-related finding.     

Detection of Congestive Heart Failure in Dogs by Doppler Echocardiography

Background: Echocardiographic prediction of congestive heart failure (CHF) in dogs has not been prospectively evaluated. Hypothesis: CHF can be predicted by Doppler echocardiographic (DE) variables of left ventricular (LV) filling in dogs with degenerative mitral valve disease (MVD) and dilated cardiomyopathy (DCM). Animals: Sixty‐three client‐owned dogs. Methods: Prospective clinical cohort study. Physical examination, thoracic radiography, analysis of natriuretic peptides, and transthoracic echocardiography were performed. Diagnosis of CHF was based upon clinical and radiographic findings. Presence or absence of CHF was predicted using receiver‐operating characteristic (ROC) curve, multivariate logistic and stepwise regression, and best subsets analyses. Results: Presence of CHF secondary to MVD or DCM could best be predicted by E : isovolumic relaxation time (IVRT) (area under the ROC curve [AUC]=0.97, P < .001), respiration rate (AUC=0.94, P < .001), Diastolic Functional Class (AUC=0.93, P < .001), and a combination of Diastolic Functional Class, IVRT, and respiration rate (R²=0.80, P < .001) or Diastolic Functional Class (AUC=1.00, P < .001), respiration rate (AUC=1.00, P < .001), and E : IVRT (AUC=0.99, P < .001), and a combination of Diastolic Functional Class and E : IVRT (R²=0.94, P < .001), respectively, whereas other variables including N‐terminal pro‐brain natriuretic peptide, E : Ea, and E : Vp were less useful. Conclusion and Clinical Importance: Various DE variables can be used to predict CHF in dogs with MVD and DCM. Determination of the clinical benefit of such variables in initiating, modulating, and assessing success of treatments for CHF needs further study.     

Pulmonary Vein‐to‐Pulmonary Artery Ratio is an Echocardiographic Index of Congestive Heart Failure in Dogs with Degenerative Mitral Valve Disease

Background

Early recognition of left‐sided congestive heart failure (CHF) in dogs with degenerative mitral valve disease (DMVD) is important because it influences medical therapy, timing of follow‐up, and outcome.

Hypothesis

Pulmonary vein diameter‐to‐pulmonary artery diameter ratio (PV/PA) measured by echocardiography can predict CHF.

Animals

Ninety‐eight client‐owned dogs, 37 controls, and 61 dogs with DMVD.

Methods

Prospective clinical cohort study. History, physical examination and Doppler‐echocardiography were performed. Dogs were classified as International Small Animal Cardiac Health Council class I, II or III. Congestive heart failure was identified in a subset of 56 dogs based on radiographic findings. The PV/PA was measured in bidimensional (2D) and M‐mode by 2 investigators blinded to the radiologists’ conclusions.

Results

Interobserver coefficients of variation for PV/PA acquisition and measurement were <10%. The PV/PA in control dogs was approximately 1 and increased with class of heart failure. The presence of CHF could be best predicted by measuring PV/PA in 2D echocardiography (cut‐off, 1.7; area under the curve, 0.98; CI, 0.97–0.98; P < .001) with a sensitivity of 96% and a specificity of 91%.

Conclusion and clinical importance

The PV/PA is a simple and reproducible echocardiographic variable that increases with class of heart failure and may help discriminate dogs in CHF from asymptomatic dogs with DMVD. Additional studies are required to determine whether PV/PA might provide additional information in the integrated interpretation of Doppler‐echocardiographic indices of left ventricular filling pressures and could be used for rapid assessment of CHF in dogs in a critical care setting.     

Relation of Vitamin D Status to Congestive Heart Failure and Cardiovascular Events in Dogs

Background

Vitamin D plays a pivotal role in cardiac function, and there is increasing evidence that vitamin D deficiency is associated with the development of congestive heart failure (CHF) in people.

Hypothesis

Serum vitamin D concentration is lower in dogs with CHF compared with unaffected controls and serum vitamin D concentration is associated with clinical outcome in dogs with CHF.

Animals

Eighty‐two client‐owned dogs.

Methods

In this cross‐sectional study, we examined the association between circulating 25‐hydroxyvitamin D [25(OH)D], a measure of vitamin D status, and CHF in dogs. In the prospective cohort study, we examined whether 25(OH)D serum concentration was associated with clinical outcome in dogs with CHF.

Results

Mean 25(OH)D concentration (100 ± 44 nmol/L) in 31 dogs with CHF was significantly lower than that of 51 unaffected dogs (123 ± 42 nmol/L; P = .023). The mean calculated vitamin D intake per kg of metabolic body weight in dogs with CHF was no different from that of unaffected dogs (1.37 ± 0.90 μg/kg metabolic body weight versus 0.98 ± 0.59 μg/kg body weight, respectively, P = .097). There was a significant association of serum 25(OH)D concentration on time to clinical manifestation of CHF or sudden death (P = .02).

Conclusion and Clinical Relevance

These findings suggest that low concentrations of 25(OH)D may be a risk factor for CHF in dogs. Low serum 25(OH)D concentration was associated with poor outcome in dogs with CHF. Strategies to improve vitamin D status in some dogs with CHF may prove beneficial without causing toxicity.     

Cardiac Troponin‐I Concentration,Myocardial Arteriosclerosis,and Fibrosis in Dogs with Congestive Heart Failure because of Myxomatous Mitral Valve Disease

Background

Few previous studies have investigated the association between biomarkers and cardiac disease findings in dogs with naturally occurring myxomatous mitral valve disease (MMVD).

Aim

To investigate if histopathological changes at necropsy could be reflected by in vivo circulating concentrations of cTnI and aldosterone, and renin activity, in dogs with naturally occurring congestive heart failure because of MMVD.

Animals

Fifty privately owned dogs with MMVD and heart failure.

Methods

Longitudinal Study. Dogs were prospectively recruited and examined by clinical and echocardiographical examination twice yearly until time of death. Blood was stored for batched analysis of concentrations of cTnI and aldosterone, and renin activity. All dogs underwent a standardized necropsy protocol.

Results

cTnI were associated with echocardiographic left ventricular end‐diastolic dimension (P < .0001) and proximal isovolumetric surface area radius (P < .004). Furthermore, in vivo cTnI concentrations reflected postmortem findings of global myocardial fibrosis (P < .001), fibrosis in the papillary muscles (P < .001), and degree of arterial luminal narrowing (P < .001) Aldosterone or renin activity did not reflect any of the cardiac disease variables investigated.

Conclusion and clinical importance

Cardiac fibrosis and arteriosclerosis in dogs with MMVD are reflected by circulating cTnI concentration, but not by aldosterone concentration or renin activity. Cardiac troponin I could be a valuable biomarker for myocardial fibrosis in dogs with chronic cardiac diseases.     

新西兰兔心衰模型心肌损伤与一氧化氮的关系探讨

为研究导管术致超容量负荷型实验性心衰兔模型随时间推移的损伤变化及其与NO的关系,应用导管术造成兔的超容量负荷型心衰模型,分别于造模后24 h和造模后7 d处死动物,取心脏组织做光镜检查,NO试剂盒检测血清NO含量,通过流式细胞仪检测心肌细胞凋亡情况,Western blot检测Caspase-3蛋白水平的表达。结果表明,①光镜下,正常组心肌细胞无损伤表现,造模24 h组及7 d组均有心肌细胞损伤表现,造模7 d组损伤更为广泛且严重。②NO试剂盒检测结果表明,造模24 h组含量(3.33±1.30)μmol/L和造模7 d组NO含量(2.81±0.77)μmol/L高于正常组(2.09±0.22)μmol/L,且造模24 h高于造模7 d。③AnnexinV联合PI染色结果表明,正常组凋亡率较低(3.72±1.92)%,随着时间推移,凋亡细胞所占比例呈上升趋势,造模7 d(10.73±2.26)%明显高于造模24 h(7.62±1.70)%。④Western blot检测结果表明,正常组基本检测不到激活的Caspase-3蛋白酶,在造模后24 h和造模后7 d Caspase-3蛋白酶均有明显表达,但造模7 d...     

间接ELISA检测鸭疫里氏杆菌抗体的研究

以提取的血清１型鸭疫里氏杆菌（Ｒ．ａ）Ｊｂ２株的脂多糖作为包被抗原,成功地建立了一种检测１型Ｒ．ａ抗体的间接ＥＬＩＳＡ方法,特异性试验和重复性试验证明此方法的特异性高、重复性好。并比较了间接ＥＬＩＳＡ方法、间接血凝试验、玻片凝集试验和琼脂扩散试验对抗体检出的敏感性,结果表明间接ＥＬＩＳＡ方法最敏感,人工感染后的鸭第７２小时即可检出血清抗体为阳性（３／４）;其次是间接血凝试验,第９６小时即可检出５０％（２／４）;玻片凝集试验在感染９天后才出现阳性（２／３）;而琼扩试验在感染后１１天仍为阴性反应。应用建立的间接ＥＬＩＳＡ方法,初步调查了南京地区鸭场此病的感染情况,发现所调查的１３日龄以前雏鸭的阳性率为０,而２１～３５日龄鸭的阳性率为８７３％。     

Atrial Natriuretic Peptide as an Indicator of the Severity of Valvular Regurgitation and Heart Failure in Horses

Natriuretic peptides are cardiac biomarkers, routinely used for diagnosis, prognosis, and guidance for treatment in human and small animal cardiology. However, their diagnostic and prognostic value in horses has received little study. The aim of this study was to investigate the plasma atrial natriuretic concentration (ANP_Pl) in a large group of horses with various degrees of valvular regurgitation (VR) and congestive heart failure (CHF). Clinical examination and two-dimensional time-motion mode and Doppler echocardiography were performed on 91 horses admitted to the Equine Teaching Hospital of Liege University, with either no, mild, moderate, or severe VR and presenting various stages of CHF. Plasma atrial natriuretic concentration was measured using a commercially available human radioimmunoassay test. Mean values of body weight, age, ANP_Pl, and echocardiographic parameters were compared among horses with no, mild, moderate, and severe VR and among horses in different CHF stages. Correlation and linear regression of ANP_Pl with each echocardiographic parameter and with the percentage of dilation of each of cardiac chambers were assessed. Horses with severe or moderate VR had significantly higher ANP_Pl than those with mild or no VR. Plasma atrial natriuretic concentration was significantly higher in horses presenting CHF than those without CHF. Plasma atrial natriuretic concentration was significantly correlated with the left atrial diameter and its percentage of dilation. These results suggest a diagnostic value of ANP_Pl in horses with VR, especially with tricuspid or mitral insufficiency with dilation of the atria.     

猪生殖-呼吸道综合征病毒CH-1_株N基因的原核表达

将ＰＲＲＳＶＣＨ１ａ株Ｎ基因用ＥｃｏＲＩ和ＰｓｔＩ双酶切从重组质粒ｐＵＣ１８ＯＲＦ７切下后,插入到原核表达载体ｐＢＶ２２０的ＰＲ、ＰＬ启动子下游,得到重组表达质粒ｐＢＶ２２０ＯＲＦ７。转化了ｐＢＶ２２０ＯＲＦ７的大肠杆菌ＪＭ８３经诱导培养后,用ＳＤＳＰＡＧＥ和Ｗｅｓｔｅｒｎｂｌｏｔ检测表达产物。结果表明ＰＲＲＳＶＣＨ１ａ株的Ｎ基因在原核载体上得到高效表达,表达产物占菌体总蛋白的１５３％。表达蛋白可望成为有价值的ＰＲＲＳ诊断抗原。     

牛膝多糖对牛蛙心脏活动的影响

应用斯氏蛙心灌流方法,观察和分析牛膝多糖对离体蛙心的作用及机理。结果发现,10μg/mL的牛膝多糖溶液即可加强心肌的收缩能力,50μg/mL时差异极著(P0.01),以后随用药浓度的增加,振幅进一步增大,二者呈显著的量效关系。牛膝多糖溶液在一定浓度范围内不影响心率,但浓度升高到500μg/mL时可使心率增加,至1000μg/mL时收缩振幅和心率进一步加大,但随后出现心脏功能衰竭。研究时选择100μg/mL的牛膝多糖浓度,其正性肌力作用与β受体有关,与M受体无关。     

Nutritional Alterations and the Effect of Fish Oil Supplementation in Dogs with Heart Failure

Alterations in body composition and nutritional status are common in humans with heart failure and are related, in part, to increases in cytokine concentrations. Cytokines have not been studied previously in dogs with naturally occurring cardiac disease nor has fish oil administration been used in this population to decrease cytokine production. The purposes of this study were to characterize nutritional and cytokine alterations in dogs with heart failure and to test the ability of fish oil to reduce cytokines and improve clinical outcome. Body composition, insulinlike growth factor-1, fatty acids, and cytokines were measured in 28 dogs with heart failure and in 5 healthy controls. Dogs with heart failure then were randomized to receive either fish oil or placebo for 8 weeks. All parameters were measured again at the end of the study period. At baseline, 54% of dogs with heart failure were cachectic and the severity of cachexia correlated with circulating tumor necrosis factor-α concentrations (P= .05). Cytokine concentrations at baseline, however, were not significantly increased in dogs with heart failure compared to controls. Baseline plasma arachidonic acid (P= .02), eicosapentaenoic acid (P= .03), and docosahexaenoic acid (P = .004) concentrations were lower in dogs with heart failure than in controls. Fish oil supplementation decreased interleukin-1β (IL-1) concentrations (P= .02) and improved cachexia (P= .01) compared to the placebo group. The mean caloric intake of the heart failure dogs as a group was below the maintenance energy requirement (P < .001), but no difference was found in food intake between the fish oil and placebo groups. Insulinlike growth factor-1 concentrations (P= .01) and reductions in circulating IL-1 concentrations over the study period (P= .02) correlated with survival. These data demonstrate that canine heart failure is associated with cachexia, alterations in fatty acids, and reduced caloric intake. Fish oil supplementation decreased IL-1 concentrations and improved cachexia. In addition, reductions in IL-1 predicted survival, suggesting that anticytokine strategies may benefit patients with heart failure.     

肉鸡腹水综合征研究进展

肉鸡腹水综合征 ,又称肺动脉高压综合征 ,是影响世界肉鸡饲养业的主要疾病之一。文章着重论述了肉鸡腹水综合征的病史、诱发因素、临床病理学特征以及诊断和治疗的最新研究进展 ,同时对其发病机理提出了三种假说。为进一步揭示其发病机理 ,更好地预防和治疗肉鸡腹水综合征提供了理论参考     

Utilization of an enzyme heat stability test and erythrocyte glycolytic intermediate assays to assist in the diagnosis of canine pyruvate kinase deficiency

A macrocytic hypochromic anemia, with marked reliculocytosis and large numbers of circulating nucleated erythrocytes, was recognized in a 3 1/2-year-old male Beagle-cross dog. A presumptive diagnosis of erythrocyte pyruvate kinase (PK) deficiency was made, even though PK activity from the patient was within the range of activities measured for normal dogs, because the PK activity should have been several times normal in light of the large number of reticulocytes present. The PK activity in a hemolysate from the patient was heat-labile compared to activities in hemolysates from normal dogs, a finding consistent with results from a previous study of PK-deficient Basenji dogs. Seven phosphorylated glycolytic intermediates and 2,3-diphosphoglycerate were measured in protein-free extracts of erythrocytes from the patient. All were present in concentrations above that present in normal canine erythrocytes, further supporting the diagnosis of PK deficiency.