Effect of Transvenous Electrical Cardioversion on Plasma Cardiac Troponin I Concentrations in Horses with Atrial Fibrillation

Background: Whether electrical cardioversion of cardiac arrhythmias results in cardiomyocyte damage is unknown.
Objective: To describe effect of transvenous electrical cardioversion (TVEC) on plasma cardiac troponin I (cTnI) concentration in horses.
Animals: All horses presented to the Cornell University Hospital for Animals for cardioversion of atrial fibrillation between May 2006 and October 2008 were eligible for inclusion in the study. Owners of 14 horses elected for TVEC and each horse was then enrolled (16 procedures).
Methods: Prospective observational study measuring concentrations of plasma cTnI before and after TVEC.
Results: Median cTnI concentration increased from 0.045 ng/mL at baseline (range 0.0–0.20 ng/mL) to 0.11 ng/mL after TVEC (range 0.0–3.73 ng/mL) ( P = .036). This increase was not associated with the number of shocks delivered, maximal energy delivered, cumulative energy delivered, chronicity of atrial fibrillation before cardioversion, or positioning of the pulmonary artery catheter.
Conclusions: The increase in cTnI is unlikely to be clinically important. The increase might be correlated with persistent atrial dysfunction after TVEC, suggesting that a longer convalescent period after the procedure could be warranted.     

European Society of Veterinary Cardiology screening guidelines for dilated cardiomyopathy in Doberman Pinschers

Background

Dilated cardiomyopathy (DCM) is the most common cardiac disease in large breed dogs and is inherited in Doberman Pinschers with a high prevalence (58%).

Cardiac Troponin I in Doberman Pinschers with Cardiomyopathy

Background: Cardiac troponin I (cTnI) is useful for detection of cardiac myocyte damage, but its efficacy in detecting various stages of dilated cardiomyopathy (DCM) in Doberman Pinschers is unclear. Objectives: To evaluate the diagnostic value of cTnI in various stages of DCM in Dobermans. Animals: Six hundred and fifty‐three cTnI measurements of 336 Doberman Pinschers. Methods: Using a longitudinal study design, staging of the disease was based upon 24‐hour‐ambulatory‐ECG (Holter) and echocardiography. A total of 447 cTnI measurements were performed in 264 healthy Dobermans, and 206 cTnI measurements in 75 Dobermans with cardiomyopathy. Eighty‐eight cTnI samples were from dogs with >100 ventricular premature contractions (VPCs)/24 hour, but without echocardiographic changes (“VPC group”). Additional 19 samples originated from dogs with only echocardiographic changes (“ECHO group”), and 56 samples from dogs with both VPCs and echocardiographic changes (“VPC plus ECHO group”). Twenty samples were from dogs with clinical signs (“clinical group”). The group “incipient” included 23 dogs, that were considered to be normal according to Holter and echocardiography at the time of the exam, but that developed DCM within 1.5 years. Results: cTnI values of dogs in all disease groups, including the “incipient” (0.30 ± 0.20) and “VPC group” (0.36 ± 0.34), were significantly (P= .04, P < .001) higher than the control group (0.07 ± 0.16). A cut‐off value of >0.22 ng/mL had a sensitivity of 79.5% and a specificity of 84.4% to detect all forms of cardiomyopathy. Conclusions and Clinical Importance: cTnI measurement is a valuable diagnostic test that can detect cardiomyopathy in dogs that are otherwise clinically normal.     

Prognostic Value of Cardiac Troponin I and L‐Lactate in Blood of Dairy Cows Affected by Downer Cow Syndrome

Background

The downer cow syndrome (DCS) is a challenging health issue in the dairy industry. No cow‐side test is available to provide an accurate prognosis for DCS cases in farm settings.

Hypothesis/Objectives

Local or systemic hypoperfusion and myocardial lesions lead to an increase in blood concentration of biomarkers cardiac troponin I (cTnI) and L‐lactate. The objective was to determine the prognostic values of these biomarkers assessed cow‐sides in addition to clinical examinations in prognostication of a negative outcome (NO: death or euthanasia within 7 days).

Animals

218 client‐owned dairy cows affected by DCS.

Methods

In a prospective study, animals were monitored for 60 days after inclusion of each cow. Blood cTnI and L‐lactate concentrations were measured on the day of inclusion. The prognostic accuracy of both biomarkers and physical examination variables was estimated to predict NO. A mixed multivariable logistic regression model was used for data analysis.

Results

Prevalence of NO in this study was 63% on day 7. Troponin concentrations greater than 0.7 ng/mL had sensitivity and specificity of 54.1% (95% CI: 45.3–62.7%) and 78.4% (95% CI: 67.3–87.1%), respectively, for predicting NO. Blood L‐lactate was not associated with the outcome. The multivariable model revealed that heart rate >100 bpm (OR; 95% CI: 3.7; 1.3–10.2) and cTnI > 0.7 ng/mL (OR; 95% CI: 5.5; 2.1–14.6) were associated with the risk of NO.

Conclusions and Clinical Importance

Hypertroponinemia and tachycardia were associated with reduced survival in DCS cases. The use of cow‐side blood cTnI concentrations and heart rate could help to rapidly identify cows in farm setting that have poor chances of recovery and would benefit from a more aggressive treatment or euthanasia.     

Investigation of serum survivin in dogs suffering from cancer: a multicenter study

BackgroundIn contrast to human medicine, only a small number of serum tumor markers are established in veterinary medicine even though they are a non-invasive diagnostic tool.ObjectivesThis study examined whether survivin could be suitable as a potential canine serum tumor marker.MethodsThis study measured the serum survivin concentrations of dogs with mammary tumors (n = 33), squamous cell carcinoma (n = 9), soft-tissue sarcoma (n = 18) and multicentric lymphoma (n = 22), using a commercially available, competitive immunoassay kit (BlueGene). The serum survivin concentrations were compared with those of a healthy control group (n = 20) and a control group of dogs with non-neoplastic diseases (n = 17).ResultsDogs with malignant tumors had serum survivin concentrations between 15 and 5,906 pg/mL (median, 72 pg/mL), those in the healthy group ranged from 7 to 99 pg/mL (median, 21 pg/mL) and those in the group of dogs suffering from non-neoplastic diseases from 15 to 93 pg/mL (median, 42 pg/mL). The differences in the survivin concentrations between the healthy dogs and dogs with malignant tumors and between the dogs with non-neoplastic diseases and those with malignant tumors were significant (p < 0.001 and p = 0.006, respectively).ConclusionsThe serum survivin concentrations in dogs with malignant tumors, with some exceptions, are higher than in dogs with benign tumors and dogs that do not suffer from a malignancy. Therefore, survivin can provide information on the presence of malignant tumors and be used as a tumor marker in dogs.     

Utility of measuring plasma N-terminal pro-brain natriuretic peptide in detecting hypertrophic cardiomyopathy and differentiating grades of severity in cats

Background: Cats with hypertrophic cardiomyopathy (HCM) often have no clinical signs or subtle signs. Measurement of N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) has been demonstrated in people to be highly specific for heart disease and also correlates with severity of HCM. NT‐proBNP may also be valuable in detecting and grading HCM in cats, but results to date have been equivocal. Objectives: The aims of this study were to evaluate NT‐proBNP as a screening test for diagnosis of HCM in cats and determine an appropriate cut‐off value and to determine if NT‐proBNP concentrations correlated with severity of HCM in cats. Methods: Plasma NT‐proBNP concentrations were measured in 201 cats using an ELISA designed for use in cats. Cats were classified using echocardiography as clinically healthy controls (n=99) or cats with equivocal (n=9), mild (n=15), moderate (n=17), or severe (n=61) HCM. Results: NT‐proBNP concentrations (median; 25th–75th interquartile percentiles) in mildly (216.1; 87.6–392.5 pmol/L), moderately (282.7; 131.9–466.6 pmol/L), and severely (839.5; 655.3–1046.4 pmol/L) affected cats were significantly higher than those in healthy controls (18.9; 3.4–62.4 pmol/L). Concentrations in severely affected cats were significantly higher than in cats from other HCM groups. There was no significant difference between mild and moderate HCM. Cut‐off values >49 pmol/L had a sensitivity of 97.8% and specificity of 66.7%; >100 pmol/L had a sensitivity of 92.4% and specificity of 93.9%; and >150 pmol/L had a sensitivity of 88% and a specificity of 100%. Conclusions: NT‐proBNP with a cut‐off value of >100 pmol/L was useful in detecting even mild HCM. Cats with increased NT‐proBNP concentrations should be examined by echocardiography.     

Preoperative and Postoperative L‐Lactatemia Assessment for the Prognosis of Right Abomasal Disorders in Dairy Cattle

Background

Preoperative L‐lactatemia and heart rate have been suggested as prognostic indicators of outcome for cows with right dilatation of the abomasum or volvulus (RDA/AV). However, postoperative L‐lactatemia has not been assessed as a potential prognostic tool.

Objectives

To determine the prognostic value of postoperative L‐lactatemia (LAC ₂), duration of treatment (Dt), relative L‐lactatemia difference (compared with preoperative L‐lactatemia [LAC₁]) ([LAC₂ − LAC₁]/LAC₂) and change in L‐lactate over time ([LAC₂ − LAC₁]/Dt) as compared to preoperative findings (LAC ₁ and heart rate [HR]) as prognostic factors in dairy cows with RDA/AV.

Animals

A total of 41 dairy cows were included: 19 with AV and 22 with RDA; 11 cows had a negative outcome (NO) and 30 cows had a positive outcome (PO) based on telephone follow‐up with owners 30 days after surgery.

Methods

Prospective cohort study. Analysis was performed using logistic regression and comparison of area under the receiver operating characteristics curve (AUC) using nonparametric tests.

Results

LAC₁ > 1.4 mmol/L or LAC₂ > 2.2 mmol/L had the same accuracy with sensitivity of 100% (95% CI, 75.1–100%) and specificity of 80% (95% CI, 61.4–92.3%) for predicting NO. The relative L‐lactatemia difference ([LAC₂ − LAC₁]/LAC₁) or lactate kinetics ([LAC₂ − LAC₁]/Dt) were not associated with prognosis. The AUC of the preoperative model (which included HR and lnLAC₁) was 0.92 (95% CI, 0.83–1.0) and that of the postoperative model (including only lnLAC₂) was 0.95 (95% CI, 0.88–1.0); these were not significantly different.

Conclusions and Clinical Importance

Postoperative L‐lactatemia is helpful to predict outcome in cows with RDA/AV. The short‐term change in blood L‐lactate is not a useful prognostic indicator, at least during the period of time spent on the farm for surgery and treatment.