An update to the 2007 American College of Veterinary Internal Medicine (ACVIM) consensus statement on the identification, evaluation, and management of systemic hypertension in dogs and cats was ...presented at the 2017 ACVIM Forum in National Harbor, MD. The updated consensus statement is presented here. The consensus statement aims to provide guidance on appropriate diagnosis and treatment of hypertension in dogs and cats.
To investigate the usefulness of radiographic measures of the left atrium and ventricle as surrogates for echocardiographic criteria in identifying dogs with stage B2 preclinical myxomatous mitral ...valve disease (MMVD).
56 client-owned dogs with preclinical mitral regurgitation attributed to MMVD examined between April 19, 2016, and November 22, 2017.
Medical records were retrospectively searched, and data collected included age, body weight, heart murmur grade, and echocardiographic and radiographic measurements. Dogs were grouped according to whether they did (case dogs) or did not (control dogs) meet echocardiographic criteria used to identify dogs with stage B2 MMVD. Measurements for lateral thoracic radiographic variables normalized to vertebral body units (VBUs) were obtained, and results were analyzed to identify variables that could best discriminate between case and control dogs.
Three radiographic variables of left atrial size (vertebral left atrial size VLAS, left atrial width, and the combined variable of VLAS + left atrial width) most accurately distinguished control dogs from case dogs, and the VLAS was the simplest and fastest to perform in a clinical setting. The optimal cutoff for VLAS was 2.5 VBUs (sensitivity, 70%; specificity, 84%; and likelihood ratio, 4.38), with VLAS ≥ 2.5 VBUs for case dogs. The maximum specificity cutoff for VLAS was 3.0 VBUs (sensitivity, 40%; specificity, 96%; and likelihood ratio, 10.0), with VLAS ≥ 3.0 VBUs for case dogs.
Results indicated that when echocardiography is unavailable, radiographic VLAS ≥ 3 VBUs could be used with minimal risk of false-positive diagnosis of stage B2 MMVD in dogs.
Background
Echocardiographic reference intervals have not been reported for North American whippets, or for whippets that have undergone pet‐level athletic training.
Objectives
To develop normal ...echocardiographic reference intervals for North American whippets and investigate differences in echocardiographic parameters based on athletic conditioning in pet whippets engaged in competitive sports.
Animals
One‐hundred healthy North American whippets.
Methods
Dogs were examined at national shows between 2005 and 2009. Echocardiographic reference intervals were constructed and the effect of athletic conditioning on parameters of structure and function was assessed.
Results
Two dimensional, M‐mode, Doppler and tissue Doppler reference ranges for healthy North American whippets are presented. Measures of left ventricular (LV) chamber diameter were larger in conditioned whippets (N = 25) and remained significantly larger than in unconditioned whippets (N = 16) when normalized for weight using allometric equations. Calculated LV mass was higher in conditioned dogs than in unconditioned dogs, and this difference persisted when LV mass was normalized by weight. Mitral E velocity was higher in conditioned dogs than in unconditioned dogs, whereas E/A and measures related to systolic function were not different.
Conclusions and Clinical Importance
Pet whippets in peak athletic condition have larger hearts than do less conditioned whippets, but measures of systolic function are similar. Whippet pet athletes may show eccentric LV hypertrophy at peak condition. Normal values for cardiac size and function in North American whippets might be considered abnormal if population‐specific whippet reference intervals are not used in analysis.
Mitral valve degeneration (MVD) is the most common form of heart disease in dogs, frequently leading to left-sided congestive heart failure and cardiac mortality. Although breed-specific disease ...characteristics and overrepresentation point towards a genetic origin for MVD, a causative mutation and complete molecular pathogenesis are unknown. Whippet dogs are overrepresented in incidence of MVD, suggesting an inherited component in this breed. Expressivity of this condition is variable with some dogs showing evidence of more severe disease at earlier ages than other dogs. This phenomenon makes a traditional case versus control genetic study prone to phenotyping error. This study sought to avoid these common pitfalls by identifying genetic loci associated with severity of MVD in Whippets through a genome-wide association study (GWAS). 138 Whippet dogs were characterized for MVD by echocardiographic examination and a novel disease severity score was developed and adjusted for age in each subject. Single nucleotide polymorphism (SNP) genotype data (170k Illumina CanineHD SnpChip) was obtained for DNA isolated from blood of each study subject. Continuous variable genome wide association was performed after correction for population stratification by efficient mixed model association expedited (EMMAX) in 130 dogs. A genome wide significant association was identified on chromosome 15 (peak locus 57,770,326; Padj = 0.049) and secondary loci of suggestive association were identified on chromosome 2 (peak locus 37,628,875; Padj = 0.079). Positional candidate genes were identified within the primary and secondary loci including follistatin-related protein 5 precursor (FSTL5) and Rho GTPase-activating protein 26 (ARHGAP26). These results support the hypothesis that severity of MVD in whippets has a genetic basis and warrants further study by either candidate gene sequencing or next-generation techniques.
Pulmonary hypertension (PH) has been recognized as a clinical syndrome for many years in veterinary medicine, but routine accurate clinical diagnosis in dogs was greatly enhanced by widespread use of ...echocardiography and Doppler echocardiography. Most cases of PH in veterinary medicine can be categorized as precapillary or postcapillary. These subsets of patients often differ with regard to clinical presentation, response to therapy, and prognosis. Effective medical therapy is now available to treat this often-devastating clinical complication of common chronic diseases, making accurate diagnosis even more important to patient longevity and quality of life.
Practical relevance The clinical importance of feline hypertension has been recognised for many years and most feline practitioners are quite familiar with this syndrome. Once systemic hypertension ...is identified, long-term management of the patient is needed to avoid catastrophic (eg, blindness due to retinal detachment) or subtle (eg, accelerated renal damage) target organ damage.
Patient group Feline systemic hypertension is most commonly a complication of renal disease and hyperthyroidism, both diseases of older feline patients. By 15 years of age, the probability of having at least one of these two diseases is high. As well cared for cats are living longer, optimal long-term management of feline hypertension in patients with concurrent diseases is an issue of clinical importance.
Clinical challenges Obtaining accurate blood pressure measurements in patients that are anxious, fractious or just plain uncooperative remains a significant issue in feline medicine, as does confident analysis of results from these patients.
Diagnostics Careful measurement of systolic blood pressure using Doppler or oscillometric techniques in conjunction with evaluation for evidence of hypertensive choroidopathy (funduscopic examination) and hypertensive cardiac changes (thoracic auscultation) are essential to the diagnosis of systemic hypertension in cats. Other diagnostic techniques, including evaluation of renal and thyroid function, are needed to detect the underlying disease condition.
Evidence base Numerous well-designed clinical studies have greatly advanced our understanding of the most appropriate methods of diagnosis and therapy of feline hypertension.
Background
The Evaluation of pimobendan in dogs with cardiomegaly caused by preclinical myxomatous mitral valve disease (EPIC) study monitored dogs with myxomatous mitral valve disease (MMVD) as they ...developed congestive heart failure (CHF).
Objectives
To describe the changes in clinical and radiographic variables occurring as dogs with MMVD and cardiomegaly develop CHF, compared to similar dogs that do not develop CHF.
Animals
One hundred and thirty‐five, and 73 dogs that did or did not develop CHF, respectively.
Materials and methods
The following variables were evaluated in 2 groups of dogs (dogs that did or did not develop CHF): Heart rate (HR), clinic respiratory rate (RR), home‐measured resting respiratory rate (RRR), rectal temperature (RT), body weight (BW), and vertebral heart sum (VHS). Absolute value and rate of change of each variable were calculated for each day a dog was in study. Daily means were calculated and plotted against time. The onset of CHF or last visit before leaving the study were set as reference time points.
Results
The most extreme values and rate of change occurred in variables immediately before onset of CHF. Vertebral heart sum increased earliest. Heart rate, RR, and RRR also increased. Rectal temperature and BW decreased. Increases in RR and RRR were most extreme and occurred immediately before CHF.
Conclusions and Clinical Importance
Dogs with MMVD and cardiomegaly experience increases in HR, RR, RRR, and VHS, and decreases in BW and RT as they develop CHF. The variables with highest absolute change and rate of change were RR and RRR. These findings reinforce the value of RR and RRR as indicators of impending or incipient CHF.
Pulmonary arterial hypertension is a description of a physiological finding rather than a diagnosis. Pulmonary arterial pressure is the result of interactions among pulmonary blood flow (right ...ventricular cardiac output), pulmonary vascular impedance and post-capillary pressure (typically reflecting left atrial pressure). When elevations in pulmonary arterial pressure (systolic/diastolic pulmonary arterial pressure > ~30/19 mmHg at rest) are accompanied by increased left atrial pressure, pulmonary arterial hypertension may be considered secondary to left-heart failure. Introduction of Doppler methods to diagnose pulmonary arterial hypertension has increased the awareness of the prevalence and importance of pulmonary arterial hypertension dogs with left-heart failure. Increasing understanding of the mechanism of development of pulmonary venous hypertension and reactive pulmonary arterial hypertension in dogs with left-heart disease has led to the development of successful additive therapies for progressive clinical signs in the setting of chronic therapy for congestive heart failure due to left-sided valvular and myocardial dysfunction. Because effective therapies for pulmonary arterial hypertension secondary to chronic left-sided cardiac dysfunction are now available, screening for pulmonary arterial hypertension should be a regular part of the Doppler echocardiographic examination in a clinical setting of chronic therapy for left-sided congestive heart failure due to valvular or myocardial disease.
Byline: Clarke Atkins, Bruce Keene, Teresa C. DeFrancesco, Sandra Tou, Valerie Chetboul, Etienne Cote, Stephen Ettinger, Philip R. Fox, Robert L. Hamlin, Jonathan P. Mochel, Jean-Louis Pouchelon, ...Rebecca L. Stepien
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