Diagnostic value of two-dimensional echocardiographic measurements of the pulmonary artery diameter and the pulmonary artery distensibility index to detect pulmonary hypertension in horses.

INTRODUCTION/OBJECTIVES: Echocardiographic diagnosis of pulmonary hypertension (PH) in horses is usually based on Doppler interrogation of tricuspid (TR) or pulmonic regurgitation (PR). This study aimed at investigating two-dimensional echocardiographic (2DE) variables, including pulmonary artery diameter (PAD) and pulmonary artery distensibility index (PADI), to diagnose PH. ANIMALS, MATERIALS AND METHODS: 41 healthy horses; 82 horses with TR or PR and normal intracardiac pressure gradients; and 35 horses with TR or PR velocities indicating PH. The 2DE variables were compared between groups, cut-offs for the diagnosis of PH were determined, and conditional inference trees served to identify the variable best predicting PH in the absence of TR or PR. RESULTS: Horses with PH had larger end-diastolic cross-sectional (short-axis) PAD (PADed-sx) (5.8 ± 1.0 cm; mean ± SD) and smaller PADI[/PADps] (15.4 ± 7.7%) than healthy horses (5.0 ± 0.6 cm, P<0.0001; 20.5 ± 4.4%, P<0.001) and horses with TR or PR but no PH (5.3 ± 0.6 cm, P=0.003; 18.8 ± 4.2%, P=0.005). PADed-sx predicted PH with sensitivity (Se) = 36% and specificity (Sp) = 94% (cut-off 6.0 cm, AUC = 0.668, P=0.002), while PADI[/PADps] predicted PH with Se = 43% and Sp = 92% (cut-off 13.7%, AUC = 0.662, P=0.004). In the absence of TR, PADed-sx and the end-diastolic long-axis aortic diameter-to-PADed-sx ratio (AoDed-lx/PADed-sx) were most suitable to diagnose PH. CONCLUSION: Pulmonary artery crosssectional (short-axis) diameter at end-diastole measured in a right-parasternal long axis view of the left ventricular outflow tract and Pulmonary artery distensibility index were moderately specific but not very sensitive to diagnosing PH. Nonetheless, they may be used as complementary indices suggesting PH in the absence of TR or PR.

Balloon valvuloplasty of valvular pulmonary stenosis in a neonatal foal.

In a 1-day old filly with a loud heart murmur, transthoracic echocardiography revealed right ventricular hypertrophy associated with severe pulmonary valvular stenosis and a transvalvular pressure gradient (between right ventricle and pulmonary artery) of 125 mmHg. Computed tomographic angiography confirmed the finding, with no evidence of other relevant concurrent abnormalities. Balloon valvuloplasty was performed using a single balloon technique. The foal recovered well from anaesthesia. Following the procedure, the right ventricle-pulmonary artery transvalvular gradient decreased to 38 mmHg. At follow up examinations after 1 month, 1 year and 2 years, the filly showed normal exercise capacity and echocardiography confirmed the persistent substantial improvement in the transvalvular outflow gradient.

Quantification of left atrial contractile function using two-dimensional speckle tracking echocardiography in horses after conversion of atrial fibrillation to sinus rhythm.

INTRODUCTION/OBJECTIVES: In horses, persistent atrial dysfunction is a prognostic indicator of recurrence of atrial fibrillation (AF). The objective of this study was to quantify left atrial (LA) contractile function in Warmblood horses after successful cardioversion of AF to sinus rhythm, using standard two-dimensional echocardiography (2DE) and two-dimensional speckle tracking (2DST) analyses, and to provide proof-of-concept for use of 2DST to detect LA contractile dysfunction in horses. ANIMALS, MATERIALS, AND METHODS: Nineteen Warmblood horses with AF and successful transvenous electrical cardioversion (TVEC) or medical cardioversion using quinidine sulfate (QS) were included. Echocardiography was performed at 24 hr, 72 hr, and 1-6 months after cardioversion. Conventional 2DE-derived indices of LA size and function and global longitudinal strain (SL) and longitudinal strain rate (SRL) during LA contractile function were measured to detect differences in LA size and function over time and between treatment modalities. The association between 2DE-derived indices and global SL and SRL, respectively, and the agreement of the variables to detect LA dysfunction were assessed. RESULTS: Global SL and SRL, as well as active LA fractional area change (FAC) identified cases with LA dysfunction after TVEC and QS cardioversion and proved useful to demonstrate LA functional recovery over time. Agreement between active LA FAC and SL and SRL, respectively, to diagnose atrial dysfunction was substantial to fair at 24 hr after cardioversion and decreased with time. CONCLUSION: This study shows that 2DST is useful to quantify LA contractile dysfunction in horses after cardioversion of AF.

Quantification of left atrial wall motion in healthy horses using two-dimensional speckle tracking.

INTRODUCTION: The mechanical function of the left atrium (LA) plays a pivotal role in modulation of left ventricular filling. Assessment of LA function might be a clinically useful prognostic tool for horses with mitral regurgitation or atrial fibrillation. However, the most accurate, reliable, and clinically useful methods to assess LA myocardial function are yet to be determined. The objective of this study was to describe the methods for quantification of LA wall motion using two-dimensional speckle tracking (2DST) echocardiography in healthy Warmblood horses to quantify measurement variability, to calculate reference intervals for 2DST variables, and to investigate their relationship to sex, age, body weight, and heart rate. ANIMALS, MATERIALS, AND METHODS: Twenty-six healthy Warmblood horses were included. 2DST analyses of LA wall motion were performed on digitally stored cine-loop recordings of a standardized right-parasternal four-chamber view focusing on the LA. Longitudinal strain, longitudinal strain rate, and time to peak LA contraction were measured to characterize LA contractile, reservoir, and conduit function. Intraobserver and interobserver measurement variability was quantified, and reference intervals were calculated. RESULTS: The coefficient of variation for intraobserver and interobserver measurement variability ranged between 2.0-11.1% and 5.1-15.4%, respectively, for global strain, strain rate, and time to peak LA contraction. Reference intervals for healthy Warmblood horses were reported. CONCLUSION: This study shows that 2DST is a feasible and reliable method to quantify LA wall motion throughout the cardiac cycle in healthy Warmblood horses. Further studies are required to establish the clinical value of 2DST for assessment of LA function.

Assessment of systolic and diastolic function in clinically healthy horses using ambulatory acoustic cardiography.

BACKGROUND: Assessment of cardiac electromechanical function in horses requires training, experience and specialised equipment and does not allow continuous monitoring over time. OBJECTIVES: The objective of this study was to establish the use of an acoustic ECG monitor (Audicor® ) in healthy horses. It provides noninvasive, examiner-independent, continuous analyses combining ECG and phonocardiography to calculate indices of cardiac mechanical activity and haemodynamics. Device usability was investigated, reference intervals calculated and reproducibility of analyses assessed. STUDY DESIGN: Prospective descriptive study. METHODS: Continuous overnight recordings were obtained in 123 healthy horses. ECG and acoustic cardiography analyses were performed. Electromechanical activating time (EMAT), rate-corrected EMATc, left ventricular systolic time (LVST), rate-corrected LVSTc and intensity and persistence of the third and fourth heart sound (S3, S4) were reported. Associations with age and reproducibility of analyses were assessed. RESULTS: Audicor® recordings of diagnostic quality were obtained in 116 horses, with an artefact-free recording time of 1:08-14:03 h (mean 10:21 h). 44.8% of the horses had atrial premature complexes (up to 0.18% of analysed beats), 4.3% had ventricular premature complexes (up to 0.021% of analysed beats). Reference intervals for acoustic cardiography variables were reported. S3 was significantly more often graded ≥5 (scale 0-10) in younger compared to older horses (P = 0.0036, R2  = 0.072). The between-day coefficient of variation ranged from 2.5 to 7.7% for EMAT, EMATc, LVST and LVSTc. MAIN LIMITATIONS: Audicor® algorithms are based on human databases. Horses were deemed clinically healthy without advanced diagnostics. Some data were lost because of technical difficulties, artefacts and noises. CONCLUSIONS: Overnight Audicor® recordings are feasible in horses. Combining ambulatory ECG and phonocardiography allows noninvasive, continuous assessment of variables representing systolic and diastolic cardiac function. ECG rhythm analyses require over-reading by a specialist, but acoustic cardiography variables are based on automated algorithms independent of examiner input. Further studies are required to establish the clinical value of acoustic cardiography in horses.

Plasma homocysteine concentrations in healthy horses and horses with atrial fibrillation.

INTRODUCTION: Homocysteine (HCY) is an amino acid produced from methionine metabolism. Plasma homocysteine concentrations ([HCY]p) are elevated (>13 µmol/L) in people with atrial fibrillation (AF) and can predict the recurrence of AF after cardioversion. This study aimed to validate a commercially available human HCY assay for use in horses to develop reference intervals for [HCY]p and compare [HCY]p in healthy horses and horses with AF. ANIMALS: Healthy horses (n = 27) and horses with AF (n = 55, 34 of which were cardioverted using transvenous electrical cardioversion). MATERIALS AND METHODS: Blood samples were analysed for HCY using an automated enzyme-cycling assay (Homocysteine Cobas C, Integra, Roche) and creatinine (compensated Jaffe method). Assay linearity and precision were assessed, reference intervals calculated and [HCY]p and creatinine compared between groups. RESULTS: The assay was precise (coefficient of variation 1.6-4.3%, n = 10 repetitions) and provided linear results (r = 0.99 for spiked and natural samples) for a range of [HCY]p. The reference interval for [HCY]p was 1.5-7.8 µmol/L. The plasma concentration of homocysteine was 4.65 ± 1.5 µmol/L (mean ± standard deviation) in healthy horses and 4.65 ± 1.72 µmol/L in horses with AF (p=0.99); [HCY]p was not associated with recurrence of AF (n = 18, p=0.97). A weak, positive correlation between plasma creatinine and [HCY]p was detected (r = 0.295, p=0.008, r2 = 0.11). CONCLUSIONS: This assay allows precise measurement of [HCY]p in horses. Unlike in people, [HCY]p is not increased in horses with AF and cannot predict AF recurrence. This might be due to differences in the underlying pathological mechanisms of AF development in people and horses.

Validation of a Point-of-Care Quantitative Equine IgG Turbidimetric Immunoassay and Comparison of IgG Concentrations Measured with Radial Immunodiffusion and a Point-of-Care IgG ELISA.

BACKGROUND: Point-of-care (POC) diagnostic tests with good sensitivity and specificity are needed for diagnosing failure of transfer of passive immunity (FTPI) in foals. Turbidimetric immunoassays (TIA) have these characteristics and provide quantitative results. A commercially available TIA-based POC test (POC-TIA) has not been validated in horses. OBJECTIVE: To validate a POC-TIA and compare results of POC-TIA, a POC-ELISA, and radial immunodiffusion (RID). ANIMALS: Heparinized blood samples (n = 127) from 48 hospitalized foals (<12 hour to 48 days). METHODS: Prospective validation study. IgG concentrations were measured using RID (gold standard), POC-TIA, and POC-ELISA. Agreement between assays was assessed using Bland-Altman analysis. Sensitivity and specificity were calculated using ROC curves. Inter- and intra-assay coefficients of variation (CVs) and linearity were evaluated for POC-TIA. RESULTS: The mean bias (95% limits of agreement) between RID and POC-TIA was -4 (-185 to 176), 27 (-201 to 255), and 308 (-377 to 993) mg/dL for samples with IgG concentrations of <400, 400-800, and >800 mg/dL, respectively. Sensitivity and specificity at optimal cutoff were 94 and 100% for the POC-TIA and 94 and 100% for the POC-ELISA to detect IgG <400 mg/dL, and 85 and 87% (POC-TIA) and 69 and 79% (POC-ELISA) to detect IgG ≤800 mg/dL. Intra- and interassay CVs for POC-TIA ranged between 1.6-3.8 and 11.9-18.8%, respectively. Linearity of the dilution series was preserved (R2 > 0.96). CONCLUSIONS AND CLINICAL IMPORTANCE: The POC-TIA provided unambiguous results and had sufficient sensitivity, specificity, accuracy, and precision to be used as an alternative to other POC tests to assess FTPI in foals.

Atrial fibrillation management in a breeding stallion.

A 20-year-old warmblood breeding stallion presented to a University practice for semen collection and evaluation was incidentally diagnosed with atrial fibrillation (AF). Electrocardiogram recordings during breeding revealed inappropriately rapid tachycardia and occasional ventricular premature depolarizations/aberrant ventricular conduction. Transvenous electrical cardioversion was performed. After successful cardioversion the horse displayed supraventricular ectopy and atrial contractile dysfunction and was administered sotalol hydrochloride in an attempt to decrease the risk of AF recurrence. Supraventricular ectopy and echocardiographic evidence of atrial dysfunction gradually improved and normalized over 6 months. No direct adverse effects of the chronic anti-arrhythmic treatment were observed and libido and semen quality were unaffected. AF recurred 6 months after cardioversion and sotalol therapy was continued to control the ventricular ectopy/aberrant ventricular conduction during semen collection. Considerations regarding pathologic arrhythmias and inappropriately high heart rates in breeding stallions with AF may be similar to those in riding horses. Sotalol hydrochloride was a safe anti-arrhythmic drug in the management of this case.

Echocardiographic Assessment of Left Ventricular Function in Healthy Horses and in Horses with Heart Disease Using Pulsed-Wave Tissue Doppler Imaging.

BACKGROUND: Assessment of left ventricular (LV) function by tissue Doppler imaging (TDI) is not well established in horses with heart disease. OBJECTIVES: To describe the use of pulsed-wave (PW) TDI for the assessment of LV function, establish reference intervals, investigate effects of mitral regurgitation (MR), aortic regurgitation (AR), and primary myocardial disease (MD), and provide proof of concept for the use of PW TDI in Warmblood horses with heart disease. ANIMALS: Thirty healthy horses, 38 horses with MR, 25 with AR, 8 with MD. METHODS: Echocardiograms were retrospectively analyzed. Reference intervals were calculated. PW TDI indices of healthy horses and horses with MR, AR, and MD were compared by one-way ANOVA and Dunnett's test. RESULTS: A complete set of PW TDI variables could be obtained in 94 of 101 horses. Variables corresponding to isovolumic intervals were most difficult to measure. Valvular regurgitation influenced variables describing isovolumic contraction and ejection. Horses with MD had significantly shortened ETm (-118.5 [-154.1 to -82.9] ms; mean difference [95% CI of difference of means]), increased PEPm /ETm (0.11 [0.05 to 0.17]), prolonged IMPm (0.28 [0.18 to 0.37]), increased S1 (8.9 [5.2 to 12.6] cm/s), and decreased E1 (-2.6 [-4.7 to -0.5] cm/s), Em (-14.2 [-19.9 to -8.5] cm/s), and Em /Am ratio (-1.6 [-2.6 to -0.6]). CONCLUSIONS AND CLINICAL IMPORTANCE: Pulsed-wave TDI might be useful for detection of LV dysfunction in horses with primary MD. The clinical value of TDI in horses with MR and AR remains uncertain.

Influence of 2nd-degree AV blocks, ECG recording length, and recording time on heart rate variability analyses in horses.

OBJECTIVES: To assess the influence of 2nd-degree AV blocks (AVB) on RR interval-based heart rate variability (HRV) variables; to investigate the effect of using PP interval time series and of artifact filtering on HRV analyses; to investigate the influence of electrocardiogram (ECG) recording length and time of recording; and to calculate day-to-day variability and reference intervals of HRV variables. ANIMALS: Thirty healthy adult horses. METHODS: RR and PP interval time series were extracted from 10-h Holter ECGs and an automated filter was applied to the RR time series (RRf). Time-domain HRV variables were calculated based on RR, PP, and RRf time series and their relation to the number of AVBs was assessed. Hourly 10- and 60-min segments were extracted to investigate the influence of segment length and recording time on HRV variables. Day-to-day variability and reference intervals of HRV variables were calculated. RESULTS: Variables of short-term HRV were significantly influenced by the number of AVBs when based on RR, but not when based on PP- and RRf time series. PP- and RRf-based HRV variables were in good agreement. The majority of HRV variables were influenced by recording time and ECG segment length. Day-to-day variability of HRV variables was low when based on 10-h ECG recordings but moderate to high when based on 60-min and 10-min recordings. CONCLUSIONS: Second-degree AVBs significantly influence conventional RR-based, but not PP- and RRf-based time-domain HRV variables. However, PP and RRf analyses have limitations and recording length and time of recording must be considered.

Echocardiographic Assessment of Left Atrial Size and Function in Warmblood Horses: Reference Intervals, Allometric Scaling, and Agreement of Different Echocardiographic Variables.

BACKGROUND: Echocardiographic assessment of left atrial (LA) size and function in horses is not standardized. OBJECTIVES: The aim of this study was to establish reference intervals for echocardiographic indices of LA size and function in Warmblood horses and to provide proof of concept for allometric scaling of variables and for the clinical use of area-based indices. ANIMALS: Thirty-one healthy Warmblood horses and 91 Warmblood horses with a primary diagnosis of mitral regurgitation (MR) or aortic regurgitation (AR). METHODS: Retrospective study. Echocardiographic indices of LA size and function were measured and scaled to body weight (BWT). Reference intervals were calculated, the influence of BWT, age, and valvular regurgitation on LA size and function was investigated and agreement between different measurements of LA size was assessed. RESULTS: Allometric scaling of variables of LA size allowed for correction of differences in BWT. Indices of LA size documented LA enlargement with moderate and severe MR and AR, whereas most indices of LA mechanical function were not significantly altered by valvular regurgitation. Different indices of LA size were in fair to good agreement but still lead to discordant conclusions with regard to assessment of LA enlargement in individual horses. CONCLUSIONS AND CLINICAL IMPORTANCE: Allometric scaling of echocardiographic variables of LA size is advised to correct for differences in BWT among Warmblood horses. Assessment of LA dimensions should be based on an integrative approach combining subjective evaluation and assessment of multiple measurements, including area-based variables. The clinical relevance of indices of LA mechanical function remains unclear when used in horses with mitral or aortic regurgitation.

Left Ventricular Function After Prolonged Exercise in Equine Endurance Athletes.

BACKGROUND: Prolonged exercise in human athletes is associated with transient impairment of left ventricular (LV) function, known as cardiac fatigue. Cardiac effects of prolonged exercise in horses remain unknown. OBJECTIVES: To investigate the effects of prolonged exercise on LV systolic and diastolic function in horses. ANIMALS: Twenty-six horses competing in 120-160 km endurance rides. METHODS: Cross-sectional field study. Echocardiography was performed before and after rides, and the following morning, and included two-dimensional echocardiography, anatomical M-mode, pulsed-wave tissue Doppler imaging, and two-dimensional speckle tracking. Correlation between echocardiographic variables and cardiac troponin I was evaluated. RESULTS: Early diastolic myocardial velocities decreased significantly in longitudinal (baseline: -17.4 ± 2.4cm/s; end of ride: -15.8 ± 3.2cm/s (P = .013); morning after: -15.4 ± 3.0cm/s (P = .0033)) and radial directions (-32.8 ± 3.4cm/s; -28.1 ± 5.8cm/s (P < .001); -26.4 ± 5.5cm/s (P < .001)). Early diastolic strain rates decreased significantly in longitudinal (1.58 ± 0.27s(-1) ; 1.45 ± 0.26s(-1) (P = .036); 1.41 ± 0.25s(-1) (P = .013)) and circumferential directions (2.43 ± 0.29s(-1) ; 1.96 ± 0.46s(-1) (P < .001); 2.11 ± 0.32s(-1) (P < .001)). Systolic variables showed ambiguous results. No correlations with serum cardiac troponin I concentrations were evident. CONCLUSIONS AND CLINICAL IMPORTANCE: Prolonged exercise in horses is associated with impaired LV diastolic function. Reduced ventricular filling persisted for 7-21 hours despite normalization of biochemical indicators of hydration status, indicating that the observed changes were not entirely related to altered preload conditions. The clinical relevance of cardiac fatigue in horses remains uncertain.

Clinical and echocardiographic findings in an 8 year old Brown Swiss cow with myocardial abscess.

Intramyocardial abscesses are rare in cattle and may lead to unspecific clinical signs. This case report describes the clinical and echocardiographic findings in an 8 year old Brown Swiss cow presented with an intramural myocardial abscess. The main clinical findings were anorexia, drop in milk yield, fever, tachycardia, and hyperfibrinogenemia. Neither heart murmurs nor cardiac arrhythmias were present on auscultation. Transthoracic echocardiographic examination revealed a prominent intramural mass embedded in the left ventricular free wall and bulging into the lumen of the left ventricle. Diagnosis was confirmed at necropsy. A culture of the abscess grew Trueperella pyogenes.

Effects of 10% hydroxyethyl starch (HES 200/0.5) solution in intraoperative fluid therapy management of horses undergoing elective surgical procedures.

The aim of the present study was to investigate the effect of pentastarch on colloid osmotic pressure (COP) and cardiopulmonary function during and up to 24 h after anaesthesia in horses. Twenty-five systemically healthy horses were anaesthetised using isoflurane-medetomidine balanced anaesthesia. Twelve were assigned to treatment with hydroxyethyl starch (HES) (H group) and 13 to no HES (NH group). In the H group, 6 mL/kg of pentastarch 10% HES (200/0.5) was infused over 1 h starting 30 min after induction of anaesthesia. Horses of the NH group received an equal amount of lactated Ringer's solution (LRS). COP and blood biochemical, cardiopulmonary and anaesthesia-related variables were measured at different time points before and after treatment. Pentastarch was effective in correcting the decrease in COP observed with LRS administration. No differences between treatments were detected for blood glucose, lactate, total proteins and electrolytes. Packed cell volume was lower with the H group immediately after finishing HES-administration and for an additional 30 min. In all horses, all blood biochemical variables other than lactate returned to normal after 12 h. No clinically relevant differences between treatments were detected for cardiopulmonary variables, although 23.1% of the NH-horses needed rescue-HES to maintain cardiovascular function, while none of the H-horses needed additional colloids. Overall, 6 mL/kg HES (200/0.5) was found to be effective in maintaining COP during anaesthesia in systemically healthy horses. Intermediate and long-term effects were below the limit of detection. The potentially beneficial effects on cardiovascular function need further investigation, especially in critically ill horses.

Risk factors for recurrence of atrial fibrillation in horses after cardioversion to sinus rhythm.

BACKGROUND: Although atrial fibrillation (AF) can be successfully treated in horses, recurrence occurs frequently. In humans, atrial function after cardioversion can predict recurrence. OBJECTIVES: To examine the prognostic value of atrial mechanical function at 24 hours after cardioversion and other potential predictor variables for AF recurrence in horses. ANIMALS: 117 horses treated for AF at 4 referral centers. METHODS: Retrospective study. Inclusion criteria were successful cardioversion, echocardiography at 24 hours after cardioversion and ≥4 months follow-up. To determine factors associated with AF recurrence, a multivariable survival model was built. RESULTS: 133 AF episodes in 117 horses were included. AF recurred in 36/100 horses with a first AF episode and in 57/133 AF episodes overall. Factors associated with recurrence in horses with a first episode were previous unsuccessful treatment attempt (hazard ratio HR 2.36, 95% confidence interval CI 1.11-4.99, P = .025) and mild or moderate mitral regurgitation (HR 2.70, 95% CI 1.23-5.91, P = .013). When the last AF episode of all horses was included, previous AF (HR 2.53, 1.33-4.82, P = .005) and active left atrial fractional area change ≤9.6% (HR 3.43, 1.22-9.67, P = .020) were significant predictors. CONCLUSIONS AND CLINICAL IMPORTANCE: The only echocardiographic variable of left atrial function with significant prognostic value for recurrence was low active left atrial fractional area change. Further research is necessary to evaluate whether echocardiography at a later timepoint could provide more prognostic information.

Recommendations for management of equine athletes with cardiovascular abnormalities.

Murmurs and arrhythmias are commonly detected in equine athletes. Assessing the relevance of these cardiovascular abnormalities in the performance horse can be challenging. Determining the impact of a cardiovascular disorder on performance, life expectancy, horse and rider or driver safety relative to the owner's future expectations is paramount. A comprehensive assessment of the cardiovascular abnormality detected is essential to determine its severity and achieve these aims. This consensus statement presents a general approach to the assessment of cardiovascular abnormalities, followed by a discussion of the common murmurs and arrhythmias. The description, diagnosis, evaluation, and prognosis are considered for each cardiovascular abnormality. The recommendations presented herein are based on available literature and a consensus of the panelists. While the majority of horses with cardiovascular abnormalities have a useful performance life, periodic reexaminations are indicated for those with clinically relevant cardiovascular disease. Horses with pulmonary hypertension, CHF, or complex ventricular arrhythmias should not be ridden or driven.

Efficacy of omeprazole powder paste or enteric-coated formulation in healing of gastric ulcers in horses.

BACKGROUND: GastroGard, an omeprazole powder paste formulation, is considered the standard treatment for gastric ulcers in horses and is highly effective. Gastrozol, an enteric-coated omeprazole formulation for horses, has recently become available, but efficacy data are controversial and sparse. OBJECTIVES: To investigate the efficacy of GastroGard and Gastrozol at labeled doses (4 and 1 mg of omeprazole per kg bwt, respectively, PO q24h) in healing of gastric ulcers. ANIMALS: 40 horses; 9.5 ± 4.6 years; 491 ± 135 kg. METHODS: Prospective, randomized, blinded study. Horses with an ulcer score ≥1 (Equine Gastric Ulcer Council) were randomly divided into 2 groups and treated for 2 weeks each with GastroGard followed by Gastrozol (A) or vice versa (B). After 2 and 4 weeks, scoring was repeated and compared with baseline. Plasma omeprazole concentrations were measured on the first day of treatment after administration of GastroGard (n = 5) or Gastrozol (n = 5). RESULTS: Compared with baseline (squamous score (A) 1.65 ± 0.11, (B) 1.98 ± 0.11), ulcer scores at 2 weeks ((A) 0.89 ± 0.11, (B) 1.01 ± 0.11) and 4 weeks ((A) 1.10 ± 0.12, (B) 0.80 ± 0.12) had significantly decreased in both groups (P < .001), independent of treatment (P = .7). Plasma omeprazole concentrations were significantly higher after GastroGard compared with Gastrozol administration (AUCGG = 2856 (1405-4576) ng/mL × h, AUCGZ = 604 (430-1609) ng/mL × h; P = .03). The bioavailability for Gastrozol was 1.26 (95% CI 0.56-2.81) times higher than for GastroGard. CONCLUSIONS AND CLINICAL IMPORTANCE: Both Gastrozol and GastroGard, combined with appropriate environmental changes, promote healing of gastric ulcers in horses. However, despite enteric coating of Gastrozol, plasma omeprazole concentrations after single labeled doses were significantly higher with GastroGard.

[Helminth control in the adult horse: the need for a re-orientation]. / Helminthenmanagement beim adulten Pferd: Notwendigkeit einer Neuorientierung.

The epidemiological situation of strongyle infections in adult horses in Switzerland is characterized by a strong dominance of small strongyles (Cyathostominae) and an overall low level of egg shedding in the faeces. The prevailing attitude towards anthelmintic therapy considers neither husbandry conditions nor pasture hygiene measures. Instead, calendar-based routine medication, comprising usually 3 to 4 annual treatments, is the typical strategy. Such an approach, however, often results in an excessive administration of anthelmintics. With respect to the continuous spread of drug resistant cyathostomins a change of strategy seems inevitable. A consensus has been agreed on between equine parasitologists and clinicians of the Vetsuisse Faculty in Zurich and Berne to focus on the concept of a selective control approach, based on individual faecal egg counts as the central element. It is now recommended that clinically healthy horses (> 4 y) are treated only when their strongyle egg count is equal to or higher than 200 eggs per gram of faeces. A regular analysis of the strongyle population based on larval cultures, the control of drug efficacy, and quarantine measures for incoming horses are mandatory components of the concept. Recent experiences in several pilot farms have indicated that only 4 % of the McMaster analyses resulted in a deworming treatment. For horses that did not receive any nematicidal anthelmintic during the current season, a "safety" treatment is recommended at the end of the grazing period.

En Suisse, la situation épidémiologique des infestations des chevaux adultes par les strongylidés est caractérisée par une nette dominance des petits strongles (Cyathostominae) et par un faible niveau d'excrétion des œufs de parasites dans les selles. Cars les conditions de détention des chevaux et les mesures relatives à l'hygiène des pâtures ne sont que rarement prises en compte dans la planification des mesures de contrôle des parasitoses, il en résulte un schéma de traitement de routine basé sur 3 à 4 traitements par année, ce qui représente un usage d'anthelminthiques souvent supérieur à la nécessité. Vu le développement continu de populations de cyatostomes résistants aux anthelminthiques, un changement de stratégie dans le contrôle des helminthes est nécessaire. Le contrôle sélectif propagé par les parasitologues et les cliniciens des deux sites de la faculté Vetsuisse propose de seulement traiter les chevaux sains adultes (> de 4 ans) si l'excrétion des œufs de strongles dépasse 200 œufs par gramme de selles. Une différentiation régulière des populations de strongles, le contrôle de l'efficacité des anthelminthiques et des mesures de quarantaines chez les nouveaux venus sont des composants indispensables de ce concept. Les expériences faites jusqu'à présent avec cette stratégie dans plusieurs exploitations-pilotes montrent que seulement 4 % des analyses coprologiques sont suivies par une application d'anthelminthiques. Pour les chevaux qui n'ont pas été vermifugés pendant toute la saison, un traitement de sécurité à la fin de la saison de pâturage est recommandé.

Analytic validation and comparison of three commercial immunoassays for measurement of plasma atrial/A-type natriuretic peptide concentration in horses.

Measurement of atrial/A-type natriuretic peptide (ANP) concentrations may be of use for assessment of cardiac disease, and reliable data on the analytic performance of available assays are needed. To assess the suitability for clinical use of commercially available ANP assays, intra-assay and inter-assay coefficient of variation and dilution parallelism were calculated for three immunoassays (RIAPen, RIAPhoen, and an ELISAPen) using blood samples from healthy and diseased horses to cover a wide range of ANP concentrations. Further, agreement between assays was assessed using linear regression and Bland-Altman analyses. For all assays, precision was moderate but acceptable and dilution parallelism was good. All assays showed analytic performance similar to other immunoassays used in veterinary medicine. However, the results from the three assays were poorly comparable. Our study highlights the need for an optimised species-specific assay for equine samples.

Blood glucose, acid-base and electrolyte changes during loading doses of alpha2-adrenergic agonists followed by constant rate infusions in horses.

The aim of the present study was to investigate changes in blood glucose concentration ([Glu]B), acid-base status and electrolyte concentrations during constant rate infusions (CRI) of two alpha2-adrenergic agonists in seven horses treated in a blinded, randomised, crossover design with xylazine or romifidine. An intravenous (IV) bolus of xylazine (1mg/kg) or romifidine (80 µg/kg) was administered followed by an IV CRI of xylazine (0.69 mg/kg/h) or romifidine (30 µg/kg/h) for 2h. Blood samples were collected from the pulmonary artery before and after loading doses, during the CRI, and for 1h after discontinuing drugs. Blood glucose, base excess (BE), pH, partial pressure of carbon dioxide (Pv¯CO2), strong ion difference (SIDest) and bicarbonate concentration ( [Formula: see text] ) increased significantly during the CRI with both alpha2-adrenergic agonists. Chloride concentration ([Cl(-)]B) and anion-gap (AG) decreased significantly compared to baseline. The decrease in sodium concentration ([Na(+)]B) was only significant with xylazine. From 1h after starting the CRI onwards, [Glu]B was significantly higher with romifidine compared to xylazine. Except [Glu]B, SIDest, and Pv¯CO2, all variables returned to normal values 1h after discontinuing xylazine. After stopping romifidine, all variables except pH remained altered for at least 1h. It was concluded that loading doses of alpha2-adrenergic agonists followed by CRIs produce [Glu]B, acid-base and electrolyte changes. The clinical significance of the reported changes remains to be investigated and absolute values should be interpreted with caution, as fluid boli were used for cardiac output measurements, but may become important during prolonged infusion and in critically ill patients.