Use of physical examination, electrocardiography, radiography, and biomarkers to predict echocardiographic stage B2 myxomatous mitral valve disease in preclinical Cavalier King Charles Spaniels.

INTRODUCTION: Cavalier King Charles Spaniels (CKCS) are predisposed to developing myxomatous mitral valve disease (MMVD). Dogs with stage B2 MMVD benefit from medication. OBJECTIVES: To develop (1) breed-specific cut-offs for individual screening tests and (2) predictive models utilizing physical examination (PE), ECG, radiograph, and blood-based biomarker variables in combination for identification of echocardiographic stage B2 MMVD in preclinical CKCS. ANIMALS: Adult, preclinical CKCS not receiving cardiac medications (N = 226). MATERIALS AND METHODS: Prospective, cross-sectional study. Enrolled CKCS underwent PE, ECG, radiography, Doppler blood pressure measurement, echocardiography, and biomarker testing. Dogs were grouped by MMVD stage using echocardiography only. The discriminatory ability of individual tests to identify stage B2 was assessed, and prediction models were developed using variables derived from four 'tests' (PE, ECG, radiography, and biomarkers). RESULTS: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and radiographic vertebral heart size (VHS) had the best discriminatory ability of individual diagnostic tests to differentiate stage A/B1 CKCS from stage B2, with an area under the curve (AUC) of 0.855 and 0.843, respectively. An NT-proBNP ≥1138 pmol/L or a VHS ≥11.5 had high specificity for predicting stage B2 (90.1% and 90.6%, respectively). Prediction models incorporating variables from multiple tests had better discriminatory ability than single tests. The four-test prediction model had an AUC of 0.971. Three and two-test models had AUCs ranging between 0.925-0.959 and 0.895-0.949, respectively. CONCLUSIONS: Both NT-proBNP and VHS have good utility for predicting echocardiographic stage B2 MMVD in CKCS as individual tests. Prediction models incorporating multiple test variables have superior discriminatory ability.

Feasibility and clinical utility of transvenous intracardiac echocardiography in conscious, sedated horses.

INTRODUCTION/OBJECTIVES: Intracardiac echocardiography (ICE) is a method of obtaining echocardiographic images with a steerable ultrasound catheter placed within the heart via a venous or arterial approach. The objectives of this study were to assess the feasibility of a 5-10 MHz, 8 French, 90 cm ICE catheter to evaluate cardiac structures and function in standing, sedated horses, and describe standard views in this species. ANIMALS: Ten apparently healthy horses weighing 458.1-618.2 kg from a university teaching herd. MATERIALS AND METHODS: Each horse had a physical examination, transthoracic echocardiography, and ICE performed through a 10 French introducer percutaneously placed in the right jugular vein in the proximal third of the neck with continuous ECG monitoring using telemetry. RESULTS: Three intracardiac echocardiography positions (cranial right atrium, mid right atrium, and right ventricle) with seven views were described with the associated 2D, pulse wave Doppler, continuous wave Doppler, color Doppler, and M-mode image acquisition standardized by referencing the intracardiac positions and common landmarks. The positions were confirmed with simultaneous transthoracic echocardiography. The procedure was well tolerated with only mild, occasional ventricular, and supraventricular arrhythmias that resolved with intracardiac echocardiography catheter repositioning. CONCLUSIONS: Intracardiac echocardiography is feasible, safe, and allows for the acquisition of diagnostic images in conscious, sedated horses.

Clinical Characteristics of Adult Dogs More Than 5 Years of Age at Presentation for Patent Ductus Arteriosus.

BACKGROUND: The median age at presentation for dogs with patent ductus arteriosus (PDA) is <6 months of age, and closure is associated with a decrease in heart size and increased survival time, which are not well described in older dogs. OBJECTIVES: To describe the clinical characteristics of dogs with PDA ≥5 years of age at the time of presentation to a veterinary referral hospital. ANIMALS: 35 client-owned dogs. METHODS: Retrospective case series. RESULTS: PDA was diagnosed at a median age of 7.4 years (range, 5.1-12.3 years). Females represented 23/35 (65.7%) of the patients. Concurrent heart disease included degenerative mitral valve disease (DMVD; 13), arrhythmias (11), pulmonary hypertension (7), and other congenital defects (2). Cardiomegaly was documented in the majority of dogs consisting of left ventricular enlargement (91%) and left atrial enlargement (86%). Median vertebral heart size in 24 dogs was 12.9 (range, 10.7-18.2). The PDA shunt direction was left-to-right in 33 and bidirectional in 2 dogs. Closure was performed in 26 dogs, including 4 with pulmonary hypertension. In 10 dogs receiving furosemide pre-operatively for management of heart failure, furosemide was discontinued (8) or the dosage decreased (2) at the time of discharge. CONCLUSIONS AND CLINICAL IMPORTANCE: Adult dogs can present with a left-to-right shunting PDA that results in cardiomegaly and clinical signs that can improve or resolve with PDA closure. This improvement is also apparent in dogs with PDA complicated by DMVD. Pulmonary hypertension that does not result in complete right-to-left shunting should not be considered a contraindication to closure.

[Late Becker's nevus. One hundred cases (author's transl)]. / Naevus tardif de Becker. A propos d'une série de 100 observations.

The authors make a survey of a series of a hundred Becker's nevi diagnosed in a recruiting center of the French National Service. It is a statistic study bearing on the male population, aged 17 to 26, in a French region which is supposed to be representative of the French male population of the same age. First of all the authors focus on the various clinical descriptions since this nevus was first described by Becker in 1949, then discuss the problems raised by pathogenic interpretation and the results of microscopic studies. About this lesion, usually said to be pigmentary and hairy, and generally appearing before 20 years of age, is still very little known. Then after a short explanation of their method of study the authors give original results. A hundred Becker's nevi were diagnosed among 19,302 young men, that is to say in a proportion of 0.52 p. 100. A study of the racial, genetic and pigmentary background doesn't enable to retain general causes but rather leads to think of local causes. Half of these Becker's nevi appeared before ten years of age, the other half appearing between 10 and 20. In only one quarter of the cases can the role of the sun be pointed out. The location of the nevi is variable; they are mainly situated on the trunk and only 32 p. 100 of them are located above nipples, which was believed to be the usual place of the lesion. Pigmentation in three quarter of the cases is light brown. The average surface is 125 cm2. Hairs can be seen in only a little more than half of the cases of no lesion associated to the nevus could be found. The study points out that Becker's nevi seem to be more various in their clinical expression and more pigment than could be thought through more classical description.