A Retrospective Cohort Evaluation of Left Ventricular Remodeling, Perioperative Complications and Outcome in Medium and Large Size Dogs with Patent Ductus Arteriosus after Percutaneous Closure.

This retrospective cohort study included one hundred fifty-seven medium and large-size dogs with the aim of evaluating the effect of signalment and echocardiographic features on complications, outcomes and left ventricular modifications before and after patent ductus arteriosus (PDA) closure. The patients were divided in two groups based on the heart remodeling after closure: Group A included dogs that had a reduction in the end-systolic volume index (ESVI) after closure compared to the ESVI measured before; Group B included dogs without a reduction in ESVI after closure. Body weight, minimal ductal diameter (MDD) of PDA, end-diastolic volume index and presence of arrhythmias at presentation were significantly higher in Group B compared to Group A. The shortening fraction and ejection fraction after closure were reduced in both groups, but in Group B there was a major reduction, and the mean values indicated a possible systolic dysfunction. Complications during the procedure and death due to cardiac reasons were greater in Group B compared to Group A. In conclusion, a higher body weight, a larger MDD, a more severe heart enlargement or arrhythmias at presentation increased the risk of developing a worsening structural and functional condition after ductal closure, and this can be associated with perioperative complications and cardiac death.

A study of the inter- and intra-operator variability on selected echocardiographic measurements in dogs.

Standard transthoracic echocardiography is considered the non-invasive gold standard for the diagnosis of most cardiac diseases. Defining reproducibility, repeatability, and reliability of this exam is imperative to reduce errors in clinical evaluations. The present study aimed at: (1) evaluating the reproducibility and repeatability of 15 echocardiographic parameters in dogs by analyzing measurements obtained from several operators with different levels of experience and comparing them to the ones obtained from two board-certified operators (gold standards - GSs); (2) assessing whether different formative paths have an influence on the variability of the echocardiographic measurements. Fifty-one operators have been included in this study, along with two diplomates of the European College of Veterinary Internal Medicine - Cardiology. Ten dogs were enrolled, 5 Golden Retrievers and 5 Cavalier King Charles Spaniels. Echocardiographic examination was performed on each dog by one GS and several operators on the same day. Results show the highest deviation from the GS and a poor inter-operator reproducibility for the M-mode measurements of the interventricular septum and the left ventricular free wall. Differently, M-mode-obtained internal diameters of the left ventricle in systole and diastole, and measurements of the aortic annulus and root show moderate to excellent intra- and inter-operator reliability and a good concordance with the GSs, demonstrating that all the operators correctly assess left ventricular systolic function and dilation, and evaluate the aortic valve. Furthermore, a specialist clinical activity, more than the acquired theoretical knowledge, affects the reliability of the echocardiographic examination by reducing the difference from the GS' measurements.

Epidemiological study of congenital heart diseases in dogs: Prevalence, popularity, and volatility throughout twenty years of clinical practice.

The epidemiology of Congenital Heart Diseases (CHDs) has changed over the past twenty years. This study aimed to evaluate the prevalence of CHDs in the population of dogs recruited in a single referral center (RC); compare the epidemiological features of CHDs in screened breeds (Boxers) versus non-screened (French and English Bulldogs, German Shepherds); investigate the association of breeds with the prevalence of CHDs; determine the popularity and volatility of breeds over a 20-year period; analysed the trends of the most popular breeds in the overall population of new-born dogs registered in the Italian Kennel Club (IKC) from 1st January 1997 to 31st December 2017. The RC's cardiological database was analysed, and 1,779 clinical records were included in a retrospective observation study. Descriptive statistics and frequencies regarding the most representative breeds and CHDs were generated. A logistic regression model was used to analyse the trends of the most common CHDs found in single and in cluster of breeds. The relationship between breed popularity and presence of CHDs was studied. The most common CHDs were Pulmonic Stenosis, Patent Ductus Arteriosus, Subaortic Stenosis, Ventricular Septal Defect, Aortic Stenosis, Tricuspid Dysplasia, Atrial Septal Defect, Double Chamber Right Ventricle, Mitral Dysplasia, and others less frequent. The most represented pure breeds were Boxer, German Shepherd, French Bulldog, English Bulldog, Maltese, Newfoundland, Rottweiler, Golden Retriever, Chihuahua, and others in lower percentage. Chihuahuas, American Staffordshire Terriers, Border Collies, French Bulldogs, and Cavalier King Charles Spaniel were the most appreciated all of which showed a high value of volatility. This study found evidence for the value of the screening program implemented in Boxers; fashions and trends influence dog owners' choices more than the worries of health problems in a breed. Effective breeding programs are needed in order to control the diffusion of CHDs without impoverishing the genetic pool.

Survival and prognostic factors in cats with restrictive cardiomyopathy: a review of 90 cases.

OBJECTIVES: Large studies focusing on restrictive cardiomyopathy (RCM) in the cat are scarce. The aims of this retrospective study were to describe epidemiological characteristics and to analyse prognostic factors affecting survival in cats with RCM. METHODS: The clinical archives of the Gran Sasso Veterinary Clinic (Milan, Italy) and of the cardiology unit of the Department of Veterinary Medicine (University of Milan, Italy) from 1997-2015 were reviewed for all cats diagnosed with RCM based on an echocardiographic examination (left atrial/biatrial enlargement, normal left ventricle wall thickness, normal or mildly decreased systolic function and restrictive left ventricle filling pattern with pulsed Doppler echocardiography). RESULTS: The study population comprised 90 cats (53 male, 37 female) with an echocardiographic diagnosis of RCM. Most were domestic shorthairs (n = 60) with a mean ± SD age of 10.0 ± 4.3 years and a median weight of 3.8 kg (interquartile range 3.2-5 kg). Most cats were symptomatic (n = 87). The most common clinical sign was respiratory distress (n = 75). Follow-up was available for 60 cats and the median survival time (MST) was 69 days (95% confidence interval [CI] 0-175 days). Cardiac-related death occurred in 50 cats. In the multivariate Cox analysis only respiratory distress showed a statistically significant effect on survival. The cats without respiratory distress showed an MST of 466 days (95% CI 0-1208); cats with respiratory distress showing an MST of 64 days (95% CI 8-120; P = 0.011). CONCLUSIONS AND RELEVANCE: RCM can be considered an end-stage condition associated with a poor prognosis, with few cats not showing clinical signs and surviving >1 year. Most cats died of cardiac disease within a very short time.

A multimodality imaging approach for guiding a modified endovascular coil embolization of a single intrahepatic portosystemic shunt in dogs.

Intrahepatic portosystemic shunts (IHPSS) in dogs are aberrant vascular anomalies that connect the portal and the systemic venous vessels. In most of the patients, the surgical approach is unfavourable due to the difficulties in isolating the IHPSS, making the option of a percutaneous transvenous coil embolization (PTCE) one of the safer occlusive procedures. This study describes the treatment of eight dogs with a single IHPSS using a multimodality imaging approach to guide the modified PTCE procedure. This new technique results in a decrease of 71% of the time of the entire procedure with the reduction of 91% in the time required involved the IHPSS identification and in the fluoroscopy exposure time avoiding the need for iodinated contrast agents during the procedure. Moreover, the placement of the catheter before the caval stent ensures its greater stability, enhancing the procedural safety in the phase when the coils are released and avoiding the risk of their dislocation.

Transesophageal echocardiography to diagnose anomalous right coronary artery type R2A in dogs.

OBJECTIVES: To assess the feasibility of transesophageal echocardiography (TEE) as an alternative to angiography for the diagnosis of R2A coronary artery (CA) abnormalities. ANIMALS: Twenty-two dogs with a diagnosis of type R2A CA anomaly were reviewed/analyzed. METHODS: A retrospective study of case records. Transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), angiography, and follow-up investigations of pulmonic stenosis (PS) with R2A CA were carried out to compare different diagnostic methods. RESULTS: Based on the TTE morphology, PS with an aberrant CA was suspected in all dogs (n = 22) and later confirmed by angiography in 18 cases (18/22), and necropsy in two cases (2/22). In 12 cases (12/22), TEE and angiography were both performed and confirmed the diagnosis of an R2A anomaly. Two cases (2/22) were diagnosed only with TEE. CONCLUSIONS: Transesophageal echocardiography may be considered an effective tool to diagnose CA abnormalities, in particular when TTE is inconclusive. Transesophageal echocardiography offers detailed and easily reproducible views of coronary ostia, and the spatial relationship between the right common CA and the great arteries. Although it is not possible to define the course of the more distal coronary branches, TEE has proven reliable in recognizing those elements that can constitute a risk for the execution of a balloon valvuloplasty (BV). Therefore, TEE can be used to confirm this type of CA anomaly and prevent a BV, which is contraindicated in these cases. In addition, TEE avoids any further vascular access, radiation exposure, and contrast medium injection.

Statins use and the risk of all and subtype hematological malignancies: a meta-analysis of observational studies.

In order to quantify the association between use of statins and the risk of all hematological malignancies and of subtypes, we performed a meta-analysis of observational studies. We achieved a MEDLINE/EMBASE comprehensive search for studies published up to August 2014 investigating the association between use of statins and the risk of hematological malignancies, including Hodgkin- and non-Hodgkin lymphoma, leukemia, and myeloma. Fixed- and random-effect models were fitted to estimate the summary relative risk (RR) based on adjusted study-specific results. Between-study heterogeneity was assessed using the Q and I(2) statistics and the sources of heterogeneity were investigated using Deeks' test. Moreover, an influence analysis was performed. Finally, publication bias was evaluated using funnel plot and Egger's regression asymmetry test. Fourteen studies (10 case-control and four cohort studies) contributed to the analysis. Statin use, compared to nonuse of statins, was negatively associated with all hematological malignancies taken together (summary RR 0.86; 95% CI: 0.77-0.96), with leukemia (0.83; 0.74-0.92), and non-Hodgkin lymphoma (0.81; 0.68 to 0.96), but it was not related to the risk of myeloma (0.89; 0.53-1.51). Long-term users of statins showed a statistically significant reduction in the risk of all hematological malignancies taken together (0.78; 0.71-0.87). Statistically significant between-studies heterogeneity was observed for all outcome except for leukemia. Heterogeneity was caused by differences confounding-adjustment level of the included studies only for Myeloma. No significant evidence of publication bias was found.

Insights into the clinical implications of carbohydrate antigen 125 as a biomarker of heart failure: a meta-analysis and systematic review of published studies.

AIMS: An increasing number of clinical studies have explored the possibility of using tumor biomarker carbohydrate antigen 125 (CA 125) in the management of patients with heart failure. This systematic review and meta-analysis was performed to comprehensively summarize the available evidence and evaluate the applicability of CA 125 in heart failure. METHODS: We searched PubMed, Embase, and Cochrane Central Register of controlled trials. Of the 253 studies identified, 23 studies investigating the application of CA 125 in the clinical management of heart failure were included for meta-analyses and systematic review. RESULTS: The serum levels of CA 125 increased significantly in heart failure patients compared with healthy controls (standardized mean difference of 1.49 U/ml, P < 0.001). The fluctuation of CA 125 was closely associated with echocardiographic parameters. Likewise, the CA 125 levels were positively correlated with brain natriuretic peptide and N-terminal pro-BNP. Further investigation found that CA 125 levels increased accordingly as cardiac function declined from the New York Heart Association class I/II to class III and further from class III to IV [1.58, 95% confidence interval (0.75-2.41) and 1.37, 95% confidence interval (0.76-1.98) U/ml, respectively]. Heart failure patients with poor outcomes showed higher CA 125 level relative to those without adverse effects in short-term or long-term follow-up. CONCLUSION: CA 125 is a promising biomarker in the diagnosis, stratification, and outcome evaluation of heart failure patients. CA 125 may be regarded as a surrogate marker of echocardiographic variables, N-terminal pro-BNP and brain natriuretic peptide.

Statins and primary liver cancer: a meta-analysis of observational studies.

Statins are among the most commonly prescribed drugs used to manage dyslipidemia. Hepatocellular carcinoma is the third leading cause of cancer mortality and its rates have recently been increasing in central and northern Europe and USA. To quantify the association between statin use and risk for HCC, we performed a meta-analysis of published studies. We conducted a MEDLINE search for observational studies reporting the association between exposure to statins and risk for incident liver cancer until March 2012. Fixed-effect and random-effect models were used to estimate summary relative risks (RR) and the corresponding 95% confidence intervals (CIs). Moreover, between-study heterogeneity and publication bias were assessed using adequate statistical tests. Five observational studies (two case-control and three cohort studies) based on 2574 cases of HCC were included. Statin treatment, compared with no treatment, was inversely related to HCC (summary RR=0.58; 95% CI 0.46-0.74). Between-study heterogeneity was significant (P<0.001) and numerically relevant (I=65%). When only longest statin use was considered, the RR was 0.66 (95% CI 0.55-0.80). Influence analysis on the overall estimate showed that heterogeneity was largely because of one study; when omitting it, the I dropped to 27% (P=0.240), whereas the summary RR was only marginally modified (RR=0.52; 95% CI 0.44-0.62). There was no evidence of publication bias. This meta-analysis suggests a favorable effect of statins on HCC, in the absence, however, of a duration-risk relationship.

Congenital heart disease in boxer dogs: results of 6 years of breed screening.

The aim of this study was to analyse the results of 6years (1999-2004) of mandatory breed screening for congenital heart disease in Boxer dogs using physical examination and echocardiography. Records of 1283 Boxers were reviewed and 165 dogs (12.86%) were found to be affected by heart disease, with aortic and pulmonic stenosis being the most frequent cardiac lesions. Comparison of these results with those of a previous survey showed a lower overall prevalence of both outflow obstructions, particularly of the more severe forms. A male predisposition for both aortic and pulmonic stenosis was evident from the study. Consistent with reports from other countries, soft left basilar heart murmurs were detected in both healthy dogs and dogs affected with congenital heart disease.

Contrast echocardiography in Boxer dogs with and without aortic stenosis.

OBJECTIVES: The aim of this study was to investigate whether contrast echocardiography could enhance the subcostal Doppler signal for aortic flow measurements and achieve myocardial opacification, in Boxer dogs with and without AS. BACKGROUND: In evaluating dogs for aortic stenosis (AS) subcostal Doppler echocardiography was used for measurement of the aortic flow velocity, a measurement that can sometimes be difficult to perform in Boxer dogs. ANIMALS, MATERIALS, AND METHODS: Cardiac auscultation, phonocardiographic and echocardiographic examinations, including a contrast study with Optison, were performed on 29 Boxer dogs selected based on previous examinations. RESULTS: The initial subcostal Doppler signal was weak in 66% of the dogs and a marked improvement was seen in all dogs after contrast injection. The peak aortic flow velocity increased 5% from 2.58+/-1.42 m/s before contrast to 2.71+/-1.54 m/s after contrast (p=0.003). This corresponds to a 2.8 mmHg increase in the pressure gradient from 26.6 mmHg before to 29.4 mmHg after contrast. A dose of 0.05-0.1 mL of Optison administered intravenously resulted in approximately 4 min of Doppler signal enhancement. With the present technique contrast echocardiography did not achieve myocardial opacification. CONCLUSIONS: Single use of the contrast agent Optison can be recommended for enhancement of the subcostal Doppler signal in dogs, in which plain Doppler signals are difficult to obtain. Albeit statistically significant, the mild increase in peak aortic flow velocity after contrast was not considered biologically or clinically significant.

Transesophageal echocardiography of the left ventricular outflow tract, aortic valve and ascending aorta in Boxer dogs with heart murmurs.

The study was aimed at evaluating the anatomy of the left ventricular outflow tract, aortic valve, and ascending aorta by means of multiplane transesophageal echocardiography in Boxer dogs with left basilar heart murmurs and at comparing two-dimensional (2D) transthoracic to transesophageal echocardiography for the diagnosis of subaortic stenosis in this breed. Twenty-eight Boxers were included in the study and allocated to four groups according to physical and routine transthoracic 2D and Doppler echocardiography findings: group A--dogs with low grade (I-II/VI) heart murmurs without overt evidence of aortic stenosis (14 dogs); group B--dogs with type 1 subaortic stenosis (seven dogs); group C--dogs with type 2 subaortic stenosis (five dogs); group D--dogs with type 3 subaortic stenosis (two dogs). Anatomic lesions were not discovered by transesophageal echocardiography in dogs belonging to group A. Transesophageal imaging confirmed the type of subaortic stenosis, as graded by transthoracic echocardiography, in diseased animals (groups BCD). Morphologic information obtained by transesophageal echocardiography in Boxer dogs was similar to that obtained by transthoracic echocardiography.

The implantation of a permanent transvenous endocardial pacemaker in 42 dogs: a retrospective study.

BACKGROUND: The primary indication for pacemaker therapy in dogs and cats is symptomatic bradyarrhythmia that does not respond to medical treatment. Different techniques have been used for pacemaker implantation since 1968. Transvenous endocardial pacemaker implantation is a minimally invasive method and represents the first choice of treatment for this type of arrhythmia. MATERIAL/METHODS: The authors reviewed retrospectively the indications, efficacy, complications, and long-term outcome in 42 cases of transvenous endocardial pacemaker implantation in dogs. RESULTS: Complications which required a second intervention occurred in 10 dogs (23.8%), while complications that did not require another procedure occurred in 5 dogs (11.9%). Two of the 42 patients died due to the pacemaker implantation (mortality: 4.76%). The mean survival age of those patients with a pacemaker that survived the procedure was 11.4 years. CONCLUSIONS: The life expectancy of our patients carrying a pacemaker was higher than the general life expectancy published in a study on a large population of dogs. The low mortality rate and long life expectancy of dogs treated makes transvenous pacemaker implantation an efficacious and safe alternative for treatment of those bradyarrhythmias that do not respond to medical therapy.

Percutaneous catheter-based treatment of pulmonic stenosis and patent ductus arteriosus in a dog.

A 6-months old female German shepherd dog was referred for management of congenital heart disease. A diagnosis of pulmonic stenosis (PS) and patent ductus arteriosus (PDA) was confirmed by Doppler echocardiography and cardiac catheterisation. The conditions were treated during a single cardiac catheterisation procedure using percutaneous techniques. Gianturco coil embolisation was used to close the PDA, and the PS was relieved using a balloon valvuloplasty technique.