Natural history of subaortic stenosis in 166 dogs (1999-2011).

INTRODUCTION: Subaortic stenosis (SAS) is one of the most common congenital cardiac diseases in dogs. The objective of this study was to provide survival times on a large population of dogs with SAS and to propose a redefined pressure gradient (PG) scale to include a mild, moderate, severe and very severe disease group. ANIMALS, MATERIALS AND METHODS: Dogs were divided into four groups based on the Doppler-derived PG across the stenosis. Disease severity was defined as follows: mild = PG < 50 mmHg; moderate = PG range 50-80 mmHg; severe = PG range 80-130 mmHg; and very severe = PG > 130 mmHg. Over the study period (1999-2011), 166 client-owned dogs were diagnosed with SAS of which 129 had follow-up information available. RESULTS: Unadjusted median survival time for severity groups were as follows: mild 10.6 years; moderate 9.9 years; severe 7.3 years; and very severe 3.0 years. Univariable analysis examining the effect of the PG, age at diagnosis and sex found only the PG and age at diagnosis had a significant effect on survival. Adjusted survival curves showed that the survival time in the very severe group was decreased compared with all other groups. CONCLUSION: Based on the results of this study, a revised SAS classification system with four PG groups is appropriate. Dogs with a PG > 130 mmHg were identified as those with the lowest median survival time.

Diagnostic accuracy of computer aided electrocardiogram analysis in dogs.

OBJECTIVES: Evaluation of a computerised electrocardiogram algorithm compared to the interpretation of a team of board-certified veterinary cardiologists. MATERIALS AND METHODS: This was a cross-sectional retrospective cohort study. A total of 399 electronic canine electrocardiogram recordings screened from 1391 electrocardiograms were enrolled in the study. A panel of seven cardiologists, masked to patient information, evaluated electrocardiograms for the following: P-wave amplitude and duration; PR-interval; R-wave amplitude; QRS duration; heart rate; mean electrical axis; and final overall diagnosis for the detection of arrhythmia and any abnormal electrocardiogram anomaly. RESULTS: The sensitivity of the electrocardiogram algorithm for detecting arrhythmias was 99.7% (95% confidence intervals, CI: 98.5 to 99.9) and the specificity was 99.5% (95% CI: 98.0 to 99.9) compared to the consensus result created by panel of cardiologists. The sensitivity of the algorithm for the detection of any electrocardiogram anomaly, including abnormal measurements, was 71.3% (95% CI: 65.5 to 76.7) and the specificity was 35.1% (95% CI: 27.0 to 43.8) compared to the panel of cardiologists. CLINICAL SIGNIFICANCE: The electrocardiogram algorithm was shown to have high sensitivity for the detection of arrhythmias, but not all electrocardiogram anomalies. The results support the use of this algorithm as a tool to aid in the triage of the electrocardiogram workflow.

Are Albumin Levels a Good Predictor of Mortality in Elderly Patients with Neck of Femur Fractures?

BACKGROUND: Neck of femur (NOF) fractures are associated with significant morbidity and mortality in elderly people with multiple co-morbidities; making management of this patient subgroup challenging. Predictors of an increase in morbidity and mortality would therefore provide a useful framework for the assessment and management of this demographic. Within the current literature, hypoalbuminaemia (<35g/dl) has been highlighted as being a good biochemical predictor of short-term mortality (<12 months). Our aims were to assess whether there was an association between low albumin levels and mortality and whether the severity adversely affects outcomes. MATERIALS AND METHODS: Patients admitted to our large district hospital between January 2011 and December 2012 who had sustained a NOF fracture, were over 65 years old and had a pre-operative albumin level were included. This retrospective, longitudinal, observational study concluded in July 2014. Demographic and pre-operative function and albumin data was collated retrospectively. An association with mortality was made. RESULTS: 471 patients had usable data. Mean pre-operative albumin level was 29.5g/dl (SD 6.22g/dl) in patients who died and 32.8g/dl (SD 6.43g/dl) in patients who survived during the study period. Pre-operative albumin level was significantly associated with survival (hazard ratio 0.957: 95% CI (0.937, 0.978); p<0.001). Thus, a reduction of 1g/dl in pre-operative albumin is associated with an increased hazard of death of 4.3%. CONCLUSIONS: Early identification of patients with hypoalbuminaemia on admission with a venous blood sample and timely input from orthogeriatrians could optimise these patients pre- and post-operatively. This may enable rates of morbidity and mortality to fall. Hypoalbuminaemia may be a reasonable predictor of shorter-term mortality in this patient subgroup. However, this may reflect existing co-morbidities rather than an isolated cause. This study supports an association between hypoalbuminaemia and poorer outcome for patients with NOF fractures.

Influence of beta blockers on survival in dogs with severe subaortic stenosis.

BACKGROUND: Subaortic stenosis (SAS) is one of the most common congenital cardiac defects in dogs. Severe SAS frequently is treated with a beta adrenergic receptor blocker (beta blocker), but this approach largely is empirical. OBJECTIVE: To determine the influence of beta blocker treatment on survival time in dogs with severe SAS. METHODS: Retrospective review of medical records of dogs diagnosed with severe, uncomplicated SAS (pressure gradient [PG] ≥80 mmHg) between 1999 and 2011. RESULTS: Fifty dogs met the inclusion criteria. Twenty-seven dogs were treated with a beta blocker and 23 received no treatment. Median age at diagnosis was significantly greater in the untreated group (1.2 versus 0.6 years, respectively; P = .03). Median PG at diagnosis did not differ between the treated and untreated groups (127 versus 121 mmHg, respectively; P = .2). Cox proportional hazards regression was used to identify the influence of PG at diagnosis, age at diagnosis, and beta blocker treatment on survival. In the all-cause multivariate mortality analysis, only age at diagnosis (P = .02) and PG at diagnosis (P = .03) affected survival time. In the cardiac mortality analysis, only PG influenced survival time (P = .03). Treatment with a beta blocker did not influence survival time in either the all-cause (P = .93) or cardiac-cause (P = .97) mortality analyses. CONCLUSIONS: Beta blocker treatment did not influence survival in dogs with severe SAS in our study, and a higher PG at diagnosis was associated with increased risk of death.