Inflammation and Behavior Changes in Dogs and Cats.

Sickness is a normal response to infections or stress triggered by proinflammatory cytokines that drive local and systemic inflammatory responses. Proinflammatory cytokines act on the brain causing the so called "sickness behavior,"which is thought to improve recovery but can become maladaptive in the long term. Chronic inflammation characterizes many diseases and there is some evidence that dogs and cats experience age-associated increases in inflammation, a condition named "inflammaging." A complex and multifactorial relationship exists between these inflammatory mechanisms, pain, and psychological illness that may complicate veterinary diagnosis and affect the outcome.

The Relationship between Signs of Medical Conditions and Cognitive Decline in Senior Dogs.

Canine cognitive dysfunction syndrome (CCDS) is a progressive age-related neurodegenerative disorder in dogs. Minimal research has been performed to investigate how clinical signs may be impacted by other medical conditions. A cross-sectional study was performed using the Canine Cognitive Assessment Scale (CCAS) to evaluate cognitive impairment as reported by owners. Owner-reported health-related measures included behaviour changes, the body condition score, and veterinary diagnoses of disease. The responses from 804 dogs in the last 25% of their expected lifespan were analysed. Factors were identified in the owner-reported behavioural signs of disease representing pathologies in four body systems: musculoskeletal-neurological, digestive, metabolic, and dermatological, with the items comprising these factors also compiled into a cumulative measure of health. The results showed a strong correlation between the CCAS score and both the musculoskeletal-neurological factor and the overall cumulative measure of health. Moderate correlations between the CCAS score and the digestive factor and metabolic factor were also observed. The correlation between the dermatological factor and the CCAS score was weak. This study highlights the need to screen dogs for concurrent diseases when using scales to assess cognitive impairment and to monitor dogs who have health conditions, particularly those that are painful, for the onset of cognitive impairment.

Sniffer dogs performance is stable over time in detecting COVID-19 positive samples and agrees with the rapid antigen test in the field.

Rapid antigen diagnostic (RAD) tests have been developed for the identification of the SARS-CoV-2 infection. However, they require nasopharyngeal or nasal swab, which is invasive, uncomfortable, and aerosolising. The use of saliva test was also proposed but has not yet been validated. Trained dogs may efficiently smell the presence of SARS-CoV-2 in biological samples of infected people, but further validation is needed both in laboratory and in field. The present study aimed to (1) assess and validate the stability over a specific time period of COVID-19 detection in humans' armpit sweat by trained dogs thanks to a double-blind laboratory test-retest design, and (2) assess this ability when sniffing people directly. Dogs were not trained to discriminate against other infections. For all dogs (n. 3), the laboratory test on 360 samples yielded 93% sensitivity and 99% specificity, an 88% agreement with the Rt-PCR, and a moderate to strong test-retest correlation. When sniffing people directly (n. 97), dogs' (n. 5) overall sensitivity (89%) and specificity (95%) were significantly above chance level. An almost perfect agreement with RAD results was found (kappa 0.83, SE 0.05, p = 0.001). Therefore, sniffer dogs met appropriate criteria (e.g., repeatability) and WHO's target product profiles for COVID-19 diagnostics and produced very promising results in laboratory and field settings, respectively. These findings support the idea that biodetection dogs could help reduce the spread of the virus in high-risk environments, including airports, schools, and public transport.

Two valid and reliable tests for monitoring age-related memory performance and neophobia differences in dogs.

The prolonged lifespan of companion dogs has resulted in increased behavioural and physical challenges linked to old age. The development of behavioural tests to identify and monitor age-related differences has begun. However, standardised testing requires validation. The present study aimed to assess external validity, interobserver reliability, and test-retest reliability of an indoor test battery for the rapid assessment of age-related behavioural differences in dogs. Two experimenters tested young dogs (N = 20, mean age ± SD = 2.7 ± 0.4 years) and old dogs (N = 18, mean age ± SD = 11.8 ± 1.3 years) in the test battery once and then again after two weeks. Our results found external validity for two subtests out of six. On both test occasions, old dogs committed more errors than young dogs in a memory subtest and showed more object avoidance when encountering a novel object. Interobserver reliability and test-retest reliability was high. We conclude that the Memory and Novel object subtests are valid and reliable for monitoring age-related memory performance and object neophobic differences in dogs.

Signs of Anxiety and Salivary Copeptin Levels in Dogs Diagnosed with Separation-Related Problems in a Short Separation Test.

The need for faster diagnosis and more accurate treatment decisions in separation-related problems (SRPs) in dogs is urgent, and a more precise behavioral phenotyping and the development of biomarkers may be of great value. Vasopressin could be a potential non-invasive biomarker of anxiety in dogs with SRPs, but reliable measurement of its concentration is challenging. Here, we compared the behavior and salivary concentrations of copeptin, an arginine vasopressin surrogate, in dogs with SRPs (Case group, n = 13) and with no problems (Control group, n = 15) as they were introduced to a novel environment and subjected to a short episode of separation and reunion with the owner. Dogs in the Case group had greater odds of showing locomotory or oral behaviors during the pre- and post-separation than Controls, while the odds were significantly lower during separation. They also had greater odds of being persistent in seeking attention and proximity from the stranger during reunion. Overall, dogs with SRPs were more likely to express an anxiety-like state during the entire test than Controls, with separation from the owner, and even its anticipation, possibly accounting for this group difference. Although salivary copeptin concentrations did not differ between the two groups, a different trend was detected in Cases and Controls that is worth exploring in further validation studies involving a larger sample.

Physiotherapy Improves Dogs' Quality of Life Measured with the Milan Pet Quality of Life Scale: Is Pain Involved?

Quality of life is defined as an individual's satisfaction with its physical and psychological health, its physical and social environment, and its ability to interact with the environment. Understanding companion dogs' QOL can help veterinarians and owners know when treatment options have successfully alleviated symptoms of disease in such fields as veterinary physiotherapy. For this study, 20 adult dogs were selected from patients of a physiotherapy referral center with orthopedic, neurological, and/or degenerative conditions. The severity of the medical problem was ranked, and the symptoms, the treatment plan, and demographic data were recorded at the time of the physical examination. In addition, the owner of the dog was asked to fill out a questionnaire on the quality of life of the pet (the Milan Pet Quality of Life scale) at the time of the first consultation as well as the last follow-up after the treatment. The MPQL measures four domains of QOL: physical (signs of medical conditions), psychological (emotional and behavioral well-being), social (quality and extent of social interactions), and environmental (freedom and safety in one's environment). The results of the study indicated a significant improvement in the psychological QOL domain following physiotherapeutic treatment. The social QOL domain declined with the severity of lameness, while the physical QOL, as reported by the owner, declined with the overall criticality of the medical condition, as ranked by the physiotherapist. The results of the study support the recent evidence of a relationship between pain and canine psychological well-being and highlight the importance of investigating psychological and emotional aspects of dogs' QOL when treating orthopedic and neurological cases with physiotherapy.

Cat-Owner Relationship and Cat Behaviour: Effects of the COVID-19 Confinement and Implications for Feline Management.

The restrictive measures implemented to stem the spread of COVID-19 abruptly changed the lives of many cats and their owners. This study explored whether the lockdown in Italy affected the cat-owner relationship, as well as cat behaviour and welfare. A survey that included questions on owner and cat's demographics, living environment, cat behaviour and a modified version of the Cat/Dog Relationship Scale (C/DORS) was distributed online during the lockdown and was completed by 548 cat owners, mainly women (81.6%). With regard to the C/DORS subscales, both emotional closeness and cat-owner interactions increased during confinement, as opposed to a reduction in perceived costs. The effect of the type of job, family role and owner's age on the C/DORS scores suggests that the relationship improved for those owners that, due to the lockdown, increased the time spent with their cats. For 58.8% of respondents, their cat's general behaviour did not change, but when changes occurred, they were mostly positive (20.4%). Attention-seeking and demanding behaviours were the most increased during lockdown (25.7%). Cats with pre-existing problematic behaviours tended to either remain stable or improve during confinement. The overall positive effects of lockdown-related environmental changes on a cat's behaviour suggest that some aspects of commonly implemented cat management practices should be revised to improve cat welfare in normal circumstances.

Factors behind the Relinquishment of Dogs and Cats by their Guardians in Portugal.

In Portugal, the relinquishment of dogs and cats is a major problem. Thus, the authors developed a questionnaire to understand the factors influencing the relinquishment of companion animals in Portugal. With a view to analyze the factors behind relinquishment by companion animal guardians, the authors analyzed surveys completed by 72 participants, divided into two groups: REL (relinquisher, n = 36), i.e., guardians who had relinquished a companion animal and NREL (non-relinquisher, n = 36) i.e., guardians who had never relinquished a companion animal. The only significant factors for the REL group were the presence of children and the type of dwelling (apartment). Additionally, the duration of guardianship of the companion animal before relinquishment (REL group) was significantly shorter if there were children in the household than if there were no children.

The Cat-Owner Relationship: Validation of the Italian C/DORS for Cat Owners and Correlation with the LAPS.

Globally, most people now own a pet. Scales have been developed to understand the impact of pet ownership on people's lives and to measure specific aspects of the owner-pet relationship. The Cat-/Dog-Owner Relationship Scale (C/DORS) is a tool developed to investigate this relationship in both dog and cat owners. The aim of the study was to refine and validate the C/DORS for cat owners in Italian. Exploratory Factor Analysis and Confirmatory Factor Analysis (CFA) were used to determine the most appropriate factor model. Construct validity was confirmed by correlating the C/DORS subscales with the Lexington Attachment to Pets (LAPS) subscales. Results confirmed the original structure of the English version (i.e., three factors: Pet Owner Interaction = POI, Perceived Emotional Closeness = PEC, Perceived Costs = PC) and CFA confirmed the structure of LAPS and C/DORS scales. Cronbach's alpha demonstrated the Italian version of the two scales to have good internal reliability for all domains. Owners of cats living exclusively indoors reported higher scores on POI and PEC compared to indoor/outdoor cats. Owning both cats and dogs was correlated with lower scores on POI, and fewer perceived costs (i.e., PC) of cat ownership. Finally, behaviour problems, not being neutered, and lack of previous experience with cat ownership were associated with lower scores on PC.

Personality and Cognitive Profiles of Animal-Assisted Intervention Dogs and Pet Dogs in an Unsolvable Task.

Dogs are biologically predisposed to communicate with humans in cooperative contexts. They show individual differences in dog-human communication and inhibition, potentially enhanced by life experience, e.g., Animal-Assisted Interventions. This study aimed to investigate whether dogs' personality, defined by biologically meaningful neural circuits described in the Reinforcement Sensitivity Theory of Personality (RST), predicted dogs' communication, task orientation, emotional state, and approach of an unsolvable task. We also investigated the differences between dogs experienced in Animal-Assisted Interventions (AAI) and inexperienced dogs. The results indicated that a high sensitivity to the RST personality trait related to managing uncertainty (Behavioural Inhibition System, BIS) predicted fewer task orientations but increased referential and non-referential looking, which we interpreted as a way to obtain directions from the owner. Conversely, a high sensitivity to the traits reflecting tendencies to approach rewards (Behavioural Approach System, BAS) and avoid punishment (Fight-Flight-Freeze System, FFFS) predicted lower looking. High sensitivity to the FFFS also predicted more frequent task orientations, which we interpreted as frustration. Finally, the dogs in the AAI program looked more at their owner and were less oriented towards the task. These results provide empirical evidence of individual differences tied to the psychobiological personality traits in canine cognitive skills. Understanding such cognitive profiles may have an enormous impact on activities that rely upon dog-human collaborative interaction.

The Dog-Owner Relationship: Refinement and Validation of the Italian C/DORS for Dog Owners and Correlation with the LAPS.

The Cat/Dog-Owner Relationship Scale (C/DORS) can be administered to both dog and cat owners. However, the scale as a whole has never been validated on a sample of dog owners. Furthermore, it has never been translated into Italian. The aim of this study was to translate the C/DORS into Italian, modify its response scale in order to improve the degree of response variability, and test its validity and reliability on a sample of dog-owners. Exploratory factor analysis revealed the same three-factor structure (Perceived Emotional Closeness = PEC, Pet-Owner Interactions = POI, Perceived Costs = PC) as the original English version, although some items had to be removed because of low- or cross-loadings. The validity of the construct was confirmed by confirmatory factor analysis, by the correlations between each of the subscales and the C/DORS total score, and by the correlations with the Lexington Attachment to Pets Scale. Cronbach's α values for each subscale were above acceptable levels. Student owners scored higher on PEC and POI than owners with other occupations. Owners of dogs with behavioural problems scored lower on PEC and higher on PC. Keeping the dog outdoor was associated with lower POI. Finally, pet dog owners scored higher on PEC than AAI dog owners.

Use of the Milan Pet Quality of Life Instrument (MPQL) to Measure Pets' Quality of Life during COVID-19.

The COVID-19 pandemic caused lifestyle changes, with unknown effect on pets' quality of life (QoL). Between May and July 2020, we distributed an online survey to investigate the role of several factors on feline and canine QoL, including lockdown-related factors. We used existing scales to measure human and pets' personalities (Reinforcement Sensitivity Theory Personality Questionnaire, RST-PQ; RST-Dog; RST-Cat) and the human-animal relationship (Lexington Attachment to Pets Scale, LAPS) and the Milan Pet Quality of Life instrument (MPQL). Overall, 235 participants reported about 242 adult pets (Ncats = 78, Ndogs = 164). Factor analysis confirmed the structure and internal reliability of the existing scales (RST-PQ, RST-Dog, RST-Cat, LAPS) and suggested a four-factor structure for the MPQL (physical, psychological, social, environmental). The results indicate that the pets' psysical QoL was largely explained by pet-related elements (pets' demographics and life experience, and pets' personality). Conversely, the pets' psychological QoL was explained mostly by owner-related elements, such as the owners' demographics, COVID-19-related changes, and the owners' personality. Predictably, the pets' environmental QoL is mostly explained by environmental factors, such as the outdoor access in the home environment and the country. Finally, the pets' social QoL was explained by the larger combination of models: pets' characteristics and personality, environment and COVID-19-related changes, and the pet-human relationship. These findings can be explained by two non-mutually exclusive mechanisms. The reported changes may be a by-product of the COVID-19 pandemic's psychological and lifestyle effects on the owners, which in turn alter the way the owners interact with their pets and look after them. However, the owners' characteristics and mood may bias their answers regarding their pets.

Effect of age on discrimination learning, reversal learning, and cognitive bias in family dogs.

Several studies on age-related cognitive decline in dogs involve laboratory dogs and prolonged training. We developed two spatial tasks that required a single 1-h session. We tested 107 medium-large sized dogs: "young" (N=41, aged 2.5-6.5 years) and "old" (N=66, aged 8-14.5 years). Our results indicated that, in a discrimination learning task and in a reversal learning task, young dogs learned significantly faster than the old dogs, indicating that these two tasks could successfully be used to investigate differences in spatial learning between young and old dogs. We also provide two novel findings. First, in the reversal learning, the dogs trained based on the location of stimuli learned faster than the dogs trained based on stimulus characteristics. Most old dogs did not learn the task within our cut-off of 50 trials. Training based on an object's location is therefore more appropriate for reversal learning tasks. Second, the contrast between the response to the positive and negative stimuli was narrower in old dogs, compared to young dogs, during the reversal learning task, as well as the cognitive bias test. This measure favors comparability between tasks and between studies. Following the cognitive bias test, we could not find any indication of differences in the positive and negative expectations between young and old dogs. Taken together, these findings do not support the hypothesis that old dogs have more negative expectations than young dogs and the use of the cognitive bias test in older dogs requires further investigation.

Impulsivity and behaviour problems in dogs: A Reinforcement Sensitivity Theory perspective.

Trait impulsivity is an increasingly relevant topic for human and non-human animal personality research. There are similarities in dog and human manifestations of trait impulsivity at the behavioural, genetic, and neurobiological level. We investigated a well-validated measure of dog impulsivity and responsivity (the Dog Impulsivity Assessment Scale, DIAS) and a neuropsychological theory of human trait approach and avoidance (the Reinforcement Sensitivity Theory of personality, RST). Owners reported their dogs' dispositional behaviour on the DIAS, an RST scale modified to describe dogs' behaviour, and a list of common dog behaviour problems. In a sample of 730 dogs, we observed convergence between the RST and the DIAS. There was a negative correlation between RST 'Behaviour Inhibition System' and DIAS impulsivity factor ('Behavioural Regulation'). RST 'Behavioural Approach System' correlated positively with DIAS 'Responsiveness'. The RST 'Fight-Flight-Freeze System' (FFFS) and the DIAS 'Aggression and response to novelty factor were both distinct from other factors. However, the DIAS 'Aggression and response to novelty' factor and the RST FFFS explained different aspects of dog behaviour problems. Importantly, whilst the DIAS factors indicated tendencies towards avoidant behaviours, the FFFS discriminated between active and passive avoidance. The findings suggest a partial overlapping between the DIAS and RST scales, and highlights the utility of personality models in investigating behaviour problems in dogs.

Do Dogs Provide Information Helpfully?

Dogs are particularly skilful during communicative interactions with humans. Dogs' abilities to use human communicative cues in cooperative contexts outcompete those of other species, and might be the result of selection pressures during domestication. Dogs also produce signals to direct the attention of humans towards outside entities, a behaviour often referred to as showing behaviour. This showing behaviour in dogs is thought to be something dogs use intentionally and referentially. However, there is currently no evidence that dogs communicate helpfully, i.e. to inform an ignorant human about a target that is of interest to the human but not to the dog. Communicating with a helpful motive is particularly interesting because it might suggest that dogs understand the human's goals and need for information. In study 1, we assessed whether dogs would abandon an object that they find interesting in favour of an object useful for their human partner, a random novel distractor, or an empty container. Results showed that it was mainly self-interest that was driving the dogs' behaviour. The dogs mainly directed their behaviour towards the object they had an interest in, but dogs were more persistent when showing the object relevant to the human, suggesting that to some extent they took the humans interest into account. Another possibility is that dogs' behaviour was driven by an egocentric motivation to interact with novel targets and that the dogs' neophila might have masked their helpful tendencies. Therefore, in study 2 the dogs had initial access to both objects, and were expected to indicate only one (relevant or distractor). The human partner interacted with the dog using vocal communication in half of the trials, and remaining silent in the other half. Dogs from both experimental groups, i.e. indicating the relevant object or indicating the distractor, established joint attention with the human. However, the human's vocal communication and the presence of the object relevant to the human increased the persistency of showing, supporting the hypothesis that the dogs understood the objects' relevance to the human. We propose two non-exclusive explanations. These results might suggest that informative motives could possibly underlie dogs' showing. It is also possible that dogs might have indicated the location of the hidden object because they recognised it as the target of the human's search. This would be consistent with taking into account the objects' relevance, without necessarily implying that the dogs understood the human's state of knowledge.

Systemic chemotherapy in combination with pericardial window has better outcomes in malignant pericardial effusions.

OBJECTIVE: Our aim was to compare systemic chemotherapy (CT) with drainage and with pericardial window in the treatment of neoplastic pericarditis in patients with various malignancies included in the International Neoplastic Pericarditis Treatment study. METHODS: Patients treated with systemic CT alone (Group A), CT plus drainage (Group B), or CT plus pericardial window (Group C) were included. Treatment response was defined as complete response (ie, no more pericardial effusion or masses), partial response (ie, reduced total score, without requiring further treatments), stable disease (ie, unchanged total score), or progressive disease (ie, increased total score). Patients with partial or complete response were considered responders. RESULTS: This preliminary report included 175 patients (56.6% male) with a mean age of 54.21±14.26 years. Gender distribution, age, and follow-up duration was similar for all groups (P>.05). Prevalent cancer types were lung cancer (50.9%), breast cancer (14.9%), and lymphoma/leukemia (14.9%). Overall, 22.3%, 42.9%, and 34.9% of patients were in treatment group A, B, and C, respectively. There were 132 responders (75.3%). The rate of responders significantly differed between groups (P<.001); it was significantly higher in Group B than in Group A (P<.05) and in Group C than in Group B (P=.006). The significant factors affecting response were therapy (P=.002) and extent of effusion (P=.037). Kaplan-Meier analysis showed that patients in Group C had a significantly better survival rate than patients in the other groups (P=.001). CONCLUSIONS: Systemic CT plus pericardial window is a more effective treatment option compared with systemic CT alone and systemic CT plus drainage in patients with malignant effusions.

Transcranial Doppler and transesophageal echocardiography: comparison of both techniques and prospective clinical relevance of transcranial Doppler in patent foramen ovale detection.

BACKGROUND: Patent foramen ovale (PFO) has been investigated in several conditions apart from cryptogenic ischemic stroke. Contrast transesophageal echocardiography (cTEE) is the gold standard for the diagnosis, although it has some known limitations. Contrast transcranial Doppler (cTCD) allows a semiquantitative estimation of right-to-left shunt (RLS) volume. The aims of our study were to confirm the diagnostic accuracy of cTCD in PFO diagnosis and to compare the abilities of cTCD and cTEE to detect a RLS and PFO, respectively, under normal breathing. The latter could represent an important feature for its clinical significance. METHODS: A total of 100 consecutive patients (59 women and 41 men, age 46 +/- 12 years) were evaluated after stabilized ischemic stroke/transient ischemic attack, migraine, and lacunae, and before neurosurgery in sitting position. All patients undertook cTEE and cTCD, at rest and under Valsalva maneuver (VM). cTEE under VM was the reference standard. A categorization of patients and a semiquantitative cTCD classification were proposed. RESULTS: In all, 63 of 100 patients had PFO diagnosed by cTEE. A general concordance of up to 90% between both techniques was found. cTCD sensitivity and specificity were 96.8% and 78.4%, respectively. In 17 of 100 patients with cTEE-proven PFO under VM, cTCD and cTEE detected RLS at rest in 75% (95% confidence interval [CI] 62%-85%) and 48% (95% CI 35%-61%) of cases, respectively (P < .001). cTEE disclosed RLS at rest in about 71% (95% CI 9%-42%) of cTCDs showing a "shower-curtain" pattern and only in about 22% (95% CI 52%-85%) of those cTCDs without that pattern. CONCLUSIONS: In diagnosing PFO, cTCD has a good accuracy compared with cTEE. To detect a RLS at rest, cTCD appears to be more sensitive than cTEE. The latter resulted positive under normal breathing, mostly in cases of significant RLS at cTCD. Our results point out the impact of cTCD in the evaluation of RLS volume, thus aiding, in association with the anatomic details by cTEE, in the prevention of the occurrence or recurrence of paradoxical embolism in individuals with and without cerebrovascular diseases. The combination of cTEE and cTCD could be considered the real gold standard for PFO in the near future.

Atrial fibrillation after non-cardiac surgery: P-wave characteristics and Holter monitoring in risk assessment.

BACKGROUND: We investigated the role of 12-lead ECG P-wave duration and dispersion and of Holter monitoring as predictors of post-thoracic surgery atrial fibrillation. METHODS: One hundred and five consecutive patients (88 males-17 females; age 60+/-9), undergoing thoracic surgery at National Cancer Institute between 2001 and 2003, were enrolled and both standard ECG and Holter monitoring were obtained from each patient. P-wave study was made on a magnified ECG paper copy. Holter monitoring was performed 1-3 days before surgery; patients were divided into three classes according to number and complexity of premature supra ventricular complexes (0: <30/h and no repetitive forms; 1: >30/h or couplets; 2: run of supraventricular tachycardia or atrial fibrillation). RESULTS: Atrial fibrillation was detected in 12 patients (11%) within 96 h from surgery. In univariable logistic model, P-wave duration was not associated with postoperative atrial fibrillation while P-wave dispersion and Holter monitoring demonstrated a statistically significant association with the occurrence of atrial fibrillation (OR of 30 vs 20 ms=2.06; CI: 1.17-3.64; p=0.012, OR of class 1-2 vs class 0=8.16; CI: 2.04-35.59; p=0.003, respectively). In the multivariable model, both P-wave dispersion and Holter were shown to be significantly associated with the end-point. Holter monitoring enhanced the predictive ability of P-wave dispersion (area under the ROC curve increased from 0.64 to 0.80). CONCLUSIONS: P-wave dispersion, but not duration, was associated with atrial fibrillation after thoracic surgery. Preoperative Holter monitoring adds further information and could be used to enhance the P-wave predictive power.

Respiratory changes in transvalvular flow velocities versus two-dimensional echocardiographic findings in the diagnosis of cardiac tamponade.

BACKGROUND: The purpose of this study was to compare the sensitivity, specificity and positive predictive value of the respiratory changes in the transvalvular flow velocities to those of right atrial collapse and right ventricular collapse in the diagnosis of cardiac tamponade. METHODS: Standard two-dimensional and Doppler echocardiography were performed with respiratory monitoring in 56 consecutive patients with mild to severe pericardial effusion. Sixteen patients met the clinical criteria for cardiac tamponade and underwent pericardiocentesis or surgical drainage. Forty patients were found to have no tamponade and were followed up for at least 2 weeks and none of them showed clinical worsening. RESULTS: The sensitivity, specificity and predictive value were, respectively, 77, 80 and 62% for an inspiratory decrease > 22% in the peak velocity of the early mitral flow; 75, 89 and 73% for an inspiratory reduction > 20% in the peak velocity of the aortic flow; 50, 69 and 36% for an inspiratory increase > 30% in the peak velocity of the early tricuspid flow; 87, 85 and 64% for an inspiratory increase > 25% in the peak velocity of the pulmonary flow. Right atrial collapse and right ventricular collapse had a sensitivity of 100 and 75%, a specificity of 33 and 85%, and a predictive value of 37 and 66%, respectively. CONCLUSIONS: In the diagnosis of cardiac tamponade: 1) right atrial collapse is the most sensitive sign but lacks any specificity; 2) except for the tricuspid valve, the respiratory variations in the transvalvular flow velocities have a reliability and a predictive value comparable with those of right ventricular collapse; 3) the predictive value is not very high, indicating that at both techniques false positive results are not negligible.