Prevalence of cardiomyopathy in apparently healthy cats.

OBJECTIVE: To determine the prevalence of cardiomyopathy and the relationship between cardiomyopathy and heart murmurs in apparently healthy cats. DESIGN: Cross-sectional study. ANIMALS: 103 privately owned, apparently healthy domestic cats. PROCEDURES: Cats were physically and echocardiographically examined by 2 investigators independently. Left ventricular wall thickness was determined via 2-dimensional echocardiography in short-axis and long-axis planes. Left ventricular hypertrophy was identified when end-diastolic measurements of the interventricular septum or posterior wall were > or = 6 mm. Cats with left ventricular hypertrophy but without left ventricular dilatation were considered to have hypertrophic cardiomyopathy (HCM). The associations between heart murmurs and Doppler echocardiographic velocity profiles indicative of dynamic ventricular outflow tract obstruction were evaluated. RESULTS: Heart murmurs were detected in 16 (15.5%; 95% confidence interval, 9.2% to 24.0%) cats; of these, 5 had cardiomyopathy. Cardiomyopathy was also identified in 16 (15.5%; 95% confidence interval, 9.2% to 24.0%) cats; 15 had HCM, and 1 had arrhythmogenic right ventricular cardiomyopathy. Of the cats with HCM, 11 had segmental left ventricular hypertrophy, 3 had diffuse left ventricular hypertrophy, and 1 had borderline left ventricular hypertrophy with marked systolic anterior motion of the mitral valve. Sensitivity and specificity of auscultatory detection of a heart murmur for diagnosing cardiomyopathy were 31% and 87%, respectively. Echocardiographic evidence of late systolic acceleration within ventricular outflow tracts was associated with the existence of a heart murmur. CONCLUSIONS AND CLINICAL RELEVANCE: Cardiomyopathy was common in the healthy cats evaluated in this study. In apparently healthy cats, detection of a heart murmur is not a reliable indicator of cardiomyopathy.

Systolic anterior motion of the mitral valve associated with right ventricular systolic hypertension in 9 dogs.

OBJECTIVES: To describe the zoographic and echocardiographic characteristics of canine patients in which systolic anterior motion of the mitral valve (SAM) was identified in association with right ventricular systolic hypertension (RVSH). ANIMALS, MATERIALS AND METHODS: Medical records and digitally recorded echocardiographic examinations were reviewed for RVSH and two-dimensional (2DE) or M-mode echocardiographic evidence of SAM. RESULTS: SAM was identified in association with RSVH in 9 patients; 5 had pulmonic stenosis, 2 had tetralogy of Fallot and 2, pulmonary hypertension. Relative to body weight, the end-diastolic and end-systolic left ventricular dimensions were subnormal in all patients. Hyperdynamic left ventricular systolic performance was identified in 8 of 9 patients. In 5 of the 9 patients, SAM was mild or moderate in degree. Left ventricular outflow tract (LVOT) obstruction and mitral valve regurgitation were documented by Doppler studies in only 3 of the 4 patients with marked SAM. However, late systolic acceleration within the LVOT was recorded in 2 additional patients for whom peak velocities were normal. CONCLUSIONS: In the cases described here, the presence of SAM is likely explained by alterations in left ventricular geometry and function associated with diminished pulmonary venous return together with sympathetic activation resulting from subnormal stroke volume. Although the hemodynamic consequences were apparently minor, the association of SAM with right-sided heart disease might be of interest to those engaged in the practice of veterinary echocardiography.

N-terminal atrial natriuretic peptide immunoreactivity in plasma of cats with hypertrophic cardiomyopathy.

Atrial natriuretic peptide (ANP) is an important regulator of fluid homeostasis and vascular tone. We sought to compare N-terminal ANP immunoreactivity (ANP-IR) in plasma from cats with and without hypertrophic cardiomyopathy (HCM). Secondarily, we evaluated relationships between ANP-IR and echocardiographical variables in cats with HCM and healthy cats. Venous blood samples were obtained from 17 cats with HCM and from 19 healthy cats. Plasma ANP-IR concentration was determined by an enzyme-linked immunoassay. Two cats with HCM had clinical evidence of congestive heart failure; the remainder had subclinical disease. Plasma ANP-IR concentration was higher in cats with HCM (3,808 +/- 1,406 fmol/L, mean +/- SD) than in control cats (3,079 +/- 1,233 fmol/L), but this difference was not statistically significant (P = .11; 95% confidence interval [CI] = -166 to 1,622). There was a significant, but modest correlation between plasma ANP-IR concentration and left ventricular posterior wall thickness (r = 0.42; P = .01). Additionally, plasma ANP-IR concentration was weakly correlated with left atrial size (r = 0.35; P = .03). A linear regression model was developed to further explore these relationships. Atrial size and wall thickness were included in the model; the 2 explanatory variables had an interactive effect on plasma ANP-IR concentration (R2 = 0.27; P = .02). There was no appreciable correlation between plasma ANP-IR concentration and any other echocardiographical variable. In a population that included cats with subclinical disease, those with HCM did not have significantly higher plasma ANP-IR concentration than did healthy cats. An exploratory multivariable regression analysis suggested a linear relationship between ANP-IR concentration and atrial size, wall thickness, and their interaction.

Hemodynamic effects of orally administered carvedilol in healthy conscious dogs.

OBJECTIVE: To evaluate the hemodynamic effects of orally administered carvedilol in healthy dogs with doses that might be used to initiate treatment in dogs with congestive heart failure. ANIMALS: 24 healthy dogs. PROCEDURE: Dogs were randomly allocated to receive carvedilol PO at a dose of 1.56, 3.125, or 12.5 mg, twice daily for 7 to 10 days; 6 dogs served as controls. Investigators were blinded to group assignment. Hemodynamic variables were recorded prior to administration of the drug on day 1 and then 2, 4, and 6 hours after the morning dose on day 1 and days 7 to 10. Change in heart rate after IV administration of 1microg of isoproterenol/kg and change in systemic arterial blood pressure after IV administration of 8 microg of phenylephrine/kg were recorded 2 and 6 hours after administration of carvedilol. RESULTS: Administration of carvedilol did not significantly affect resting hemodynamic variables or response to phenylephrine. The interaction of day and carvedilol dose had a significant effect on resting heart rate, but a significant main effect of carvedilol dose on resting heart rate was not detected. Increasing carvedilol dose resulted in a significant linear decrease in heart rate response to isoproterenol. CONCLUSIONS AND CLINICAL RELEVANCE: In healthy conscious dogs, orally administered carvedilol at mean doses from 0.08 to 0.54 mg/kg given twice daily did not affect resting hemodynamics. Over the dose range evaluated, there was a dose-dependent attenuation of the response to isoproterenol, which provided evidence of beta-adrenergic receptor antagonism.

Balloon valvuloplasty for palliative treatment of tricuspid stenosis with right-to-left atrial-level shunting in a dog.

A 3.75-year-old castrated male Chesapeake Bay Retriever was referred for evaluation of tachypnea, exercise intolerance, and cyanosis. Echocardiographically, there was severe tricuspid stenosis and right-to-left atrial-level shunting of blood. Marked compensatory polycythemia had developed; the PCV was 75%. Balloon dilation of the tricuspid stenosis was performed. Subsequent echocardiographic examinations demonstrated a reduction in the pressure gradient across the tricuspid valve. The PCV returned to the reference range, and the dog's clinical status improved during the 12 months after the procedure. Tricuspid stenosis is an uncommon lesion in dogs and, in the dog of this report, was assumed to have resulted from tricuspid dysplasia. Cyanosis was a result of right-to-left shunting of blood. Limited treatment is available for dogs with cyanotic heart disease. In this dog, balloon dilation of the stenotic tricuspid valve was palliative.