The relationship between the diameter of the left atrium (LA) and aorta (Ao) is considered as a prognostic factor in chronic mitral valve disease. As the left atrium is a three-dimensional structure, methods based on measurement of the chamber volume can be more accurate than linear methods.The aim of this study was to assess the feasibility of measuring LA volume with 2D echocardiography using the biplane modified Simpson (SIMP) method in 33 dogs with various classes of myxomatous mitral valve disease (MMVD), as well as to present values of LA function using the atrial diastolic and systolic volume indices (ADVI and ASVI), cardiac index (ACI) and atrial ejection fraction (AEF). We observed agreement among the LA/Ao ratio and the atrial volume indices (ADVI and ASVI) and the ACI, suggesting that the values of the variables increase as the LA/Ao ratio increases due to atrial remodeling that accompanies MMVD progression. The data demonstrated a good assessment of atrial function, allowing a better understanding of LA's role in the pathophysiology of MMVD.
RESUMO O desenvolvimento de novas ferramentas, como a ecocardiografia bidimensional feature tracking (2D-FTI), permite diagnosticar, de forma precoce, se há disfunção miocárdica em doenças cardíacas, inclusive as congênitas. O defeito septal ventricular (DSV) é a alteração congênita mais observada em felinos, no entanto pouco se sabe sobre a disfunção cardíaca nessa cardiopatia, especialmente em animais assintomáticos. O objetivo deste estudo foi avaliar, por meio do 2D-FTI, a deformação miocárdica ventricular esquerda pela mensuração dos índices ecocardiográficos strain (St) e strain rate (StR) radial, circunferencial e longitudinal, em gatos saudáveis e com DSV. Foram avaliados 12 gatos saudáveis e seis gatos com DSV para obtenção de St e StR em diversos segmentos miocárdicos. No sentido longitudinal, houve diferença estatística (P<0,05) para os segmentos septal basal, mediano e apical epicárdicos (P=0,0017; P<0,0001; P=0,0288), lateral mediano epicárdico (P=0,0327), septal mediano endocárdico (P=0,0035), lateral mediano endocárdico (P=0,0461), St epicárdico (P=0,0250) e St global (P=0,0382). Também houve diferença no segmento lateral mediano circunferencial endocárdico (P=0,0248), lateral mediano radial (St: P=0,0409; StR: P=0,0166) e posterior mediano radial (P=0,0369). O estudo evidenciou que, mesmo em animais assintomáticos com DSV, há redução na deformação miocárdica ventricular principalmente no sentido longitudinal, demonstrando maior vulnerabilidade dessas fibras.
Background: The multiple myeloma is a neoplasia characterized by the uncontrolled proliferation of plasma cells (plasmacytes) in the bone marrow and in other tissues. The infiltration of the neoplasia cells associated to the high level of anomalous immunoglobulin production (M protein) results in a variety of clinic-pathologic anomalies. It is a rare disease in dogs, corresponding to 0.3% of all malignant neoplasia and 2% of the hematopoietic, with few literature descriptions. So, the present paper aims at properly report a multiple myeloma in a dog of non-defined breed, emphasizing the clinic, laboratorial, radiographic and pathologic aspects.Case: In a Veterinary Teaching Hospital, an 11-year-old dog of non-defined breed was admitted, weighing 10.8 kg of body mass. The clinic history was claudication of the right thoracic member, hyporexia and lethargy in the past 20 days. The main abnormalities in the physical examination were holosystolic cardiac murmur III/VI on mitral focus, and high sensibility to touch in the right humerus. Laboratory tests showed pancytopenia, serum hypercalcemia and Bence-Jones proteinuria. Radiographic examination confirmed polyostotic punctate osteolysis on the right humerus; pelvic, femurs and vertebrae bones from L2 to L7, on generalized condition. Cytology by aspiration puncture from the left femur marrow bone did not confirm neoplasia cells. The clinic condition of the referred animal was progressively getting worse and euthanasia was performed. At the dog’s necropsy it was spotted tumor infiltrations on the femur, the humerus and the vertebrae canal. Histopathological exam of the bone marrow revealed diffuse occupation by distinguished plasmacytes, in some áreas reaching around 100% of cell population. Metastases on the primary tumor were found on the liver, kidney and spleen.Discussion: The diagnosis of multiple myeloma in this dog was confirmed by bone marrow histopathological exam. It is confirmed when there is more than 20% of plasmacytes in the examined structure. In this report, certain areas were spotted with 100% occupation of neoplasia cells. On the other hand, the first cytological assess did not reveal any abnormalities, suggesting that the place which received the puncture (aspiration) was not infiltrated by tumor cells. It is described that in the bone marrow may occur grouping of plasmacytes, as it was observed the animal’s necropsy of this report. This aspect point out that the diagnosis cannot be discarded only with a negative cytological exam from the bone marrow; especially if there are clinic, laboratorial and radiographic signs compatible to the illness. The spotted clinic signs by this patient are frequent in dogs with multiple myeloma, as well as the laboratory results, except to the monoclonal gammopathy. Due to a no realization of electrophoresis, this abnormality cannot be confirmed. At the initial assessment of the disease, the radiographic exam is considered golden standard as it was observed in this dog. The radiographic abnormalities were determinant, once they conducted the diagnosis towards the suspected neoplasia. According to current diagnosis criteria, on this present case, the pancytopenia, serum hypercalcemia and Bence-Jones proteinuria also helped towards the suspicion of multiple myeloma. However, the evaluation of the bone marrow was decisive to the final diagnosis; and a special attention was given to puncture more than one place in the bone marrow, which improved/enhanced the diagnosis possibility in this patient.Keywords: plasma cells, bone marrow, pancytopenia, osteolysis, radiography.
A presente revisão tem por objetivo aprimorar o conhecimento sobre Dilated Cardiomyopathy (DCM) em cães, visando à compreensão dos aspectos clínicos, diagnóstico e tratamento. A DCM é caracterizada por dilatação ventricular, disfunção sistólica e arritmias que podem culminar em insuficiência cardíaca e morte. É a segunda cardiopatia mais frequente em cães, acometendo principalmente animais de grande porte e machos. A etiologia é idiopática, mas alguns genes associados à doença já foram identificados. A manifestação clínica é dividida basicamente em estágios oculto e sintomático. O estágio oculto é caracterizado pela presença de alterações elétricas e/ou morfológicas e ausência de sinais clínicos. Os cães podem apresentar o estágio oculto longo até o desenvolvimento de insuficiência cardíaca de forma aguda ou morte súbita. O estágio sintomático é definido pela presença de insuficiência cardíaca esquerda ou biventricular. O diagnóstico somente é confirmado por meio de ecocardiograma e/ou Holter. Estes exames são considerados padrão-ouro, uma vez que apresentam alta sensibilidade na identificação precoce da doença. Cães de raças predispostas devem ser monitorados anualmente a partir dos três anos de idade. O tratamento tem o intuito de minimizar os efeitos da insuficiência cardíaca, sendo instituído de acordo com a fase em que o animal se encontra. O prognóstico após início dos sinais clínicos é desfavorável. Alguns fatores podem influenciar a sobrevida de forma positiva ou negativa. A realização de exames periódicos é de grande importância para obter o diagnóstico precoce e intervir de maneira a retardar a progressão da doença.
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