Assessment of plasma lactate and core‐peripheral temperature gradient in association with stages of naturally occurring myxomatous mitral valve disease in dogs

Abstract

Objective -To evaluate plasma lactate concentrations and core-peripheral temperature gradients as perfusion parameters in dogs with heart failure caused by myxomatous mitral valve disease (MMVD) and to determine whether the above perfusion parameters are correlated with disease stages. Design -Prospective observational study. Setting -University teaching hospital. Animals -After excluding 129 dogs because of exclusion criteria, 7 dogs with heart failure classified as stage B2 and 10 dogs classified as stage C according to the American Heart Association (AHA)/American College of Cardiology (ACC) were included in the study. Six dogs without MMVD were evaluated as the control group. Interventions-None. Measurements and Main Results -Among the evaluated parameters, the plasma lactate concentrations were increased in stage C (median 3.70 mmol/L [33.3 mg/dL], interquartile range (IQR) 0.72 mmol/L [6.5 mg/dL]) compared with those in the control (median 2.80 mmol/L [25.2 mg/dL], IQR 0.8 mmol/L [7.2 mg/dL]; P = 0.024) and stage B2 groups (median 2.70 mmol/L [24.3 mg/dL], IQR 1.8 mmol/L [16.2 mg/dL]; P = 0.045). Significant differences were not observed in the core-peripheral temperature gradients among the control, stage B2, and stage C dogs. Conclusions -Dogs with structural heart disease as a result of MMVD may have occult tissue hypoperfusion in stage C that is demonstrated by hyperlactatemia. (J Vet Emerg Crit Care 2018; 28(6): 532-540) Abbreviations BP blood pressure HF heart failure HR heart rate IQR interquartile range LA left atrium From the Veterinary

Temporal changes in clinical and radiographic variables in dogs with preclinical myxomatous mitral valve disease: The EPIC study

“…Body weight and RT both decreased over time as dogs progressed into CHF. The decrease in RT is likely to be a consequence of impaired peripheral perfusion . The decrease in BW may be a consequence of the loss of skeletal muscle mass, but we did not record body condition or muscle condition scores at each visit and therefore cannot be sure of this conclusion.…”

Advances in the diagnosis of acute pancreatitis in dogs

“…Increased Spec cPL (Texas A&M University, Gastrointestinal Laboratory) concentrations have been reported in dogs with myxomatous mitral valve disease (MMVD) 85 . In 42 dogs with congestive heart failure (CHF), Spec cPL (Texas A&M University, Gastrointestinal Laboratory) concentrations were correlated with severity of heart failure and given that CHF is associated with occult tissue hypoperfusion, we suspect that this correlation may reflect subclinical secondary pancreatic injury in CHF 85,86 . Alternatively, the increased pancreatic lipase concentrations may be secondary to pancreatic edema in the absence of inflammation, which recently was reported in a pilot study of dogs with portal hypertension 87 .…”

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“…The two possible explanations for reducing the ability to perform peripheral vasoconstriction were the age of these animals or the use of the pimobendan vasodilator drug. Feger & Braune (2005) corroborated these data by reporting that the advancing age directly influences sympathetic responsiveness in humans, with a reduction in the physiological temperature gradient in elderly patients (Feger & Braune 2005, Lima et al 2009, Soares et al 2018.…”

“…Finally, studies showed that a detailed physical examination assists in identifying changes in peripheral perfusion parameters that faithfully reflect the imminent risk of acute circulatory failure. Soares et al (2018) demonstrated that patients with chronic stage C mitral valve disease had increased lactate values even if stable macro-hemodynamically, but with normalized temperature gradients, while animals in stage B2 had altered center-peripheral deltas. The two possible explanations for reducing the ability to perform peripheral vasoconstriction were the age of these animals or the use of the pimobendan vasodilator drug.…”