Guidelines for the Diagnosis and Treatment of Canine Chronic Valvular Heart Disease

BackgroundEvaluation of myocardial function is clinically challenging in dogs with degenerative mitral valve disease (DMVD). Although myocardial dysfunction is caused by pathologic degeneration, histopathologic progression is poorly understood.ObjectivesTo characterize myocardial and pulmonary pathologic changes according to severity in dogs with naturally occurring DMVD, and to investigate whether or not pathologic degeneration is reflected by traditional clinical indices.AnimalsOne hundred and seventeen dogs with naturally occurring DMVD.MethodsProspective observational study. Biopsied left atrium (LA), left ventricle (LV), and lung were evaluated histologically, and an attempt was made to correlate pathologic findings with clinical indices.ResultsSevere myocardial changes were observed in all International Small Animal Cardiac Health Council classes. In the lung, heart failure cell levels were significantly increased in class III patients (P < .0001). In a paired comparison, the LA showed significantly more severe degeneration than the LV, including myocardial fatty replacement, immune cell infiltration, and interstitial fibrosis (P < .0001). In contrast, myocardial cells were more hypertrophied in the LV than in the LA (P < .0001). Left ventricular end‐diastolic dimension (LVEDd) was associated with fatty replacement (P = .033, R 2 = 0.584) and myocardial vacuolization (P = .003, R 2 = 0.588) in the LA.Conclusions and Clinical ImportanceIn DMVD, although severe pathologic changes may be evident even in early stages, there may be pathologic discrepancy between the LA and the LV. Myocardial degeneration may be reflected by clinical indices such as LVEDd and EF.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pathologic Manifestations on Surgical Biopsy and Their Correlation with Clinical Indices in Dogs with Degenerative Mitral Valve Disease

Lee

Mizuno

et al. 2015

“…In each dog, based on clinical signs, echocardiographic examinations, and thoracic radiography, CVHD was classified as Stage B1, B2, C, or D according to the American College of Veterinary Internal Medicine (ACVIM) consensus statement 17. Stage B1 included dogs without clinical signs of CVHD and echocardiographic evidence of cardiomegaly (ie, LA/Ao < 1.6 and LVEDDN < 1.85) 14, 15, 17, 18.…”

Section: Methodsmentioning

confidence: 99%

Vitamin D Status in Different Stages of Disease Severity in Dogs with Chronic Valvular Heart Disease

Osuga

Nakamura

Morita

et al. 2015

BackgroundIn humans with heart disease, vitamin D deficiency is associated with disease progression and a poor prognosis. A recent study showed that serum 25‐hydroxyvitamin D [25(OH)D] concentration, the hallmark of vitamin D status, was lower in dogs with heart failure than in normal dogs, and a low concentration was associated with poor outcome in dogs with heart failure.ObjectivesTo elucidate the vitamin D status of dogs with chronic valvular heart disease (CVHD) at different stages of disease severity.AnimalsForty‐three client‐owned dogs with CVHD.MethodsIn this cross‐sectional study, dogs were divided into 3 groups (14 dogs in Stage B1, 17 dogs in Stage B2, and 12 dogs in Stage C/D) according to ACVIM guidelines. Dogs underwent clinical examination including echocardiography. Serum 25(OH)D concentrations were measured in each dog.ResultsSerum 25(OH)D concentration was significantly lower in Stage B2 (median, 33.2 nmol/L; range, 4.9–171.7 nmol/L) and C/D (13.1 nmol/L; 4.9–58.1 nmol/L) than in Stage B1 (52.5 nmol/L; 33.5–178.0 nmol/L) and was not significantly different between Stage B2 and Stage C/D. Among clinical variables, there were significant negative correlations between 25(OH)D concentration and both left atrial‐to‐aortic root ratio and left ventricular end‐diastolic diameter normalized for body weight.Conclusions and Clinical ImportanceThese results indicate that vitamin D status is associated with the degree of cardiac remodeling, and the serum 25(OH)D concentration begins to decrease before the onset of heart failure in dogs with CVHD.

“…Accordingly, each dog was classified into 1 of 4 clinical cohorts (Fig 1, Table 1): group 1—asymptomatic, healthy dogs without HD; group 2—asymptomatic, healthy dogs with HD but not CHF; group 3—dogs with respiratory distress attributable to respiratory disease; group 4—dogs with respiratory distress from pulmonary edema and CHF. HD severity was graded using ISACHC18 and ACVIM‐HD19, 26 schemes. Briefly, these schemes were characterized as follows: The ISACHC cardiac disease grading system specified: class IA—subclinical HD disease without radiographic or echocardiographic evidence of cardiac enlargement; class IB—subclinical HD with radiographic or echocardiographic evidence of cardiac enlargement; class II—mild signs of CHF (eg, increased respiratory rate and effort, exercise intolerance) because of cardiogenic pulmonary edema, and associated with cardiomegaly; class IIIA—severe, overt signs of CHF that could be treated on an outpatient basis; class IIIB—severe signs of CHF requiring hospitalization.…”

Section: Methodsmentioning

confidence: 99%

Relationship of Plasma N‐terminal Pro‐brain Natriuretic Peptide Concentrations to Heart Failure Classification and Cause of Respiratory Distress in Dogs Using a 2nd Generation ELISA Assay

Fox

Oyama

Hezzell

et al. 2014

BackgroundCardiac biomarkers provide objective data that augments clinical assessment of heart disease (HD).Hypothesis/ObjectivesDetermine the utility of plasma N‐terminal pro‐brain natriuretic peptide concentration [NT‐proBNP] measured by a 2nd generation canine ELISA assay to discriminate cardiac from noncardiac respiratory distress and evaluate HD severity.AnimalsClient‐owned dogs (n = 291).MethodsMulticenter, cross‐sectional, prospective investigation. Medical history, physical examination, echocardiography, and thoracic radiography classified 113 asymptomatic dogs (group 1, n = 39 without HD; group 2, n = 74 with HD), and 178 with respiratory distress (group 3, n = 104 respiratory disease, either with or without concurrent HD; group 4, n = 74 with congestive heart failure [CHF]). HD severity was graded using International Small Animal Cardiac Health Council (ISACHC) and ACVIM Consensus (ACVIM‐HD) schemes without knowledge of [NT‐proBNP] results. Receiver‐operating characteristic curve analysis assessed the capacity of [NT‐proBNP] to discriminate between dogs with cardiac and noncardiac respiratory distress. Multivariate general linear models containing key clinical variables tested associations between [NT‐proBNP] and HD severity.ResultsPlasma [NT‐proBNP] (median; IQR) was higher in CHF dogs (5,110; 2,769–8,466 pmol/L) compared to those with noncardiac respiratory distress (1,287; 672–2,704 pmol/L; P < .0001). A cut‐off >2,447 pmol/L discriminated CHF from noncardiac respiratory distress (81.1% sensitivity; 73.1% specificity; area under curve, 0.84). A multivariate model comprising left atrial to aortic ratio, heart rate, left ventricular diameter, end‐systole, and ACVIM‐HD scheme most accurately associated average plasma [NT‐proBNP] with HD severity.Conclusions and Clinical ImportancePlasma [NT‐proBNP] was useful for discriminating CHF from noncardiac respiratory distress. Average plasma [NT‐BNP] increased significantly as a function of HD severity using the ACVIM‐HD classification scheme.