RESUMOFelino de 3,3kg, fêmea, oito anos de idade, castrada, sem definição racial, foi atendida no Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo (HOVET-USP), com histórico de dispneia, prostração, hiporexia e consequente emagrecimento progressivo, havia uma semana. Foram realizados exames de sangue: hemograma com contagem de plaquetas, função renal, função hepática e dosagens séricas de sódio e potássio, eletrocardiograma (ECG), radiografia torácica, ecoDopplercardiograma, e os resultados dos exames indicaram diagnóstico presuntivo de cardiomiopatia arritmogênica do ventrículo direito. O diagnóstico foi confirmado pela necropsia e pela constatação da presença de tecido fibroadiposo no miocárdio no exame histopatológico, possibilitando, assim, o relato do primeiro caso de cardiomiopatia arritmogênica do ventrículo direito, em gato, no Brasil. Palavras-chave: gato, dispneia, histopatológico ABSTRACT A female 3.3kg feline, eight years-old, spayed, without racial definition, was submitted to the Veterinary Hospital of the School of Veterinary Medicine and Animal Science, São Paulo University (HOVET-USP
Background: Chronic mitral valve regurgitation is the most common heart disease in dogs. It is caused by myxomatous mitral valve degeneration, an acquired degenerative disease that can lead to congestive heart failure. Pimobendan is a mixed action drug, with inotropic and vasodilator proprieties, widely used to treat such dogs. Amlodipine is a pure vasodilator drug used as an anti-hypertensive agent, with no inotropic effects. This study aimed to compare echocardiographic, electrocardiographic and blood pressure parameters between dogs with congestive heart failure treated with pimobendan and those treated with amlodipine in addition to conventional therapy.Materials, Methods & Results: A prospective, randomized, double-blind study was conducted in dogs with stage C chronic mitral valve regurgitation according to the 2009 American College of Veterinary Internal Medicine (ACVIM) guidelines, who weighed up to 15 kg. Randomization was performed using appropriate software and the sealed envelope technique. Blinding of the owner, the main researcher, and the person who performed the clinical analysis was guaranteed by the use of identical capsules and bottles for both pimobendan and amlodipine. Statistical analysis was performed using specialized software. Eligibility was determined by predefined inclusion and exclusion criteria. Dogs with cardiac disease other than mitral and/or tricuspid degeneration, patients already undergoing pharmacological treatment with drugs other than enalapril and furosemide, patients with systolic blood pressure below 100 mmHg, patients with chronic kidney disease in stages III or IV according to International Renal Interest Society staging system for chronic kidney disease (2009), and patients with other systemic debilitating diseases were excluded from the study. The animals were randomized into two groups based on the drug they received. Group A received pimobendan (n = 10) and group B received amlodipine (n = 11). All animals were also treated with furosemide and enalapril maleate and evaluated three times over a period of sixty days (T0, T30, T60). Changes in echodopplercardiographic and electrocardiographic parameters and systolic blood pressure were investigated. There were no significant differences in electrocardiographic parameters or systolic blood pressure between the groups at any time. Among the echocardiographic parameters, only early diastolic myocardial peak velocity (Em) and late diastolic myocardial peak velocity (Am) showed a significant difference between groups.Discussion: This was the first prospective randomized double-blind study comparing pimobendan and amlodipine in the treatment of dogs with stage C chronic mitral valve regurgitation according to the ACVIM consensus statement. The use of pimobendan in these patients has been debated because myocardial inotropism is generally preserved in them. Some authors argue that early use of the drug can even lead to deleterious effects on the heart. In the present study, the groups showed no statistically significant differences in systolic blood pressure or electrocardiographic parameters. Among the echocardiographic parameters, statistically significant differences were only observed in the speed of Em waves between groups at T0, in the speed of Em waves in the amlodipine group between T0 and T60 times, and in the speed of Am waves in the amlodipine group between T30 and T60 times. Both parameters are indices of diastolic function and may indicate a change in early myocardial relaxation. From the findings of this study, we could not conclude whether one drug was superior to the other.
RESUMOA cardiomiopatia arritmogênica do ventrículo direito (CAVD) é uma importante causa de morte súbita em cães da raça Boxer. A validação de fatores prognósticos para essa doença auxiliaria na detecção de animais mais gravemente afetados e sua exclusão dos programas de reprodução. O objetivo deste estudo foi avaliar o valor prognóstico da presença de manifestações clínicas, dos índices de variabilidade de frequência cardíaca (VFC) e das arritmias supraventriculares ou ventriculares registradas à monitorização eletrocardiográfica com Holter na sobrevida de cães Boxer em diferentes estágios da CAVD. Essas variáveis foram analisadas, de forma prospectiva, em 69 cães Boxer, divididos em cinco grupos: cães Boxer controle (grupo CB, <50 VPC/24 horas, n=28), cães Boxer suspeitos (grupo SB, 50 a 300 VPC/24 horas, n=8), cães Boxer com CAVD (grupo ARVC, >300 VPC/24 horas, n=19), cães Boxer com CAVD e disfunção sistólica sem insuficiência cardíaca congestiva (grupo SDB sem ICC, n=6) e com ICC (grupo SDB com ICC, n=8). A análise estatística compreendeu teste ANOVA, correlação de Pearson e análise de riscos proporcionais de Cox. Comparando-se com o grupo CB, não foi encontrada diminuição nos índices de VFC nos grupos SB, ARVC ou SDB sem ICC; por outro lado, o grupo SDB com ICC apresentou diminuição desses índices. Não houve relação entre os índices de VFC e a morte de origem cardíaca; porém, a presença de síncopes com ou sem sinais clínicos de ICC e o número de episódios de taquicardia ventricular (TV) correlacionaram-se com a sobrevida dos animais. Estes resultados permitem concluir que a presença de sinais clínicos de ICC, a presença de síncopes e o número de TV ao Holter apresentam valor prognóstico de sobrevida em cães Boxer com CAVD.Palavras-chave: cães Boxer, cardiomiopatia arritmogênica, sistema nervoso autônomo, taquicardia ventricular ABSTRACT Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an important cause of sudden death in Boxer dogs. Validation of prognostic factors for this disease could help in detecting more
In humans, left atrial enlargement and reduced contractile functions are associated with adverse cardiovascular events and a poor prognosis in many dilatation of the left atrium occurs with the gradual evolution of chronic mitral valve disease and is well diseases. The left atrium is the most compromised cardiac chamber in dogs with chronic mitral valve disease (CMVD). Therefore, this study aimed to compare the main parameters of left atrial enlargement (left atrium/aorta ratio, left atrial diameter and volume indices) and contractile function (transmitral flow peak velocity A wave and time velocity integral, atrial fraction, and atrial ejection force) at different stages of valve disease, and correlate the left atrial diameter, volume, and contractile function indices with echocardiographic variables predictive of heart failure in dogs (transmitral flow peak velocity E wave, E wave/IVRT ratio, E wave/E´wave ratio, and E wave/A wave ratio). The results showed that progressive characterized by the left atrium/aorta ratio and left atrium volume index. The left atrial diameter and volume indices and left atrium/aorta ratio correlated positively with the transmitral flow peak velocity E wave and E wave/IVRT ratio, which are important indices of diastolic function. The left atrial contractile function indices increased as CMVD evolved. Except for the atrial fraction, the left atrial contractile function indices correlated with the left ventricular filling pressure indices.
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