Symmetric dimethylarginine in dogs with myxomatous mitral valve disease at various stages of disease severity

Abstract

Symmetric dimethylarginine (SDMA) is a serum biomarker of renal damage in dogs. Moreover, SDMA concentration is an independent predictor of development of severe heart failure (HF) in humans with cardiac disease. This study evaluates whether the serum concentration of SDMA in dogs with myxomatous mitral valve disease (MMVD) is influenced by the severity of heart disease, pulmonary hypertension (PH) and treatment of HF. A total of 99 client-owned dogs were included in this retrospective case-control study; 78 dogs were affected by MMVD and classified according to the American College of Veterinary Internal Medicine (ACVIM) guidelines, and 21 were healthy controls. For each dog, history, physical examination, complete blood count, biochemical profile, thoracic radiography, 6-lead standard electrocardiogram and trans-thoracic echocardiography were available. Comparisons were performed between groups of dogs belonging to different ACVIM stages and between dogs with and without PH. The median SDMA concentration was neither significantly different among groups of dogs in different disease stages (overall P = 0.010), nor among dogs with MMVD, nor between those with [14.5 μg/dl (10.5-18.8)] and without PH [13 μg/dl (9-17.2)] (P = 0.295). The concentration of SDMA did not differ between dogs when considering the combined effect of the ACVIM group and cardiac treatment (overall P = 0.486). Furthermore, no correlation was found between SDMA concentration and radiographic and echocardiographic parameters associated with increased MMVD severity. In conclusion, this study failed to demonstrate the presence of renal impairment in dogs with MMVD, and the increase in renal parameters in some dogs in the more advanced stage of MMVD could be attributed to pre-renal azotemia.

Plasmatic Dimethylarginines in Dogs With Myxomatous Mitral Valve Disease

“…This finding confirms the results of a previous prospective study in which SDMA was correlated with cardiac disease severity and with echocardiographic parameters of left atrio-ventricular dilation ( 14 ). Conversely, two other retrospective studies failed to demonstrate a correlation between SDMA and MMVD progression ( 36 , 37 ). The discrepancy between our study and these latter studies can be explained by differences in study design and laboratory analytical method used to determine SDMA.…”

“…In the study of Savarese et al no therapies effect has been shown ( 36 ), whereas in the other study increasing doses of furosemide seemed to be associated with an increase of SDMA concentrations. However, the combined analysis of therapy effect with MMVD ACVIM stage did not show any significant result ( 37 ). Cardiovascular therapy effect on SDMA in dogs with MMVD is still unclear and, so far, it is not possible to discriminate if the variation of SDMA concentrations is more influenced by cardiovascular drugs effect on glomerular filtration rate, or by the cardiac disease itself.…”

“…The discrepancy between our study and these latter studies can be explained by differences in study design and laboratory analytical method used to determine SDMA. Our study had a prospective design and we used high-performance liquid chromatography coupled with tandem mass spectrometry, considered a reliable diagnostic tool for measuring DMAs ( 38 ), whereas SDMA concentrations were measured through high-throughput immunoassay in previous studies ( 36 , 37 ). Symmetric dimethylarginine was also positively correlated with laboratory (i.e., NT-proBNP) and echocardiographic (i.e., LA/Ao and lateral and septal MV E/E ' ) indices of cardiac wall stress, remodeling, and dysfunction.…”

“…In dogs, diuretic therapy has been shown to impair renal function, leading to an increase of renal parameters. Two studies obtained contrasting results regarding the effect of therapies on SDMA concentrations in dogs with MMVD ( 36 , 37 ). In the study of Savarese et al no therapies effect has been shown ( 36 ), whereas in the other study increasing doses of furosemide seemed to be associated with an increase of SDMA concentrations.…”

Clinical and Echocardiographic Findings in an Aged Population of Cavalier King Charles Spaniels

“…Pulmonary arterial pressure was estimated solely by measuring the TR velocity. Pulmonary hypertension was assessed using three different cut-offs: ≥2.8 m/s [ 26 , 27 ], >3 m/s [ 10 , 28 ], and >3.4 m/s [ 29 ].…”