CARDIOMIOPATIA DILATADA CANINA. SEDICAR VET 9. Ecocardiografía, cardiomiopatía dilatada canina, Dilated Cardiomyopathy. #ecocardiograf. CARDIOMIOPATIA DILATADA EM CÃO DA RAÇA BOXER DE 8 MESES DE . LOBO, L. L.; PEREIRA, R. Cardiomiopatia dilatada canina. Revista portuguesa. Los pacientes con cardiopatía chagásica crónica, eran más viejos (55±10 años) que los pacientes La enfermedad de Chagas causa la miocardiopatía dilatada específica más común. .. cos (perros/gatos) identificados como reservorios de.
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Survival and echocardiographic evaluation of dogs with idiopathic dilated cardiomyopathy treated with carvedilol. Soares I ; G. Pereira II ; L. Petrus I ; M. Yamaki I ; M. Sixty dogs with idiopathic dilated cardiomyopathy were randomly treated with traditional therapy – digitalis, diuretics, angiotensin-converting inhibitors – group A or treated with these drugs plus carvedilol group B. Echocardiographic variables were measured before and after 3, 13, 26, and 52 weeks of treatment or until death.
Comparisons between groups and time were performed. No significant differences between groups were found in the most of the echocardiographic variables.
The left ventricular end-systolic diameter indexed to body surface area LVESDi dilatadaa significantly in the group A dogs compared to the group B animals. In conclusion, the stability of the LVESDi observed in the group treated with carvedilol may represent the beneficial effect over the ventricular remodeling.
Dilated cardiomyopathy DCM is the second most common cause of cardiac morbidity and mortality in dogs, mainly among large and giant breeds. The definitive diagnosis is cardiomiopxtia by echocardiography, in which cardiac chamber dilation and systolic dysfunction are observed.
In the last decade, many cardiomuopatia have shown that the diastolic function, as well as systolic, has a very important role in the progression of the disease. Even though the systolic function is the most known determinant of DCM clinical outcome, many human patients with severe contractility impairment show only mild symptoms Werner et al. Some authors Vanoverscheld et al. The transmitral flow TMF pattern, usually used to assess the diastolic function, is frequently abnormal in DCM and the “restrictive” pattern is correlated to severe disease and is a strong indicator of mortality Pinamonti et al.
On the other hand, some studies point to systolic function, represented mainly by ejection and shortening fraction, as important predictor of mortality MacMahon et al.
The classical therapy of DCM is based on diuretics, angiotensin-converting enzyme ACE inhibitors, and positive inotropes.
Data have shown the beneficial action of carvedilol on systolic Chizzola et al. Moreover, favorable effects on survival and symptoms were described by many authors Packer et al. This study aimed to evaluate the effects of carvedilol on systolic and diastolic functional parameters, ventricular remodeling, and survival in dogs with idiopathic dilated cardiomyopathy. The study groups consisted of 60 dogs presented to the cardiology service at the Veterinary Teaching Hospital due to presence of clinical manifestations related to cardiac disorder or just for screening.
Exclusion criteria were other diseases that could affect the cardiovascular system, mainly renal and endocrine disorders, as well as severe arrhythmias in which antiarrhythmic therapy was primordial.
Previous or current dilatasa with diuretics was allowed. After idiopathic DCM was diagnosed, each dog was randomly assigned to receive one of the two treatment protocols.
Diuretics were used in cases of congestive heart failure documented by thoracic radiography. Every dog was submitted to physical examination, blood pressure measurement, complete blood count CBC and biochemical profile, ECG, thoracic radiographs, and echocardiography before T 0 and after three T 113 T 226 T 3 and 52 T 4 weeks of therapy or until death.
CARDIOMIOPATIA DILATADA CANINA. SEDICAR VET 9.
The dogs were randomized to receive either protocol A or B, in alternating fashion. So, the first dog enrolled received the protocol A, the second received the protocol B, and so on. The first investigator ECS was blinded to the protocol administered to each dog.
Cardiopulmonary auscultation was performed on all dogs. Abdominal palpation, evaluation of the canima status by skin elasticity, mucous membranes coloration, and femoral pulse were performed as well.
The systolic blood pressure was recorded by Doppler sphygmomanometry. Three measurements were recorded and czrdiomiopatia average was considered. Unipolar, bipolar, and chest leads were recorded, which provided information about rhythm disturbances, screening for ventricular and supraventricular premature beats, atrial fibrillation, and ventricular or supraventricular tachycardia. Lateral and dorsoventral thoracic radiographs cardiomiopatla performed in order to look for cardiomegaly, pulmonary edema, and pleural effusion.
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The Doppler studies were done from the left apical four-chamber view and included evaluation of transmitral flow TMF. The studied TMF variables were: E-wave peak velocity E max and E wave deceleration time E dect.
From five-chamber view, the left ventricle outflow and mitral inflow profile were recorded at the same time, so the isovolumetric relaxation time IVRT could be measured. The recording of the aortic cardiomiopafia allowed the measurement of the stroke volume SVas well as the left ventricular ejection time LVET. The stroke volume di,atada indexed to the body surface area SVi and the left ventricular ejection time was corrected to the heart rate, resulting in the left ventricular ejection time index LVETi as follows: Data obtained from M-mode measurement and Doppler studies allowed calculation of the velocity of circumferencial shortening VCF as: This variable was corrected to canuna heart rate: Age, blood pressure, and heart rate homogeneity between the groups at baseline were evaluated by t-student test.
The distribution of Dobermans and Boxers in each group was compared by means of chi-square test.
The same method was used to compare the incidence of atrial fibrillation, the severity of heart failure and gender of the dogs of groups A and B. When the values were less than 5, the exact Fisher test was used Armitage and Berry, Echocardiographic variables differences were studied considering groups and time.
So, group and time effect, as well as the interaction between group and time were evaluated. When the interaction was considered statistically insignificant, group effect for every time points and time effect for both groups were tested. When the interaction was significant, comparisons between groups were done separately for each time point and the time effect cafdiomiopatia tested individually for each group.
P value less than 0. Survival curves were obtained by the Kaplan-Meier method.
Survival time was counted from the day of diagnosis of DCM to the day of death. The Log-Rank test was applied in order to compare both survival curves Armitage cardjomiopatia Berry, Sixty dogs were enrolled in the study. From the remaining 45 dogs 25 group A, 20 group B32 were males and 13 females, averaging ranging from 2 to year-old, and included several breeds: Three were mongrel dogs.
Baseline characteristics including gender, age, blood pressure, heart rate, severity of heart failure, and presence of atrial xilatada are shown on the Table 1.
No statistical differences between groups A and B were observed with regards to these variables. During the first evaluation T 0pleural effusion was detected in the thoracic radiographs cardiomiopafia five dogs of group Canna and in six dogs of group B; pulmonary edema was seen in seven cases of group A and in five of group B animals, while both pleural effusion and pulmonary edema were demonstrated by thoracic radiographies of two dogs of group A and one dog of group B.
All dogs had cardiomegaly. Concerning the results of electrocardiograms performed before initiating the treatment T 0four cases in group A dogs had isolated ventricular premature complexes VPC and the same happened in eight dogs of group B. Atrial premature complexes APC were seen dilatads the electrocardiogram of two dogs included in group A. Some dogs died during the follow-up period. So, the distribution at each time point was: Due to the few number of observations in the last time point, that could compromise the statistical analysis, T 4 was excluded.
In spite of this, the study of these allowed to notice variations over time regardless the group. So, regarding the variable LVEDDi, a statistically significant difference was not found between groups A and B at any one of the time points, but it increased along the time when both groups were considered together.
Significance levels related to the study of these variables – along the time and independently of group – are described in the Table 4. The fact that the group of dogs not treated with carvedilol showed increase in the LVESDi over the time, while the same did not happen in the group treated with carvedilol can be interpreted as an attenuattion effect of this drug on ventricular remodeling.
Many authors have described the benefits of carvedilol on ventricular function and remodeling in human patients with ischemic and non-ischemic cardiomyopathy. Nevertheless, the authors did not observe changes in ventricular diameter. On the other hand, a rise of the systolic and diastolic ventricular volume was related by Quaife et al. Recently, Oyama et al. Concerning about the action of the drug on the diastolic function, Palazzuolli et al.
The lack of statistical significant differences in the other echocardiographic variables between groups A and B can be explained by the small number of dogs, mainly at the last time point studied. Due to such a small study population the standard deviation had a broad range, what could lead to statistically insignificant results.
The conservative dose cardiomioppatia 0. These authors studied the hemodynamic and renal effects of carvedilol in healthy and cardiac dogs and observed that a dose of 0. So, it was decided to use an intermediate dose. Moreover, many dogs included in the study suffered from severe heart failure and there was not certainty about the safety of prescribing a higher dose in these patients. Nevertheless, the low dose may be responsible for the insignificant results.
Some echocardiographic variables changed over the time, regardless of group. The elevation of variables related to systolic function, as FS and VCFi, might have occurred dilattada of positive inotropic action of digoxin, as well as afterload reduction caused by ACE inhibitor and diuretics. Concerning diastolic function, the E dect was the only variable that suffered a significant change over the time, increasing in both groups at 26 weeks of therapy.
That could point to ventricular relaxation improvement but as it occurred independently of group, it could not ensure that carvedilol accounted for this change.
ACE inhibitors, as well as carvedilol, have vasodilatatory properties that could have reduced intraventricular pressure in association with the E dect increase. However, this arrhythmia is frequently observed in the natural occurring DCM, so the exclusion of dogs with atrial fibrillation of the study could significantly reduce the sample size.
Moreover, the importance of a clinical research like this consists in the evaluation of the response to the drug in the natural disease. Nevertheless, the statistical analysis failed to show favorable effects of carvedilol over survival, the careful observation of Kaplan-Meier curves allows to conclude that dogs not treated with carvedilol died earlier. Undoubtedly, this fact ccanina a very important clinical relevance. The most of the dogs included in this study had advanced heart failure; therefore, many of them died early during the follow-up period.
Probably, a larger study population, the use of a higher dose as well as the up-titration could lead to more cafdiomiopatia results, with important differences between carvedilol treated and not treated groups. Statistical methods in medical research. Manual of veterinary echocardiographs.
The impact of baseline left ventricular size and mitral regusgitation on reverse left ventricular remodeling in response to carvedilol: