Journals

Question 1

In a study by Lopez-Alvarez et al, what factors were found to be independently associated with outcome in dogs with CHF? Lopez Alverez et al. Clinical severity score system in dogs with degenerative mitral valve disease. JVIM 2015. 29.

Answer 1

Cough, exercise intolerance, decreased appetite, breathlessness, syncope, murmur >III, absence of a respiratory sinus arrhythmia. A clinical severity score system was developed, ranging from none to severe. Dogs with 3-4 risk factors were considered to be at intermediate risk and had a survival time of 1000 days, whereas dogs with 5> risk factors were considered to be severe and had a MST of 167 days.

Question 2

In a study by Kaye et al, what were the major findings regarding TAPSE in Boxers with ventricular arrhythmias? Kaye et al. Association of TAPSE with survival time in Boxer dogs with ventricular arrhythmias. JVIM 2015. 29.

Answer 2

Tricuspid annular plane systolic excursion is a useful estimate of RV function in humans. Quantitative estimate of longitiduinal RV shortening. TAPSE was lower in Boxers with >50 VPCs/24h than in Boxers without. TAPSE

Question 3

In a study by Borgarelli et al, what where the major findings regarding the presence of pulmonary hypertension in a population of dogs with MMVD? Borgarelli et al. Prevalence and prognostic importance of PHT in dogs with MMVD. JVIM 2015. 29.

Answer 3

PHT is common in dogs with MMVD; more commonly identified in stage C compared to B2. MST for entire study population (212 dogs) was 567 days. On univariate analysis, stage C heart failure, presence of PH, LA/Ao >1.7, LVEDn >1.73, tricuspid regurgitation pressure gradient (TRPG) >55mmHg were associated with worse outcomes. On multivariate analysis, the presence of TRPG >55mmHG and LA/Ao remained significant predictors of worse outcome. In dogs with MMVD, the presence of moderate to severe PH worsens outcome.

Question 4

In a study by Merveille et al, what were the major conclusions regarding PV/PA as an assessment for the presence of CHF? Merveill et al. Pulmonary vein to pulmonary artery ratio is an echocardiographic index of CHF in dogs with DMVD. JVIM 2015. 29.

Answer 4

In dogs with progressive DMVD leading to CHF, it can be anticipated that increased pulmonary venous pressure associated with venous enlargement would cause an increase in the PV/PA ratio. Right parasternal long axis 4 chamber view used to visualize longitudinal section of medial PV and right PA in cross section. In dogs, was determined that PV/PA increases with increasing stages of CHF. Using a cut off value of 1.7 in 2D, PV/PA permitted acute discrimination of dogs in CHF from asymptomatic dogs.

Question 5

What were the findings of a study by Osuga et al looking at the effects of vitamin D status in different stages of disease of dogs with chronic valvular heart disease? Osuga et al. Vitamin D status in different stages of disease severity in dogs with chronic valvular heart disease. JVIM 2015 29.

Answer 5

Calcitriol promotes cardiac contractility by binding to vitamin D receptors on cardiomyocytes and affecting intracellular Ca handling. Also exerts anti-hypertrophic effects on cardiomyocytes. In humans, vitamin D deficiency has been determined to be an adverse reisk factor in patients with cardiovascular disease. Vitamin D concentrations were significantly lower in dogs with stage B2 and C/D heart disease than B1. Vitamin D status is associated with the degree of cardiac remodeling and serum concentrations begin to decrease before the onset of heart failure in dogs with CVHD.

Question 6

In a study by Han et al, what were the findings regarding serum cPLI concentrations in dogs with heart failure and chronic mitral valve disease? Han, Choi, Hyun. Canine pancreatic specific lipase concentration in dogs with heart failure and chronic mitral valvular insufficiency. JVIM 2015. 29.

Answer 6

Chronic mitral valvular insufficiency is common in dogs and may cause clinical signs of congestion and poor tissue perfusion, which may lead to pancreatitis and elevated serum cPLI concentrations. An increase in serum cPLI concentrations were identified in dogs with increasing severity of heart diesease (54 ug/L in control group; 223 ug/L in severe group). Suggests periodic monitoring of serum cPLI may be useful in dogs with heart failure.

Question 7

What were the major findings of a study by Fox et al evaluating the relation of plasma NTproBNP concentrations to heart failure severity and cause of respiratory distress in dogs? Fox et al. Relationship of plasma NTproBNP concentrations to heart failure classification and cause of respiratory distress in dogs using a second generation ELISA assay. JVIM 2015 29.

Answer 7

Plasma NTproBNP was higher in CHF dogs than those with noncardiac respiratory distress. A cut-off of >/= 2447pmol/L discriminated CHF from non-cardiac distress. Average NTBNP increased significantly as a function of heart disease severity using the ACVIM classification scheme.

Question 8

What was the major finding in a study by Beier et al evaluating the role of hypothyroidism in DCM in Dobermans? Beier et al. The role of hypothyroidism in the etiology and progression of DCM in doberman pinschers. JVIM 2015. 29.

Answer 8

This study did not confirm a role of hypothyroidism in the etiology or progression of DCM. Treatment of hypothyroidism did not improve the clinical outcome.

Question 9

What were the major findings of a study by Sangster et al evaluating cardiac biomarkers in hyperthyroid cats? Sangster et al. Cardiac biomarkers in hyperthyroid cats. JVIM 2014. 28.

Answer 9

Hyperthyroid cats and cats with HCM had plasma NTBNP and ctNI concentrations that were significantly higher than those of healthy cats, but there was no significant difference between hyperthyroid cats and cats with HCM with respect to concentration of either biomarker. Concentrations of both, as well as ventricular wall thickness, had decreased significantly in cats who were subsequently treated for hyperthyroidism. Neither NTpBNP nor cTNI can distinguish hypertrophy associated with hyperthyroidism from primary HCM.

Question 10

In a study by Eason et al evaluating the influence of beta blockers on survival in dogs with SAS, what was the major finding? Eason et al. Influence of beta blockers on survival in dogs with severe SAS. JVIM 2014 28.

Answer 10

SAS is one of the most common congenital defects in dogs; severe SAS is often treated with a beta blocker, but this is largely empirical. STudy found that only age at diagnosis and pressure gradient at diagnosis affected survival time, with only PG influencing survival time in the cardiac mortality analysis. Treatment with a beta-blocker did not influence survival time in all-cause or cardiac cause mortality analysis.

Question 11

In a study of ARVC in Boxers, what were the major findings? Meurs et al. Natural history of ARVC in the Boxer Dog: a prospective study. JVIM 2014. 28.

Answer 11

ARVC is a disease of middle age dogs and frequently is associated with a striatin deletion. Syncope occurs in 1/3 of affected dogs. Systolic dysfunction is uncommon. The prognosis for many affected dogs is good.

Question 12

In a study of left atrial enlargement comparing methods of left atrial volume versus LaAo, what were the major findings? Wesselowski et al. Discrepancies in identification of LA enlargement using LA volume versus LaAo in dogs. JVIM 2014 28.

Answer 12

LA size is prognostically important in dogs with MMVD. LA vol/BW identified LAE in 12 cases in which the LAAo was normal; 7 of these dogs were in stage B1 and 5 in stage B2. No diagnostic discrepancies were apparent in dogs with a severe mitral regurgitation severity score. LA Vol/BW may be superior to LAAo for identification of mild LAE.

Question 13

What were the major findings of a study by Reimann et al evaluating the role of biopterin in dogs with MMVD? REimann et al. Biopterin status in dogs with MMVD is associated with disease severity and cardiovascular risk factors. JVIM 2014. 28.

Answer 13

Endothelial dysfunction has been suggested to be associated with MMVD in dogs. Under conditions of oxidative stress, biopterin is oxidized to an inactive form and therefore, plasma concentrations of biopterin may reflect endothelial dysfunction and oxidative stress. Higher plasma concentrations of biopterin were found in dogs with CHF than all other groups. Females had higher concentrations. Biopterin was found to decrease with age. Cardiovascular risk factors such as passive smoking and increased body weight were associated with lower biopterin conditions.

Question 14

What were the major findings of a study by Langhorn et al evaluating CTnI and CTnT as prognostic markers in cats with HCM? Langhorn et al. CTnI and T as prognostic markers in cats with HCM. JVIM 2014 28.

Answer 14

Myocardial injury as detected by CTnI and T in cardiac disease is associated with increased risk of death in humans and dogs. In cat, troponin concentrations at admission were prognostic for death as were the last available concentrations of each. The final cTnT concentration was a significant predictor of death even when adjusting for admission concentration. Low sensitivities and specificities of these findings however prevent outcome prediction in individual cats.

Question 15

In a study by Nakamura et al, what was the main finding regarding the prognostic value of LA function in dogs with chronic MMVD? Nakamura et al. Prognostic value of LA function in dogs with chronic MMVD. JVIM 2014. 28.

Answer 15

Regarding both size and function, the LA has a strong correlation with the prognosis of dogs with CMVHD. The most significant independent predictor of mortality in this study was the LA active fractional area change (LAFACact).

Question 16

In a study of cTnI in cats with HCM by Borgeat et al, what were the major findings with regards to time to cardiac death? Borgeat et al. Plasma cTnI and cardiac death in cats with HCM. JVIM 2014 28.

Answer 16

Plasma concentration of cTnI (cutoff 0.7ng/mL) is a predictor of cardiac death in cats that is independent of the presence of heart failure or LA dilatation. In univariable analysis, NTpBNP >250pmol/L was associated with cardiac death, but this did not remain significant after controlling for the effect of clinical signs or LA size/function.

Question 17

In a study by Scollan et al evaluating the use of CT compared to echocardiogram in dogs with pericardial effusion, what was the major finding? Scollan et al. Use of multidetector CT in the assesement of dogs with pericardial effusion. JVIM 2015. 29.

Answer 17

Multidetector CT did not improve the detection of cardiac masses in dogs with PE over echocardiography. The benefit of CT was primarily in the detection of pulmonary metastasis and extracardiac lesions using a single imaging modality.

Question 18

What were the major findings of a study evaluating ATE in cats in general practice by Borgeat et al? Borgeat et al. ATE in 250 cats in general practice. JVIM 2014 28.

Answer 18

61% of cats were euthanized on immediate presentation, with no factors identified that predicted euthanasia on presentation. 70% survived 24 hours, 44% survived for at least 7 days. Hypothermia, management by clinc #2 were independent predictors of 24 hour euthanasia/death. For cats surviving >24 hours, hyothermia and failure to receive aspirin/clopidogrel or both were independent predictors of euthanasia/death within 7 days. For cats that survived >7 days, MST was 94 days, with 6 cats alive 1 year post-presentation.

Question 19

In a study evaluating the diagnostic yield of cytologic analysis of pericardial effusion in dogs by Cagle et al, what were the major findings? Cagle et al. Diagnostic yield of cytologic analysis of pericardial effusion in dogs. JVIM 2014. 28.

Answer 19

Cytology was non-diagnostic in 93% of cases. Overall cytologic analysis of PE diagnostic utility was 7.u7% and increased to 20% if the effusion HCt was

Question 20

In a study by Rasmussen et al evaluating syncope in dogs with MMVD what were the major findings? Rasmussen et al. Holter monitoring of small breed dogs with advanced MMVD with and without a history of syncope. JVIM. 2014. 28.

Answer 20

Compared with dogs without a history of syncope, dogs with advanced MMVD and a history of syncope did not have a higher occurrence of arrhythmias, but had less sinus arrhythmia and had changes in heart rate variables representing decreased overall heart rate variability, decreased parasympathetic and increased sympathetic modulation of heart rate.

Question 21

In a study by Lopez-Alverez et al evaluating ECG evaluation in dogs with DMVD, what were the major findings? Lopez Alverez et al. Longitudinal ECG evaluation of dogs with DMVD. JVIM 2014. 28.

Answer 21

Dogs with DMVD have an increase in HR and a decrease in heart rate variability over a year before death, with greater changes observed in dogs that died or were euthanized because of cardiac disease. Both heart rate and vasovagul tonus index (VVTI) can potentially be regarded as biomarkers for all-cause mortality.

Question 22

In a study evaluating outcome in dogs with PDA by Saunders et al, what were the major findings? Saunders et al. Long-term outcome in dogs with PDA: 520 cases (1994-2009) JVIM 2014 28.

Answer 22

PDA closure confers important survival benefits and results in long term reverse remodeling in most dogs. Clinical signs at presentation, concurrent congenital heart disease and severe mitral regurgitation significantly affect survival. Increased left ventricular systolic dimensions and systolic dysfunction at baseline correlated significantly with persistent remodeling.

Question 23

In a study by Ames et al evaluting the effects of enalapril/benazepril on the RAAS system, what were the major findings? Ames et al. Effects of high doses of enalapril and benazepril on the pharmacologically activated RAAS in clinically normal dogs. AJVR 2015. 76.

Answer 23

Administration of high doses of enalapril and benazepril (1mg/kg PO q12h) significantly inhibited ACE activity, but did not prevent increases in mean urine and serum and aldosterone concentrations resulting from furosemide activation of RAAS. Suggests that aldosterone breakthrough from ACE inhibition is a dose-independent effect of ACEI.

Question 24

What were the major findings of a study by Cremer et al evaluating plasma and serum serotonin in cavaliers with MMVD? Cremer et al. Plasma and serum serotonin concentrations and surface-bound platelet serotonin expression in CKCS with MMVD. AJVR 2015. 76.

Answer 24

A substantive influence of circulating serotonin on MMVD stages prior to CHF development in CKCS was not supported by this study. Highly activated platelets with pronounced serotonin binding was strongly associated with thrombocytopenia but not with MMVD.

Question 25

What were the major findings of a study by Jenkins et al evaluating the pressor response to angiotensin by ARBs and benazepril in cats? Jenkins et al. Attenuation of the pressor response to exogenous angiotensin by angiotensin receptor blockers and benazepril in clinically normal cags. AJVR 2015. 76.

Answer 25

The purpose was to compare the attenuation of the ANG1 induced BP response by once-daily oral administration of various doses of ARBS (ibersartan, telmisartan, losartan), benazepril, or placebo in clinically normal cats. Among drugs, telmisartan attenuated SBP to a significantly greater degree than benazepril and all other treatments. At 24 hours, telmisartan was more effective than benazepril. Results indicated that telmisartan may have advantages over benazepril for cats with renal/cardiovascular disease.

Question 26

A case study by Sime et al details parvoviral myocarditis in a 5 week old Dachshund. What were the major conclusions of this report? Sime et al. Parvoviral myocarditis in a 5 week old Dachshund. JVECC 2015 25 (6)

Answer 26

CPV may cause myocarditis in puppies that are infected in utero or in the first weeks of life. Generally no GI signs, respiratory distress occurs acutely. Treatment typically unsuccessful due to severe cardiac damage, however, dogs that survive the acute phase may go on to develop chronic cardiac changes and juvenile DCM. Rapid fecal parvo tests will usually be negative. Myocardial parvo should be a ddx in young pupies and juveniles who present with acute respiratory signs and heart failure.

Question 27

What were the major findings of a study by Edwards et al evaluating the outcome of PPV in dogs and cats with CHF? Edwards et al. Outcome of PPV in dogs and cats with CHF 16 cases (1992-2012) JVECC 24 (5) 2014

Answer 27

Overall survival to discharge was 62.5%. Survival rates for patients treated after 2005 and not receiving pentobarbital was 77% Mean duration of PPV was 31+-/21 hours; average time from presentation for CHF to initiation of PPV was 6 hours. Azotemia at the time of ventilation, development of anuria/oliguria, and use of pentobarbital were significantly associated with outcome. No significant effect attributed to age, sex, weight, species, cause of heart disease, furosemide dose, length of ventilation, use of vasopressors, first-time CHF events or plasma lactate concentrations on survival to discharge.

Question 28

What were the major findings of a study by Harada et al comparing the diuretic effect of furosemide given by various routes? Harada et al. Comparison of the diuretic effect of furosemide by different methods of administration in healthy dogs. JVECC 2015 25 (3)

Answer 28

SQ administration resulted in UOP/hr that peaked at 1 hour, with UOP/hr returning to baseline at 4 hours after injection. After IV injection, UOP/hr peaked at 1 hour, returned to baseline at 2 hours after injection. With PO administration, UOP/hr peaked at 2 hours, took 6 hours to return to baseline. With CRI administration, UOP/hr was delayed to 4 hours after injection, but UOP/hr maintained throughout administration. Did not evaluate IM administration… Concluded that SQ route may be an effective means for administration in dogs when IV access is difficult.

Question 29

What were the major findings of a study by Bomassi et al evaluating characteristics and findings in dogs and cats with VSDs? Bomassi et al. Signalment, clinical features, echocardiographic findings and outcome of dogs and cats with VSDs: 109 cases. JAVMA 2015. 247.

Answer 29

VSDs were isolated in 48% of patients and were membranous or perimembranous in 75%. Most isolated VSDs were subclinical. Most dogs and cats with isolated VSDs had a long survival time, few had clinical signs at diagnosis and none with follow-up developed clinical signs after diagnosis.

Question 30

In a study by Olive et al evaluating the effect of the cardiac and respiratory cycles on the VHS during fluoroscopy, what were the major findings? Olive et al. Effect of cardiac and respiratory cycles on VHS measured on fluoroscopic images of healthy dogs. JAVMA 20156. 246.

Answer 30

The combination the respiratory and cardiac cycles induced a maximal difference in VHS of 0.97 and 1.11 VU in the inspiratory and expiratory phases respectively. In addition to allowing optimal pulmonary assessment, consistently taking radiographs at end-inspiratory tidal volume may help to limit VHS variability due to the respiratory cycle.

Question 31

What were the major findings of a study by Wells et al evaluating a cage-side analysis of cTnI in cats? Wells et al. Evaluation of blood cardiac troponin I concentrations obtained with a cage side analyze to differentiate cats with cardiac and non-cardiac causes of dyspnea. JAVMA 2014. 244.

Answer 31

The 25 cats in the study with a cardiac cause of dyspnea had a significantly higher blood cTnI concentration than the healthy cats or the 14 cats with a non-cardiac cause. Measurement of cTnI with a cage side assay in an emergency setting may be useful for differentiating cardiac from non-cardiac causes of dyspnea in cats. **Did not provide a cut-off value…***

Question 32

What were the major conclusions of a study by Reina-Dorste et al evaluating pimobendan use in cats? Reina-Doreste et al. Case-control study of the effects of pimobendan on survival time in cats with HCM and CHF. JAVMA 2014. 245.

Answer 32

Cats (with HCM or HOCM) receiving pimobendan had a significant benefit in survival time. MST of case cats receiving pimo was 626 days whereas MST of cats not receiving pimo was 103 days. No significant difference was detected in any other variable. The addition of pimo to traditional treatment for CHF may provide a substantial benefit in survival time for HCM-affected cats with CHF and possibly HOCM-affected cats with CHF.

Question 33

In a study by Chetboul et al regarding the epidemiological, clinical and echocardiographic features and survival times of dogs and cats with tetralogy of fallot, what were the main findings?

JAVMA 2016.

Answer 33

• Terrier breeds were the most common canine types.
• 90% of animals had clinical signs at time of TOF diagnosis, including cyanosis.
• Most of the VSDs were large.
• Median age at cardiac related death was 23.4 months (no sig diff between dogs and cats)
• Cardiac related death occurred predominantly in young adult dogs and cats with TOF and most animals had severe clinical signs at time of diagnosis.

Question 34

What were the major findings of the EPIC study (effect of pimobendan in dogs with preclinical myxomatous mitral valve disease and cardiomegaly) by Boswood et al?

JVIM 2016 30

Answer 34

• 360 dogs with MMVD (LaAO >1.6; VHS >10.5)
• Median time to primary endpoint (development of CHF, cardiac related death or euthanasia) was 1228 days in pimo group compared to 766 in placebo group.
• Dogs in pimo group lived longer (1059 days) compared to placebo group (902 days)
• Administration of pimo to dogs with MMVD and echocardiographic/radiographic evidence of cardiomegaly results in prolongation of the preclinical period and is safe and well-tolerated.
• Prolongation of the preclinical period is substantial (15 months) and represents substantial clinical benefit.

Question 35

What were the primary findings of a study by Reimann et al evaluted increased serum CRP concentrations in dogs with CHF due to MMVD?

Vet Journal 2016 209

Answer 35

• Dogs with CHF (group C) had slightly higher CRP concentrations than other groups; severity of asymptomatic MMVD showed no association with CRP concentration.

Question 36

What were the findings of a study evaluating the influence of enalapril and spironolactone on electrolyte concentrations in Dobermans with DCM by Thomason et al?

Vet Journal 2014 202

Answer 36

• Combination of ACEI with aldosterone receptor antagonist can increase serum potassium and magnesium and lower serum sodium.
• Study evaluated two drugs in dobermans
• NO significant changes in sodium or creatinine. Serum magnesium, potassium, BUN increased significantly over time, however, these increases were of no apparent clinical relevance.

Question 37

What were the findings of a study by Guglielmini et al regarding the sensitivity, specificity and interobserver variability of survey thoracic radiographs for the detection of heart base masses in dogs?

JAVMA 2016 248.

Answer 37

• Survey thoracic radiography is a highly specific but not a highly sensitive predictor of heart base masses in dogs.

Question 38

What were the findings of a study by Sanders and Chapel evaluating the effects of catheter shape, interelectrode spacing, and electrode size on transesophageal atrial pacing in dogs?

AJVR 2016 77

Answer 38

• Sought to determine effects of catheter shape, interelectrode spacing (IS), electrode size (ES) on pacing threshold (PT), extraneous muscular stimulation (EMS) and zone of capture (ZOC) for dogs undergoing transesophageal atrial pacing (TAP)
• Results showed that a curved catheter with multiple 4mm electrodes providing for variable IS would be ideal for TAP in dogs.
• In humans, TAP catheters are straight—perhaps curved cathters may reduce the PT.

Question 39

What were the findings of a study by Martinelli in the preliminary investigation of cardiovascular-renal disorders in dogs with chronic mitral valve disease?

JVIM 2016 6: 30

Answer 39

• Chronic MMVD is associated with an increased prevalence of CKD and anemia in dogs.
• Medical management of CHF may play a role in inducing CKD (dogs being treated for CHF had a significantly higher prevalence of CKD than did dogs that had not received treatment)
• The class of heart disease and the IRIS stage were directly correlated.
• The presence of cardiovascular-renal disorders decreased survival time compared to only the presence of MMVD alone.
• Anemia did not appear to play a role in worsening heart function.

Question 40

What were the findings of a study by Kluser et al regarding predictors of sudden cardiac death in Dobermans with DCM?

JVIM 2016 30

Answer 40

• Volume overload of the left ventricle (LVEDV/BSA >91.3mL/m2) was the single best variable to predict sudden cardiac death.
• Probability of SCD increases 8.5 fold for every 50ml/m2 unit increment in LVEDV/BSA
• The presence of ventricular tachycardia, increased cTnI concentration, and fastest rate of VPCs (>260bpm) were additional important variables to predict SCD

Question 41

What were the findings of a study by Hezzell et al regarding differentiation of cardiac from noncardiac pleural effusions in cats using second generation quantitative and point of care NT-proBNP measurements?

JVIM 2016 30

Answer 41

• Measurement of NT-proBNP using a quantitative ELISA in plasma and pleural fluid, or a POC test in plasma but NOT pleural fluid, distinguishes cardiac from non-cardiac causes of pleural effusion.

Question 42

What were the primary findings of a study by Jung et al regarding atrial fibrillation as a prognostic indicator in medium to large sized dogs with MMVD and CHF?

JVIM 2016 30

Answer 42

• For dogs with AF, MST was 142 days as compared to those without AF (234 days).
• MST significantly prolonged for dogs with AF whose rates were adequately controlled when compared to dogs that failed to respond to negative chronotropic agents.

Question 43

What were the findings of a retrospective evaluation of the incidence and prognostic significance of spontaneous echocardographic contrast in relation to cardiac disease and CHF in cats (725 cases) by Peck et al?

JVECC 2016 26:5

Answer 43

• Cats with SEC were at significantly increased risk of death as compared to those without SEC.
• Cats with DCM, unclassified and hypertrophic cardiomyopathy were significantly more likely to have SEC compared to cats with other types of cardiac disease.
• These cats may benefit from anticoagulant therapy due to the increased risk of SEC in these populations.

Question 44

What were the findings of a study by Lisciandro regarding the use of the DH views of the AFAST and TFAST for the detection of pericardial effusion in dogs?

JVECC 2016 26 1.

Answer 44

• The DH view of the FAST exam was found to be clinically helpful for the detection of pericardial effusions. Looking into the thorax via DH during both TFAST and AFAST exams should be routine practice.