Aurélia Leroux

Prevalence and Risk Factors for Cardiac Diseases in a Hospital‐Based Population of 3,434 Horses (1994–2011)

BACKGROUND Risk factors for cardiac diseases in horses have not been explored in a large population of animals. OBJECTIVES To describe risk factors for various cardiac diseases in a hospital-based population of horses. ANIMALS Files of 3,434 horses admitted at the Internal Medicine Department of the Liege Equine Teaching Hospital between 1994 and 2011 were reviewed and of those, 284 were categorized as having moderate-to-severe cardiac disease. METHODS Observational study. After calculating prevalence for each cardiac disease, we tested whether breed (chi-square test) or sex, age, body weight (BW), and other cardiac diseases (logistic regressions) were risk factors (p < .05 significant). RESULTS Mitral regurgitation (MR, 4.4%), atrial fibrillation (AF, 2.3%), aortic regurgitation (AR, 2.1%), and tricuspid regurgitation (TR, 1.7%) were the most common cardiac abnormalities detected. Determinants were male sex and increasing age for AR (OR = 2.03, CI = 1.07-4.94), racehorses breed and middle-age for TR (OR = 4.36; CI = 1.10-17.24), and high BW for AF (OR = 3.54; CI = 1.67-7.49). MR was the most common valvular disease associated with AF, clinically important ventricular arrhythmia, pulmonary regurgitation (PR), and congestive heart failure (CHF). TR was also associated with AF, PR, and CHF; AR was not associated with CHF. CONCLUSIONS AND CLINICAL IMPORTANCE Several previously suspected risk factors for a variety of equine cardiac diseases are statistically confirmed and other risk factors are highlighted in the studied hospital-based population. These observations should be taken into account in health and sports monitoring of horses presenting predisposing factors.

Effect of breed, sex, age and body weight on Echocardiographic Measurements in the Equine Species

Little is known about the effect of various animals signalment variables on echocardiographic reference values in the equine species. This study was performed to evaluate the effect of sex, breed, age and body weight (BW) on echocardiographic measurements in the equine species. Echocardiography was performed on 212 ponies or horses of various breeds, aged from 1 day to 37 years old (mean±SD: 7.8 ± 5.8 years), BW 38-890 kg (mean ± SD: 421 ± 133 kg), and free of cardiac disease. Fifty of those animals aged from 2 months to 35 years old (mean ± SD: 11.6 ± 6.4 years old); BW 77-662 kg (mean ± SD: 436 ± 135 kg) were also examined using the pulsed-wave Doppler mode. Standard two-dimensional and M-mode echocardiography were performed on all animals. Standard pulsed-wave Doppler examination of each cardiac valve was performed on the 50 first examined animals. Data were analysed using a general linear model including the effect of sex, age, breed and BW after logarithmic transformation of the data. Therefore, the same analysis was performed separately on animals aged ≤ 2 years-old and on older animals. All dimensional echocardiographic measurements were significantly affected by BW and most of them were significantly affected by breed, but not by sex. Only the aortic and the pulmonary artery internal diameter were significantly affected by age. None of the Doppler measurements were significantly affected by the tested variables. In conclusion, in the equine species, dimensional echocardiographic reference values should be established using regression equations as a function of BW, which could increase the diagnostic value of this leading technique in equine cardiology. Breed could also have an effect on those measurements.

Two-dimensional and M-mode echocardiographic reference values in healthy adult Saanen goats

Echocardiography has become a routine non-invasive cardiac diagnostic tool in most species. Accurate measurement of cardiac dimensions requires reference values, which are poorly documented in goats. The aim of the present study was to test the inter-day repeatability and to establish the reference values of two-dimensional (2D-) and time-motion (M-) mode echocardiographic variables in healthy adult Saanen goats. Six goats were investigated three times by the same observer at one-day interval using a standardised 2D- and M-mode echocardiographic protocol. The intra-observer inter-day repeatability was tested using analysis of variance, calculation of the coefficient of variation and confidence intervals. A single echocardiographic examination was performed in six other goats, and values obtained in the 12 goats were used to establish the 2D- and M-mode echocardiographic reference values in healthy adult female Saanen goats. Statistical analysis revealed a good inter-day repeatability of the echocardiographic cardiac measurements. Echocardiographic reference values obtained in healthy adult Saanen goats seemed slightly higher than those reported in healthy Swedish domestic goats and were similar to those reported in healthy adult sheep.

Carriage and acquisition rates of Clostridium difficile in hospitalized horses, including molecular characterization, multilocus sequence typing and antimicrobial susceptibility of bacterial isolates

Clostridium difficile has been identified as a significant agent of diarrhoea and enterocolitis in both foals and adult horses. Hospitalization, antibiotic therapy or changes in diet may contribute to the development of C. difficile infection. Horses admitted to a care unit are therefore at greater risk of being colonized. The aim of this study was to investigate the carriage of C. difficile in hospitalized horses and the possible influence of some risk factors in colonization. During a seven-month period, faecal samples and data relating the clinical history of horses admitted to a veterinary teaching hospital were collected. C. difficile isolates were characterized through toxin profiles, cytotoxicity activity, PCR-ribotyping, antimicrobial resistance and multilocus sequence typing (MLST). Ten isolates were obtained with a total of seven different PCR-ribotypes, including PCR-ribotype 014. Five of them were identified as toxinogenic. A high resistance to gentamicin, clindamycin and ceftiofur was found. MLST revealed four different sequencing types (ST), which included ST11, ST26, ST2 and ST15, and phylogenetic analysis showed that most of the isolates clustered in the same lineage. Clinical history suggests that horses frequently harbour toxigenic and non-toxigenic C. difficile and that in most cases they are colonized regardless of the reason for hospitalization; the development of diarrhoea is more unusual.

Repeatability, variability and reference values of pulsed wave Doppler echocardiographic measurements in healthy Saanen goats

BackgroundPulsed wave (PW) Doppler echocardiography has become a routine non invasive cardiac diagnostic tool in most species. However, evaluation of intracardiac blood flow requires reference values, which are poorly documented in goats. The aim of this study was to test the repeatability, the variability, and to establish the reference values of PW measurements in healthy adult Saanen goats. Using a standardised PW Doppler echocardiographic protocol, 10 healthy adult unsedated female Saanen goats were investigated three times at one day intervals by the same observer. Mitral, tricuspid, aortic and pulmonary flows were measured from a right parasternal view, and mitral and aortic flows were also measured from a left parasternal view. The difference between left and right side measurements and the intra-observer inter-day repeatability were tested and then the reference values of PW Doppler echocardiographic parameters in healthy adult female Saanen goats were established.ResultsAs documented in other species, all caprine PW Doppler parameters demonstrated a poor inter-day repeatability and a moderate variability. Tricuspid and pulmonary flows were best evaluated on the right side whereas mitral and aortic flows were best obtained on the left side, and reference values are reported for healthy adult Saanen goats.ConclusionsPW Doppler echocardiography allows the measurement of intracardiac blood flow indices in goats. The reference values establishment will help interpreting these indices of cardiac function in clinical cardiac cases and developing animal models for human cardiology research.

Prognostic value of echocardiographic and Doppler parameters in horses admitted for colic complicated by systemic inflammatory response syndrome

Objective To assess the prognostic value of echocardiographic parameters of left ventricular (LV) function in horses with systemic inflammatory response syndrome (SIRS). Design Prospective observational study. Setting Veterinary teaching hospital. Animals Forty-one horses admitted for colic with clinical evidence of SIRS. Interventions All horses underwent Doppler echocardiographic examination on admission. LV echocardiographic parameters, including pulsed-wave tissue Doppler imaging parameters, were compared between nonsurvivors (n = 29) and horses that survived to discharge (n = 12). Measurements and Main Results With comparable heart rate and LV preload estimate, LV stroke volume index, the velocity time integral, deceleration time, ejection time of Doppler aortic flow, and peak early diastolic myocardial velocity were lower in the nonsurviving than in the surviving horses, while pre-ejection period to ejection time ratio (PEP/ET) of Doppler aortic flow and the peak early diastolic filling velocity to peak early diastolic myocardial velocity ratio (E/Em) were higher (P < 0.05). A cut-off value of 0.26 for PEP/ET predicted mortality with 100% sensitivity and 42% specificity (area under the receiver operating characteristic curve: 0.71), whereas a cut-off value of 2.67 for E/Em predicted mortality with 100% sensitivity and 83% specificity (area under the receiver operating characteristic curve: 0.89). Conclusions Echocardiography may provide prognostic information in colic horses with clinical evidence of SIRS. Especially, PEP/ET and E/Em could be useful markers of systolic and diastolic dysfunction, respectively, to detect horses with a high risk of death requiring more intensive cardiovascular monitoring as it has been reported in human patients with septic shock.OBJECTIVE To assess the prognostic value of echocardiographic parameters of left ventricular (LV) function in horses with systemic inflammatory response syndrome (SIRS). DESIGN Prospective observational study. SETTING Veterinary teaching hospital. ANIMALS Forty-one horses admitted for colic with clinical evidence of SIRS. INTERVENTIONS All horses underwent Doppler echocardiographic examination on admission. LV echocardiographic parameters, including pulsed-wave tissue Doppler imaging parameters, were compared between nonsurvivors (n = 29) and horses that survived to discharge (n = 12). MEASUREMENTS AND MAIN RESULTS With comparable heart rate and LV preload estimate, LV stroke volume index, the velocity time integral, deceleration time, ejection time of Doppler aortic flow, and peak early diastolic myocardial velocity were lower in the nonsurviving than in the surviving horses, while pre-ejection period to ejection time ratio (PEP/ET) of Doppler aortic flow and the peak early diastolic filling velocity to peak early diastolic myocardial velocity ratio (E/Em) were higher (P < 0.05). A cut-off value of 0.26 for PEP/ET predicted mortality with 100% sensitivity and 42% specificity (area under the receiver operating characteristic curve: 0.71), whereas a cut-off value of 2.67 for E/Em predicted mortality with 100% sensitivity and 83% specificity (area under the receiver operating characteristic curve: 0.89). CONCLUSIONS Echocardiography may provide prognostic information in colic horses with clinical evidence of SIRS. Especially, PEP/ET and E/Em could be useful markers of systolic and diastolic dysfunction, respectively, to detect horses with a high risk of death requiring more intensive cardiovascular monitoring as it has been reported in human patients with septic shock.

Using natriuretic peptides to detect cardiac diseases in horses

WHEN considering the use of cardiac biomarkers for diagnosis, prognosis and monitoring of cardiac diseases, is equine cardiology catching up with small animal and human cardiology? The paper by Van der Vekens and others (2015), summarised on page 624 of this issue of Veterinary Record , presents an initial step towards achieving this goal by testing a new technique to measure plasma proANP concentrations in horses with and without cardiac disease.⇓ Echocardiography is the technique currently used to diagnose and monitor cardiac diseases in horses. However, with further studies, total proANP determined using a the new methodology could become a practical clinical tool Photograph: University of Liege Natriuretic peptides, including atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), are hormones synthesised by cardiomyocytes. They play an important role in blood pressure regulation, diuresis and natriuresis. They are also known to increase in response to a cardiomyocytes stretch due to pressure or volume overload, for example, during prolonged strenuous …