Dominique De Clercq

Cardiac changes in horses with atypical myopathy.

BACKGROUND Atypical myopathy (AM) is an acute, fatal rhabdomyolysis in grazing horses that mainly affects skeletal muscles. Postmortem examinations have shown that myocardial damage also occurs. Limited information is available on the effect of AM on cardiac function in affected and surviving horses. OBJECTIVES To describe electrocardiographic and echocardiographic changes associated with AM in the acute stage of the disease and after follow-up. ANIMALS Horses (n = 12) diagnosed with AM in which cardiac ultrasound examination and ECG recording were available. METHODS All horses underwent clinical examinations, serum biochemistry, electrocardiography, and echocardiography. Four surviving horses underwent the same examinations after 2-10 weeks. RESULTS All but 1 horse had increased cardiac troponin I concentrations and 10 horses had ventricular premature depolarizations (VPDs). All horses had prolonged corrected QT (QT(cf) ) intervals on the day of admission and abnormal myocardial wall motion on echocardiography. One of the surviving horses still had VPDs and prolonged QT(cf) at follow-up after 10 weeks. CONCLUSIONS AND CLINICAL IMPORTANCE The AM results in characteristic electrocardiographic and echocardiographic changes and may be associated with increased cardiac troponin I concentrations and VPDs. In survivors, abnormal cardiac function still may be found at follow-up after 10 weeks. Additional research in a larger group of horses is necessary to identify the long-term effects of AM on cardiac function.

Long-term follow-up of atrial function after cardioversion of atrial fibrillation in horses

Atrial fibrillation (AF) causes atrial electrical and contractile remodelling in horses. The aim of this study was to quantify left atrial (LA) contractile function and its time course of recovery after cardioversion of naturally-occurring AF in horses. The study population included 42 AF horses which were successfully treated using transvenous electrical cardioversion TVEC (n=39) or quinidine sulfate (n=3), with trivial or mild mitral regurgitation present in 25 horses. Thirty-seven healthy horses were used as controls. AF duration was estimated based on the history and previous examinations. Echocardiography was performed during general anaesthesia after TVEC (day 0) and on days 1, 2, 6 and then 7 weeks after cardioversion. The two-dimensional (2D) echocardiographic measurements included LA diameter, area and ejection phase indices such as fractional shortening. Atrial TDI measurements included peak myocardial velocity during atrial contraction (A), time to onset A, time to peak A and duration of A. During follow-up after cardioversion, atrial contractile function measured by 2D echocardiography and TDI gradually improved. At 7 weeks following cardioversion, TDI-based myocardial velocities returned to reference values. However, AF horses still showed significantly larger atrial dimensions, lower 2D ejection phase indices and prolonged TDI-based conduction time compared to the control group. In conclusion, AF-induced atrial contractile dysfunction gradually improves in the weeks following cardioversion, but at 7 weeks post-cardioversion, significant differences remain compared to healthy controls.

Tissue Doppler imaging and 2-dimensional speckle tracking of left ventricular function in horses exposed to lasalocid.

BACKGROUND Tissue Doppler imaging (TDI) and 2-dimensional speckle tracking (2DST) can quantify left ventricular (LV) function in horses. OBJECTIVES To evaluate LV function by TDI and 2DST in horses with myocardial dysfunction after accidental ionophore intoxication. ANIMALS Sixty-seven horses exposed to lasalocid in feed. METHODS Prospective study. Horses were included in the study if a full cardiac examination was performed, consisting of determination of cardiac troponin I (cTnI), electrocardiography, and echocardiography. By TDI, radial systolic velocity and strain were measured. By 2DST, circumferential (SC) and radial (SR) strain at papillary muscle and chordal level and longitudinal (SL) strain were measured. RESULTS Twenty horses showed signs of myocardial injury. Forty-nine examinations were performed on these horses between day 30 and 490 after suspected onset of exposure. Five horses had increased cTnI and ventricular tachycardia and 15 had increased cTnI without ventricular tachycardia. Horses with mild myocardial damage showed few significant differences compared with a control group. Horses with severe myocardial damage showed severely decreased TDI, 2DST and fractional shortening measurements (P < .05), indicating impaired LV function. Long-term follow-up of 2 surviving horses demonstrated full recovery in 1 horse and permanent myocardial fibrosis in the other. The lowest measurements per horse (n = 20) for all TDI measurements, SL, SR at chordal level, and FS correlated significantly with maximal cTnI (P < .05). Over all examinations (n = 49), TDI and 2DST measurements correlated well with FS (P < .05). CONCLUSIONS AND CLINICAL IMPORTANCE The TDI and 2DST measurements allowed accurate detection and quantification of LV dysfunction in horses exposed to lasalocid.

Human and equine cardiovascular endocrinology: beware to compare

Cardiac biomarkers such as troponins and natriuretic peptides are routinely used in human medicine for the evaluation of myocardial damage and heart failure. Recently, these markers have also been introduced in veterinary medicine. Comparison between human and equine cardiac biomarker studies show important species differences, which can partly be explained by variations in physiology or pathophysiology. Most important are physiological differences in heart rate, cardiovascular response to exercise, food and water intake, and molecular elimination in plasma. Pathological differences are even more prominent. In humans, troponins and natriuretic peptides are mostly used for the diagnosis of acute coronary syndromes and heart failure. These cardiac entities, however, are rare in horses. In this species, cardiac biomarkers are rather proposed for the assessment of valvular or myocardial disease. In conclusion, these species differences corroborate that extrapolation of cardiac biomarker data should always be performed with caution and species-specific data should be applied whenever possible.

Evaluation of tissue Doppler imaging for regional quantification of radial left ventricular wall motion in healthy horses

OBJECTIVE To compare the feasibility and repeatability of tissue Doppler imaging (TDI) for quantification of radial left ventricular (LV) velocity and deformation from different imaging planes and to correlate cardiac event timing data obtained by TDI to M-mode and pulsed-wave Doppler-derived time intervals in horses. ANIMALS 10 healthy adult horses. PROCEDURES Repeated echocardiography was performed by 2 observers from right and left parasternal short-axis views at papillary muscle and chordal levels. The TDI measurements of systolic and diastolic velocity, strain rate, strain peak values, and timing were performed in 8 LV wall segments (LV free wall and interventricular septum from right parasternal views; left and right region of LV wall from left parasternal views). The inter- and intraobserver within- and between-day variability and measurement variability were assessed. The correlation between TDI-based measurements and M-mode and pulsed-wave Doppler-based time measurements was calculated. RESULTS TDI measurements of velocity, strain rate, and strain were feasible in each horse, although deformation could often not be measured in the LV free wall. Systolic and diastolic time intervals could be determined with low to moderate variability, whereas peak amplitude variability ranged from low to high. The TDI-based time measurements were significantly correlated to M-mode and pulsed-wave Doppler measurements. CONCLUSIONS AND CLINICAL RELEVANCE TDI measurements of radial LV velocity and deformation were feasible with low to moderate variability in 8 LV segments. These measurements can be used for evaluating LV function in further clinical studies.

Cardiovascular responses to transvenous electrical cardioversion of atrial fibrillation in anaesthetized horses.

OBJECTIVE To examine the influence of direct current shock application in anaesthetized horses with atrial fibrillation (AF) and to study the effects of cardioversion to sinus rhythm (SR). STUDY DESIGN Prospective clinical study. ANIMALS Eight horses successfully treated for AF (transvenous electrical cardioversion after amiodarone pre-treatment). METHODS Cardioversion catheters and a pacing catheter were placed under sedation [detomidine 10 microg kg(-1) intravenously (IV)]. After additional sedation (5-10 microg kg(-1) detomidine, 0.1 mg kg(-1) methadone IV), anaesthesia was induced with ketamine, 2.2 mg kg(-1) and midazolam, 0.06 mg kg(-1) (IV) in a sling and maintained with isoflurane in oxygen. Flunixin meglumine, 1.1 mg kg(-1), was administered IV. Shocks were delivered as biphasic truncated exponential waves, synchronized with the R-wave of the electrocardiogram. Monitoring included pulse oximetry, electrocardiography, capnography, inhalational anaesthetic agent concentration, arterial blood pressure, LiDCO and PulseCO cardiac index (CI) and arterial blood gases. Values before and after the first unsuccessful shock and before and after cardioversion to SR were compared. RESULTS Values before the first shock were comparable to reported values in healthy, isoflurane anaesthetized horses. Reliable CI measurements could not be obtained using the PulseCO technique. Intermittent positive pressure ventilation was required in most horses (bradypnea and/or PaCO(2) >8 kPa, 60 mmHg), while dobutamine was administered in two horses (0.3-0.5 microg kg(-1) minute(-1)). After the 1st unsuccessful shock application, systolic arterial pressure (SAP) was decreased (p = 0.025), other recorded values were not influenced (CI measurements not available for this analysis). SR was associated with increases in CI (p = 0.039) and stroke index (p = 0.002) and a decrease in SAP (p = 0.030). CONCLUSIONS AND CLINICAL RELEVANCE Despite the presence of AF, cardiovascular function was well maintained during anaesthesia and was not affected by shock application. Cardiac index and stroke index increased and SAP decreased after cardioversion.

Noninvasive determination of atrial fibrillation cycle length by atrial colour tissue Doppler imaging in horses.

REASONS FOR PERFORMING STUDY Atrial fibrillation cycle length (AFCL) is an indicator of atrial electrical remodelling during atrial fibrillation (AF). OBJECTIVES To compare AFCL measured invasively from an intra-atrial electrogram (AFCLEGM ) with AFCL measured noninvasively by atrial colour tissue Doppler imaging (AFCLTDI ). STUDY DESIGN Prospective descriptive clinical study. METHODS Measurements were performed in 31 episodes of AF or flutter in 29 horses (588 ± 61 kg bwt, 9 ± 3 years old) admitted for transvenous electrical cardioversion. The AFCLEGM was measured from an intracardiac electrogram using a bipolar sensing/pacing electrode inserted into the right atrium. The AFCLTDI was measured from atrial colour tissue velocity curves in the following 5 regions: 1) left atrial free wall from a right parasternal 4-chamber view, 2) left atrial free wall from a short-axis view, 3) left atrial free wall from a left parasternal long-axis view, 4) interatrial septum, and 5) right atrial dorsal wall near the tuberculum intervenosum. The AFCLEGM and AFCLTDI from the 5 regions were compared using a one-way repeated-measures ANOVA with Bonferroni correction for multiple comparisons and calculation of the Bland-Altman mean bias and limits of agreement of AFCLEGM and AFCLTDI . RESULTS The AFCLEGM was 161 ± 18 ms in 29 AF episodes. Two horses showed atrial flutter and had an AFCLEGM of 244 and 324 ms. The mean bias between AFCLTDI and AFCLEGM ranged from -18 to +9 ms depending on the atrial wall region. The AFCLTDI was significantly shorter in the left atrial free wall from the right parasternal 4-chamber view and short-axis view than in the other regions (P<0.001). CONCLUSIONS Tissue Doppler imaging allows noninvasive measurement of AFCL in horses with AF and is able to identify spatial differences within the equine atria. Atrial fibrillation cycle length is an indicator of atrial electrical remodelling and is an important parameter to study AF pathophysiology or the effect of antiarrhythmic drugs.

Influence of atrioventricular interaction on mitral valve closure and left ventricular isovolumic contraction measured by tissue Doppler imaging.

Background—The influence of atrioventricular (AV) interaction on mitral valve closure (MVC) and left ventricular (LV) isovolumic contraction is not fully clarified. We investigated the relationship among AV delay, MVC, and LV isovolumic contraction using a horse model because of the low heart rate and physiologically long AV delay. Methods and Results—Six horses were evaluated during sinus rhythm, right ventricular pacing without preceding atrial contraction, and dual-chamber pacing at AV delays of 150 to 350 ms, programmed at a constant rate. Right parasternal 4-chamber views were recorded for simultaneous measurements of MVC from anatomic M-mode and radial tissue Doppler-based LV pre-ejection velocity and isovolumic acceleration. During sinus rhythm and long AV delays (≥300 ms), 2 positive pre-ejection velocity peaks were present. The first peak was identified as LV recoil during atrial relaxation and consistently preceded MVC by 33±17 ms. The second peak was related to LV isovolumic contraction, occurring after MVC. This suggests that MVC was caused by atrial relaxation and followed by true isovolumic contraction. During short AV delays (<300 ms) and right ventricular pacing, MVC occurred significantly later. Only 1 pre-ejection peak was present, of which the end coincided with MVC with a mean difference of –1.5±10 ms. This suggests that LV contraction caused MVC. Peak velocity and isovolumic acceleration were significantly higher (P<0.001) because the mitral valve was open at the onset of LV contraction. Conclusions—Depending on the AV delay, MVC can be atrio- or ventriculogenic, resulting in significant alterations of the LV peak pre-ejection velocity and isovolumic acceleration.

Isolation and identification of Mycobacterium avium subspecies silvaticum from a horse

Routine cultivation methods are able to distinguish between isolates of the Mycobacterium avium and the Mycobacterium tuberculosis complex. However, molecular tools are needed to further identify the several subspecies in the M. avium complex, especially for the subspecies avium and silvaticum. A rapid technique using HhaI restriction digestion of a 349 bp amplification product of the 85B antigen (α-antigen) gene was used for the identification of M. avium subsp. silvaticum in a three-year-old gelding presenting with caseous, necrotizing, granulomatous lesions. The result was confirmed by sequencing of the 85B antigen gene.

A Functional Turbidimetric Method to Determine C-Reactive Protein in Horses

A turbidimetric method to determine serum C-reactive protein (CRP) concentration, based on soybean oil–phosphocholine interaction, was performed on horse serum samples to evaluate its potential diagnostic value in veterinary medicine. Intralipid 20% in 0.1 M Tris–calcium buffer (pH 7.5) was added to horse serum. After 30 min of incubation at 37°C, the CRP–phosphocholine complexes were turbidimetrically, bichromatically (660 nm/700 nm) quantified on a commercial analyzer. Furthermore, comparison between CRP and other inflammatory markers, including white blood cell and neutrophil counts, was performed to evaluate the diagnostic value of both tests. Standardization of the assay was done using a commercial human CRP calibrator. The CRP measurements were performed on serum samples (296 patients and 34 controls). Reference values were found to be lower than 10 mg/l. The method was found to be linear between 1 and 400 mg/l. A moderate correlation was observed between CRP values and the relative neutrophil counts. Receiver-operating characteristics analysis demonstrated the area under the curve for CRP was 0.928, which was superior (P < 0.001) to the neutrophil count (0.804) and the leukocyte count (0.664) in detecting the presence of inflammation. This CRP assay showed reliable results as an acute phase test in horses, confirming its species-independent capability to detect CRP in various mammals, including horses.