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

in BMC Veterinary Research (2012), 8

Background Pulsed 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 ... [more ▼]

Background Pulsed 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. Results As 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. Conclusions PW 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. [less ▲]

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

in Veterinary Record : Journal of the British Veterinary Association (2012), 170(6), 154

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 ... [more ▼]

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 this 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 standardized 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 6 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. [less ▲]

L'insuffisance mitrale chez le cheval.

in Annales de Médecine Vétérinaire (2012), Accepté pour publication sous réserve de modifications mineures

Etude rétrospective de 12 cas de défaut du septum interventriculaire chez le cheval

in In Proceedings of the 39ème journées annuelles de l'Association des Vétérinaires Equins Français (AVEF) (2011, December 05)

Introduction Le défaut du septum interventriculaire ou communication interventriculaire (CIV) est l’anomalie congénitale la plus fréquente chez le cheval. Le diagnostic et le pronostic de cette pathologie ... [more ▼]

Introduction Le défaut du septum interventriculaire ou communication interventriculaire (CIV) est l’anomalie congénitale la plus fréquente chez le cheval. Le diagnostic et le pronostic de cette pathologie sont réalisés au moyen de l’échocardiographie Doppler pulsé. Cette étude a pour but de décrire les cas observés entre 1998 et 2008 à la clinique équine de l’Université de Liège, mais aussi de déterminer leur devenir à long terme. Matériel et méthodes Sept chevaux présentant une CIV ont été présentés en clinique. Leur race, âge, sexe, symptômes, et le motif de la consultation ont été notés puis une échocardiographie Doppler pulsé a été effectuée. Un suivi téléphonique a aussi été mis en place en 2011 pour connaître leur évolution à long terme. Résultats Les 7 chevaux présentés avaient entre 1 mois et 11 ans. Six chevaux étaient des demi-sang et le septième était un poney islandais. Tous les chevaux présentaient un souffle bilatéral holo- ou pan-systolique de grade égale ou supérieur à 5/6, plus intense à droite en région tricuspide. Cinq chevaux étaient référés pour souffle sans symptôme associé tandis que les 2 autres présentaient des œdèmes, de l’intolérance à l’effort et de la dyspnée. A l’échocardiographie, toutes les CIV étaient localisées à la base du septum dans sa partie membraneuse. Cependant, pour le premier cheval, examiné en 1998, une communication atypique entre le ventricule gauche (VG) et l’oreillette droite (OD) fut observée. La taille des CIV variait entre 0,5 et 6,6cm et la vitesse du shunt, toujours dirigé de gauche à droite, était comprise entre 2,5 et 5,5 m/s. Le premier cheval, référé en clinique en 1998, était en insuffisance cardiaque très sévère et présentait une dilatation des 2 ventricules et des 2 oreillettes, une fibrillation auriculaire et une insuffisance mitrale et tricuspide sévères. Le 2ème cheval avec des signes d’insuffisance cardiaque était un poulain d’1 mois avec une CIV de grande taille (2,6 cm) associé à un début de dilatation du ventricule droit sans autre anomalie cardiaque. Enfin, 3 des 5 chevaux asymptomatiques présentaient différentes insuffisances valvulaires mais seulement légères à modérées et une sténose pulmonaire a été observé chez l’un d’entre eux. Discussion et conclusions Les résultats de cette étude sont en accord avec la littérature. Les CIV sont associées à un souffle bilatéral holo- ou pan-systolique important et sont majoritairement localisés dans la partie membraneuse du septum. Une vitesse élevée du shunt est associée à une CIV de petite taille et à un pronostic vital et sportif bon. Par contre, en cas de CIV associé à d’autres anomalies graves comme des insuffisances valvulaires sévères, le pronostic est sombre. [less ▲]

Pronostic value of echocardiographic and Doppler parameters in colic horses with endotoxic shock: A preliminary study

Conference (2011, February 05)

Endotoxemia is the first mortality cause in equine intensive care. In humans with septic shock, some echocardiographic indicators are used to predict the efficiency of fluid resuscitation and outcome ... [more ▼]

Endotoxemia is the first mortality cause in equine intensive care. In humans with septic shock, some echocardiographic indicators are used to predict the efficiency of fluid resuscitation and outcome, allowing an early-goal-directed therapy. Echocardiography has never been investigated for this indication in horses. The aim of this study was to assess the prognosis value of echocardiographic and Doppler parameters of left ventricular (LV) function in horses with severe endotoxic shock. Twenty-one horses admitted to the clinic for colic with clinical signs of severe endotoxic shock underwent Doppler echocardiographic examination. LV echocardiographic and Doppler parameters were compared between the survivors (n=6) and the non-survivors (n=15) horses using a multivariable ANOVA analysis. The pre-ejection period to ejection time ratio (PEP/ET) of the Doppler aortic flow was significantly higher in the non-survivors than in the survivors group. All other measured parameters (including heart rate and end-diastolic-volume) were not significantly different between the groups. Doppler parameters of left ventricular function are subject to high variability and low repeatability in horses. This might explain that most variables were not significantly different between the two groups. Moreover, the number of investigated horses was limited, especially in the survivors group. However, with comparable HR and LV preload, a higher PEP/ET suggested a more compromised systolic dysfunction in the non-survivors. PEP/ET is often considered to be one of the best indicators of systolic function in horses and its measurement might therefore be useful in indicating the need for inotropic support in the management of horses with endotoxic shock. [less ▲]

Doppler Echocardiographic follow up of three horses with congestive heart failure and treated with quinapril, digoxin, and diuretics

Poster (2011, February)

Angiotensin converting enzyme inhibitors are recommended therapy in human and canine patients with congestive heart failure (CHF), but little is known concerning their efficiency to treat horses with CHF ... [more ▼]

Angiotensin converting enzyme inhibitors are recommended therapy in human and canine patients with congestive heart failure (CHF), but little is known concerning their efficiency to treat horses with CHF. Enalapril has been shown to be poorly absorbed in horses and quinapril has been shown to decrease the severity of the insufficiency and to increase the stroke volume (SV) and the cardiac output (CO) in horses with mitral regurgitation (MR) without signs of CHF. The objective of this cases report was to evaluate the effect of quinapril associated with routine treatment in horses with CHF. Three horses with clinical, echocardiographic and electrocardiographic signs of severe MR, CHF and secondary atrial fibrillation were studied (Fig 1 to 3). None of them had been previously treated for those problems. According to the ACVIM classification system for management of canine CHF, they were therefore classified in class C. They were treated with quinapril 0.2mg/kg SID PO, digoxin 0.011mg/kg BID PO, and furosemide 1mg/kg BID IM. Standard echocardiographic and Doppler measurements were performed before treatment (T0), and 1 and 4 weeks after starting treatment (W1 and W4, respectively). All horses showed a transient clinical improvement (decrease of edemas and disappearance of the dyspnea) after 1 week of treatment, but clinical signs deteriorated within the following weeks in 2 horses that were euthanized for ethical reasons. The third horse kept a steady clinical status and was discharged with the treatment pursued at home. Evolution (in %) of main echocardiographic parameters at W1 and W4 compared to T0 values are showed in Table1. Large individual variations in response to the treatment were seen. Nevertheless, in all horses, a decrease of the Heart Rate (HR) was observed after 1 week of treatment, but the HR increased again after 1 month of treatment (Fig 4). On the contrary, no increase in SV or CO, and no decrease in LVIDd were seen in response to treatment (Fig 5). In the 2 horses that were euthanized, the fractional shortening (FS) and the pre-ejection to ejection time ratio (PEP/ET) decreased and the mitral E peak velocity increased with treatment, whereas they followed the opposite evolution in the surviving horse. No conclusion can be drawn from this study because of the limited number of studied cases. However, it would be interesting to extend it to additional cases and to less severely affected cases (i.e. horses classified in class C after initial treatment or class B horses). Negative chronotropic effect of digoxin was suggested after 1 week of treatment since a decrease of the HR was observed in all horses. However, this effect seemed to decrease after 1 month of treatment. Those preliminary results of echocardiography suggest that quinapril in association with digoxin and furosemide at the used dosage could be inefficient to reduce the left ventricular filling pressure and to improve the myocardial contractility in horses with severe CHF. This could however be due to the fact that the 3 studied horses were cases refractory to classic treatment (thus to be classified in class D). [less ▲]

Echocardiographic assessment of left ventricular systolic function in colic horses

in Journal of Equine Veterinary Science (2011), 31(8), 481-487

Background: Echocardiography has not been reported to study hemodynamic disturbances in colic horses. Objectives: To non invasively assess the impact of colic-related endotoxin shock on equine cardiac ... [more ▼]

Background: Echocardiography has not been reported to study hemodynamic disturbances in colic horses. Objectives: To non invasively assess the impact of colic-related endotoxin shock on equine cardiac function. Animals: Fifty horses admitted in clinic on emergency for colic. Methods: A shock score from 1 to 4 was established for each horse based on clinical evaluation, non invasive systolic blood pressure and blood tests measurements. Left ventricular echocardiographic and Doppler parameters were compared between the 4 groups according to the shock score (1 = no or discrete signs of shock, n=11; 2 = mild shock, n=17; 3 = moderate shock, n=12; 4 = severe shock, n=10) using a multivariable analysis. Horses with a score shock of 1 were considered as control. Significance was set at P < 0.05. Results: The stroke volume, stroke index, ejection time, ejection time index corrected for heart rate, aortic velocity time integral, aortic flow acceleration time and aortic flow deceleration time were significantly lower whereas acceleration rate of aortic flow ejection and heart rate were significantly higher in shocked horses than in controls. Cardiac output was not significantly different between groups. Conclusions and Clinical importance: Even if those results are difficult to interpret because of the shock-induced changes in loading conditions of the heart, they suggest that alterations in some indicators of systolic function can be quantified by Doppler echocardiography in horses with colic-induced endotoxemic shock. Ultrasonographic monitoring of cardiovascular function could thus be of interest in equine intensive care. [less ▲]

Prospective study of hemodynamic disorders mesured by echocardiography and associated with endotoxemia in horses

Conference (2010, September 11)

Endotoxemia is the first mortality cause in intensive care horses. In human, hemodynamic disturbances have been showed to be associated with septic shock whereas in horses, this facet of endotoxemia has ... [more ▼]

Endotoxemia is the first mortality cause in intensive care horses. In human, hemodynamic disturbances have been showed to be associated with septic shock whereas in horses, this facet of endotoxemia has not yet been studied. The aim of the study was to assess the impact of endotoxin shock on equine cardiac function. Fifty horses admitted in clinic with signs of endotoxic shock and 17 healthy control horses were submitted to a doppler echocardiographic exam. The endotoxemic horses were classified in 4 groups according to their shock score based on clinical evaluation (heart rate (HR) and respiratory rate), non invasive systolic blood pressure, and blood tests (Packed cell volume and lactates). Score 1, 2, 3 and 4 groups included 11, 17, 12 and 10 horses, respectively. Left ventricular (LV) echocardiographic and Doppler parameters were compared between the 5 groups using a multivariable ANOVA analysis. The LV internal diameter, ejection time, ejection time corrected for HR and mean velocity of circumferential fiber shortening corrected for HR, the aortic velocity time integral and deceleration time, and the stroke volume were significantly lower, whereas the HR and the peak velocity of the late diastolic filling of the mitral Doppler flow and its velocity time integral were significantly higher in grade 2 to 4 endotoxemic horses than in control horses. Because of the tachycardia compensating the lower stroke volume in endotoxemic horses, the cardiac output was not significantly different between groups. Despite the fact that the increase in HR, the fall in preload and a probable decrease in afterload doubtless played a role in the observed changes, the results of this study suggest an impaired systolic and diastolic LV function in horses with moderate to severe endotoxemia. Doppler echocardiographic monitoring of the cardiovascular function could thus be of interest in equine intensive care. [less ▲]

Inertie clinique et observance thérapeutique dans les valvulopathies chroniques du coeur gauche.

in Revue Médicale de Liège (2010), 65(5-6), 290-8

Valvular heart diseases are of increasing importance among the general adult population. When compared with other heart diseases, there are few trials in the field of valvular heart disease and randomized ... [more ▼]

Valvular heart diseases are of increasing importance among the general adult population. When compared with other heart diseases, there are few trials in the field of valvular heart disease and randomized clinical trials are particularly scarce. Two sets of guidelines exist: one in the USA and the other in Europe. However, they are not always consistent due to the lack of randomized data and it appears that, frequently, there is a gap between the existing guidelines and their effective application. [less ▲]

Biopsies rectales chez le cheval : technique, innocuité, et valeur diagnostique de l'examen histopathologique.

Master of advanced studies dissertation (2009)

La biopsie rectale est couramment utilisée sur les chevaux présentant un amaigrissement, de la diarrhée chronique ou des coliques récidivantes. Le but de cette étude est la mise au point de cette ... [more ▼]

La biopsie rectale est couramment utilisée sur les chevaux présentant un amaigrissement, de la diarrhée chronique ou des coliques récidivantes. Le but de cette étude est la mise au point de cette technique, l’étude de son innocuité et de sa valeur diagnostique. Huit biopsies rectales sont prélevées en différents endroits, avec la pince à biopsie utérine de la clinique, sur chacun des 12 chevaux de l’étude, 7 malades et 5 témoins, sous anesthésie générale ou simple sédation. Des prélèvements de duodénum, iléon, caecum, colon et rectum sont effectués post mortem sur chaque cheval. Un examen histopathologique sur lames colorées à l’hématoxyline-éosine, est réalisé. Pour un droitier, il est plus facile de prélever dans le cadran supérieur droit. Les autopsies montrent que 91% des biopsies à 30 cm de l’anus et 48% de celles à 15 cm sont localisées en avant du cul-de-sac rétropéritonéal. Des hématomes sont fréquents (44%) surtout ventralement. Une seule perforation est observée. Au microscope, l’inflammation sur les biopsies rectales est plus marquée à 30 cm et chez les chevaux malades. Des études similaires avec la méthode proctoscopique et avec une pince à biopsie utérine de plus petit calibre, seraient intéressantes en vue de comparer les résultats. [less ▲]