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 ▲]

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 ▲]