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See detailPrevalence and Risk Factors for Various Cardiac Diseases in a Hospital-Based Population of 3434 Horses (1994-2011)
Leroux, Aurélia ULg; Detilleux, Johann ULg; Sandersen, Charlotte ULg et al

in Journal of Veterinary Internal Medicine (2013), 27(6), 1563-70

Background: Risk factors for several cardiac diseases have been suspected in horses, but few have been statistically demonstrated in a large equine population. Objectives: To describe risk factors for ... [more ▼]

Background: Risk factors for several cardiac diseases have been suspected in horses, but few have been statistically demonstrated in a large equine population. Objectives: To describe risk factors for various cardiac diseases in a hospital-based equine population. Animals: Files of 3434 horses admitted at the internal medicine department of the Liege Equine Teaching Hospital between 1994 and 2011were reviewed and of those, 284 were categorized as suffering from moderate to severe cardiac disease. Methods: Observational study. After calculating prevalence for each cardiac disease, we tested whether breed (chi-square test) or gender, age, body weight (BW) and other cardiac diseases (logistic regressions) were risk factors (p<0.05 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. Determinants were male gender 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 major valvular disease associated with AF, pathological ventricular arrhythmia, pulmonary regurgitation (PR) and congestive heart failure (CHF). TR was also linked to AF, PR and CHF; AR was not linked to CHF. Conclusions and clinical importance: Several previously suspected risks factors of a variety of equine cardiac diseases are statistically confirmed in the studied hospital-based population. Similar observation could be suspected in a larger randomized population and should be taken into account in health and sport’s monitoring of horses presenting predisposing factors. [less ▲]

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See detailPrevalence and Risk Factors for Various Cardiac Diseases in a Hospital-Based Population of 3434 Horses (1994-2011)
Leroux, Aurélia ULg; Detilleux, Johann ULg; Sandersen, Charlotte ULg et al

in Journal of Veterinary Internal Medicine (2013), 27(6), 1563-70

Background: Risk factors for several cardiac diseases have been suspected in horses, but few have been statistically demonstrated in a large equine population. Objectives: To describe risk factors for ... [more ▼]

Background: Risk factors for several cardiac diseases have been suspected in horses, but few have been statistically demonstrated in a large equine population. Objectives: To describe risk factors for various cardiac diseases in a hospital-based equine population. Animals: Files of 3434 horses admitted at the internal medicine department of the Liege Equine Teaching Hospital between 1994 and 2011were reviewed and of those, 284 were categorized as suffering from moderate to severe cardiac disease. Methods: Observational study. After calculating prevalence for each cardiac disease, we tested whether breed (chi-square test) or gender, age, body weight (BW) and other cardiac diseases (logistic regressions) were risk factors (p<0.05 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. Determinants were male gender 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 major valvular disease associated with AF, pathological ventricular arrhythmia, pulmonary regurgitation (PR) and congestive heart failure (CHF). TR was also linked to AF, PR and CHF; AR was not linked to CHF. Conclusions and clinical importance: Several previously suspected risks factors of a variety of equine cardiac diseases are statistically confirmed in the studied hospital-based population. Similar observation could be suspected in a larger randomized population and should be taken into account in health and sport’s monitoring of horses presenting predisposing factors. [less ▲]

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See detailRisks factors for valvular regurgitations in 3499 equids: a cross-sectional study.
Leroux, Aurélia ULg; Detilleux, Johann ULg; Sandersen, Charlotte ULg et al

in Proceedings of the 2013 ACVIM Forum (2013)

Risk factors for valvular regurgitations (VR) have been suspected in equids, but no extensive epidemiologic study has been performed in a large mixed equine population. Therefore, the aim of this study ... [more ▼]

Risk factors for valvular regurgitations (VR) have been suspected in equids, but no extensive epidemiologic study has been performed in a large mixed equine population. Therefore, the aim of this study was to statistically test risk factors for VR in a large population of equids. Hospital records were reviewed for 3.499 equids, admitted at the internal medicine department of the Liege Equine Teaching Hospital between 1994 and 2011, aged ≥2 years, and which underwent thorough cardiac clinical evaluation. Of this population, 495 cases had ECG and echocardiography performed because of a clinical suspicion of cardiac disease. Chi-square test or logistic regressions (as appropriate) were used to test if breed, gender, age, body weight (BW), and co-existence of various cardiac diseases were risk factors for each VR. Moreover, the risk of development of congestive heart failure (CHF) was tested for each VR. Significance was set at p<0.05. Most of the studied animals were warmbloods, and observed prevalences were 4.4% for mitral regurgitation (MR), 2.1% for aortic regurgitation (AR), 1.7% for tricuspid regurgitation (TR), and 1.0% for pulmonary regurgitation (PR). Significant risk factors were male gender and increasing age for AR (OR=2.03, CI=1.07-4.94), and racehorses breed group and middle-age for TR (OR=4.36; CI=1.10-17.24). No effect of age or BW was demonstrated for MR. MR was the major valvular disease associated with atrial fibrillation (AF), ventricular tachyarrhythmia, PR and CHF. TR was also linked to AF, PR and CHF; but AR was not linked to CHF. In conclusion, several previously suspected risks factors for VR were confirmed statistically in this study and should be taken into account in health and athletic monitoring of horses presenting predisposing factors. [less ▲]

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See detailPronostic value of echocardiographic and Doppler parameters in colic horses with endotoxic shock: A preliminary study
Borde, Laura ULg; Amory, Hélène ULg; Leroux, Aurélia ULg et al

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 ▲]

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See detailDoppler Echocardiographic follow up of three horses with congestive heart failure and treated with quinapril, digoxin, and diuretics
Leroux, Aurélia ULg; Sandersen, Charlotte ULg; Borde, Laura ULg et al

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 ▲]

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See detailEchocardiographic assessment of left ventricular systolic function in colic horses
Borde, Laura ULg; Amory, Hélène ULg; Leroux, Aurélia ULg et al

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 ▲]

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See detailMyocardial depression as a component of endotoxic shock in horses: preliminary results of an echocardiographic study
Borde, Laura ULg; Amory, Hélène ULg; Leroux, Aurélia ULg et al

Conference (2010, October 16)

Cardiovascular consequences of septic shock are well described in humans but these hemodynamic disturbances have not yet been studied in endotoxic horses. The endotoxins act directly and indirectly to ... [more ▼]

Cardiovascular consequences of septic shock are well described in humans but these hemodynamic disturbances have not yet been studied in endotoxic horses. The endotoxins act directly and indirectly to cause a myocardial depression associated with a systemic hypotension responsible for a fall of both the cardiac output and the systemic vascular resistance in end-stage endotoxic shock. The hypothesis was that myocardial depression was a component of endotoxic shock in horses. In this way, fifty horses admitted in clinic with signs of endotoxic shock and 17 healthy control horses were submitted to a doppler echocardiographic exam to assess the impact of endotoxic shock on equine cardiac function. A shock score from 1 to 4, based on clinical evaluation, non invasive systolic blood pressure, and blood tests was attributed to each endotoxic horse. Echocardiographic and Doppler parameters were compared between the 5 groups using a multivariable ANOVA analysis. Score 1, 2, 3 and 4 groups included 11, 17, 12 and 10 horses, respectively. Some markers of systolic function included the ejection time (ET), ET corrected for HR and mean velocity of circumferential fibre 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 endotoxemic horses than in controls. Thanks to an increase in HR, the cardiac output was not significantly different between groups. Even if the tachycardia, the fall in preload and a probable decrease in afterload doubtless influence the observed changes, the results of this study suggest that a myocardial depression with both an impaired systolic and diastolic left ventricular function could be a component of endotoxic shock in horses. [less ▲]

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See detailProspective study of hemodynamic disorders mesured by echocardiography and associated with endotoxemia in horses
Borde, Laura ULg; Amory, Hélène ULg; Leroux, Aurélia ULg et al

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 ▲]

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