Effect of Body Position on the 6-Lead ECG of Dogs

ECGs recorded from dogs show characteristic morphology and changes in morphology with various disease states. These changes are determined by comparing individual recordings to reference ranges established from recordings obtained from normal dogs in right lateral (RL) recumbency. Using these reference ranges for ECGs recorded from dogs in other positions may not be valid. We compared ECG complexes from 39 normal dogs obtained in RL, left lateral (LL), and standing (ST) body positions. ECGs from dogs in ST position showed increased Q-wave and R-wave amplitudes in leads I and II, increased R-wave and S-wave amplitudes in leads aVR and aVL, and decreased R-wave and S-wave amplitudes in lead III when compared with recordings obtained in RL position. ECGs from dogs in LL position showed increased R-wave amplitude in leads II, III, and aVF and S-wave amplitude in lead aVL but decreased R-wave amplitude in lead aVR when compared with recordings obtained in RL position. The mean electrical axis (MEA) shifted to the left in ST position but remained within the normal range in LL position. We determined that both a change in the relative position of the recording electrodes with respect to the heart as well as a change in intrathoracic cardiac position contributed to these changes. P-wave amplitude, P-R and S-T intervals, and QRS complex durations remained unaltered by changes in body position. Our findings indicate that ECGs of dogs recorded in RL, LL, and ST positions yield dramatically different results, and investigators should use position-specific reference ranges to minimize potential misinterpretation of ECG results

Surgical and survival outcomes with perioperative or neoadjuvant immune-checkpoint inhibitors combined with platinum-based chemotherapy in resectable NSCLC: A systematic review and meta-analysis of randomised clinical trials

: The use of neoadjuvant or perioperative anti-PD(L)1 was recently tested in multiple clinical trials. We performed a systematic review and meta-analysis of randomised trials comparing neoadjuvant or perioperative chemoimmunotherapy to neoadjuvant chemotherapy in resectable NSCLC. Nine reports from 6 studies were included. Receipt of surgery was more frequent in the experimental arm (odds ratio, OR 1.39) as was pCR (OR 7.60). EFS was improved in the experimental arm (hazard ratio, HR 0.55) regardless of stage, histology, PD-L1 expression (PD-L1 negative, HR 0.74) and smoking exposure (never smokers, HR 0.67), as was OS (HR 0.67). Grade > = 3 treatment-related adverse events were more frequent in the experimental arm (OR 1.22). The experimental treatment improved surgical outcomes, pCR rates, EFS and OS in stage II-IIIB, EGFR/ALK negative resectable NSCLC; confirmatory evidence is warranted for stage IIIB tumours and with higher maturity of the OS endpoint

Comparison and combination of a hemodynamics/biomarkers-based model with simplified PESI score for prognostic stratification of acute pulmonary embolism: findings from a real world study

Background: Prognostic stratification is of utmost importance for management of acute Pulmonary Embolism (PE) in clinical practice. Many prognostic models have been proposed, but which is the best prognosticator in real life remains unclear. The aim of our study was to compare and combine the predictive values of the hemodynamics/biomarkers based prognostic model proposed by European Society of Cardiology (ESC) in 2008 and simplified PESI score (sPESI).Methods: Data records of 452 patients discharged for acute PE from Internal Medicine wards of Tuscany (Italy) were analysed. The ESC model and sPESI were retrospectively calculated and compared by using Areas under Receiver Operating Characteristics (ROC) Curves (AUCs) and finally the combination of the two models was tested in hemodinamically stable patients. All cause and PE-related in-hospital mortality and fatal or major bleedings were the analyzed endpointsResults: All cause in-hospital mortality was 25% (16.6% PE related) in high risk, 8.7% (4.7%) in intermediate risk and 3.8% (1.2%) in low risk patients according to ESC model. All cause in-hospital mortality was 10.95% (5.75% PE related) in patients with sPESI score ≥1 and 0% (0%) in sPESI score 0. Predictive performance of sPESI was not significantly different compared with 2008 ESC model both for all cause (AUC sPESI 0.711, 95% CI: 0.661-0.758 versus ESC 0.619, 95% CI: 0.567-0.670, difference between AUCs 0.0916, p=0.084) and for PE-related mortality (AUC sPESI 0.764, 95% CI: 0.717-0.808 versus ESC 0.650, 95% CI: 0.598-0.700, difference between AUCs 0.114, p=0.11). Fatal or major bleedings occurred in 4.30% of high risk, 1.60% of intermediate risk and 2.50% of low risk patients according to 2008 ESC model, whereas these occurred in 1.80% of high risk and 1.45% of low risk patients according to sPESI, respectively. Predictive performance for fatal or major bleeding between two models was not significantly different (AUC sPESI 0.658, 95% CI: 0.606-0.707 versus ESC 0.512, 95% CI: 0.459-0.565, difference between AUCs 0.145, p=0.34). In hemodynamically stable patients, the combined endpoint in-hospital PE-related mortality and/or fatal or major bleeding (adverse events) occurred in 0% of patients with low risk ESC model and sPESI score 0, whilst it occurred in 5.5% of patients with low-risk ESC model but sPESI ≥1. In intermediate risk patients according to ESC model, adverse events occurred in 3.6% of patients with sPESI score 0 and 6.65% of patients with sPESI score ≥1.Conclusions: In real world, predictive performance of sPESI and the hemodynamic/biomarkers-based ESC model as prognosticator of in-hospital mortality and bleedings is similar. Combination of sPESI 0 with low risk ESC model may identify patients with very low risk of adverse events and candidate for early hospital discharge or home treatment.

Reference intervals for transthoracic echocardiography in the American Staffordshire Terrier

This study reports the echocardiographic reference intervals in the American Staffordshire Terrier (AST). The echocardiographic variables obtained in 57 healthy adult AST were compared with published data from the general canine population and other breeds. In the AST, the left ventricular volumes were lower than values reported in Boxers and Dobermans (P<0.0001), but higher than in small breeds (P<0.0001). The left ventricular ejection fraction was higher than Boxers and Dobermans (P<0.0001), but lower than small breed dogs (P=0.027). The aortic peak velocity values were similar to Boxers (P=0.55) but higher than the general canine population (P<0.0001). The reference intervals presented in this study are clinically useful for an accurate echocardiographic interpretation and screening in the AST

Prostatic Localization of a Migrating Grass Awn Foreign Body in a Dog

A 13-year-old male mixed-breed dog was examined because of hematuria and pyrexia. Ultrasonographic examination of the genitourinary tract showed the presence of a migrating grass awn in the right prostatic lobe. Laparotomy allowed, under ultrasonographic guidance, to remove entirely the migrating grass awn from the prostatic parenchyma. The recovery was uneventful and four months after the surgery the owner reported that the dog showed the complete resolution of the clinical signs and full return to normal activity. To our knowledge, this case report describes for the first time the clinical presentation, imaging findings, management and outcome for a dog with prostatic localization of a migrating grass awn

Transesophageal echocardiography as the sole guidance for occlusion of patent ductus arteriosus using the Amplatz® Canine Ductal Occluder in dogs: a preliminary study.

Transesophageal echocardiography (TEE) has proven useful in evaluating patent ductus arteriosus (PDA) morphology thereby guiding appropriate device selection. Additionally, TEE, in combination with fluoroscopy, has been used to guide the transcatheter coil embolization and for deployment of Amplatz Canine Ductal Occluder (ACDO) in dogs. Recently, we described the use of transthoracic echocardiography (TTE) guidance during transcatether PDA occlusion with ACDO without the use of fluoroscopy, but observed problems of deployment in patients with sub-optimal acoustic windows. However, TEE, can overcome issues of sub-optimal TTE acoustic windows and provides higher image resolution of cardiac and vascular regions. Therefore, we hypothesized that TEE could be used to successfully visualize the vascular structures and interventional devices to safely perform PDA occlusion with ACDO without requiring fluoroscopy.We recruited 5 dogs with patent ductus arteriosus (PDA) for TEE-guided percutaneous ductal occlusion with an ACDO. Dogs were anesthetized, positioned in right lateral recumbency and the right femoral artery was accessed percutaneously (modified Seldinger technique). The TEE probe was advanced to a midesophageal position with minimal force to obtain a long axis 4-chamber view (transverse plane). The probe was then retroflexed and withdrawn to a cranial esophageal position until a cross section of the descending aorta was seen. To visualize PDA to the probe was slightly straightened and turned counterclockwise, and the ultrasonic beam was oriented between 60 and 120 degrees.In all dogs, the guide wire and a long introducer-sheath were guided from the aorta through the PDA into the main pulmonary artery by TEE monitoring. The ACDO was advanced through the introducer-sheath until the flat distal disk was visualized within the main pulmonary artery by TEE monitoring. The distal disk was positioned against the pulmonic ostium and the coupled proximal disk was deployed within the ductal ampulla while being monitored by TEE visualization.The guide wires, long introducer-sheath and ACDO appeared hyperechoic on TEE images and TEE guidance provided images of sufficient quality to clearly monitor the procedures in real-time. Real-time monitoring also allowed for immediate corrections to guide wire, catheter or device positioning. The procedures were successful and without complications in all patients.We have demonstrated that TEE monitoring, like TTE monitoring, can guide every step of transcatheter ACDO embolization procedures without requiring fluoroscopy, thereby avoiding radiation exposure, and provides an alternative to TTE-based guidance, especially when TTE visualization of the PDA is insufficient for safe and timely ACDO deployment

Transesophageal echocardiography as the sole guidance for occlusion of patent ductus arteriosus using the Amplatz® Canine Ductal Occluder in dogs: a preliminary study.

Transesophageal echocardiography (TEE) has proven useful in evaluating patent ductus arteriosus (PDA) morphology thereby guiding appropriate device selection. Additionally, TEE, in combination with fluoroscopy, has been used to guide the transcathete 2012 ECVIM Abstracts 1515 coil embolization and for deployment of Amplatz Canine Ductal Occluder (ACDO) in dogs. Recently, we described the use of transthoracic echocardiography (TTE) guidance during transcatether PDA occlusion with ACDO without the use of fluoroscopy, but observed problems of deployment in patients with sub-optimal acoustic windows. However, TEE, can overcome issues of suboptimal TTE acoustic windows and provides higher image resolution of cardiac and vascular regions. Therefore, we hypothesized that TEE could be used to successfully visualize the vascular structures and interventional devices to safely perform PDA occlusion with ACDO without requiring fluoroscopy.We recruited 5 dogs with patent ductus arteriosus (PDA) for TEE-guided percutaneous ductal occlusion with an ACDO. Dogs were anesthetized, positioned in right lateral recumbency and the right femoral artery was accessed percutaneously (modified Seldinger technique). The TEE probe was advanced to a midesophageal position with minimal force to obtain a long axis 4-chamber view (transverse plane). The probe was then retroflexed and withdrawn to a cranial esophageal position until a cross section of the descending aorta was seen. To visualize PDA to the probe was slightly straightened and turned counterclockwise, and the ultrasonic beam was oriented between 60 and 120 degrees.In all dogs, the guide wire and a long introducer-sheath were guided from the aorta through the PDA into the main pulmonary artery by TEE monitoring. The ACDO was advanced through the introducer-sheath until the flat distal disk was visualized within the main pulmonary artery by TEE monitoring. The distal disk was positioned against the pulmonic ostium and the coupled proximal disk was deployed within the ductal ampulla while being monitored by TEE visualization.The guide wires, long introducer-sheath and ACDO appeared hyperechoic on TEE images and TEE guidance provided images of sufficient quality to clearly monitor the procedures in real-time. Real-time monitoring also allowed for immediate corrections to guide wire, catheter or device positioning. The procedures were successful and without complications in all patients.We have demonstrated that TEE monitoring, like TTE monitoring, can guide every step of transcatheter ACDO embolization procedures without requiring fluoroscopy, thereby avoiding radiation exposure, and provides an alternative to TTE-based guidance, especially when TTE visualization of the PDA is insufficient for safe and timely ACDO deployment