Right heart echocardiographic variables and prediction of clinical severity in dogs with pulmonary stenosis

Background: Pulmonary stenosis (PS) usually is evaluated using echocardiography. A multiparametric approach, in addition to the maximum pressure gradient (PG), might be indicated to better characterize PS severity and address its management. Hypothesis/objectives: Our hypothesis was that right heart size and function are associated with echocardiographic and clinical severity of pulmonary stenosis in dogs. Animals: Client-owned dogs with PS. Methods: Prospective, multicenter, observational study. Enrolled dogs underwent complete echocardiographic examination. Associations among right heart echocardiographic variables, PS transvalvular PG >80 mm Hg and presence of clinical signs (exercise intolerance, syncope, right-sided congestive failure, or some combination of these) were assessed using logistic regression analysis. Results: Eighty-eight dogs with PS. Twenty-eight dogs were symptomatic. Increased right ventricular end-diastolic free wall thickness (odds ratio [OR] > 100; 95% confidence interval [95%CI], 50- > 100; P = .01) and decreased aorta-to-pulmonary artery velocity time integral ratio (OR, 80 mm Hg. Decreased tricuspid annular plane systolic excursion (OR, 0.35; 95%CI, 0.15-0.77; P = .01) and increased right ventricular end-diastolic area (OR, 1.4; 95%CI, 1.08-2.02; P = .01) were independently associated with clinical severity. Conclusion and clinical importance: Structural and functional right heart echocardiographic variables are associated with echocardiographic and clinical severity in dogs with PS. A multiparametric approach is advised to better assess PS severity

PulseNet: Deep Learning ECG-signal classification using random augmentation policy and continous wavelet transform for canines

Evaluating canine electrocardiograms (ECG) require skilled veterinarians, but current availability of veterinary cardiologists for ECG interpretation and diagnostic support is limited. Developing tools for automated assessment of ECG sequences can improve veterinary care by providing clinicians real-time results and decision support tools. We implement a deep convolutional neural network (CNN) approach for classifying canine electrocardiogram sequences as either normal or abnormal. ECG records are converted into 8 second Lead II sequences and classified as either normal (no evidence of cardiac abnormalities) or abnormal (presence of one or more cardiac abnormalities). For training ECG sequences are randomly augmented using RandomAugmentECG, a new augmentation library implemented specifically for this project. Each chunk is then is converted using a continuous wavelet transform into a 2D scalogram. The 2D scalogram are then classified as either normal or abnormal by a binary CNN classifier. Experimental results are validated against three boarded veterinary cardiologists achieving an AUC-ROC score of 0.9506 on test dataset matching human level performance. Additionally, we describe model deployment to Microsoft Azure using an MLOps approach. To our knowledge, this work is one of the first attempts to implement a deep learning model to automatically classify ECG sequences for canines.Implementing automated ECG classification will enhance veterinary care through improved diagnostic performance and increased clinic efficiency

Effect of potential renal acid load of foods on urinary citrate excrection in calcium renal stone formers

The aim of this study was to investigate the influence of the potential renal acid load (PRAL) of the diet on the urinary risk factors for renal stone formation. The present series comprises 187 consecutive renal calcium stone patients (114 males, 73 females) who were studied in our stone clinic. Each patient was subjected to an investigation including a 24-h dietary record and 24-h urine sample taken over the same period. Nutrients and calories were calculated by means of food composition tables using a computerized procedure. Daily PRAL was calculated considering the mineral and protein composition of foods, the mean intestinal absorption rate for each nutrient and the metabolism of sulfur-containing amino acids. Sodium, potassium, calcium, magnesium, phosphate, oxalate, urate, citrate, and creatinine levels were measured in the urine. The mean daily PRAL was higher in male than in female patients (24.1\ub124.0 vs 16.1\ub120.1 mEq/day, P=0.000). A significantly (P=0.01) negative correlation (R=0.18) was found between daily PRAL and daily urinary citrate, but no correlation between PRAL and urinary calcium, oxalate, and urate was shown. Daily urinary calcium (R=0.186, P=0.011) and uric acid (R=0.157, P=0.033) were significantly related to the dietary intake of protein. Daily urinary citrate was significantly related to the intakes of copper (R=0.178, P=0.015), riboflavin (R=0.20, P=0.006), piridoxine (R=0.169, P=0.021) and biotin (R=0.196, P=0.007). The regression analysis by stepwise selection confirmed the significant negative correlation between PRAL and urinary citrate (P=0.002) and the significant positive correlation between riboflavin and urinary citrate (P=0.000). Urinary citrate excretion of renal stone formers (RSFs) is highly dependant from dietary acid load. The computation of the renal acid load is advisable to investigate the role of diet in the pathogenesis of calcium stone disease and it is also a useful tool to evaluate the lithogenic potential of the diet of the individual patien

ECG of the Month. Spontaneous regression of a third-degree atrioventricular block in a dog with aortic endocarditis.

Spontaneous regression of a third-degree atrioventricular block in a dog with aortic endocarditis

Right heart echocardiographic variables and prediction of clinical severity in dogs with pulmonary stenosis

BackgroundPulmonary stenosis (PS) usually is evaluated using echocardiography. A multiparametric approach, in addition to the maximum pressure gradient (PG), might be indicated to better characterize PS severity and address its management. Hypothesis/ObjectivesOur hypothesis was that right heart size and function are associated with echocardiographic and clinical severity of pulmonary stenosis in dogs. AnimalsClient-owned dogs with PS. MethodsProspective, multicenter, observational study. Enrolled dogs underwent complete echocardiographic examination. Associations among right heart echocardiographic variables, PS transvalvular PG >80 mm Hg and presence of clinical signs (exercise intolerance, syncope, right-sided congestive failure, or some combination of these) were assessed using logistic regression analysis. ResultsEighty-eight dogs with PS. Twenty-eight dogs were symptomatic. Increased right ventricular end-diastolic free wall thickness (odds ratio [OR] > 100; 95% confidence interval [95%CI], 50- > 100; P = .01) and decreased aorta-to-pulmonary artery velocity time integral ratio (OR, 80 mm Hg. Decreased tricuspid annular plane systolic excursion (OR, 0.35; 95%CI, 0.15-0.77; P = .01) and increased right ventricular end-diastolic area (OR, 1.4; 95%CI, 1.08-2.02; P = .01) were independently associated with clinical severity. Conclusion and Clinical ImportanceStructural and functional right heart echocardiographic variables are associated with echocardiographic and clinical severity in dogs with PS. A multiparametric approach is advised to better assess PS severity

ECG of the month

A 14-year-old 18-kg (39.6-lb) sexually intact male German Shorthaired Pointer was evaluated because of severe weakness and inability to maintain a standing position. The owner had found the dog outdoors in lateral recumbency, after it had been outside for several hours during the winter season. It had been recently determined that the dog had vestibular syndrome. On physical examination, the dog was in lateral recumbency and had dull mentation. The dogâ\u80\u99s rectal temperature was 33.8°C (92.84°F); oral mucous membranes were pale pink, and capillary refill time was 2 seconds. The femoral pulses were weak and irregular, and the heart rate was variable (120 to 200 beats/min). A grade 2/6 left apical midsystolic heart murmur was auscultated. Bradypnea (10 breaths/min) with deep breaths and expiratory apneas were observed. The initial diagnostic evaluation included hematologic and serum biochemical analyses, blood gas analyses, blood pressure measurement, thoracic radiography, ECG, and echocardiography. The CBC revealed mild leukocytosis (18,200 WBCs/μL; reference range, 5,000 to 17,000 WBCs/μL) with neutrophilia (15,400 neutrophils/μL; reference range, 3,700 to 12,000 neutrophils/μL). Venous blood gas analysis revealed metabolic acidosis (pH, 7300 [reference range, 7360 to 7.410]; HCO3-concentration, 15.3 mEq/L [reference range, 20 to 24 mEq/L]; pCO2, 36 mm Hg [reference range, 40 to 50 mm Hg]; base excess, -5.7 mmol/L [reference range, -4 to +4 mmol/L]) with hyperlactatemia (4.1 mmol/L; reference range, 0.5 to 2.5 mmol/L). Results of serum biochemical analyses were within reference ranges. Systolic blood pressure measurement revealed systemic hypotension (70 mm Hg). No abnormalities were detected on thoracic radiographs. Echocardiography revealed a mild thickening and prolapse of the mitral valve leaflets, with mild mitral valve regurgitation and normal heart chamber dimensions. Electrocardiography was performed to evaluate the arrhythmia

Percutaneous Balloon Dilation in Two Dogs with Cor Triatriatum Dexter

Percutaneous balloon dilation was performed in a Rhodesian Ridgeback and in an American Staffordshire Terrier affected by cor triatriatum dexter (CTD). Both cases had ascites without jugular venous distension or pleural effusion. In both dogs the CTD presented a perforated membrane but with different morphology: in one case the coronary sinus entered the caudal chamber of the CTD together with the caudal vena cava. In the other case, the coronary sinus communicated with the cranial chamber of the CTD together with the cranial vena cava. Percutaneous balloon dilation of the CTD was successfully performed, and both dogs had uneventful surgery recoveries. At two years of follow-up, the dogs were free from clinical signs and cardiac medication

Left atrial anteroposterior diameter in dogs: reference interval, allometric scaling, and agreement with the left atrial-to-aortic root ratio

Left atrial enlargement (LAE) is a well-known negative prognostic factor in dogs with myxomatous mitral valve disease (MMVD). Left atrial-to-aortic root ratio (LA/Ao) is the most commonly used method to evaluate left atrial (LA) size in dogs, while the left atrial anteroposterior diameter (LAD) has been proposed as an additional measurement of LA size in different species. The aim of this study was to establish a normal reference range of LAD normalized to body weight (LADn) in dogs using allometric scales, and to evaluate the agreement between LADn and LA/Ao in the detection of LAE in dogs with MMVD. This was a retrospective, multicenter, observational study. We included 330 healthy dogs, 30 dogs with MMVD in ACVIM stage B1, 30 dogs in ACVIM stage B2, and 30 dogs in ACVIM stage C. The reference range for the LAD, depending on body weight, was between 16.91 mm and 49.68 mm. The reference range for the LADn in healthy dogs was between 10.49 and 15.72. LADn was significantly greater in dogs with MMVD compared to healthy dogs, and a significant difference in LADn was noted between different ACVIM stages (P<0.001). The most accurate cut-off value of LADn to differentiate between dogs in groups B2 and C was 20.3 (sensitivity, 83.3%; specificity, 83.3%). There was a misclassification rate of 37% between LADn and LA/Ao in the detection of LAE in group B1. This study provides a normal reference range for LAD in dogs, which can be used as an additional tool to assess LAE in dogs with MMVD

Transjugular Patent Ductus Arteriosus Occlusion in Seven Dogs Using the Amplatzer Vascular Plug II

Although vascular plugs for the closure of patent ductus arteriosus (PDA) have been validated in dogs, studies are lacking on its use as a first-choice device with a transjugular approach. The present case series describes the transvenous right jugular embolization of PDA using an Amplatzer Vascular Plug II in seven dogs of different ages, breeds, and body weights. Complete closure of the PDA was demonstrated in all cases. All dogs showed significant hemodynamic reduction of pulmonary overcirculation and left heart size after the procedure and at following echocardiographic check-ups. Transjugular PDA occlusion using an Amplatzer Vascular Plug II can thus be considered as a safe alternative to the arterial or venous femoral approach using an Amplatzer canine ductal occluder (ACDO), particularly in puppies with small femoral vessels