Cardiac troponin I as compared to troponin T for the detection of myocardial damage in horses

Background: Different cardiac troponin I (cTnI) assays give different results. Only 1 manufacturer has marketed troponin T (cTnT) assays. Therefore, cTnT often is preferred for detection of myocardial infarction in human patients. Studies of cTnT in horses are limited. Objectives: To compare a cTnI and a high-sensitive cTnT assay (hs-cTnT) in horses. Animals: Cardiac troponin I and cTnT were determined in 35 healthy horses (group 1), 23 horses suspected to have primary myocardial damage (group 2a), and 41 horses with secondary myocardial damage caused by structural heart disease (group 2b). Methods: All cTnI samples were analyzed at laboratory A (limit of detection [LOD]: 0.03 ng/mL), whereas cTnT samples were analyzed at 2 laboratories with the same hs-cTnT assay (laboratory B, LOD: 10.0 pg/mL; laboratory C, LOD: 4.0 pg/mL). Results: The median cTnI concentration in group 2a (0.90 ng/mL; range, 0.03–58.27 ng/mL) was significantly higher (P < .001) than in group 1 (0.03 ng/mL; range, 0.03–0.09 ng/mL) or group 2b (0.05 ng/mL; range, 0.03–30.92 ng/mL), and the optimal cut-off for detection of primary myocardial damage was 0.095 ng/mL (sensitivity: 90.5%, specificity: 100%). Using an LOD of 10.0 pg/mL for all cTnT samples, a cut-off value of 10.5 pg/mL was found, but sensitivity was low (42.9%). When only samples analyzed at laboratory C (n = 58) were included, a cut-off of 6.6 pg/mL was found (sensitivity: 81%, specificity: 100%). Conclusions and Clinical Importance: Despite large quantitative differences, cTnI and cTnT are both useful for detection of myocardial damage in horses

The use of cardiac biomarkers in veterinary medicine: the equine perspective

In human medicine, cardiac biomarkers, such as natriuretic peptides and troponins, are routinely used for the diagnosis, prognosis and monitoring of heart diseases. Similarly, these biomarkers are determined in small animals to differentiate non-cardiac from cardiac diseases. Knowledge about these biomarkers in horses is limited and requires further investigation. The first equine studies about atrial natriuretic peptide (ANP) and N-terminal ANP (NT-proANP) are promising, and show a clear correlation with atrial dimension size. Equine brain natriuretic peptides assays are still unavailable. The troponins, in particular troponin I, have been more extensively studied in horses, and their use for the diagnosis of myocardial damage has been fully demonstrated. They have replaced the less specific lactate dehydrogenase and creatine kinase isoenzymes, which makes the use of the last mentioned no longer legitimate. A final possible equine biomarker is aldosterone. Reference values in horses have been established. However, in only one study, a correlation between aldosterone and cardiac disease has been reported

Radiographic and ultrasonographic evaluation of the esophagus in the horse

The purpose of this study was to describe the radiographic and ultrasonographic appearance of the esophagus of ten healthy horses. Contrast radiography showed variations in the long-axis shape of the esophagus at the thoracic inlet. Administration of a large volume contrast medium by intubation showed stasis of contrast material for several minutes in two of the ten horses. The wall thickness of the non-distended esophagus on ultrasound was 2.6 +/- 0.3 mm with significant differences depending on the location. Distention of the esophagus by intubation or by a bolus of water or concentrate resulted in a decrease in wall thickness and it facilitated measuring with less variation. Stasis at the thoracic inlet was seen in five of the ten horses, when a water bolus was administered. Ultrasonographic evaluation of 100g spontaneously swallowed commercial concentrate was better than fluid (water bolus or 2.5mL/kg contrast medium) administration via intubation to assess esophageal motility at the thoracic inlet. Stasis seen at the thoracic inlet after bolus administration by intubation should not be regarded as an abnormal finding, and swallowing, with the subsequent peristaltic wave, has a positive influence on the bolus passage time

Intravascular absorption syndrome : case report of a life-threatening complication during hysteroscopy

A 40-year old, healthy woman underwent hysteroscopic endometrial ablation with a bipolar electrocautery using 0.9% saline as distension fluid. After 45 minutes of surgery, arterial oxygen saturation decreased and liquid was obstructing the laryngeal mask. With an estimated total fluid deficit of 5000 mL, fluid overload was suspected and the patient's trachea was intubated. Furosemide was given intravenously and a urinary catheter was inserted. The intra-abdominal pressure, measured through the urinary catheter, was 28 mmHg. As ventilation became unfeasible, the patient became cyanotic and no clear pulse could be detected, cardiopulmonary resuscitation was started. In order to decrease the abdominal pressure, a laparotomy was performed and extracorporeal membrane oxygenation was started to increase the arterial oxygenation. After one week in the Intensive Care Unit, the patient was extubated and gradually recovered without further complications nor residual morbidity. The pathophysiological aspects of the evolution to severe pulmonary edema due to massive fluid translocation during operative hysteroscopy, and the rationale behind the successful interventions are being discussed. Close continuous monitoring of the amount of fluid deficit should be performed to avoid severe fluid overload during operative hysteroscopy. Extracorporeal membrane oxygenation can be life-saving to bridge the period of desaturation until standard treatment suffices to provide adequate oxygenation

Ventricular response during lungeing exercise in horses with lone atrial fibrillation

Reasons for performing the study Atrial fibrillation (AF) is the most important dysrhythmia affecting performance in horses and has been associated with incoordination, collapse and sudden death. Limited information is available on ventricular response during exercise in horses with lone AF. Objectives To investigate ventricular response in horses with lone AF during a standardised lungeing exercise test. Methods A modified base-apex electrocardiogram was recorded at rest and during a standardised lungeing exercise test from 43 horses diagnosed with lone AF. During the test horses walked for 7min, trotted for 10min, cantered for 4min, galloped for 1min and recovered for 7min. Results Individual average heart rate during walk ranged from 42 to 175beats/min, during trot from 89 to 207 beats/min, during canter from 141 to 269 beats/min, and during gallop from 191 to 311 beats/min. Individual beat-to-beat maximal heart rate ranged from 248 to 492 beats/min. Ventricular premature depolarisations were present in 81% of the horses: at rest (16%), during exercise (69%), and during recovery (2%). In 33% of the horses, broad QRS complexes with R-on-T morphology were found. Conclusions Exercising horses with lone AF frequently develop disproportionate tachycardia. In addition, QRS broadening and even R-on-T morphology is frequently found. QRS broadening may originate from ventricular ectopic foci or from aberrant intraventricular conduction, for example due to bundle branch block. This might explain the high number of complexes currently classified as ventricular premature depolarisations. Potential relevance Prevalence of QRS broadening and especially R-on-T was very high in horses with AF and was found at low levels of exercise. These dysrhythmias are considered risk factors for the development of ventricular tachycardia and fibrillation and they might explain signs of weakness, collapse or sudden death that have been reported in horses with AF

Spectrum of arthroscopic findings in 84 canine elbow joints diagnosed with medial compartment erosion

Elbow dysplasia is an important cause of forelimb lameness in large breed dogs. The aim of this study was to report on the arthroscopic findings associated with medial compartment erosion (MCE) of the canine elbow joint. Retrospectively, records of 84 elbow joints from 66 dogs diagnosed arthroscopically with MCE were retrieved from a medical records database (2008 - 2012). The radiographic degree of osteoarthritis was determined. Arthroscopic images and videos were evaluated in detail. In nine joints (10.7%), MCE was the only pathological finding (= group 1). Group 2 (n = 50, 59.5%) consisted of elbows with MCE concomitant with medial coronoid process (MCP) pathology. In group 3 (n = 25 joints, 29.8%), MCE was diagnosed during a second-look arthroscopy in dogs presented with lameness after arthroscopic treatment for medial coronoid disease. There was a significant age difference (p < 0.001) between the groups, with dogs in group 1 being the oldest. Complete erosion of the medial compartment was most commonly found in group 1, whereas focal cartilage erosion was mostly identified in group 2. Overall, additional cartilage pathology of the lateral part of the humeral condyle and/or the radial head was recognized in 58.3% of the joints (49/84)

Peritoneopericardiale hernia diafragmatica met eenmalige pericardiale effusie bij een beagle

A male, four-year-old, castrated Beagle was presented with ascites, tachypnee, partial anorexia and lethargy. Through radiography, echocardiography and computed tomography, the diagnosis of pericardial effusion and a peritoneopericardial diaphragmatic hernia was made, where probably only omentum was herniated into the pericardium. Abdominocentesis and pericardiocentesis were performed. The peritoneopericardial diaphragmatic hernia was treated conservatively because, after one pericardiocentesis, no new pericardial effusion developed and the patient did well. At a control visit six months later, the patient was active, playful and without recurrence of pericardial effusion