Treatment of dogs with compensated myxomatous mitral valve disease with spironolactone-a pilot study

Spironolactone improves outcome in dogs with advanced myxomatous mitral valve disease (MMVD). Its efficacy in preclinical MMVD is unknown. The hypothesis was the administration of spironolactone to dogs with compensated MMVD demonstrating risk factors for poorer prognosis will decrease the rate of disease progression. The aim was to provide pilot data to evaluate preliminary effects and sample size calculation for a definitive clinical trial

Clinical Severity Score System in Dogs with Degenerative Mitral Valve Disease

BACKGROUND: Several risk factors already have been determined for dogs with degenerative mitral valve disease (DMVD). Risk factors often have been considered in isolation and have not always taken into account additional information provided by the history and physical examination (PE). HYPOTHESIS/OBJECTIVES: Data obtained from history and PE of dogs with DMVD provide prognostic information and can be used for risk stratification. ANIMALS: Client‐owned dogs (n = 244) with DMVD recruited from first opinion practice. METHODS: Prospective longitudinal follow‐up of dogs with DMVD. History and PE data were obtained at 6‐month intervals and analyzed with time‐dependent Cox models to derive relative risk of cardiac death. Independent hazard ratios were used to derive a clinical severity score (CSS), the prognostic value of which was evaluated by analyzing the median survival times for different risk groups and ROC analysis. Analysis of the progression of CSS over time also was undertaken. RESULTS: History of cough, exercise intolerance, decreased appetite, breathlessness (difficulty breathing) and syncope with PE findings of heart murmur intensity louder than III/VI and absence of respiratory sinus arrhythmia were independently associated with outcome and allowed development of the CSS. Clinical severity score distinguished groups of dogs with significantly different outcomes. CONCLUSIONS AND CLINICAL IMPORTANCE: Routinely obtained clinical findings allow risk stratification of dogs with DMVD. Results of ancillary diagnostic tests may be complementary to history and PE findings and always should be interpreted in conjunction with these findings

Risk indictors in cats with preclinical hypertrophic cardiomyopathy: a prospective cohort study

Objectives This study aimed to identify indicators of the risk of progression of preclinical hypertrophic cardiomyopathy (HCM). Methods This was a prospective cohort study following a population of cats with preclinical HCM. Cats serially underwent physical examination, blood pressure measurement, blood sampling and echocardiography. Development of congestive heart failure (CHF), arterial thromboembolism (ATE) or sudden death (SD) were considered cardiac-related events. Associations between factors recorded at baseline, and on revisit examinations, and the development of a cardiac-related event were explored using receiver operator characteristic (ROC) analysis. Results Forty-seven cats were recruited to the study and were followed for a median period of 1135 days. Fifteen cats (31.9%) experienced at least one cardiac-related event; six CHF, five ATE and five SD. One cat experienced a cardiac-related event per 10.3 years of patient follow-up. Cats with increased left atrial (LA) size and higher concentrations of N-terminal pro B-type natriuretic peptide (NTproBNP) at baseline were more likely to experience an event. Cats with a greater rate of enlargement of LA size between examinations were also more likely to experience an event. Conclusions and relevance Factors easily measured, either once or serially, in cats with preclinical HCM can help to identify those at greater risk of going on to develop clinical signs

Speckle tracking echocardiography in cats with preclinical hypertrophic cardiomyopathy

Abstract Background Cats with hypertrophic cardiomyopathy (HCM) have decreased left ventricular (LV) longitudinal deformation detected by mitral annular plane systolic excursion (MAPSE) and speckle tracking echocardiography. People with preclinical HCM have decreased systolic LV longitudinal and radial strain (S) and strain rate (SR), with preserved circumferential S and SR. Hypothesis/Objectives Cats with preclinical HCM have decreased systolic LV deformation compared to normal cats. Animals Seventy‐three client‐owned cats with (n = 37) and without (n = 36) preclinical HCM. Methods Retrospective echocardiographic study. Left and right ventricular longitudinal S and SR, LV radial and circumferential S and SR were calculated by STE. Left ventricular mass was also calculated. Correlation between STE variables and LV hypertrophy was determined and receiver‐operating characteristic (ROC) curves were plotted for prediction of HCM. Results Cats with HCM had smaller absolute longitudinal S (−14.8 ± 3.3% vs −19.7 ± 2.7%, P < .001), longitudinal SR (−2.36 ± 0.62 vs −2.95 ± 0.68 second−1, P < .001), radial S (46.2 ± 21.3% vs 66.7 ± 17.6%, P < .001), and radial SR (5.60 ± 2.08 vs 6.67 ± 1.8 second−1, P < .001) compared to healthy controls. No difference was observed for circumferential S and SR. Cats with HCM had greater LV mass (13.2 ± 3.7 g vs 8.6 ± 2.7 g, P < .001). The ROC with the greatest area under the curve (AUC) for the identification of HCM (0.974) was plotted from a logistic regression equation combining LV mass, MAPSE at the free wall, and LV internal diameter in diastole (LVIDd). Conclusions and clinical importance Cats with preclinical HCM have decreased long axis and radial deformation. Decreased longitudinal deformation and decreased LVIDd are factors that would support a diagnosis of HCM

Differentiation of Cardiac from Noncardiac Pleural Effusions in Cats using Second-Generation Quantitative and Point-of-Care NT-proBNP Measurements

BACKGROUND: Pleural effusion is a common cause of dyspnea in cats. N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) measurement, using a first‐generation quantitative ELISA, in plasma and pleural fluid differentiates cardiac from noncardiac causes of pleural effusion. HYPOTHESIS/OBJECTIVES: To determine whether NT‐proBNP measurements using second‐generation quantitative ELISA and point‐of‐care (POC) tests in plasma and pleural fluid distinguish cardiac from noncardiac pleural effusions and how results compare to the first‐generation ELISA. ANIMALS: Thirty‐eight cats (US cohort) and 40 cats (UK cohort) presenting with cardiogenic or noncardiogenic pleural effusion. METHODS: Prospective cohort study. Twenty‐one and 17 cats in the US cohort, and 22 and 18 cats in the UK cohort were classified as having cardiac or noncardiac pleural effusion, respectively. NT‐proBNP concentrations in paired plasma and pleural fluid samples were measured using second‐generation ELISA and POC assays. RESULTS: The second‐generation ELISA differentiated cardiac from noncardiac pleural effusion with good diagnostic accuracy (plasma: sensitivity, 95.2%, specificity, 82.4%; pleural fluid: sensitivity, 100%, specificity, 76.5%). NT‐proBNP concentrations were greater in pleural fluid (719 pmol/L (134–1500)) than plasma (678 pmol/L (61–1500), P = 0.003), resulting in different cut‐off values depending on the sample type. The POC test had good sensitivity (95.2%) and specificity (87.5%) when using plasma samples. In pleural fluid samples, the POC test had good sensitivity (100%) but low specificity (64.7%). Diagnostic accuracy was similar between first‐ and second‐generation ELISA assays. CONCLUSIONS AND CLINICAL IMPORTANCE: Measurement of NT‐proBNP using a quantitative ELISA in plasma and pleural fluid or POC test in plasma, but not pleural fluid, distinguishes cardiac from noncardiac causes of pleural effusion in cats

Investigating the benefits of online peer mentoring for student confidence and motivation

Purpose - The purpose of this paper is to report the findings of an online peer-mentoring initiative for language students at the Open University, UK. The communities of practice (CoP) model (Wenger, 2010) was used as a theoretical framework within which to explore the nature and extent of mentor and mentee participation; and the impact of the scheme on student confidence and motivation. Design/methodology/approach - Within a qualitative paradigm, multi-data sources were employed to collect and analyse data. Participation was measured from analysis of online interaction, while participant views were captured through interviews, forum posts and surveys. Findings - Findings revealed that mentors were perceived by students who used the scheme to be instrumental in building confidence and motivation. In addition, varying participation patterns indicated that students used the online learning communities to meet their differing needs during their studies. These needs involved passively reading posts as well as actively posting. Research limitations/implications - Any direct statistical correlation between student confidence and motivation and online peer mentoring was beyond the scope of this study and could be the focus of future research. Additionally, research might also explore the impact of student mentors on student participation in wider CoPs. Practical implications - Practical recommendations from the study include the importance of mentor training to develop effective communication strategies and to differentiate the role from that of tutor moderators, whose remit is to respond to academic content-related queries in module-wide forums. Originality/value - There is little research into the nature and impact of online peer mentoring on student motivation and confidence. This study aimed to bridge this gap

Efficacy of pimobendan in the prevention of congestive heart failure or sudden death in doberman pinschers with preclinical dilated cardiomyopathy (the PROTECT study)

&lt;p&gt;Background: The benefit of pimobendan in delaying the progression of preclinical dilated cardiomyopathy (DCM) in Dobermans is not reported.&lt;/p&gt; &lt;p&gt;Hypothesis: That chronic oral administration of pimobendan to Dobermans with preclinical DCM will delay the onset of CHF or sudden death and improve survival.&lt;/p&gt; &lt;p&gt;Animals: Seventy-six client-owned Dobermans recruited at 10 centers in the UK and North America.&lt;/p&gt; &lt;p&gt;Methods: The trial was a randomized, blinded, placebo-controlled, parallel group multicenter study. Dogs were allocated in a 1:1 ratio to receive pimobendan (Vetmedin capsules) or visually identical placebo.&lt;/p&gt; &lt;p&gt;The composite primary endpoint was prospectively defined as either onset of CHF or sudden death. Time to death from all causes was a secondary endpoint.&lt;/p&gt; &lt;p&gt;Results: The proportion of dogs reaching the primary endpoint was not significantly different between groups (P = .1). The median time to the primary endpoint (onset of CHF or sudden death) was significantly longer in the pimobendan (718 days, IQR 441–1152 days) versus the placebo group (441 days, IQR 151–641 days) (log-rank P = 0.0088). The median survival time was significantly longer in the pimobendan (623 days, IQR 491–1531 days) versus the placebo group (466 days, IQR 236–710 days) (log-rank P = .034).&lt;/p&gt; &lt;p&gt;Conclusion and Clinical Importance: The administration of pimobendan to Dobermans with preclinical DCM prolongs the time to the onset of clinical signs and extends survival. Treatment of dogs in the preclinical phase of this common cardiovascular disorder with pimobendan can lead to improved outcome.&lt;/p&gt