Virginia Luis Fuentes | Royal Veterinary College (original) (raw)

Papers by Virginia Luis Fuentes

Research paper thumbnail of Retrospective evaluation of hypertrophic cardiomyopathy in 68 dogs

Journal of Veterinary Internal Medicine, Mar 24, 2022

Background: There is a lack of clinical data on hypertrophic cardiomyopathy (HCM) in dogs. Hypoth... more Background: There is a lack of clinical data on hypertrophic cardiomyopathy (HCM) in dogs. Hypothesis/Objectives: To investigate signalment, clinical signs, diagnostic findings, and survival in dogs with HCM. Animals: Sixty-eight client-owned dogs. Methods: Retrospective multicenter study. Medical records were searched between 2003 and 2015. The diagnosis of left ventricular (LV) hypertrophy was made by echocardiographic examination. Results: Three hundred and forty-five dogs with LV hypertrophy were identified, of which 277 were excluded. The remaining 68 dogs were 0.3 to 14 years old and predominantly <10 kg (85%), and without a sex predilection. Twenty-four % were Shih Tzu and 24% terrier breeds. Most (80%) had a systolic heart murmur. Ownerdetermined exercise intolerance (37%) and syncope (18%) were most commonly reported signs. The majority (84%) of dogs had symmetrical LV hypertrophy, whereas asymmetrical septal and LV free wall hypertrophy was observed in 9% and 6% of dogs, respectively. Isolated basal interventricular septal hypertrophy was not observed. Commonly recorded were systolic anterior motion of the mitral valve (60%) and LV diastolic dysfunction (89% of dogs where diastolic function was

Research paper thumbnail of Mitral Annular Plane Systolic Excursion and Tricuspid Annular Plane Systolic Excursion in Cats with Hypertrophic Cardiomyopathy

Journal of Veterinary Internal Medicine, Mar 30, 2017

Background: Left ventricular (LV) systolic dysfunction is associated with increased risk of death... more Background: Left ventricular (LV) systolic dysfunction is associated with increased risk of death in cats with hypertrophic cardiomyopathy (HCM). Mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE, respectively) are measures of longitudinal systolic function and are reduced in human patients with HCM. Hypotheses: Cats with HCM have lower MAPSE and TAPSE compared to control cats; lower MAPSE and TAPSE are associated with the presence of congestive heart failure (CHF) and reduced survival time. Animals: 64 cats with HCM and 27 healthy cats. Forty-five cats with HCM were not showing clinical signs, and 19 had CHF. Methods: Retrospective study. Anatomic M-mode from the left apical 4-chamber view was used to record MAPSE from the free wall (MAPSE FW) and septum (MAPSE IVS) and TAPSE.

Research paper thumbnail of Prognostic Indicators in Cats with Hypertrophic Cardiomyopathy

Journal of Veterinary Internal Medicine, Oct 17, 2013

BackgroundLeft atrial (LA) enlargement, congestive heart failure (CHF), and aortic thromboembolis... more BackgroundLeft atrial (LA) enlargement, congestive heart failure (CHF), and aortic thromboembolism (ATE) are associated with decreased survival in cats with hypertrophic cardiomyopathy (HCM), but the prognostic value of echocardiographic variables has not been well characterized.Hypothesis/ObjectivesWe hypothesized that LA echocardiographic variables and assessment of left ventricular (LV) diastolic and systolic function would have prognostic value in cats with HCM.AnimalsTwo hundred eighty‐two cats diagnosed with HCM.MethodsClinical and echocardiographic records of affected cats seen at the Royal Veterinary College from 2004 to 2009 were retrospectively analyzed. Only cats with echocardiographic confirmation of LV diastolic wall thickness ≥6 mm were included. Outcomes were obtained from clinical records or referring veterinarians and owners.ResultsDeaths occurred in 164 cats, of which 107 were believed to have been cardiac deaths. Univariable predictors of an increased risk of cardiac death included older age, absence of a murmur, presence of a gallop sound or arrhythmia, presentation with either CHF or ATE, extreme LV hypertrophy (≥9.0 mm), LV fractional shortening (FS%) ≤30%, regional wall hypokinesis, increased left atrial size, decreased left atrial function, spontaneous echo‐contrast/thrombus or both, absence of left ventricular outflow tract obstruction, and a restrictive diastolic filling pattern. Cox's proportional hazard analysis identified LA dysfunction, low LV systolic function, and extreme LV hypertrophy as independent predictors of decreased cardiac survival time.Conclusions and Clinical ImportanceEchocardiographic measurement of LA function, extreme LV hypertrophy, and LV systolic function provides important prognostic information in cats with HCM.

Research paper thumbnail of Cardiomyopathy prevalence in 780 apparently healthy cats in rehoming centres (the CatScan study)

Journal of Veterinary Cardiology, Dec 1, 2015

Short title for use as a running head.

Research paper thumbnail of Thin and hypokinetic myocardial segments in cats with cardiomyopathy

Journal of Veterinary Cardiology

Research paper thumbnail of Natural history of hypertrophic cardiomyopathy in cats from rehoming centers: The CatScan II study

Journal of Veterinary Internal Medicine

BackgroundThe natural history of hypertrophic cardiomyopathy (HCM) in cats has been mainly studie... more BackgroundThe natural history of hypertrophic cardiomyopathy (HCM) in cats has been mainly studied in cats referred for suspected heart disease, which can skew the results towards cats with clinical signs. Few data are available on factors associated with development of HCM in cats.Hypotheses(1) Clinical variables can predict which cats will develop HCM; (2) HCM in cats not referred for suspected heart disease is associated with a low rate of cardiovascular events.AnimalsOne hundred seven cats from rehoming centers without a history of clinical signs of cardiac or systemic disease at the time of adoption.MethodsProspective longitudinal study. After rehoming, shelter cats were reexamined for serial echocardiograms. Cox regression analysis was used to identify predictors of development of HCM in cats that were normal at baseline. Adverse cardiovascular events including heart failure, thromboembolism, or sudden death were recorded.ResultsCats were monitored for a median of 5.6 [1.2‐9.2...

Research paper thumbnail of Anterior mitral valve leaflet length in cats with hypertrophic cardiomyopathy

Journal of Veterinary Cardiology, 2021

INTRODUCTION Anterior mitral valve leaflet (AMVL) elongation is a recognised feature of hypertrop... more INTRODUCTION Anterior mitral valve leaflet (AMVL) elongation is a recognised feature of hypertrophic cardiomyopathy (HCM). However, whether AMVL elongation precedes left ventricular hypertrophy in cats is currently unknown. The aim of this study was to explore the risk of developing an HCM phenotype in cats with an elongated AMVL. ANIMALS FIFTY-FIVE APPARENTLY HEALTHY CATS WITH A NORMAL BASELINE ECHOCARDIOGRAM AND A FOLLOW-UP ECHOCARDIOGRAM AT >1 YEAR. MATERIALS AND METHODS This was a retrospective longitudinal study. Cats at the baseline were grouped based on whether or not they developed an HCM phenotype at follow-up. AMVL length and left atrial and left ventricular dimensions were measured from two-dimensional images. RESULTS The median follow-up period of the study population was 5.4 years (25th and 75th quartile, 2.7-6.7). During this time, 17 cats (30.9%) developed an HCM phenotype. At the baseline, cats that subsequently developed an HCM phenotype had greater AMVL length (9.4 mm [25th and 75th quartile, 9.0-10.6] vs. 8.5 mm [25th and 75th quartile, 7.6-9.1], p < 0.0001) and maximal left ventricular wall thickness (4.5 mm [25th and 75th quartile, 4.1-4.7] vs. 4.0 mm [25th and 75th quartile, 3.7-4.6], p = 0.007) than those that did not. Multiple logistic regression analysis confirmed that both baseline variables were independent predictors for development of an HCM phenotype. CONCLUSIONS The AMVL length was greater in cats that subsequently developed left ventricular hypertrophy. Further studies investigating the clinical application of AMVL in the natural history of feline HCM are warranted.

Research paper thumbnail of ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs

Journal of Veterinary Internal Medicine, 2019

This report, issued by the ACVIM Specialty of Cardiology consensus panel, revises guidelines for ... more This report, issued by the ACVIM Specialty of Cardiology consensus panel, revises guidelines for the diagnosis and treatment of myxomatous mitral valve disease (MMVD, also known as endocardiosis and degenerative or chronic valvular heart disease) in dogs, originally published in 2009. Updates were made to diagnostic, as well as medical, surgical, and dietary treatment recommendations. The strength of these recommendations was based on both the quantity and quality of available evidence supporting diagnostic and therapeutic decisions. Management of MMVD before the onset of clinical signs of heart failure has changed substantially compared with the 2009 guidelines, and new strategies to diagnose and treat advanced heart failure and pulmonary hypertension are reviewed.

Research paper thumbnail of Assessment of mitral regurgitation in dogs: comparison of results of echocardiography with magnetic resonance imaging

The Journal of small animal practice, 2015

Echocardiography is used routinely to assess mitral regurgitation severity, but echocardiographic... more Echocardiography is used routinely to assess mitral regurgitation severity, but echocardiographic measures of mitral regurgitation in dogs have not been compared with other quantitative methods. The study aim was to compare echocardiographic measures of mitral regurgitation with cardiac magnetic resonance imaging-derived mitral regurgitant fraction in small-breed dogs. Dogs with myxomatous mitral valve disease scheduled for magnetic resonance imaging assessment of neurological disease were recruited. Correlations were tested between cardiac magnetic resonance imaging-derived mitral regurgitant fraction and the following echocardiographic measures: vena contracta/aortic diameter, transmitral E-wave velocity, amplitude of mitral prolapse/aortic diameter, diastolic left ventricular diameter:aortic diameter, left atrium:aortic diameter, mitral regurgitation jet area ratio and regurgitant fraction calculated using the proximal isovelocity surface area method. Measurement of cardiac magne...

Research paper thumbnail of Retrospective evaluation of hypertrophic cardiomyopathy in 68 dogs

Journal of Veterinary Internal Medicine

BackgroundThere is a lack of clinical data on hypertrophic cardiomyopathy (HCM) in dogs.Hypothesi... more BackgroundThere is a lack of clinical data on hypertrophic cardiomyopathy (HCM) in dogs.Hypothesis/ObjectivesTo investigate signalment, clinical signs, diagnostic findings, and survival in dogs with HCM.AnimalsSixty‐eight client‐owned dogs.MethodsRetrospective multicenter study. Medical records were searched between 2003 and 2015. The diagnosis of left ventricular (LV) hypertrophy was made by echocardiographic examination.ResultsThree hundred and forty‐five dogs with LV hypertrophy were identified, of which 277 were excluded. The remaining 68 dogs were 0.3 to 14 years old and predominantly <10 kg (85%), and without a sex predilection. Twenty‐four % were Shih Tzu and 24% terrier breeds. Most (80%) had a systolic heart murmur. Owner‐determined exercise intolerance (37%) and syncope (18%) were most commonly reported signs. The majority (84%) of dogs had symmetrical LV hypertrophy, whereas asymmetrical septal and LV free wall hypertrophy was observed in 9% and 6% of dogs, respectivel...

Research paper thumbnail of Biomarker changes with systolic anterior motion of the mitral valve in cats with hypertrophic cardiomyopathy

Journal of Veterinary Internal Medicine, 2020

BackgroundN‐terminal pro B‐type natriuretic peptide (NT‐proBNP) and cardiac troponin‐I (cTnI) are... more BackgroundN‐terminal pro B‐type natriuretic peptide (NT‐proBNP) and cardiac troponin‐I (cTnI) are biomarkers commonly evaluated in cats with suspected heart disease. Many cats with hypertrophic cardiomyopathy (HCM) have systolic anterior motion of the mitral valve (SAM), but its influence on circulating NT‐proBNP or cTnI concentrations is currently unknown.Hypothesis/ObjectivesCats with HCM and SAM (HCMSAM+) have higher NT‐proBNP and cTnI concentrations than do cats with HCM but without SAM (HCMSAM−).AnimalsOne hundred forty cats with HCM: 70 with SAM and 70 without SAM.MethodsRetrospective case‐to‐case study. Cats were recruited if diagnosed with HCM by echocardiography and results were available for NT‐proBNP or cTnI concentrations or both. Cats with SAM were matched to those without SAM for clinical presentation, left atrial (LA) size and left ventricular (LV) fractional shortening.ResultsA total of 119 NT‐proBNP and 123 cTnI results were available. The HCMSAM+ cats had higher me...

Research paper thumbnail of Micro-computed tomography (micro-CT) for the assessment of myocardial disarray, fibrosis and ventricular mass in a feline model of hypertrophic cardiomyopathy

Scientific Reports, 2020

Micro-computed tomography (micro-CT) is a high-resolution imaging modality that provides accurate... more Micro-computed tomography (micro-CT) is a high-resolution imaging modality that provides accurate tissue characterization. Hypertrophic cardiomyopathy (HCM) occurs as a spontaneous disease in cats, and is characterized by myocardial hypertrophy, disarray and fibrosis, as in humans. While hypertrophy/mass (LVM) can be objectively measured, fibrosis and myocyte disarray are difficult to assess. We evaluated the accuracy of micro-CT for detection and quantification of myocardial disarray and fibrosis by direct comparison with histopathology. 29 cat hearts (12 normal and 17 HCM hearts) underwent micro-CT and pathologic examination. Myocyte orientation was assessed using structure tensor analysis by determination of helical angle (HA), fractional anisotropy (FA) and myocardial disarray index (MDI). Fibrosis was segmented and quantified based on comparison of gray-scale values in normal and fibrotic myocardium. LVM was obtained by determining myocardial volume. Myocardial segments with lo...

Research paper thumbnail of Supraventricular tachycardia in 23 cats; comparison with 21 cats with atrial fibrillation (2004–2014)

Journal of Veterinary Cardiology, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Long‐term incidence and risk of noncardiovascular and all‐cause mortality in apparently healthy cats and cats with preclinical hypertrophic cardiomyopathy

Journal of Veterinary Internal Medicine, 2019

BackgroundEpidemiologic knowledge regarding noncardiovascular and all‐cause mortality in apparent... more BackgroundEpidemiologic knowledge regarding noncardiovascular and all‐cause mortality in apparently healthy cats (AH) and cats with preclinical hypertrophic cardiomyopathy (pHCM) is limited, hindering development of evidence‐based healthcare guidelines.ObjectivesTo characterize/compare incidence rates, risk, and survival associated with noncardiovascular and all‐cause mortality in AH and pHCM cats.AnimalsA total of 1730 client‐owned cats (722 AH, 1008 pHCM) from 21 countries.MethodsRetrospective, multicenter, longitudinal, cohort study. Long‐term health data were extracted by medical record review and owner/referring veterinarian interviews.ResultsNoncardiovascular death occurred in 534 (30.9%) of 1730 cats observed up to 15.2 years. Proportion of noncardiovascular death did not differ significantly between cats that at study enrollment were AH or had pHCM (P = .48). Cancer, chronic kidney disease, and conditions characterized by chronic weight‐loss‐vomiting‐diarrhea‐anorexia were t...

Research paper thumbnail of Surgical valvulotomy for tricuspid valve stenosis in a dog

Journal of Veterinary Cardiology, 2019

A 2 year 4 month old female neutered Labrador retriever was presented for evaluation right sided ... more A 2 year 4 month old female neutered Labrador retriever was presented for evaluation right sided congestive heart failure. Echocardiographic examination revealed tricuspid valve dysplasia with only two small orifices in the valve resulting in severe tricuspid stenosis. The dog underwent a right fifth lateral intercostal thoracotomy and surgical tricuspid valvulotomy, under cardiopulmonary bypass. The stenosis was relieved by dividing the valve leaflets between the two orifices with continuation to the commissures, creating a 'bi-leaflet' valve. The dog made a good recovery initially with echocardiography at 48 hours after surgery showing a reduction in tricuspid valve E and A wave velocities and pressure half time (from 230 ms to to 65 ms). She was discharged five days after surgery with spironolactone, benazepril, pimobendan and clopidogrel. The dog was represented two days later having collapsed, with pyrexia, facial swelling and pitting edema on the ventral neck and intermandibular region. Investigations did not reveal an underlying cause and the clinical signs resolved with supportive therapy. Two years after surgery the dog was free of clinical signs with normal exercise tolerance and only mild tricuspid regurgitation on echocardiography, with discontinuation of all medications.

Research paper thumbnail of Speckle tracking echocardiography in cats with preclinical hypertrophic cardiomyopathy

Journal of Veterinary Internal Medicine, 2019

BackgroundCats with hypertrophic cardiomyopathy (HCM) have decreased left ventricular (LV) longit... more BackgroundCats 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/ObjectivesCats with preclinical HCM have decreased systolic LV deformation compared to normal cats.AnimalsSeventy‐three client‐owned cats with (n = 37) and without (n = 36) preclinical HCM.MethodsRetrospective 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.ResultsCats with HCM had smaller absolute longitudinal S (−14.8 ± 3.3% vs ...

Research paper thumbnail of Phenotypic description of cardiac findings in a population of Dogue de Bordeaux with an emphasis on atrial fibrillation

Veterinary journal (London, England : 1997), Apr 1, 2018

The aim of this study was to describe the clinical phenotype of Dogue de Bordeaux (DdB) referred ... more The aim of this study was to describe the clinical phenotype of Dogue de Bordeaux (DdB) referred for cardiac investigation, with particular reference to the prevalence of atrial fibrillation and associated features. Review of canine medical records of two United Kingdom veterinary referral hospitals identified 64 DdB with available echocardiographic and electrocardiographic (ECG)/Holter data. Atrial fibrillation was documented in 25 (39%) dogs and supraventricular tachycardia was recorded in five (7.8%) dogs. In a subset of 34 dogs, excluding congenital heart disease (n=17), presence of a cardiac mass (n=7) and non-cardiac neoplasia (n=6), 19 (56%) dogs had atrial fibrillation, with a median heart rate of 200 beats per min (bpm) on presentation. Atrial fibrillation was inconsistently associated with cardiac chamber remodelling, but was frequently associated with systolic dysfunction (13/19, 68.4%) and right sided atrial or ventricular dilatation (14/19, 73.7%) in dogs with atrial fi...

Research paper thumbnail of Prognostic value of mitral annular systolic plane excursion and tricuspid annular plane systolic excursion in cats with hypertrophic cardiomyopathy

Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology, Jan 10, 2018

Hypertrophic cardiomyopathy (HCM) has a variable prognosis; left atrial size, presence of clinica... more Hypertrophic cardiomyopathy (HCM) has a variable prognosis; left atrial size, presence of clinical signs and left ventricular systolic function have been shown to predict outcomes. Mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE) assess longitudinal ventricular systolic function and are decreased in cats with HCM. The aim of the study was to ascertain whether MAPSE and TAPSE have prognostic value in HCM and if cats with pleural effusion have lower MAPSE and TAPSE than cats with pulmonary oedema. One hundred eighty-four client-owned cats diagnosed with HCM. This is a retrospective study. Echocardiography was used to diagnose HCM (end-diastolic left ventricular wall thickness ≥ 6 mm) and to measure MAPSE and TAPSE. Survival information was obtained. No multivariable model including MAPSE or TAPSE could be generated in this population. Cats with pleural effusion ± pulmonary oedema had lower MAPSE measured at the interventricular sep...

Research paper thumbnail of Time spent with cats is never wasted: Lessons learned from feline acromegalic cardiomyopathy, a naturally occurring animal model of the human disease

PloS one, 2018

In humans, acromegaly due to a pituitary somatotrophic adenoma is a recognized cause of increased... more In humans, acromegaly due to a pituitary somatotrophic adenoma is a recognized cause of increased left ventricular (LV) mass. Acromegalic cardiomyopathy is incompletely understood, and represents a major cause of morbidity and mortality. We describe the clinical, echocardiographic and histopathologic features of naturally occurring feline acromegalic cardiomyopathy, an emerging disease among domestic cats. Cats with confirmed hypersomatotropism (IGF-1>1000ng/ml and pituitary mass; n = 67) were prospectively recruited, as were two control groups: diabetics (IGF-1<800ng/ml; n = 24) and healthy cats without known endocrinopathy or cardiovascular disease (n = 16). Echocardiography was performed in all cases, including after hypersomatotropism treatment where applicable. Additionally, tissue samples from deceased cats with hypersomatotropism, hypertrophic cardiomyopathy and age-matched controls (n = 21 each) were collected and systematically histopathologically reviewed and compare...

Research paper thumbnail of Surgical treatment of pulmonic stenosis in dogs under cardiopulmonary bypass: outcome in nine dogs

The Journal of small animal practice, 2018

To describe the outcome for nine dogs with pulmonic stenosis treated by open patch grafting using... more To describe the outcome for nine dogs with pulmonic stenosis treated by open patch grafting using expanded polytetrafluoroethylene under cardiopulmonary bypass. Data were collected from the hospital records of all dogs that had undergone right ventricular outflow tract grafting with an expanded polytetrafluoroethylene patch under cardiopulmonary bypass between 2006 and 2012 for the treatment of pulmonic stenosis. Echocardiographic images were reviewed and the pressure gradient across the right ventricular outflow tract re-measured. Owners of dogs still alive at the time of writing were invited to return to the hospital for reassessment. Nine dogs met the inclusion criteria. Median pressure gradient preoperatively was 118 mmHg, (range 102 to 259 mmHg) reducing to a median of 20 mmHg (range 7 to 53 mmHg) at 48 hours postoperatively and 14 mmHg (range 10 to 70 mmHg), with a median percentage reduction of 89% (range 41 to 94%) at long-term follow-up. Eight of nine dogs survived surgery,...

Research paper thumbnail of Retrospective evaluation of hypertrophic cardiomyopathy in 68 dogs

Journal of Veterinary Internal Medicine, Mar 24, 2022

Background: There is a lack of clinical data on hypertrophic cardiomyopathy (HCM) in dogs. Hypoth... more Background: There is a lack of clinical data on hypertrophic cardiomyopathy (HCM) in dogs. Hypothesis/Objectives: To investigate signalment, clinical signs, diagnostic findings, and survival in dogs with HCM. Animals: Sixty-eight client-owned dogs. Methods: Retrospective multicenter study. Medical records were searched between 2003 and 2015. The diagnosis of left ventricular (LV) hypertrophy was made by echocardiographic examination. Results: Three hundred and forty-five dogs with LV hypertrophy were identified, of which 277 were excluded. The remaining 68 dogs were 0.3 to 14 years old and predominantly <10 kg (85%), and without a sex predilection. Twenty-four % were Shih Tzu and 24% terrier breeds. Most (80%) had a systolic heart murmur. Ownerdetermined exercise intolerance (37%) and syncope (18%) were most commonly reported signs. The majority (84%) of dogs had symmetrical LV hypertrophy, whereas asymmetrical septal and LV free wall hypertrophy was observed in 9% and 6% of dogs, respectively. Isolated basal interventricular septal hypertrophy was not observed. Commonly recorded were systolic anterior motion of the mitral valve (60%) and LV diastolic dysfunction (89% of dogs where diastolic function was

Research paper thumbnail of Mitral Annular Plane Systolic Excursion and Tricuspid Annular Plane Systolic Excursion in Cats with Hypertrophic Cardiomyopathy

Journal of Veterinary Internal Medicine, Mar 30, 2017

Background: Left ventricular (LV) systolic dysfunction is associated with increased risk of death... more Background: Left ventricular (LV) systolic dysfunction is associated with increased risk of death in cats with hypertrophic cardiomyopathy (HCM). Mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE, respectively) are measures of longitudinal systolic function and are reduced in human patients with HCM. Hypotheses: Cats with HCM have lower MAPSE and TAPSE compared to control cats; lower MAPSE and TAPSE are associated with the presence of congestive heart failure (CHF) and reduced survival time. Animals: 64 cats with HCM and 27 healthy cats. Forty-five cats with HCM were not showing clinical signs, and 19 had CHF. Methods: Retrospective study. Anatomic M-mode from the left apical 4-chamber view was used to record MAPSE from the free wall (MAPSE FW) and septum (MAPSE IVS) and TAPSE.

Research paper thumbnail of Prognostic Indicators in Cats with Hypertrophic Cardiomyopathy

Journal of Veterinary Internal Medicine, Oct 17, 2013

BackgroundLeft atrial (LA) enlargement, congestive heart failure (CHF), and aortic thromboembolis... more BackgroundLeft atrial (LA) enlargement, congestive heart failure (CHF), and aortic thromboembolism (ATE) are associated with decreased survival in cats with hypertrophic cardiomyopathy (HCM), but the prognostic value of echocardiographic variables has not been well characterized.Hypothesis/ObjectivesWe hypothesized that LA echocardiographic variables and assessment of left ventricular (LV) diastolic and systolic function would have prognostic value in cats with HCM.AnimalsTwo hundred eighty‐two cats diagnosed with HCM.MethodsClinical and echocardiographic records of affected cats seen at the Royal Veterinary College from 2004 to 2009 were retrospectively analyzed. Only cats with echocardiographic confirmation of LV diastolic wall thickness ≥6 mm were included. Outcomes were obtained from clinical records or referring veterinarians and owners.ResultsDeaths occurred in 164 cats, of which 107 were believed to have been cardiac deaths. Univariable predictors of an increased risk of cardiac death included older age, absence of a murmur, presence of a gallop sound or arrhythmia, presentation with either CHF or ATE, extreme LV hypertrophy (≥9.0 mm), LV fractional shortening (FS%) ≤30%, regional wall hypokinesis, increased left atrial size, decreased left atrial function, spontaneous echo‐contrast/thrombus or both, absence of left ventricular outflow tract obstruction, and a restrictive diastolic filling pattern. Cox's proportional hazard analysis identified LA dysfunction, low LV systolic function, and extreme LV hypertrophy as independent predictors of decreased cardiac survival time.Conclusions and Clinical ImportanceEchocardiographic measurement of LA function, extreme LV hypertrophy, and LV systolic function provides important prognostic information in cats with HCM.

Research paper thumbnail of Cardiomyopathy prevalence in 780 apparently healthy cats in rehoming centres (the CatScan study)

Journal of Veterinary Cardiology, Dec 1, 2015

Short title for use as a running head.

Research paper thumbnail of Thin and hypokinetic myocardial segments in cats with cardiomyopathy

Journal of Veterinary Cardiology

Research paper thumbnail of Natural history of hypertrophic cardiomyopathy in cats from rehoming centers: The CatScan II study

Journal of Veterinary Internal Medicine

BackgroundThe natural history of hypertrophic cardiomyopathy (HCM) in cats has been mainly studie... more BackgroundThe natural history of hypertrophic cardiomyopathy (HCM) in cats has been mainly studied in cats referred for suspected heart disease, which can skew the results towards cats with clinical signs. Few data are available on factors associated with development of HCM in cats.Hypotheses(1) Clinical variables can predict which cats will develop HCM; (2) HCM in cats not referred for suspected heart disease is associated with a low rate of cardiovascular events.AnimalsOne hundred seven cats from rehoming centers without a history of clinical signs of cardiac or systemic disease at the time of adoption.MethodsProspective longitudinal study. After rehoming, shelter cats were reexamined for serial echocardiograms. Cox regression analysis was used to identify predictors of development of HCM in cats that were normal at baseline. Adverse cardiovascular events including heart failure, thromboembolism, or sudden death were recorded.ResultsCats were monitored for a median of 5.6 [1.2‐9.2...

Research paper thumbnail of Anterior mitral valve leaflet length in cats with hypertrophic cardiomyopathy

Journal of Veterinary Cardiology, 2021

INTRODUCTION Anterior mitral valve leaflet (AMVL) elongation is a recognised feature of hypertrop... more INTRODUCTION Anterior mitral valve leaflet (AMVL) elongation is a recognised feature of hypertrophic cardiomyopathy (HCM). However, whether AMVL elongation precedes left ventricular hypertrophy in cats is currently unknown. The aim of this study was to explore the risk of developing an HCM phenotype in cats with an elongated AMVL. ANIMALS FIFTY-FIVE APPARENTLY HEALTHY CATS WITH A NORMAL BASELINE ECHOCARDIOGRAM AND A FOLLOW-UP ECHOCARDIOGRAM AT >1 YEAR. MATERIALS AND METHODS This was a retrospective longitudinal study. Cats at the baseline were grouped based on whether or not they developed an HCM phenotype at follow-up. AMVL length and left atrial and left ventricular dimensions were measured from two-dimensional images. RESULTS The median follow-up period of the study population was 5.4 years (25th and 75th quartile, 2.7-6.7). During this time, 17 cats (30.9%) developed an HCM phenotype. At the baseline, cats that subsequently developed an HCM phenotype had greater AMVL length (9.4 mm [25th and 75th quartile, 9.0-10.6] vs. 8.5 mm [25th and 75th quartile, 7.6-9.1], p < 0.0001) and maximal left ventricular wall thickness (4.5 mm [25th and 75th quartile, 4.1-4.7] vs. 4.0 mm [25th and 75th quartile, 3.7-4.6], p = 0.007) than those that did not. Multiple logistic regression analysis confirmed that both baseline variables were independent predictors for development of an HCM phenotype. CONCLUSIONS The AMVL length was greater in cats that subsequently developed left ventricular hypertrophy. Further studies investigating the clinical application of AMVL in the natural history of feline HCM are warranted.

Research paper thumbnail of ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs

Journal of Veterinary Internal Medicine, 2019

This report, issued by the ACVIM Specialty of Cardiology consensus panel, revises guidelines for ... more This report, issued by the ACVIM Specialty of Cardiology consensus panel, revises guidelines for the diagnosis and treatment of myxomatous mitral valve disease (MMVD, also known as endocardiosis and degenerative or chronic valvular heart disease) in dogs, originally published in 2009. Updates were made to diagnostic, as well as medical, surgical, and dietary treatment recommendations. The strength of these recommendations was based on both the quantity and quality of available evidence supporting diagnostic and therapeutic decisions. Management of MMVD before the onset of clinical signs of heart failure has changed substantially compared with the 2009 guidelines, and new strategies to diagnose and treat advanced heart failure and pulmonary hypertension are reviewed.

Research paper thumbnail of Assessment of mitral regurgitation in dogs: comparison of results of echocardiography with magnetic resonance imaging

The Journal of small animal practice, 2015

Echocardiography is used routinely to assess mitral regurgitation severity, but echocardiographic... more Echocardiography is used routinely to assess mitral regurgitation severity, but echocardiographic measures of mitral regurgitation in dogs have not been compared with other quantitative methods. The study aim was to compare echocardiographic measures of mitral regurgitation with cardiac magnetic resonance imaging-derived mitral regurgitant fraction in small-breed dogs. Dogs with myxomatous mitral valve disease scheduled for magnetic resonance imaging assessment of neurological disease were recruited. Correlations were tested between cardiac magnetic resonance imaging-derived mitral regurgitant fraction and the following echocardiographic measures: vena contracta/aortic diameter, transmitral E-wave velocity, amplitude of mitral prolapse/aortic diameter, diastolic left ventricular diameter:aortic diameter, left atrium:aortic diameter, mitral regurgitation jet area ratio and regurgitant fraction calculated using the proximal isovelocity surface area method. Measurement of cardiac magne...

Research paper thumbnail of Retrospective evaluation of hypertrophic cardiomyopathy in 68 dogs

Journal of Veterinary Internal Medicine

BackgroundThere is a lack of clinical data on hypertrophic cardiomyopathy (HCM) in dogs.Hypothesi... more BackgroundThere is a lack of clinical data on hypertrophic cardiomyopathy (HCM) in dogs.Hypothesis/ObjectivesTo investigate signalment, clinical signs, diagnostic findings, and survival in dogs with HCM.AnimalsSixty‐eight client‐owned dogs.MethodsRetrospective multicenter study. Medical records were searched between 2003 and 2015. The diagnosis of left ventricular (LV) hypertrophy was made by echocardiographic examination.ResultsThree hundred and forty‐five dogs with LV hypertrophy were identified, of which 277 were excluded. The remaining 68 dogs were 0.3 to 14 years old and predominantly <10 kg (85%), and without a sex predilection. Twenty‐four % were Shih Tzu and 24% terrier breeds. Most (80%) had a systolic heart murmur. Owner‐determined exercise intolerance (37%) and syncope (18%) were most commonly reported signs. The majority (84%) of dogs had symmetrical LV hypertrophy, whereas asymmetrical septal and LV free wall hypertrophy was observed in 9% and 6% of dogs, respectivel...

Research paper thumbnail of Biomarker changes with systolic anterior motion of the mitral valve in cats with hypertrophic cardiomyopathy

Journal of Veterinary Internal Medicine, 2020

BackgroundN‐terminal pro B‐type natriuretic peptide (NT‐proBNP) and cardiac troponin‐I (cTnI) are... more BackgroundN‐terminal pro B‐type natriuretic peptide (NT‐proBNP) and cardiac troponin‐I (cTnI) are biomarkers commonly evaluated in cats with suspected heart disease. Many cats with hypertrophic cardiomyopathy (HCM) have systolic anterior motion of the mitral valve (SAM), but its influence on circulating NT‐proBNP or cTnI concentrations is currently unknown.Hypothesis/ObjectivesCats with HCM and SAM (HCMSAM+) have higher NT‐proBNP and cTnI concentrations than do cats with HCM but without SAM (HCMSAM−).AnimalsOne hundred forty cats with HCM: 70 with SAM and 70 without SAM.MethodsRetrospective case‐to‐case study. Cats were recruited if diagnosed with HCM by echocardiography and results were available for NT‐proBNP or cTnI concentrations or both. Cats with SAM were matched to those without SAM for clinical presentation, left atrial (LA) size and left ventricular (LV) fractional shortening.ResultsA total of 119 NT‐proBNP and 123 cTnI results were available. The HCMSAM+ cats had higher me...

Research paper thumbnail of Micro-computed tomography (micro-CT) for the assessment of myocardial disarray, fibrosis and ventricular mass in a feline model of hypertrophic cardiomyopathy

Scientific Reports, 2020

Micro-computed tomography (micro-CT) is a high-resolution imaging modality that provides accurate... more Micro-computed tomography (micro-CT) is a high-resolution imaging modality that provides accurate tissue characterization. Hypertrophic cardiomyopathy (HCM) occurs as a spontaneous disease in cats, and is characterized by myocardial hypertrophy, disarray and fibrosis, as in humans. While hypertrophy/mass (LVM) can be objectively measured, fibrosis and myocyte disarray are difficult to assess. We evaluated the accuracy of micro-CT for detection and quantification of myocardial disarray and fibrosis by direct comparison with histopathology. 29 cat hearts (12 normal and 17 HCM hearts) underwent micro-CT and pathologic examination. Myocyte orientation was assessed using structure tensor analysis by determination of helical angle (HA), fractional anisotropy (FA) and myocardial disarray index (MDI). Fibrosis was segmented and quantified based on comparison of gray-scale values in normal and fibrotic myocardium. LVM was obtained by determining myocardial volume. Myocardial segments with lo...

Research paper thumbnail of Supraventricular tachycardia in 23 cats; comparison with 21 cats with atrial fibrillation (2004–2014)

Journal of Veterinary Cardiology, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Long‐term incidence and risk of noncardiovascular and all‐cause mortality in apparently healthy cats and cats with preclinical hypertrophic cardiomyopathy

Journal of Veterinary Internal Medicine, 2019

BackgroundEpidemiologic knowledge regarding noncardiovascular and all‐cause mortality in apparent... more BackgroundEpidemiologic knowledge regarding noncardiovascular and all‐cause mortality in apparently healthy cats (AH) and cats with preclinical hypertrophic cardiomyopathy (pHCM) is limited, hindering development of evidence‐based healthcare guidelines.ObjectivesTo characterize/compare incidence rates, risk, and survival associated with noncardiovascular and all‐cause mortality in AH and pHCM cats.AnimalsA total of 1730 client‐owned cats (722 AH, 1008 pHCM) from 21 countries.MethodsRetrospective, multicenter, longitudinal, cohort study. Long‐term health data were extracted by medical record review and owner/referring veterinarian interviews.ResultsNoncardiovascular death occurred in 534 (30.9%) of 1730 cats observed up to 15.2 years. Proportion of noncardiovascular death did not differ significantly between cats that at study enrollment were AH or had pHCM (P = .48). Cancer, chronic kidney disease, and conditions characterized by chronic weight‐loss‐vomiting‐diarrhea‐anorexia were t...

Research paper thumbnail of Surgical valvulotomy for tricuspid valve stenosis in a dog

Journal of Veterinary Cardiology, 2019

A 2 year 4 month old female neutered Labrador retriever was presented for evaluation right sided ... more A 2 year 4 month old female neutered Labrador retriever was presented for evaluation right sided congestive heart failure. Echocardiographic examination revealed tricuspid valve dysplasia with only two small orifices in the valve resulting in severe tricuspid stenosis. The dog underwent a right fifth lateral intercostal thoracotomy and surgical tricuspid valvulotomy, under cardiopulmonary bypass. The stenosis was relieved by dividing the valve leaflets between the two orifices with continuation to the commissures, creating a 'bi-leaflet' valve. The dog made a good recovery initially with echocardiography at 48 hours after surgery showing a reduction in tricuspid valve E and A wave velocities and pressure half time (from 230 ms to to 65 ms). She was discharged five days after surgery with spironolactone, benazepril, pimobendan and clopidogrel. The dog was represented two days later having collapsed, with pyrexia, facial swelling and pitting edema on the ventral neck and intermandibular region. Investigations did not reveal an underlying cause and the clinical signs resolved with supportive therapy. Two years after surgery the dog was free of clinical signs with normal exercise tolerance and only mild tricuspid regurgitation on echocardiography, with discontinuation of all medications.

Research paper thumbnail of Speckle tracking echocardiography in cats with preclinical hypertrophic cardiomyopathy

Journal of Veterinary Internal Medicine, 2019

BackgroundCats with hypertrophic cardiomyopathy (HCM) have decreased left ventricular (LV) longit... more BackgroundCats 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/ObjectivesCats with preclinical HCM have decreased systolic LV deformation compared to normal cats.AnimalsSeventy‐three client‐owned cats with (n = 37) and without (n = 36) preclinical HCM.MethodsRetrospective 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.ResultsCats with HCM had smaller absolute longitudinal S (−14.8 ± 3.3% vs ...

Research paper thumbnail of Phenotypic description of cardiac findings in a population of Dogue de Bordeaux with an emphasis on atrial fibrillation

Veterinary journal (London, England : 1997), Apr 1, 2018

The aim of this study was to describe the clinical phenotype of Dogue de Bordeaux (DdB) referred ... more The aim of this study was to describe the clinical phenotype of Dogue de Bordeaux (DdB) referred for cardiac investigation, with particular reference to the prevalence of atrial fibrillation and associated features. Review of canine medical records of two United Kingdom veterinary referral hospitals identified 64 DdB with available echocardiographic and electrocardiographic (ECG)/Holter data. Atrial fibrillation was documented in 25 (39%) dogs and supraventricular tachycardia was recorded in five (7.8%) dogs. In a subset of 34 dogs, excluding congenital heart disease (n=17), presence of a cardiac mass (n=7) and non-cardiac neoplasia (n=6), 19 (56%) dogs had atrial fibrillation, with a median heart rate of 200 beats per min (bpm) on presentation. Atrial fibrillation was inconsistently associated with cardiac chamber remodelling, but was frequently associated with systolic dysfunction (13/19, 68.4%) and right sided atrial or ventricular dilatation (14/19, 73.7%) in dogs with atrial fi...

Research paper thumbnail of Prognostic value of mitral annular systolic plane excursion and tricuspid annular plane systolic excursion in cats with hypertrophic cardiomyopathy

Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology, Jan 10, 2018

Hypertrophic cardiomyopathy (HCM) has a variable prognosis; left atrial size, presence of clinica... more Hypertrophic cardiomyopathy (HCM) has a variable prognosis; left atrial size, presence of clinical signs and left ventricular systolic function have been shown to predict outcomes. Mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE) assess longitudinal ventricular systolic function and are decreased in cats with HCM. The aim of the study was to ascertain whether MAPSE and TAPSE have prognostic value in HCM and if cats with pleural effusion have lower MAPSE and TAPSE than cats with pulmonary oedema. One hundred eighty-four client-owned cats diagnosed with HCM. This is a retrospective study. Echocardiography was used to diagnose HCM (end-diastolic left ventricular wall thickness ≥ 6 mm) and to measure MAPSE and TAPSE. Survival information was obtained. No multivariable model including MAPSE or TAPSE could be generated in this population. Cats with pleural effusion ± pulmonary oedema had lower MAPSE measured at the interventricular sep...

Research paper thumbnail of Time spent with cats is never wasted: Lessons learned from feline acromegalic cardiomyopathy, a naturally occurring animal model of the human disease

PloS one, 2018

In humans, acromegaly due to a pituitary somatotrophic adenoma is a recognized cause of increased... more In humans, acromegaly due to a pituitary somatotrophic adenoma is a recognized cause of increased left ventricular (LV) mass. Acromegalic cardiomyopathy is incompletely understood, and represents a major cause of morbidity and mortality. We describe the clinical, echocardiographic and histopathologic features of naturally occurring feline acromegalic cardiomyopathy, an emerging disease among domestic cats. Cats with confirmed hypersomatotropism (IGF-1>1000ng/ml and pituitary mass; n = 67) were prospectively recruited, as were two control groups: diabetics (IGF-1<800ng/ml; n = 24) and healthy cats without known endocrinopathy or cardiovascular disease (n = 16). Echocardiography was performed in all cases, including after hypersomatotropism treatment where applicable. Additionally, tissue samples from deceased cats with hypersomatotropism, hypertrophic cardiomyopathy and age-matched controls (n = 21 each) were collected and systematically histopathologically reviewed and compare...

Research paper thumbnail of Surgical treatment of pulmonic stenosis in dogs under cardiopulmonary bypass: outcome in nine dogs

The Journal of small animal practice, 2018

To describe the outcome for nine dogs with pulmonic stenosis treated by open patch grafting using... more To describe the outcome for nine dogs with pulmonic stenosis treated by open patch grafting using expanded polytetrafluoroethylene under cardiopulmonary bypass. Data were collected from the hospital records of all dogs that had undergone right ventricular outflow tract grafting with an expanded polytetrafluoroethylene patch under cardiopulmonary bypass between 2006 and 2012 for the treatment of pulmonic stenosis. Echocardiographic images were reviewed and the pressure gradient across the right ventricular outflow tract re-measured. Owners of dogs still alive at the time of writing were invited to return to the hospital for reassessment. Nine dogs met the inclusion criteria. Median pressure gradient preoperatively was 118 mmHg, (range 102 to 259 mmHg) reducing to a median of 20 mmHg (range 7 to 53 mmHg) at 48 hours postoperatively and 14 mmHg (range 10 to 70 mmHg), with a median percentage reduction of 89% (range 41 to 94%) at long-term follow-up. Eight of nine dogs survived surgery,...