An 11-year-old 6.2-kg (13.6-lb) neutered male domestic shorthair cat was evaluated on an emergency basis because of sudden-onset hind limb paralysis and vocalization. On physical examination, the cat was quiet and unable to use its hind limbs to walk. An irregularly irregular heart rhythm with a rate of 190 beats/min and a gallop sound was auscultated. No heart murmur was present. The cat was tachypneic (respiratory rate, 50 breaths/min) and had increased bronchovesicular sounds bilaterally. Rectal temperature was 33.7°C (92.7°F). The hind limbs were cold to the touch with no appreciable femoral pulses on palpation or Doppler ultrasonographic examination bilaterally.
To compare measurements of left ventricular volume and function derived from 2-D transthoracic echocardiography (2DE), transesophageal echocardiography (TEE), and the ultrasound velocity dilution cardiac output method (UDCO) with those derived from cardiac MRI (cMRI) in healthy neonatal foals.
6 healthy 1-week-old Standardbred foals.
Foals were anesthetized and underwent 2DE, TEE, and cMRI; UDCO was performed simultaneously with 2DE. Images acquired by 2DE included the right parasternal 4-chamber (R4CH), left apical 4- and 2-chamber (biplane), and right parasternal short-axis M-mode (M-mode) views. The longitudinal 4-chamber view was obtained by TEE. Measurements assessed included left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), ejection fraction, stroke volume (LVSV), cardiac output (CO), and cardiac index (CI). Bland-Altman analyses were used to compare measurements derived from biplane, R4CH, and M-mode images and UDCO with cMRI-derived measurements. Repeatability of measurements calculated by 3 independent reviewers was assessed by the intraclass correlation coefficient.
Compared with cMRI, all 2DE and TEE modalities underestimated LVEDV and LVESV and overestimated ejection fraction, CO, and CI. The LVSV was underestimated by the biplane, R4CH, and TEE modalities and overestimated by UDCO and M-mode methods. However, the R4CH-derived LVSV, CO, and CI were clinically comparable to cMRI-derived measures. Repeatability was good to excellent for measures derived from the biplane, R4CH, M-mode, UDCO, and cMRI methods and poor for TEE-derived measures.
CONCLUSIONS AND CLINICAL RELEVANCE
All assessed modalities yielded clinically acceptable measurements of LVEDV, LVESV, and function, but those measurements should not be used interchangeably when monitoring patient progress.
Objective—To determine the effect of PO administration of pimobendan on clinical and echocardiographic variables and survival time in cats with heart failure characterized by ventricular systolic dysfunction.
Design—Retrospective cohort study.
Animals—27 client-owned cats (16 male and 11 female) with heart failure, treated with pimobendan (mean ± SD dosage, 0.26 ± 0.08 mg/kg [0.118 ± 0.036 mg/lb], PO, q 12 h).
Procedures—Information on medical history, laboratory results, diagnostic imaging findings, treatments received, and survival time were obtained from medical records of cats that received pimobendan because of cardiac disease. When possible, additional follow-up information was obtained through telephone interviews with referring veterinarians and owners.
Results—The mean ± SD age of all 27 cats was 8.9 ± 5.2 years. All cats had received several cardiac medications. Types of heart disease represented included unclassified cardiomyopathy (CM; n = 11 [41%]), dilated CM (8 [30%]), arrhythmogenic right ventricular CM (4 [15%]), congenital heart disease (3 [11 %]), and hypertrophic CM with regional hypokinesis (1 [4%]). All cats had ventricular systolic dysfunction. One cat with systolic anterior motion of the mitral valve became severely hypotensive after initial administration of pimobendan and was excluded from the survival analysis. Median survival time was 167 days (95% confidence interval, 32 to 339 days).
Conclusions and Clinical Relevance—Pimobendan appeared to be well tolerated in cats with heart failure characterized by ventricular systolic dysfunction of various etiologies. Cats with systolic anterior motion of the mitral valve may develop systemic hypotension when treated with pimobendan. Additional studies are needed to establish dosages for pimobendan and its effects before it can be recommended for treatment of cats with CHF.