miercuri, 13 martie 2013

Degenerative Mitral Valve Disease in dogs



35 th. Annual Worls Small Animal Veterinary Association Congress,
Geneva, June 2 - 5 2010.



THE  INCIDENCE  OF  DEGENERATIVE  MITRAL VALVE  DISEASE 
IN MALE AND FEMALE   DOGS

Brăslaşu M.C., Brăslaşu E. Daniela , Joiţa Silvia,
Tudor N.,  Predoi Ştefania, Georgescu Gabriela

Faculty of Veterinary Medicine, Bucharest, Romania





1389 dogs with cardiac and extra-cardiac diseases were examined in the Internal Disease Clinic – Cardiology Department from the Faculty of Veterinary Medicine Bucharest. The examinations included a clinical examination, electrocardiographic, echocardiographic and radiographic examination, blood pressure determination and laboratory evaluations.
Only animals with III – VI/VI degree heart murmur and specific clinical signs at the echocardiographic examination have been included in the study.
A population of  1389 dogs, 50.25% males and 49,75% females from different breeds was  examined.  187 dogs (13.46%) were diagnosed with valvular disease. 96.25% (180 dogs) have been diagnosed with mitral valvular disease.
Dogs diagnosed with MVD (murmur on the mitral area, III-V/VI murmur intensity, increase of ventricular cavities, mitral distrophy) were small breed dogs (73.18%) and small to medium breed dogs (26.82%).
Regarding sex predisposition, males seem to be much more predisposed to MVD. It has been observed that:
a.                        Valvular disease was diagnosed in 68.45% males and  31.55% females
b.                       MVD was diagnosed in 68.33% males and 31.67% females
c.                        Valvular (non-mitral) disease was diagnosed in 71.43%  males and  28.57% females
In small breed dogs  the disease was diagnosed in 67.42% males and  32.58% females, and in small to medium breed dogs in 70.83% males and  29.17% females.
The examinations revealed male dogs are much more predisposed to valvular diseases. A 2:1 ratio – males/females- has been described in this study.

SUMMARY

A number of 1389 dogs with cardiac and extra-cardiac diseases were examined in the Internal Disease Clinic – Cardiology Department from the Faculty of Veterinary Medicine Bucharest. The examination included a clinical examination, electrocardiographic, echocardiographic and radiographic examination, blood pressure determination and laboratory evaluations.
Only the animals with III – VI/VI degree heart murmur and specific clinical signs at the echocardiographic examination have been included in the study.
A population of  1389 dogs, 50.25% males and 49,75% females, from different breeds, was  included in the study. 187 dogs (13.46%) were diagnosed with valvular disease. 96.25% (180 dogs) have been diagnosed with mitral valvular disease.
Dogs diagnosed with MVD (murmur on the mitral area, III-V/VI murmur intensity, increase of ventricular cavities, mitral distrophy) were small breed dogs (73.18%) and small to medium breed dogs (26.82%).
Regarding sex predisposition, males seem to be much more predisposed to MVD. It has been observed that:
d.           Valvular disease was diagnosed in 68.45% males and  31.55% females
e.            MVD was diagnosed in 68.33% males and 31.67% females
f.             Valvular (non-mitral) disease was diagnosed in 71.43%  males and  28.57% females
In small breed dogs  the disease was diagnosed in 67.42% males and  32.58% females, and in small to medium breed dogs in 70.83% males and  29.17% females.
The examination revealed male dogs are much more predisposed to valvular diseases. A 2:1 ratio – males/females- has been described in this study.


Matherial and Method

Degenerative Mitral Valve Disease (DMVD, also known as endocardiosis and myxomatous valve degeneration) is a condition frequently met in medical practice, with mitral valvulopathies being the most significant in this category of diseases.
The aim of this research paper is to show that cardiac diseases, in this case CVHD, is much more frequent in males. In human medicine, the low incidence of cardiopathies in women is considered to be due to the protective role of feminine hormones on the heart.
This research paper includes a statistical study regarding the incidence of CVHD, and more specifically of mitral myxomatous valve degenerative in dog.
The research has 2 phases:
-         the first phase was realized in a 12 month period (the abstract of the research)
-         in the second phase, the research has been extended over a period of 16 and a half months
Only the patients with B and C degree valvular disease have been considered in this study (in accordance with Guidelines for the Diagnosis and Treatment of Canine Chronic Valvular Heart Disease, 2009).






   

Dachshund, female, 14 years. Degenerative mitral valve disease:
mitral valve prolaps and atrial flutter.


DMVD  diagnosis

            Patients included in the study presented:
  1. symptoms of cardial decompensation (3rd and 4th degree modified NYHA classification, 2009)
  2. functional symptoms (3rd and 4th degree heart murmurs)
  3. physical symptoms detected by echography, radiography and electrocardiography

Patients with 1st and 2nd degree heart murmur and patients with mitral thickness and reduced atrio-ventricular regurgitation observed at the echographic examination have not been included in the study.

Results and Debates
           
             A number of 1972 dogs from different breeds have been examined in the Internal Disease Department of the Faculty of Veterinary Medicine Bucharest, during a period of 1 and a half years (November 2008 – May, 2010). There were clinically healthy dogs, with cardial or non-cardial diseases.
From the total number of dogs, 49.50% were females and  50,50% were males. Sex ratio was therefore almost equal.
Following clinical examinations, 263 dogs have been diagnosed with cronical valvulopathies (13,33%). From the 263 patients, 254 showed mitral valve disease (12,88%). The results are comparable with data from literature -10% (Ettinger S.J., 2005, 2010; Atkins C. & col., 2009; Rush J.E, 2009).
DMVD has been diagnosed in small breed dogs, small to medium and medium breed dogs.
The incidence of chronic valvulopathies was much higher in males than in females, with a ratio of 2:1.
A)     valvulopathies (all included): females 33,08 – males 66,92%
B)     Mitral valvulopathies : females 33,08%, males 66,92%
C)    Non-mitral valvulopathies : females 36,36%, males 63,63%


Total number of examined animals
(1972 animals)


Total number of “valvulopathies”


Mitral Valvulopathies



Non mitral valvulopathies

If we compare the values from the 12 month period with those obtained in the 16 month period (table 1), we can conclude that the ratio 2:1 (males : females) didn’t change.
A 45 days research has shown that 5 from the 6 females diagnosed with mitral valvulopathies have been neutered several years ago (7-8).


  
TIME
12 Months
16 Months
Total number of examined animals
1389
1972
Female
49.75 %
49.50 %
Male
50.25 %
50.50 %
Total number of valvulopathies
13.46 %
13.33 %
Female
31.55 %
33.08 %
Male
68.45 %
66.92 %
Mitral valvulopathies
12.95 %
12.88 %
Female
31.67%
33.08 %
Male
68.33 %
66.92 %
Non-mitral valvulopathies
0.50 %
0.55 %
Female
28.57 %
36.36 %
Male
71.43 %
63.63 %

CONCLUSIONS

  1. DVMD has been diagnosed in 13.33% from the 1972 dogs evaluated in a 18 months period.
  2. 12.88% from the examined animals have been diagnosed with mitral valve disease.
  3. Even though the ratio males/females has been almost equal in the population evaluated, males have been much more affected than females. Ratio males/females was 2:1.
  4. Neutered females are much more proned to develop mitral valvulopathies (83.33%), compared to intact females (16.66%).
  5. Statistical researches show that females are less affected by cardial diseases than males (the same situation has been observed in dilatative cardiomiopathy. Therefore, it could be inferred that sexual hormones have a protective role on the heart.

BIBLIOGRAPHY

Atkins C., Bonagura J., Ettinger S.J., Fox P., Gordon S., Haggstrom J., Hamlin R., Keene B., Luis – Fuentes V., Stepien R., 2009 – Guidelines for the Diagnosis and Treatment of Canine Chronic Valvular Heart Disease. J. Vet. Int. Med., 23, 6, 1132 – 1150.
Ettinger S.J., Feldman E.C., 2005, 2010 – Textbook of Veterinary Internal Medicine. VI - VII th. Edition. Saunders Elsevier.
Lombard C.W.,. Bussadori Claudio M., Jöns O., 2006 – Clinical efficacy of Pimobendan versus Benazepril for the treatment of acquired atrioventricular valvular disease in dogs. J. Am. Anim. Hosp. Assoc., 42, 249 – 261.
Rush J. E., 2009 - Chronic Valvular Disease in Dogs. In: Bomagura J.D., Twedt D.C. – Kirk's. Current Veterinary Therapy. XIV. Saunders Elsevier.






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