Left and Right Myocardial Functionality Assessed by Two-Dimensional Speckle-Tracking Echocardiography in Cats with Restrictive Cardiomyopathy

Q: What are the key findings of this study?

Cats with EMF-RCM exhibited lower systolic and diastolic left ventricular myocardial deformations and altered right ventricular epicardial longitudinal strain compared to healthy controls.

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Endomyocardial form of feline restrictive cardiomyopathy (EMF-RCM) (n=25). Intervention: Endomyocardial form of restrictive cardiomyopathy (EMF-RCM) assessed via two-dimensional speckle-tracking echocardiography (2D-STE) vs. Healthy control cats without heart disease or medication (n=15). Primary outcome: Layer-specific left and right ventricular systolic and diastolic myocardial deformation indices assessed by two-dimensional speckle-tracking echocardiography (2D-STE) (p=<0.05).

Q: What does this research mean for the field?

Cats with the endomyocardial form of restrictive cardiomyopathy exhibit significantly depressed systolic and diastolic left ventricular myocardial deformation and altered right ventricular strain compared to healthy controls. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess layer-specific left and right ventricular myocardial functionality using two-dimensional speckle-tracking echocardiography in cats with the endomyocardial form of restrictive cardiomyopathy.

Ryôhei Suzuki; Yunosuke Yuchi; Haruka Kanno; Takahiro Teshima; Hirotaka Matsumoto; Hidekazu Koyama

doi:10.3390/ani11061578

May 28, 2021AnimalsOpen Access

Left and Right Myocardial Functionality Assessed by Two-Dimensional Speckle-Tracking Echocardiography in Cats with Restrictive Cardiomyopathy

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Key result

EMF-RCM links to significantly reduced biventricular myocardial deformation compared with healthy controls.

P<0.05
n=25

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Why the study?

EMF-RCM carries a poor prognosis in cats, and it was hypothesized that both left and right myocardial functional abnormalities occur and contribute to its pathophysiology and clinical status.

Does two-dimensional speckle-tracking echocardiography (2D-STE) detect layer-specific left and right ventricular systolic and diastolic myocardial dysfunction in cats with the endomyocardial form of restrictive cardiomyopathy compared with healthy control cats?

Key Points

To assess layer-specific left and right ventricular myocardial functionality using two-dimensional speckle-tracking echocardiography in cats with the endomyocardial form of restrictive cardiomyopathy.
Included 25 client-owned cats consisting of 10 cats diagnosed with endomyocardial restrictive cardiomyopathy (stage B2: n=2; stage C: n=8) and 15 healthy control cats.
Assessed layer-specific myocardial function (whole, endocardial, and epicardial) in left ventricular longitudinal and circumferential directions, as well as right ventricular longitudinal direction, using two-dimensional speckle-tracking echocardiography recorded at 134 to 170 frames/s.
Cats with restrictive cardiomyopathy had significantly depressed left ventricular deformations in systole (whole longitudinal strain, epicardial longitudinal strain, and endocardial circumferential strain) and diastole (early and late diastolic longitudinal strain rates, and late diastolic circumferential strain rate) compared to controls.
Global left ventricular circumferential strain in the endocardial layer and the circumferential endocardial-to-epicardial strain ratio were significantly lower in cats with restrictive cardiomyopathy.
Right ventricular systolic longitudinal strain in epicardial layers was significantly lower and the endocardial-to-epicardial strain ratio was significantly higher in cats with restrictive cardiomyopathy than in controls.

Study Design

Type

Case-Control (n=25)

Blinding

Single trained observer (H.Ka.) remained unaware of the examination data of the cats during offline 2D-STE analysis

Multicenter

No

Structured PICO

Does two-dimensional speckle-tracking echocardiography (2D-STE) detect layer-specific left and right ventricular systolic and diastolic myocardial dysfunction in cats with the endomyocardial form of restrictive cardiomyopathy compared with healthy control cats?

P

Population

25 client-owned cats in Japan, comprising 10 cats clinically diagnosed with the endomyocardial form of restrictive cardiomyopathy (2 stage B2, 8 stage C) and 15 healthy control cats enrolled prospectively between November 2018 and September 2020.

E

Exposure

Two-dimensional speckle-tracking echocardiography (2D-STE) assessment of layer-specific (whole, endocardial, epicardial) left ventricular longitudinal and circumferential strain/strain rate and right ventricular longitudinal strain/strain rate in cats with EMF-RCM

C

Comparator

Healthy control cats (n=15; domestic shorthair n=7, Maine Coon n=2, Himalayan n=2, American shorthair n=1, Russian blue n=1, Sphynx n=1, Scottish fold n=1) with normal physical, ECG, radiographic, blood pressure, and echocardiographic findings and no medications

O

Outcome

Layer-specific (whole, endocardial, epicardial) systolic and diastolic myocardial deformation indices in the left ventricular longitudinal and circumferential directions and right ventricular longitudinal direction measured by 2D-STEsurrogate

Main Result

p-value: p=<0.05

Limitations

Noninvasive clinical investigation without histopathological findings to make a definitive diagnosis and assess myocardial histopathological alterations.
Could not exclude the influence of prior cardiac medications (such as pimobendan, loop diuretics, ACE inhibitors, and beta-blockers) on 2D-STE values in 70% of EMF-RCM cats.
Small sample size (10 EMF-RCM cats and 15 controls) which may affect statistical power and limit extrapolation.
Presence of confounding pathophysiological factors in EMF-RCM cats such as heart failure, pulmonary edema, and pulmonary hypertension.
Only longitudinal right ventricular strain and strain rate were evaluated, without assessing right ventricular circumferential function.
Lack of histopathological confirmation of diagnosis and myocardial fibrosis due to noninvasive clinical study design
Potential confounding effect of concurrent cardiac medications (loop diuretics, pimobendan, ACE inhibitors, beta-blockers, prostacyclin derivatives, antithrombotics) received by 70% of EMF-RCM cats
Small sample size (10 EMF-RCM cats and 15 healthy controls) limiting statistical power and generalizability
Confounding comorbidities in EMF-RCM cats including congestive heart failure, pulmonary edema, pleural effusion, and pulmonary hypertension
Evaluation of right ventricular deformation was restricted to the longitudinal direction without circumferential RV assessment

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Implication

Layer-specific 2D speckle-tracking echocardiography demonstrates biventricular systolic and diastolic myocardial dysfunction—specifically depressed LV endomyocardial circumferential strain—in cats with the endomyocardial form of restrictive cardiomyopathy.

Abstract

The endomyocardial form of restrictive cardiomyopathy (EMF-RCM), a primary disorder of the myocardium, is one of the diseases with poor prognosis in cats. We hypothesized that both the left and right myocardial functional abnormalities may occur in cats with EMF-RCM, causing this disease pathophysiology and clinical status. Out of the 25 animals included in this study, 10 were client-owned cats with EMF-RCM, and 15 were healthy cats. In this study, cats were assessed for layer-specific myocardial function (whole, endocardial, and epicardial) in the left ventricular longitudinal and circumferential directions, and right ventricular longitudinal direction, via two-dimensional speckle-tracking echocardiography (2D-STE). Cats with EMF-RCM had depressed left ventricular myocardial deformations both in systole (whole longitudinal strain, epicardial longitudinal strain, and endocardial circumferential strain) and diastole (early and late diastolic longitudinal strain rates, and late diastolic circumferential strain rate) compared to controls. Furthermore, some right ventricular myocardial deformations (systolic longitudinal strain in epicardial layers, and endocardial-to-epicardial strain ratio) were significantly differerent in cats with EMF-RCM. Myocardial function assessed by 2D-STE could reveal left and right myocardial dysfunction.

Discussion

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Cite This Study

Suzuki et al. (2021) conducted a case-control in Endomyocardial form of feline restrictive cardiomyopathy (EMF-RCM) (n=25). Endomyocardial form of restrictive cardiomyopathy (EMF-RCM) assessed via two-dimensional speckle-tracking echocardiography (2D-STE) vs. Healthy control cats without heart disease or medication (n=15) was evaluated on Layer-specific left and right ventricular systolic and diastolic myocardial deformation indices assessed by two-dimensional speckle-tracking echocardiography (2D-STE) (p=<0.05). Cats with EMF-RCM exhibited lower systolic and diastolic left ventricular myocardial deformations and altered right ventricular epicardial longitudinal strain compared to healthy controls.

synapsesocial.com/papers/6a79d2758a3ae1c742326f0e https://doi.org/10.3390/ani11061578

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Left and Right Myocardial Functionality Assessed by Two-Dimensional Speckle-Tracking Echocardiography in Cats with Restrictive Cardiomyopathy

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Left and Right Myocardial Functionality Assessed by Two-Dimensional Speckle-Tracking Echocardiography in Cats with Restrictive Cardiomyopathy

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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