Submitted by Jorge Silva (jorgelmsilva@ufrrj.br) on 2017-04-11T21:02:55Z No. of bitstreams: 1 2015 - Daniel de Castro Trindade.pdf: 4241082 bytes, checksum: 050e5970f8afecacd5ab5af40fcf6348 (MD5) / Made available in DSpace on 2017-04-11T21:02:55Z (GMT). No. of bitstreams: 1 2015 - Daniel de Castro Trindade.pdf: 4241082 bytes, checksum: 050e5970f8afecacd5ab5af40fcf6348 (MD5) Previous issue date: 2015-07-29 / The heart rate variability (HRV) consist in a method able of assess the modulation of the autonomic nervous system (ANS) on the heart, allowing to determine possible simpatovagal changes. The analysis of time and frequency domain are types of signal processing used to investigate this variability, both dependent of the measures of RR intervals. The aim of this study was to evaluate the simpatovagal balance through HRV analysis by Holter method in dogs with valvar disease submitted to convencional drug therapy for heart failure or associate with Pimobendan. We used 37 adult dogs (13 males and 24 females), 03-14 years old and different breeds constituting 03 groups: CONT (healthy dogs without any treatment); CTP (dogs with heart failure receiving conventional therapy for CHF) and CTP + Pimo (dogs with heart failure receiving conventional therapy for CHF, associated with Pimobendan). The Holter examination was performed in different veterinary clinics in the Rio de Janeiro state, lasting 30 minutes and after a minimum period of 30 days from starting treatment. The parameters studied were: minimum heart rate; mean; maximum and QRS number. In the time domain were studied values: NN mean, SDNN, SDANN, SDNN index, rMSSD and pNN50. In the frequency domain the values studied were: Fc; HF; LF; VLF; LF / HF. Statistical values were showed as mean ? sem. The mean values of minimum heart rate, mean, maximum and QRS complex number of the different groups showed no statistical significance (P> 0.05). The mean values of the study of HRV in the time domain, the CTP and CTP + Pimo groups showed significant reduction (P <0.05) of the following parameters (SDNN; SDANN; SDNNIDX; RMSSD and pNN50) vs CONT group. In the heart rate variability in the frequency domain, CTP and CTP + Pimo groups showed significantly lower values of total power spectrum vs CONT (P <0.05); LF smaller values of CTP vs CONT group (P <0.05); larger values of LF of CTP + Pimo vs CTP group (P <0.05); smaller values of VLF of CTP + Pimo vs CONT group (P <0.01); lower values of LF / HF of CTP vs CONT group (P <0.05) and higher values to CTP + Pimo vs CTP group (P <0.01). Our study showed significant changes in HRV reduction in the time and frequency domains in CTP and CTP + Pimo groups when compared to CONT group. However, dogs treated with Pimobendan showed no significant evidence of improvement in their HRV parameters when compared to other dogs with heart failure that did not receive this drug, at least during the period proposed in this study. The changes in HRV parameters in dogs with heart failure were able to maintain even working with patients showing large breed diversity, of weights, sex and age; showing significant lower values in time and frequency domain when compared to normal dogs. The Pimobendan therapy, still no described in literature as able to influence HRV parameters in dogs with heart failure, in our study showed that animals treated with this drug showed larger sympathetic modulation, verified by LF/HF relation. / A variabilidade da frequ?ncia card?aca (VFC) constitui um m?todo capaz de aferir a modula??o do Sistema Nervoso Aut?nomo (SNA) sobre o cora??o, permitindo determinar poss?veis altera??es simpatovagais. A an?lise do dom?nio de tempo e frequ?ncia s?o tipos de processamento de sinal utilizados para investigar essa variabilidade, ambos dependentes da efic?cia das medidas dos intervalos RR. O objetivo deste estudo foi avaliar o balan?o simpatovagal atrav?s da an?lise da VFC pelo m?todo de Holter em c?es portadores de doen?a valvar submetidos ? terapia farmacol?gica convencional para insufici?ncia card?aca ou associada ? droga Pimoendan. Utilizamos 37 c?es adultos (13 machos e 24 f?meas), de 03 a 14 anos de idade e de diferentes ra?as, formando 03 grupos experimentais: CONT (c?es sadios n?o submetidos a qualquer tratamento); CTP (c?es cardiopatas submetidos ? terapia convencional para ICC) e CTP + Pimo (cardiopatas submetidos ? terapia convencional para ICC, associada ao Pimobendan). O exame Holter foi realizado em diferentes cl?nicas veterin?rias do estado do RJ, com dura??o de 30 minutos e ap?s um per?odo m?nimo de 30 dias do in?cio das terapias. Os par?metros estudados foram: frequ?ncia card?aca m?nima; m?dia; m?xima e N? QRS. No dom?nio do tempo foram estudados os valores de: NN m?dio, SDNN, SDANN, SDNN ?ndex, rMSSD e pNN50. No dom?nio da frequ?ncia foram estudados os valores: HF; LF; VLF; LF/HF. Os valores estat?sticos foram representados como m?dia ? s.e.m. Os valores m?dios das frequ?ncias card?acas m?nima, m?dia, m?ximas e n?mero de complexos QRS apresentados pelos c?es dos diferentes grupos n?o mostraram signific?ncia estat?stica (P > 0,05). Nos valores m?dios do estudo da VFC no dom?nio do tempo, os animais dos grupos CTP e CTP + Pimo apresentaram redu??o significativa (P < 0,05) dos seguintes par?metros (SDNN; SDANN; SDNNIDX; RMSSD e pNN50) vs grupo CONT. No dom?nio da frequ?ncia, os grupos CTP e CTP + Pimo mostraram valores significativamente inferiores da pot?ncia total de espectro vs CONT (P < 0,05); menores valores de LF do grupo CTP vs grupo CONT (P < 0,05); maiores valores de LF do grupo CTP + Pimo vs CTP (P < 0,05), menores valores de VLF do grupo CTP + Pimo vs CONT (P < 0,01); menores valores da raz?o LF/HF do grupo CTP vs CONT (P < 0,05) e maiores valores para CTP + Pimo vs CTP (P< 0,01). Nosso estudo mostrou mudan?as significativas da redu??o da VFC nos dom?nios do tempo e da frequ?ncia nos grupos CTP e CTP + Pimo quando comparados ao grupo CONT. Por?m, c?es tratados com Pimobendan n?o mostraram evid?ncia significativa em melhora de seus par?metros da VFC quando comparado aos outros c?es cardiopatas que n?o receberam esta droga, pelo menos durante o per?odo proposto nesse estudo. As altera??es em par?metros da VFC em c?es cardiopatas foram capazes de se manter mesmo trabalhando com pacientes apresentando grande diversidade racial, de pesos, sexo e idade; mostrando valores significativamente inferiores nos dom?nios do tempo e frequ?ncia quando comparados aos c?es normais. A terapia com Pimobendan, ainda n?o descrita na literatura como capaz de influenciar par?metros da VFC em c?es cardiopatas, em nosso estudo mostrou que animais tratados com essa droga apresentaram maior modula??o simp?tica, comprovada atrav?s da rela??o LF/HF.

A insuficiência valvar crônica de mitral (IVCM) é a principal cardiopatia de cães, correspondendo a 75-85% dos casos de cardiopatias. É causada pela degeneração mixomatosa da valva mitral (endocardiose de mitral) sendo, então, uma doença degenerativa adquirida e que pode ocasionar a insuficiência cardíaca congestiva (ICC). Pode acometer qualquer raça de cão, mas é mais frequentemente observada nas raças de pequeno porte, dentre as quais, Poodle miniatura, Spitz Alemão, Dachshund, Yorkshire Terrier, Chihuahua e Cavalier King Charles Spaniel. Na endocardiose de mitral, o volume sanguíneo regurgitado causa sobrecarga do lado esquerdo do coração, devido ao aumento das pressões atrial e ventricular esquerdas, seguida de dilatação e hipertrofia dessas cavidades cardíacas. A elevação da pressão ventricular esquerda pode causar hipertensão pulmonar, congestão e, em estágios avançados, edema pulmonar. A doença pode evoluir assintomática, enquanto que naqueles casos que evoluem para insuficiência cardíaca congestiva (ICC) os sintomas mais usuais são: tosse, intolerância ao exercício, dispneia e síncope. Em 2009 o colégio americano de medicina interna veterinária (American College of Veterinary Internal Medicine -ACVIM) elaborou diretrizes para o tratamento da IVCM, tendo por base a classificação funcional adaptada do American College of Cardiology. Neste trabalho foram utilizados os fármacos anlodipino e pimobendana em associação a outros usualmente indicados no tratamento da ICC em cães, segundo consenso de 2009, indicados no tratamento da ICC em cães. Dois grupos (A e B) de cães, cada um constituído por 10 pacientes com IVCM em estágio C, foram tratados com furosemida e maleato de enalapril, sendo que os animais do grupo A receberão pimobendana e os do grupo B, anlodipino. Os animais foram avaliados em diferentes momentos (T0, T30, T60) observando-se as alterações nos exames ecodopplercardiográfico e eletrocardiográfico, bem como de pressão arterial sistólica / Chronic mitral valve regurgitation is the most frequent heart disease of dogs, accounting for 75-85 % of cases of heart diseases. It is caused by myxomatous mitral valve degeneration (mitral endocardiosis), therefore, an acquired degenerative disease that can lead to congestive heart failure (CHF). It affects any breed of dog, but is most often seen in small-sized breeds, like Miniature Poodle, German Spitz, Dachshund, Yorkshire Terrier, Chihuahua, and Cavalier King Charles Spaniel. In mitral endocardiosis, regurgitated blood volume causes overload on the left side of the heart due to increased left atrial and ventricular pressures, followed by dilation and hypertrophy of these heart chambers. The increase in left ventricular pressure can cause pulmonary hypertension, congestion and, in advanced stages, pulmonary edema. The disease can be asymptomatic, but in those cases that progress to congestive heart failure (CHF), the most common symptoms are coughing, exercise intolerance, dyspnea and syncope. In 2009 the American College of Veterinary Internal Medicine (ACVIM) has developed guidelines for the treatment of IVCM, based on the adapted functional classification of the American College of Cardiology. In this paper, amlodipine and pimobendan were used in combination with other commonly used drugs indicated in the treatment of CHF in dogs. Two groups (A and B) of dogs were used, each one consisted by 10 patients in stage C. Both received furosemide and enalapril maleate and animals of group A, additionally, received pimobendan and those of group B, amlodipine. All animals were evaluated at three different times (T0, T30, T60) observing changes in echodopplercardiographic and electrocardiographic examinations, as well as systolic blood pressure

A insuficiência valvar crônica de mitral (IVCM) é a principal cardiopatia de cães, correspondendo a 75-85% dos casos de cardiopatias. É causada pela degeneração mixomatosa da valva mitral (endocardiose de mitral) sendo, então, uma doença degenerativa adquirida e que pode ocasionar a insuficiência cardíaca congestiva (ICC). Pode acometer qualquer raça de cão, mas é mais frequentemente observada nas raças de pequeno porte, dentre as quais, Poodle miniatura, Spitz Alemão, Dachshund, Yorkshire Terrier, Chihuahua e Cavalier King Charles Spaniel. Na endocardiose de mitral, o volume sanguíneo regurgitado causa sobrecarga do lado esquerdo do coração, devido ao aumento das pressões atrial e ventricular esquerdas, seguida de dilatação e hipertrofia dessas cavidades cardíacas. A elevação da pressão ventricular esquerda pode causar hipertensão pulmonar, congestão e, em estágios avançados, edema pulmonar. A doença pode evoluir assintomática, enquanto que naqueles casos que evoluem para insuficiência cardíaca congestiva (ICC) os sintomas mais usuais são: tosse, intolerância ao exercício, dispneia e síncope. Em 2009 o colégio americano de medicina interna veterinária (American College of Veterinary Internal Medicine -ACVIM) elaborou diretrizes para o tratamento da IVCM, tendo por base a classificação funcional adaptada do American College of Cardiology. Neste trabalho foram utilizados os fármacos anlodipino e pimobendana em associação a outros usualmente indicados no tratamento da ICC em cães, segundo consenso de 2009, indicados no tratamento da ICC em cães. Dois grupos (A e B) de cães, cada um constituído por 10 pacientes com IVCM em estágio C, foram tratados com furosemida e maleato de enalapril, sendo que os animais do grupo A receberão pimobendana e os do grupo B, anlodipino. Os animais foram avaliados em diferentes momentos (T0, T30, T60) observando-se as alterações nos exames ecodopplercardiográfico e eletrocardiográfico, bem como de pressão arterial sistólica / Chronic mitral valve regurgitation is the most frequent heart disease of dogs, accounting for 75-85 % of cases of heart diseases. It is caused by myxomatous mitral valve degeneration (mitral endocardiosis), therefore, an acquired degenerative disease that can lead to congestive heart failure (CHF). It affects any breed of dog, but is most often seen in small-sized breeds, like Miniature Poodle, German Spitz, Dachshund, Yorkshire Terrier, Chihuahua, and Cavalier King Charles Spaniel. In mitral endocardiosis, regurgitated blood volume causes overload on the left side of the heart due to increased left atrial and ventricular pressures, followed by dilation and hypertrophy of these heart chambers. The increase in left ventricular pressure can cause pulmonary hypertension, congestion and, in advanced stages, pulmonary edema. The disease can be asymptomatic, but in those cases that progress to congestive heart failure (CHF), the most common symptoms are coughing, exercise intolerance, dyspnea and syncope. In 2009 the American College of Veterinary Internal Medicine (ACVIM) has developed guidelines for the treatment of IVCM, based on the adapted functional classification of the American College of Cardiology. In this paper, amlodipine and pimobendan were used in combination with other commonly used drugs indicated in the treatment of CHF in dogs. Two groups (A and B) of dogs were used, each one consisted by 10 patients in stage C. Both received furosemide and enalapril maleate and animals of group A, additionally, received pimobendan and those of group B, amlodipine. All animals were evaluated at three different times (T0, T30, T60) observing changes in echodopplercardiographic and electrocardiographic examinations, as well as systolic blood pressure

Contexte : Les maladies valvulaires dégénératives (MVD) représentent la pathologie cardiaque acquise la plus fréquente chez le chien. Malgré une recherche active, à l’heure actuelle aucun traitement étudié ne s’est avéré efficace dans le traitement du stade asymptomatique de la condition. Le pimobendane est un nouvel agent inodilatateur, qui s’est montré prometteur dans le traitement des stades avancés des MVD, mais peu est connu sur ses effets hémodynamiques et son impact sur le volume de régurgitation dans les MVD naturelles asymptomatiques. Hypothèses : L’introduction du pimobendane réduit la fraction de régurgitation (FR) chez les chiens atteints de MVD asymptomatiques. Sujets étudiés : Vingt-quatre chiens de compagnie, appartenant à la clientèle du Centre Hospitalier Universitaire Vétérinaire (CHUV) de l’université de Montréal et affectés par une MVD de classe ISACHC 1b. Méthode: Étude prospective, contrôlée et conduite à l’aveugle. Les chiens ont été assignés à un groupe traitement (n=19) recevant du pimobendane (0,2-0,3 mg/Kg q12h) ou à un groupe contrôle (n=5). Les évaluations échocardiographiques ont été effectuées sur une période de 6 mois. Résultats : L’introduction du pimobendane n’a pas été associée à une diminution de la FR chez les chiens affectés par une MVD asymptomatique de classe ISACHC 1b au cours de l’étude (p=0,85). Une augmentation significative de la fraction d’éjection (80,8 +/- 1,42 vs. 69,0 +/- 2,76, p=0,0064) ainsi qu’une baisse du diamètre ventriculaire gauche télé systolique (p=0.011) ont été observées chez le groupe pimobendane au jour 30. Toutefois, cet effet sur la fonction systolique n’a pas persisté au cours des 6 mois d’évaluation. / Background: Mitral Valve disease (MVD) is the most common acquired cardiac affectation of the dog, and is therefore associated with an undeniable clinical and economical importance for veterinarians and pet owners. Despite active research, at this time no known treatment has been proven to delay the onset of congestive heart failure. Pimobendan is a novel inodilator that has shown promising results in the treatment of advanced MVD, but little is known about its hemodynamic effects, especially regarding the mitral regurgitant volume in naturally occurring asymptomatic MVD. Hypothesis: Administration of pimobendan decreases the regurgitant fraction (RF) of dogs with asymptomatic MVD. Animals: Twenty-four client-owned dogs affected by ISACHC class Ib MVD. Methods: Prospective, blinded, controlled clinical trial. Dogs were assigned to a pimobendan (0.2-0.3 mg/Kg q12h) treatment group (n=19) or a control group (n=5). Echocardiographic evaluations were performed over a 6 month study period. Results: Administration of pimobendan to treatment did not decrease the RF of dogs affected by asymptomatic class 1b MVD over the study period (p=0.85). There was a significant increase in the ejection fraction of the pimobendan treated dogs at day (80.8 +/- 1.42 vs. 69.0 +/- 2.76, p=0.0064), and a decrease in systolic left ventricular diameter (p=0.011). However, this improvement in systolic function was not sustained over the 6 month trial period.

Contexte : Les maladies valvulaires dégénératives (MVD) représentent la pathologie cardiaque acquise la plus fréquente chez le chien. Malgré une recherche active, à l’heure actuelle aucun traitement étudié ne s’est avéré efficace dans le traitement du stade asymptomatique de la condition. Le pimobendane est un nouvel agent inodilatateur, qui s’est montré prometteur dans le traitement des stades avancés des MVD, mais peu est connu sur ses effets hémodynamiques et son impact sur le volume de régurgitation dans les MVD naturelles asymptomatiques. Hypothèses : L’introduction du pimobendane réduit la fraction de régurgitation (FR) chez les chiens atteints de MVD asymptomatiques. Sujets étudiés : Vingt-quatre chiens de compagnie, appartenant à la clientèle du Centre Hospitalier Universitaire Vétérinaire (CHUV) de l’université de Montréal et affectés par une MVD de classe ISACHC 1b. Méthode: Étude prospective, contrôlée et conduite à l’aveugle. Les chiens ont été assignés à un groupe traitement (n=19) recevant du pimobendane (0,2-0,3 mg/Kg q12h) ou à un groupe contrôle (n=5). Les évaluations échocardiographiques ont été effectuées sur une période de 6 mois. Résultats : L’introduction du pimobendane n’a pas été associée à une diminution de la FR chez les chiens affectés par une MVD asymptomatique de classe ISACHC 1b au cours de l’étude (p=0,85). Une augmentation significative de la fraction d’éjection (80,8 +/- 1,42 vs. 69,0 +/- 2,76, p=0,0064) ainsi qu’une baisse du diamètre ventriculaire gauche télé systolique (p=0.011) ont été observées chez le groupe pimobendane au jour 30. Toutefois, cet effet sur la fonction systolique n’a pas persisté au cours des 6 mois d’évaluation. / Background: Mitral Valve disease (MVD) is the most common acquired cardiac affectation of the dog, and is therefore associated with an undeniable clinical and economical importance for veterinarians and pet owners. Despite active research, at this time no known treatment has been proven to delay the onset of congestive heart failure. Pimobendan is a novel inodilator that has shown promising results in the treatment of advanced MVD, but little is known about its hemodynamic effects, especially regarding the mitral regurgitant volume in naturally occurring asymptomatic MVD. Hypothesis: Administration of pimobendan decreases the regurgitant fraction (RF) of dogs with asymptomatic MVD. Animals: Twenty-four client-owned dogs affected by ISACHC class Ib MVD. Methods: Prospective, blinded, controlled clinical trial. Dogs were assigned to a pimobendan (0.2-0.3 mg/Kg q12h) treatment group (n=19) or a control group (n=5). Echocardiographic evaluations were performed over a 6 month study period. Results: Administration of pimobendan to treatment did not decrease the RF of dogs affected by asymptomatic class 1b MVD over the study period (p=0.85). There was a significant increase in the ejection fraction of the pimobendan treated dogs at day (80.8 +/- 1.42 vs. 69.0 +/- 2.76, p=0.0064), and a decrease in systolic left ventricular diameter (p=0.011). However, this improvement in systolic function was not sustained over the 6 month trial period.