Heart rate variability and quality of life in dogs with mitral valve disease treated with metoprolol
PDF
XML

Keywords

autonomic nervous system, beta-blockers, holter, pNN50.

How to Cite

Beluque, T., Camacho, A. A., Ampuero, R. N., Braz, J. B., Kirnew, M. D., Canola, R. A. M., … Sousa, M. G. (2021). Heart rate variability and quality of life in dogs with mitral valve disease treated with metoprolol . Brazilian Journal of Veterinary Medicine, 43(1), e003020. https://doi.org/10.29374/2527-2179.bjvm003020

Abstract

Mitral valve disease (MVD) is a progressive disease that can reduce cardiac output. Activation of the sympathetic autonomic nervous system is one of the body’s first responses in order to maintain cardiac output, but may have deleterious effects on the cardiovascular system. This study investigated the effect of metoprolol on heart rate variability and quality of life in dogs with severe MVD (stage C, according to the guidelines of the American College of Veterinary Internal Medicine). Eight dogs between nine and thirteen years of age were enrolled and screening tests such as complete blood count, serum biochemistry profile, systolic blood pressure, thoracic radiographs, electrocardiogram, echocardiogram and long-term electrocardiography (24 hours) were performed. The patients were treated with enalapril, furosemide, spironolactone, and pimobendan until considered clinically stable, and metoprolol was then added to the therapy. One month later, all animals were re-assessed. Owners responded to a questionnaire about their dog’s quality of life before and after beta-blocker therapy. The value for pNN50 (percentage difference between adjacent N-N intervals more than 50 ms) was significantly higher (P=0.039) after treatment with metoprolol, indicating higher heart rate variability as indicated by the increased parasympathetic component. Furthermore, quality of life was improved in 30% of patients after metoprolol was initiated. The results suggest that treatment with beta-blockers in dogs with stage C MVD may yield additional benefits in comparison to standard CHF treatment.

https://doi.org/10.29374/2527-2179.bjvm003020
PDF
XML

References

Acierno, M. J., Brown, S., Coleman, A. E., Jepson, R. E., Papich, M., Stepien, R. L., & Syme, H. M. (2018). ACVIM consensus statement: guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. Journal of Veterinary Internal Medicine, 32(6), 1803-1822. http://dx.doi.org/10.1111/jvim.15331. PMid:30353952.

Atkins, C., Bonagura, J., Ettinger, S., 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. Journal of Veterinary Internal Medicine, 23(6), 1142-1150. http://dx.doi.org/10.1111/j.1939-1676.2009.0392.x. PMid:19780929.

Bálint, A., Eleőd, H., Körmendi, J., Bódizs, R., Reicher, V., & Gácsi, M. (2019). Potential physiological parameters to indicate inner states in dogs: the analysis of ecg, and respiratory signal during different sleep phases. Frontiers in Behavioral Neuroscience, 13(207), 207. http://dx.doi.org/10.3389/fnbeh.2019.00207. PMid:31607871.

Blake, R. R., Shaw, D. J., Culshaw, G. J., & Martinez-Pereira, Y. (2018). Poincaré plots as a measure of heart rate variability in healthy dogs. Journal of Veterinary Cardiology, 20(1), 20-32. http://dx.doi.org/10.1016/j.jvc.2017.10.006. PMid:29277470.

Bogucki, S. Z., & Noszczyk-Nowak, A. (2015). Short-term heart rate variability (HRV) in healthy dogs. Polish Journal of Veterinary Sciences, 18(2), 307-312. http://dx.doi.org/10.1515/pjvs-015-0040. PMid:26172180.

Bogucki, S. Z., & Noszczyk-Nowak, A. (2017). Short-term heart rate variability in dogs with sick sinus syndrome or chronic mitral valve disease as compared to healthy controls. Polish Journal of Veterinary Sciences, 20(1), 167-172. http://dx.doi.org/10.1515/pjvs-2017-0021. PMid:28525326.

Boon, J. (2011). Veterinary echocardiography (2nd ed.). Chichester: Wiley-Blackwell.

Chompoosan, C., Buranakarl, C., Chaiyabutr, N., & Chansaisakorn, W. (2014). Decreased sympathetic tone after short-term treatment with enalapril in dogs with mild chronic mitral valve disease. Research in Veterinary Science, 96(2), 347-354. http://dx.doi.org/10.1016/j.rvsc.2014.01.006. PMid:24559801.

Craig, L., Meyers-Manor, J. E., Anders, K., Sütterlin, S., & Miller, H. (2017). The relationship between heart rate variability and canine aggression. Applied Animal Behaviour Science, 188(1), 59-67. http://dx.doi.org/10.1016/j.applanim.2016.12.015.

Crosara, S., Borgarelli, M., Perego, M., Häggström, J., La Rosa, G., Tarducci, A., Santilli, R. A. (2010). Holter monitoring in 36 dogs with myxomatous mitral valve disease. Australian Veterinary Journal, 88(10), 386-392. http://doi:10.1111/j.1751-0813.2010.00628.x.

Cunningham, J. G. (2004). Tratado de fisiologia veterinária (3. ed). Rio de Janeiro: Guanabara Koogan.

Freeman, L. M., Rush, J. E., Farabaugh, A. E., & Must, A. (2005). Development and evaluation of a questionnaire for assessing health-related quality of life in dogs with cardiac disease. Journal of the American Veterinary Medical Association, 226(11), 1864-1868. http://dx.doi.org/10.2460/javma.2005.226.1864. PMid:15934254.

Frigerio, M., & Roubina, E. (2005). Drugs for left ventricular remodeling in heart failure. The American Journal of Cardiology, 96(12A), 10L-18L. http://dx.doi.org/10.1016/j.amjcard.2005.09.060. PMid:16399088.

Gheorghiade, M., Colucci, W. S., & Swedberg, K. (2003). Beta-blockers in chronic heart failure. Circulation, 107(12), 1570-1575. http://dx.doi.org/10.1161/01.CIR.0000065187.80707.18. PMid:12668487.

Jensen, B. C., OʼConnell, T. D., & Simpson, P. C. (2014). Alpha-1-adrenergic receptors in heart failure: the adaptive arm of the cardiac response to chronic catecholamine stimulation. Journal of Cardiovascular Pharmacology, 63(4), 291-301. http://dx.doi.org/10.1097/FJC.0000000000000032. PMid:24145181.

Keene, B. W., Atkins, C. E., Bonagura, J. D., Fox, P. R., Häggström, J., Fuentes, V. L., Oyama, M. A., Rush, J. E., Stepien, R., & Uechi, M. (2019). ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. Journal of Veterinary Internal Medicine, 33(3), 1127-1140. http://dx.doi.org/10.1111/ jvim.15488. PMid:30974015.

Klapholz, M. (2009). Beta-blocker use for the stages of heart failure. Mayo Clinic Proceedings, 84(8), 718-729. http://dx.doi.org/10.4065/84.8.718. PMid:19648389.

Liu, H., Yang, Z., Huang, L., Qu, W., Hao, H., & Li, L. (2017). Heart-rate variability indices as predictors of the response to vagus nerve stimulation in patients with drug-resistant epilepsy. Epilepsia, 58(6), 1015-1022. http://dx.doi.org/10.1111/epi.13738. PMid:28440954.

Mehta, R. H., Supiano, M. A., Oral, H., Grossman, P. M., Montgomery, D. S., Smith, M. J., & Starling, M. R. (2003). Compared with control subjects, the systemic sympathetic nervous system is activated in patients with mitral regurgitation. American Heart Journal, 145(6), 1078-1085. http://dx.doi.org/10.1016/S0002-8703(03)00111-X. PMid:12796766.

Morgan, K. R. S., Monteith, G., Raheb, S., Colpitts, M., & Fonfara, S. (2020). Echocardiographic parameters for the assessment of congestive heart failure in dogs with myxomatous mitral valve disease and moderate to severe mitral regurgitation. Veterinary Journal, 263, 105518. http://dx.doi.org/10.1016/j.tvjl.2020.105518. PMid:32928487.

Olexova, L. B., Sekaninova, N., Jurko Junior, A., Visnovcova, Z., Grendar, M., Jurko, T., & Tonhajzerova, I. (2020). Respiratory sinus arrhythmia as an index of cardiac vagal control in mitral valve prolapse. Physiological Research, 69(1, Suppl. 1), S163-S169. http://dx.doi.org/10.33549/physiolres.934402. PMid:32228022.

Oliveira, M. S., Muzzi, R. A. L., Araújo, R. B., Muzzi, L. A. L., Ferreira, D. F., Nogueira, R., & Silva, E. F. (2012). Heart rate variability parameters of myxomatous mitral valve disease in dogs with and without heart failure obtained using 24-hour Holter electrocardiography. The Veterinary Record, 170(24), 622-625. http://dx.doi.org/10.1136/vr.100202. PMid:22645158.

Oliveira, M. S., Muzzi, R. A. L., Araújo, R. B., Muzzi, L. A. L., Ferreira, D. F., & Silva, E. F. (2014). Heart rate variability and arrhythmias evaluated with Holter in dogs with degenerative mitral valve disease. Arquivo Brasileiro de Medicina Veterinária e Zootecnia, 66(2), 425-432. http://dx.doi.org/10.1590/1678-41626097.

Oui, H., Oh, J., Keh, S., Lee, G., Jeon, S., Kim, H., Yoon, J., & Choi, J. (2015). Measurements of the pulmonary vasculature on thoracic radiographs in healthy dogs compared to dogs with mitral regurgitation. Veterinary Radiology & Ultrasound, 56(3), 251-256. http://dx.doi.org/10.1111/vru.12234. PMid:25545202.

Pirintr, P., Saengklub, N., Limprasutr, V., Sawangkoon, S., & Kijtawornrat, A. (2017). Sildenafil improves heart rate variability in dogs with asymptomatic myxomatous mitral valve degeneration. The Journal of Veterinary Medical Science, 79(9), 1480-1488. http://dx.doi.org/10.1292/jvms.17-0016. PMid:28717064.

Plumb, D. C. (2011). Plumb’s veterinary drug handbook (7th ed.). Hoboken: Wiley-Blackwell.

Rasmussen, C. E., Falk, T., Zois, N. E., Moesgaard, S. G., Häggström, J., Pedersen, H. D., Ablad, B., Nilsen, H. Y., & Olsen, L. H. (2012). Heart rate, heart rate variability, and arrhythmias in dogs with myxomatous mitral valve disease. Journal of Veterinary Internal Medicine, 26(1), 76-84. http://dx.doi.org/10.1111/j.1939-1676.2011.00842.x. PMid:22151356.

Rasmussen, C. E., Vesterholm, S., Ludvigsen, T. P., Haggstrom, J., Pedersen, H. D., Moesgaard, S. G., & Olsen, L. H. (2011). Holter monitoring in clinically healthy Cavalier King Charles Spaniels, Wire-haired Dachshunds, and Cairn Terriers. Journal of Veterinary Internal Medicine, 25(3), 460-468. http://dx.doi.org/10.1111/j.1939-1676.2011.0707.x. PMid:21418322.

Santos, W. F., Aben Athar, C. V., Lopes, J. V. R., Santos, I. O. M. G., & Paiva, J. P. (2013). Prevalência da doença valvar degenerativa crônica de mitral e da bronquite crônica diagnosticadas em avaliação pré-operatória em cães (Canis familiaris) atendidos no Hospital Veterinário da Universidade Federal Rural do Rio de Janeiro no período de março. Revista de Educação Continuada em Medicina Veterinária e Zootecnia do CRMV-SP, 11(2), 87.

Schober, K. E., Hart, T. M., Stern, J. A., Li, X., Samii, V. F., Zekas, L. J., Scansen, B. A., & Bonagura, J. D. (2010). Detection of congestive heart failure in dogs by doppler echocardiography. Journal of Veterinary Internal Medicine, 24(6), 1358-1368. http://dx.doi.org/10.1111/j.1939-1676.2010.0592.x. PMid:20840304.

Spier, A. W., & Meurs, K. M. (2004). Assessment of heart rate variability in Boxers with arrhythmogenic right ventricular cardiomyopathy. Journal of the American Veterinary Medical Association, 224(4), 534-537. http://dx.doi.org/10.2460/javma.2004.224.534. PMid:14989545.

Sztajzel, J. (2004). Heart rate variability: a noninvasive electrocardiographic method to measure the autonomic nervous system. Swiss Medical Weekly, 134(35-36), 514-522.

Triposkiadis, F., Karayannis, G., Giamouzis, G., Skoularigis, J., Louridas, G., & Butler, J. (2009). The sympathetic nervous system in heart failure: physiology, pathophysiology and clinical implications. Journal of the American College of Cardiology, 54(19), 1747-1762. http://dx.doi.org/10.1016/j.jacc.2009.05.015. PMid:19874988.

Vanderlei, L. C., Pastre, C. M., Hoshi, R. A., Carvalho, T. D., & Godoy, M. F. (2009). Basic notions of heart rate variability and its clinical applicability. Revista Brasileira de Cirurgia Cardiovascular, 24(2), 205-217. http://dx.doi.org/10.1590/S0102-76382009000200018. PMid:19768301.

Zacà, V., Rastogi, S., Mishra, S., Wang, M., Sharov, V. G., Gupta, R. C., Goldstein, S., & Sabbah, H. N. (2009). Atenolol is inferior to metoprolol in improving left ventricular function and preventing ventricular remodeling in dogs with heart failure. Cardiology, 112(4), 294-302. http://dx.doi.org/10.1159/000159123. PMid:18832825.

Zacché, E., Assumpção, T. C. A., Corsini, T. B., & Camacho, A. A. (2017). Time domain heart rate variability in Boxer dogs with arrhythmogenic right ventricular cardiomyopathy. Ciência Rural, 47(5), 1-6. http://dx.doi.org/10.1590/0103-8478cr20160740.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2021 Tamyris Beluque, Aparecido Antonio Camacho, Roberto Navarrete Ampuero, Jaislane Bastos Braz, Murillo Daparé Kirnew, Raphaela Arantes Marques Canola, Elizabeth Carvalho, Marlos Gonçalves Sousa