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Contribution to the Diagnosis and Prognosis of Canine PAUL FRIDTJOF MÕTSKÜLA PAUL CONTRIBUTION TO THE DIAGNOSIS AND PROGNOSIS OF CANINE CARDIAC DISEASE THROUGH THROUGH DISEASE OF CANINE CARDIAC AND PROGNOSIS THE DIAGNOSIS TO CONTRIBUTION CONTRIBUTION TO THE DIAGNOSIS AND PROGNOSIS OF CANINE CARDIAC DISEASE THROUGH ELECTRODIAGNOSTICS AND DIAGNOSTIC IMAGING ELECTRODIAGNOSTICS AND DIAGNOSTIC IMAGING AND DIAGNOSTIC ELECTRODIAGNOSTICS ELEKTRO- JA PILTDIAGNOSTIKA TÄIENDAVAD RAKENDUSED KOERTE SÜDAMEHAIGUSTE DIAGNOOSIMISEL NING PROGNOOSIMISEL PAUL FRIDTJOF MÕTSKÜLA A Thesis for applying for the degree of Doctor of Philosophy in Veterinary Science Väitekiri filosoofiadoktori kraadi taotlemiseks loomaarstiteaduse erialal Tartu 2020 Eesti Maaülikooli doktoritööd Doctoral Theses of the Estonian University of Life Sciences CONTRIBUTION TO THE DIAGNOSIS AND PROGNOSIS OF CANINE CARDIAC DISEASE THROUGH ELECTRODIAGNOSTICS AND DIAGNOSTIC IMAGING ELEKTRO- JA PILTDIAGNOSTIKA TÄIENDAVAD RAKENDUSED KOERTE SÜDAMEHAIGUSTE DIAGNOOSIMISEL NING PROGNOOSIMISEL PAUL FRIDTJOF MÕTSKÜLA A Thesis for applying for the degree of Doctor of Philosophy in Veterinary Science Väitekiri filosoofiadoktori kraadi taotlemiseks loomaarstiteaduse erialal Tartu 2020 Institute of Veterinary Medicine and Animal Sciences Estonian University of Life Sciences According to Decision N° 4 of October 01, 2020, the Doctoral Committee of Veterinary and Food Science of Estonian University of Life Sciences has accepted the thesis as ready for defence of the degree of Doctor of Philosophy in Veterinary Science. Opponent: Prof. Dr Gerhard Wess, Dip ACVIM Dip ECVIM-CA (cardiology) Dip ECVIM-CA (internal medicine) Small Animal Clinic Faculty of Veterinary Medicine Ludwig Maximilian University, Munich, Germany Supervisors: Prof. Toomas Orro, DVM PhD Chair of Clinical Veterinary Medicine Institute of Veterinary Medicine and Animal Sciences Estonian University of Life Sciences Prof. Virginia Luis Fuentes, MA VetMB PhD CertVR DVC MRCVS DipACVIM DipECVIM Department of Clinical Science and Services Queen Mother Hospital for Animals The Royal Veterinary College, UK Prof. David Connolly, BSc BVetMed PhD CertVC CertSAM DipECVIM (Cardiology) MRCVS Department of Clinical Science and Services Queen Mother Hospital for Animals The Royal Veterinary College, UK Dr. Ranno Viitmaa, DVM PhD Chair of Clinical Veterinary Medicine Institute of Veterinary Medicine and Animal Sciences Estonian University of Life Sciences Defence of the thesis: International video conference in the BigBlueButton web room at 10:00, March 8, 2021. The publication of this dissertation is supported by the Estonian University of Life Sciences. © Paul F. Mõtsküla 2020 ISSN – 2382-7076 ISBN – 978-9949-698-63-9 (printed) ISBN – 978-9949-698-64-6 (pdf) Eks elu paneb asjad paika… Prof. J. Alaots. Mai 1997 CONTENTS LIST OF ORIGINAL PUBLICATIONS ...............................................10 ABBREVIATIONS .....................................................................................12 1. INTRODUCTION .................................................................................14 2. REVIEW OF THE LITERATURE ....................................................17 2.1. Classification of cardiomyopathies ................................................17 2.1.1. Classification of human cardiomyopathies ...........................17 2.1.2. Classification of canine cardiomyopathies ............................18 2.1.2.1. Boxer cardiomyopathy ......................................................18 2.1.2.2. Cardiomyopathies and other cardiac pathologies in Dogue de Bordeaux ........................................................................20 2.2. Methods used for diagnostics of cardiomyopathies ...................21 2.2.1. Clinical features .........................................................................21 2.2.2. Electrodiagnostics .....................................................................22 2.2.2.1. 12-lead ECG ......................................................................22 2.2.2.2. Ambulatory ECG (Holter monitoring) ..........................23 2.2.2.3. Event monitoring ..............................................................24 2.2.3. Diagnostic imaging ...................................................................24 2.2.3.1. Radiography .......................................................................24 2.2.3.2. Echocardiography .............................................................24 2.2.3.3. cMRI ....................................................................................25 2.2.4. Genetics ......................................................................................26 2.3. Prognostic factors ............................................................................27 2.3.1. Dilated cardiomyopathy ...........................................................28 2.3.2. Arrhythmogenic right ventricular cardiomyopathy .............29 3. AIMS OF THE STUDY ........................................................................31 4. MATERIALS AND METHODS ........................................................32 4.1. Study population...............................................................................32 4.1.1. Inclusion and exclusion criteria ..............................................32 4.1.2. Baseline clinical data (I–III) ....................................................33 4.1.3. Survival information (I, II) ......................................................33 4.2. Echocardiography data (I–IV) .......................................................33 4.3. Electrocardiographic data (I–III) ...................................................35 4.4. Cardiac magnetic resonance imaging data (IV) ...........................35 4.5. Ethical considerations ......................................................................36 4.6. Statistical analysis ..............................................................................37 5. RESULTS ..................................................................................................39 5.1. Study population (I–IV) ..................................................................39 5.2. Electrocardiographic data (I–III) ...................................................42 5.3. Echocardiographic data (I–IV) ......................................................43 5.4. Follow-up and survival information (I, II) ...................................46 5.5. Cardiac magnetic resonance imaging data (IV) ...........................47 6. DISCUSSION ..........................................................................................49 6.1. General considerations ....................................................................49 6.2. Prognostic factors of arrhythmogenic right ventricular cardiomyopathy in Boxers (I, II) ...........................................................50 6.2.1. Syncope ......................................................................................50 6.2.2. Systolic dysfunction ..................................................................50 6.2.3. Signalment: sex and age ...........................................................51 6.2.4. Tricuspid annular plane systolic excursion measurement (II) ..........................................................................................................52 6.2.5. Ventricular arrhythmias (I) ......................................................53 6.3. Cardiac findings in a population of Dogue de Bordeaux (III) .54 6.3.1. Population overview .................................................................54 6.3.2. Supraventricular arrhythmias and left ventricular systolic dysfunction ...........................................................................................55 6.3.3. Supraventricular arrhythmias and right atrial and ventricular dilation ...............................................................................56 6.3.4. Ventricular arrhythmias and right ventricular dilation ........56 6.3.5. Supraventricular tachycardia and age .....................................57 6.4. Comparison of echocardiography with cardiac magnetic resonance imaging (IV) ...........................................................................58 7. CONCLUSIONS ....................................................................................61 8. REFERENCES .......................................................................................62 9. SUMMARY IN ESTONIAN ................................................................83 10. ACKNOWLEDGEMENTS ...............................................................91 ORIGINAL PUBLICATIONS.................................................................93 CURRICULUM VITAE ...........................................................................137 ELULOOKIRJELDUS ............................................................................140 LIST OF PUBLICATIONS ....................................................................143 LIST OF ORIGINAL PUBLICATIONS This thesis is based on the original studies reported in the following four original publications (I–IV), referred to in the text by their respective Roman numerals: I Mõtsküla P.F., Linney C., Palermo V., Connolly D.J., French A., Dukes McEwan J., Luis Fuentes V., 2013. Prognostic value of 24-hour ambulatory ECG (Holter) monitoring in Boxer dogs. Journal of Veterinary Internal Medicine 27, 904–912. II Kaye B.M., Borgeat K., Mõtsküla P.F., Luis Fuentes V., Connolly D.J., 2015. Association of tricuspid annular plane systolic excursion with survival
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