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Fenótipo de cardiomiopatia hipertrófica em gatos : alterações ecocardiográficas e diagnóstico, um estudo de 26 casos
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O fenótipo de cardiomiopatia hipertrófica está associado a variados diagnósticos diferenciais, incluindo cardiomiopatia hipertrófica, hipertensão sistémica, hipertiroidismo, entre outros. Embora cardiomiopatia hipertrófica seja reconhecida como uma doença cardíaca frequente em gatos, é crucial que estas doenças sistémicas sejam devidamente investigadas previamente a efetuar este diagnóstico. O presente estudo prospetivo foi efetuado a partir de 26 casos de gatos diagnosticados com o fenótipo de cardiomiopatia hipertrófica, no Centro de Cardiologia Veterinária do Porto, durante o período do estágio curricular, tendo como objetivo a descrição das alterações ecocardiográficas registadas e interpretação dos valores da pressão arterial sistémica, tiroxina e troponina-I destes animais. Os gatos da amostra foram avaliados ecocardiograficamente, tendo sido este exame acompanhado de um eletrocardiograma e, por vezes, da avaliação ecográfica do parênquima pulmonar. Posteriormente, foram recolhidos os valores da pressão arterial sistémica, T4 e cTnI dos gatos em que a sua medição foi recomendada pelo médico veterinário cardiologista. Os gatos da amostra demonstraram uma grande variação na localização, distribuição e gravidade da hipertrofia ventricular esquerda, registando uma prevalência superior da hipertrofia do septo interventricular. O fenótipo de cardiomiopatia hipertrófica do tipo obstrutivo foi identificado em 39% dos gatos avaliados. Foi observado um padrão de fluxo transmitral anormal em 23% da amostra, dilatação atrial esquerda em 54% e contraste espontâneo positivo em 15%. A ecografia pulmonar revelou a presença de linhas B em 23% dos gatos, não estando esta alteração associada ao aumento do rácio AE/Ao médio, e derrame pleural foi identificado em 39% dos mesmos. Outras alterações frequentes incluíram insuficiência valvular mitral e hipertrofia subjetiva dos músculos papilares ventriculares. Quinze por cento da amostra registou a presença hipertensão sistémica, um deles apresentando simultaneamente hipertiroidismo, e o aumento exagerado do valor de cTnI num dos gatos sugeriu a presença de uma alteração cardíaca de natureza inflamatória. Os resultados do estudo vão maioritariamente de encontro com as alterações características do fenótipo de cardiomiopatia hipertrófica descritas em estudos prévios, e revelam uma prevalência considerável de hipertrofia ventricular potencialmente secundária na amostra, destacando a importância de uma abordagem abrangente no diagnóstico destes casos
ABSTRACT - HYPERTROPHIC CARDIOMYOPATHY PHENOTYPE IN CATS : ECHOCARDIOGRAPHIC CHANGES AND DIAGNOSIS, A STUDY OF 26 CASES - The hypertrophic cardiomyopathy phenotype is associated with a series of differential diagnoses, including hypertrophic cardiomyopathy, systemic hypertension, hyperthyroidism, among others. Although hypertrophic cardiomyopathy is recognized as a common cardiac disease in cats, it is crucial that these systemic diseases be considered and ruled out before making this diagnosis. The present prospective study was conducted on 26 cats diagnosed with hypertrophic cardiomyopathy phenotype at the Veterinary Cardiology Center of Porto during the internship period, aiming to describe the echocardiographic changes recorded and interpret the values of systemic arterial pressure, thyroxine, and troponin-I in these animals. The 26 cats underwent an echocardiographic evaluation, accompanied by an electrocardiogram and, in some case, an ultrasound evaluation of the pulmonary parenchyma. Subsequently, the values of systemic arterial pressure, T4, and cTnI from the cats in which their measurement was recommended by the veterinary cardiologist were collected for analysis. The cats in the sample showed a wide variation in the location, distribution, and severity of left ventricular hypertrophy, with a higher prevalence of hypertrophy of the interventricular septum. The obstructive hypertrophic cardiomyopathy phenotype was identified in 39% of the evaluated cats. An abnormal transmitral flow pattern was observed in 23% of the animals studied, left atrial dilation in 54%, and positive spontaneous contrast in 15%. The pulmonary ultrasound revealed the presence of B lines in 23% of the cats, with this alteration not being associated with an increase in the average AE/Ao ratio, and pleural effusion was identified in 39% of the total sample. Other frequent changes included mitral valve insufficiency and subjective hypertrophy of the ventricular papillary muscles. Fifteen percent of the sample showed systemic hypertension, one of them simultaneously presenting hyperthyroidism, and the exaggerated increase in the cTnI value in one of the cats suggested the presence of an inflammatory condition. The study results mostly correspond to the characteristic changes of the hypertrophic cardiomyopathy phenotype described in previous studies, revealing a considerable prevalence of potentially secondary ventricular hypertrophy in the sample, highlighting the importance of a comprehensive approach in the diagnosis of these cases
ABSTRACT - HYPERTROPHIC CARDIOMYOPATHY PHENOTYPE IN CATS : ECHOCARDIOGRAPHIC CHANGES AND DIAGNOSIS, A STUDY OF 26 CASES - The hypertrophic cardiomyopathy phenotype is associated with a series of differential diagnoses, including hypertrophic cardiomyopathy, systemic hypertension, hyperthyroidism, among others. Although hypertrophic cardiomyopathy is recognized as a common cardiac disease in cats, it is crucial that these systemic diseases be considered and ruled out before making this diagnosis. The present prospective study was conducted on 26 cats diagnosed with hypertrophic cardiomyopathy phenotype at the Veterinary Cardiology Center of Porto during the internship period, aiming to describe the echocardiographic changes recorded and interpret the values of systemic arterial pressure, thyroxine, and troponin-I in these animals. The 26 cats underwent an echocardiographic evaluation, accompanied by an electrocardiogram and, in some case, an ultrasound evaluation of the pulmonary parenchyma. Subsequently, the values of systemic arterial pressure, T4, and cTnI from the cats in which their measurement was recommended by the veterinary cardiologist were collected for analysis. The cats in the sample showed a wide variation in the location, distribution, and severity of left ventricular hypertrophy, with a higher prevalence of hypertrophy of the interventricular septum. The obstructive hypertrophic cardiomyopathy phenotype was identified in 39% of the evaluated cats. An abnormal transmitral flow pattern was observed in 23% of the animals studied, left atrial dilation in 54%, and positive spontaneous contrast in 15%. The pulmonary ultrasound revealed the presence of B lines in 23% of the cats, with this alteration not being associated with an increase in the average AE/Ao ratio, and pleural effusion was identified in 39% of the total sample. Other frequent changes included mitral valve insufficiency and subjective hypertrophy of the ventricular papillary muscles. Fifteen percent of the sample showed systemic hypertension, one of them simultaneously presenting hyperthyroidism, and the exaggerated increase in the cTnI value in one of the cats suggested the presence of an inflammatory condition. The study results mostly correspond to the characteristic changes of the hypertrophic cardiomyopathy phenotype described in previous studies, revealing a considerable prevalence of potentially secondary ventricular hypertrophy in the sample, highlighting the importance of a comprehensive approach in the diagnosis of these cases
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária, área científica de Clínica
Palavras-chave
Ecocardiografia Cardiomiopatia hipertrófica Hipertensão sistémica Hipertiroidismo Echocardiography Hypertrophic cardiomyopathy Systemic hypertension Hyperthyroidism
Contexto Educativo
Citação
Antunes MVSN. 2024. Fenótipo de cardiomiopatia hipertrófica em gatos : alterações ecocardiográficas e diagnóstico, um estudo de 26 casos [dissertação de mestrado]. Lisboa: FMV-Universidade de Lisboa
Editora
Universidade de Lisboa, Faculdade de Medicina Veterinária