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Prevalência de cardiomiopatia hipertrófica subclínica em gatos aparentemente saudáveis com idade igual ou superior a 7 anos na zona da Grande Lisboa
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Resumo(s)
As cardiomiopatias têm um carácter progressivo, apesar de se manifestarem, frequentemente, de forma subclínica, conduzindo a um subdiagnóstico ou diagnóstico tardio, que apenas ocorre quando se instalam sinais clínicos e o prognóstico é pior. Ainda assim, ao que sabemos, não existem estudos que incidam sobre este tema em Portugal, o que reflete a necessidade de uma melhor compreensão sobre o panorama que se verifica no país. O presente trabalho pretendeu contribuir para expandir o conhecimento sobre a incidência de cardiomiopatia hipertrófica subclínica, potenciais fatores de risco e métodos de diagnóstico, bem como sensibilizar para a necessidade de implementação de esquemas de monitorização de rotina. A amostra deste estudo consistiu em 24 gatos aparentemente saudáveis da zona da grande Lisboa, com idade igual ou superior a 7 anos, sem sinais clínicos de origem cardíaca e sem doença cardíaca previamente diagnosticada. Todos os animais foram submetidos a medição de pressão arterial e determinação das concentrações plasmáticas de ureia e creatinina e de T4, para despiste de hipertensão sistémica, doença renal crónica e hipertiroidismo, respetivamente. A cada gato foi realizado exame físico, colheita de sangue para determinação do proBNP, raio-X torácico para obtenção do vertebral heart scale (VHS) e ecocardiografia como gold standard para o diagnóstico de cardiomiopatia. Os resultados obtidos evidenciaram uma prevalência de 45,8% de CMH, sem observação de alterações compatíveis com outros fenótipos. Apesar de não se terem determinado fatores de risco com valor estatisticamente significativo, os animais com doença assintomática foram, em média, mais pesados que os saudáveis. Foram registados sopros cardíacos em 16,7% dos animais e 12,5% revelou dilatação do átrio esquerdo no exame ecocardiográfico. Foi detetado aumento da fração de encurtamento do ventrículo esquerdo em 45,8% dos animais, sendo que desses, 63,6% tinha hipertrofia ventricular. A frequência cardíaca, a pressão arterial e o VHS não demonstraram relação estatisticamente significativa com a presença de CMH subclínica. A determinação do proBNP não demonstrou utilidade clínica na previsão de cardiomiopatia subclínica, tendo todos os animais revelado concentrações dentro do intervalo de referência. Estas constatações revelam a aparente grande incidência de cardiomiopatia hipertrófica subclínica na população felina amostrada e demonstram a complexidade do diagnóstico nestes estádios iniciais. Assim, torna-se evidente a urgência de implementação de diretrizes para rastreio e sinalização precoce dos animais afetados, de modo a poder monitorizar a sua evolução
ABSTRACT - Prevalence of subclinical hypertrophic cardiomiopathy in apparently healthy cats aged 7 years and older in the Greater Lisbon area - Cardiomyopathies have a progressive nature, although they are often manifested subclinically, leading to underdiagnosis or late diagnosis, which only occur when clinical signs appear, and the prognosis is worse. Even so, as far as we know, there are no studies on this subject in Portugal, which reflects the need for a better understanding of the situation in the country. This study aimed to contribute to expand the knowledge on the incidence of subclinical hypertrophic cardiomyopathy, potential risk factors and diagnostic methods, as well as to raise awareness on the need to implement routine monitoring programmes. The sample of this study consisted of 24 apparently healthy cats from the Greater Lisbon area, aged 7 years or older, without clinical signs of cardiac origin and without previously diagnosed cardiac disease. All animals were submitted to blood pressure measurement, and determination of plasma urea and creatinine, and of T4 concentrations to screen for systemic hypertension, chronic kidney disease and hyperthyroidism, respectively. For each cat, a physical examination, blood sampling for plasma proBNP determination, thoracic X-ray to obtain the vertebral heart scale (VHS), and echocardiography as gold standard for the diagnosis of cardiomyopathy were performed. A prevalence of 45.8% of HCM was detected, without the observation of abnormalities compatible with other phenotypes. Although no statistically significant risk factors were found, the animals with asymptomatic disease were, on average, heavier than the healthy ones. Heart murmurs were recorded in 16.7% of the animals, and 12.5% showed left atrial dilatation on echocardiography. An increase in the left ventricular shortening fraction was detected in 45.8% of the animals, and of these, 63.6% had ventricular hypertrophy. Heart rate, arterial pressure and VHS did not show a statistically significant relationship with the presence of subclinical HCM. The determination of proBNP did not demonstrate clinical utility in predicting subclinical disease, with all animals revealing concentrations within the reference range. These findings reveal the apparent high incidence of subclinical HCM in the sampled feline population and demonstrate the complexity of the diagnosis in these early stages. Therefore, the urgency of implementing guidelines for screening and early signalling of affected animals is evident, in order to be able to monitor their evolution
ABSTRACT - Prevalence of subclinical hypertrophic cardiomiopathy in apparently healthy cats aged 7 years and older in the Greater Lisbon area - Cardiomyopathies have a progressive nature, although they are often manifested subclinically, leading to underdiagnosis or late diagnosis, which only occur when clinical signs appear, and the prognosis is worse. Even so, as far as we know, there are no studies on this subject in Portugal, which reflects the need for a better understanding of the situation in the country. This study aimed to contribute to expand the knowledge on the incidence of subclinical hypertrophic cardiomyopathy, potential risk factors and diagnostic methods, as well as to raise awareness on the need to implement routine monitoring programmes. The sample of this study consisted of 24 apparently healthy cats from the Greater Lisbon area, aged 7 years or older, without clinical signs of cardiac origin and without previously diagnosed cardiac disease. All animals were submitted to blood pressure measurement, and determination of plasma urea and creatinine, and of T4 concentrations to screen for systemic hypertension, chronic kidney disease and hyperthyroidism, respectively. For each cat, a physical examination, blood sampling for plasma proBNP determination, thoracic X-ray to obtain the vertebral heart scale (VHS), and echocardiography as gold standard for the diagnosis of cardiomyopathy were performed. A prevalence of 45.8% of HCM was detected, without the observation of abnormalities compatible with other phenotypes. Although no statistically significant risk factors were found, the animals with asymptomatic disease were, on average, heavier than the healthy ones. Heart murmurs were recorded in 16.7% of the animals, and 12.5% showed left atrial dilatation on echocardiography. An increase in the left ventricular shortening fraction was detected in 45.8% of the animals, and of these, 63.6% had ventricular hypertrophy. Heart rate, arterial pressure and VHS did not show a statistically significant relationship with the presence of subclinical HCM. The determination of proBNP did not demonstrate clinical utility in predicting subclinical disease, with all animals revealing concentrations within the reference range. These findings reveal the apparent high incidence of subclinical HCM in the sampled feline population and demonstrate the complexity of the diagnosis in these early stages. Therefore, the urgency of implementing guidelines for screening and early signalling of affected animals is evident, in order to be able to monitor their evolution
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária, na área científica de Clínica
Palavras-chave
Cardiomiopatia Hipertrófica Subclínica Prevalência Diagnóstico Gatos Subclinical Hypertrophic Cardiomiopathy Prevalence Diagnosis Cats
Contexto Educativo
Citação
Silva ARO. 2023. Prevalência de cardiomiopatia hipertrófica subclínica em gatos aparentemente saudáveis com idade igual ou superior a 7 anos na zona da Grande Lisboa [dissertação de mestrado]. Lisboa: FMV-Universidade de Lisboa
Editora
Universidade de Lisboa, Faculdade de Medicina Veterinária