{"id":1088,"date":"2014-03-01T15:29:25","date_gmt":"2014-03-01T15:29:25","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1088"},"modified":"2022-02-16T18:49:58","modified_gmt":"2022-02-16T18:49:58","slug":"cutting-edge-cardiology-five-state-of-the-art-developments","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/cardiology\/cutting-edge-cardiology-five-state-of-the-art-developments\/","title":{"rendered":"Cutting Edge Cardiology: Five State-of-the-Art Developments"},"content":{"rendered":"<p class=\"p1\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2016\/06\/T1403F01.pdf\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9886\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2011\/07\/pdf_button.png\" alt=\"pdf_button\" width=\"110\" height=\"27\" \/><\/a><\/p>\n<hr \/>\n<p class=\"p1\"><em><span class=\"s1\">Ashley B. Saunders, DVM, Diplomate ACVIM (Cardiology), Texas A&amp;M University<\/span><\/em><\/p>\n<p class=\"p1\"><span class=\"s1\">Making a difference in the diagnosis and management of dogs and cats with heart disease\u2014Dr. Saunders highlights 5 developments in veterinary cardiology: Digital radiography, cardiac biomarkers, smartphone apps and devices, cardiac medication, and interventional procedures.<\/span><\/p>\n<hr \/>\n<p class=\"p1\"><span class=\"s1\">Veterinary practitioners strive to provide patients and owners with state-of-the-art preventive, diagnostic, and therapeutic care. This article highlights 5 developments in veterinary cardiology that have made a difference in the diagnosis and management of dogs and cats with heart disease. These developments encompass:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Diagnostic tests<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Technology<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Cardiac medications<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Other cardiac therapies.<\/span><\/li>\n<\/ul>\n<h2 class=\"p3\"><span class=\"s1\"><b>1. DIGITAL RADIOGRAPHY<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Digital radiography is now used in many veterinary practices, and thoracic radiographs are an integral part of a cardiac evaluation. Improvements in technology and image quality produce radiographic images that are undoubtedly helpful in: <\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Diagnosing and monitoring cardiac disease and congestive heart failure (CHF)<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Identifying noncardiac causes of cough (eg, mainstem bronchial compression, tracheal collapse, inflammatory airway disease).<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">The benefits of current digital technology include:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Rapid acquisition of images and ability to make contrast adjustments<\/b> that improve image quality without having to change settings and retake images, as required when using standard film.<\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Post processing software<\/b> that allows the clinician to zoom in on specific structures of interest or take measurements (<b>Figure 1<\/b>). For example, vertebral heart size measurement establishes baseline heart size and can be used to trend patient data.<\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Digital files of radiographic images<\/b> that can be stored, retrieved, and transmitted immediately to colleagues, clients, or specialists. The ability to rapidly share digital images allows practitioners and specialists to work together seamlessly, enhancing patient care.<\/span><\/li>\n<\/ul>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Screen-Shot-2015-06-18-at-1.49.13-PM.png\"><img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone wp-image-4785\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Screen-Shot-2015-06-18-at-1.49.13-PM.png\" alt=\"Screen Shot 2015-06-18 at 1.49.13 PM\" width=\"501\" height=\"576\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Screen-Shot-2015-06-18-at-1.49.13-PM.png 531w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Screen-Shot-2015-06-18-at-1.49.13-PM-261x300.png 261w\" sizes=\"(max-width: 501px) 100vw, 501px\" \/><\/a><\/p>\n<h2><b>2. CARDIAC BIOMARKERS<\/b><\/h2>\n<p class=\"p1\"><span class=\"s1\">A biomarker is a measure of a biological or pathologic process that can be used to: <\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Detect disease<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Monitor disease progression<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Potentially determine treatment approach<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Predict prognosis. <\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">Cardiac biomarker measurement is not a stand-alone test, but rather part of a diagnostic evaluation that includes thoracic radiographs, electrocardiography, and echocardiography; these collective diagnostics determine the clinical picture for each patient. Numerous studies in dogs and cats have been performed over the past decade to determine which cardiac biomarkers are most useful, and how best to interpret measurement results.<\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Cardiac Troponin I<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">The serum level of cardiac troponin I, a protein involved in cardiac muscle contraction, is a sensitive and specific marker of myocardial damage. High-sensitivity cardiac troponin I assays (ADVIA Centaur TnI-Ultra Assay, medical.siemens.com; validated and available at vetmed .tamu.edu\/gilab\/service\/assays\/cardiac-troponin) have a lower detection limit than standard assays, which allows the former to detect lower circulating levels of cardiac troponin I. Elevations denote myocardial injury but do not indicate the specific cause of the damage, similar to alanine aminotransferase as a blood-based indicator of hepatic cellular damage. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Some cardiac troponin I release from myocardial cells occurs with age, often resulting in measurable concentrations. Significant elevations can indicate: <\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Isolated insult or continuous myocardial damage, depending on whether values decrease or remain persistently elevated<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Myocarditis caused by infectious or parasitic agents, such as Chagas\u2019 disease<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Noncardiac diseases, including gastric dilation volvulus and sepsis (eg, pyometra).<\/span><\/li>\n<\/ul>\n<p><b>N-Terminal Pro\u2013B-Type Natriuretic Peptide<\/b><\/p>\n<p class=\"p1\"><span class=\"s1\">Natriuretic peptides are released in response to stretch or damage to the heart, and are elevated in the most commonly diagnosed acquired (versus congenital) heart diseases (<b>Table 1<\/b>). In dogs and cats, specific indications for measuring N-terminal pro\u2013B-type natriuretic peptide (NT-proBNP) include:<\/span><span class=\"s2\"><sup>2<\/sup><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Detection of heart disease in suspect animals of predisposed breeds or families<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Presence of physical examination findings or clinical signs of heart disease<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Differentiation of respiratory from cardiac causes of breathing difficulty.<\/span><\/li>\n<\/ul>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Screen-Shot-2015-06-18-at-1.49.23-PM.png\"><img decoding=\"async\" class=\"alignnone wp-image-4786 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Screen-Shot-2015-06-18-at-1.49.23-PM-e1455813253564.png\" alt=\"Screen Shot 2015-06-18 at 1.49.23 PM\" width=\"343\" height=\"127\" \/><\/a><\/p>\n<p><span class=\"s1\">As noted in the last bullet, elevations in NT-proBNP can increase veterinary practitioners\u2019 confidence in distinguishing heart failure from respiratory disease in cats with respiratory signs.<\/span><span class=\"s2\"><sup>3<\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">More recent data suggests that elevated NT-proBNP values in Doberman pinschers indicate additional testing with echocardiography to aid in detection of occult dilated cardiomyopathy (DCM).<\/span><span class=\"s2\"><sup>4<\/sup><\/span><span class=\"s1\"> This is of particular interest because occult DCM can be challenging to identify and, if therapy is initiated early in the disease process, patients may experience significantly extended time to clinical signs and survival.<\/span><\/p>\n<h2 class=\"p3\"><span class=\"s1\"><b>3. SMARTPHONE APPS &amp; DEVICES <\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Technological advances have allowed smartphones to be valuable tools in the diagnosis and monitoring of heart disease.<\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>AliveCor Products<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">The AliveCor heart monitor device (alivecorvet.com), which is compatible with the iPhone 4\/4S\/5\/5S\/5C, wirelessly communicates with the free, downloadable Veterinary AliveECG app that provides instant, high-quality electrocardiograms (ECGs) and heart rate data in dogs, cats, and other species (<b>Figure 2<\/b>).<\/span><\/p>\n<p class=\"p1\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Screen-Shot-2015-06-18-at-1.49.32-PM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-4787\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Screen-Shot-2015-06-18-at-1.49.32-PM.png\" alt=\"Screen Shot 2015-06-18 at 1.49.32 PM\" width=\"347\" height=\"729\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Screen-Shot-2015-06-18-at-1.49.32-PM.png 347w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Screen-Shot-2015-06-18-at-1.49.32-PM-143x300.png 143w\" sizes=\"(max-width: 347px) 100vw, 347px\" \/><\/a><\/p>\n<p class=\"p1\"><span class=\"s1\">The device can be attached to the phone as a case, or used in proximity to the phone, which can be particularly useful for anxious, panting, or small pets. The ECG is recorded as a rhythm strip, with the ability to annotate with patient information as well as adjust recording speed, duration, and sensitivity settings. ECGs can be saved, stored, and transmitted as PDF files.<\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Resting Respiratory Rate App<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Involving owners in monitoring their pets\u2019 heart disease can promote successful patient management and improve quality of life. The Resting Respiratory Rate app (yourdogsheart.com) for both iPhone and Android smartphones provides a mechanism for owners to record resting respiratory rate (RRR) and allows the data to be transmitted from owner to veterinarian.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Once an owner is properly instructed and a <em>normal<\/em> at-home respiratory rate for the pet is determined, respiratory rates acquired at home, while the pet is resting or sleeping, can be incredibly useful when monitoring CHF. For example, most dogs have a RRR less than 35 breaths\/min, and many dogs have rates that are much lower\u2014in the mid-teens to mid-twenties. Owners who report clinical signs of heart failure (<b>Table 2<\/b>) can be advised to administer additional diuretic therapy and seek medical attention. It can be used in cats with heart disease as well.<\/span><\/p>\n<p class=\"p1\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Screen-Shot-2015-06-18-at-1.49.39-PM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4788 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Screen-Shot-2015-06-18-at-1.49.39-PM-e1455813389412.png\" alt=\"Screen Shot 2015-06-18 at 1.49.39 PM\" width=\"518\" height=\"210\" \/><\/a><\/p>\n<h2 class=\"p3\"><span class=\"s1\"><b>4. CARDIAC MEDICATION<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Pimobendan (VETMEDIN, vetmedin.com) is a phosphodiesterase-3 inhibitor and calcium sensitizer classified pharmacologically as an inodilator because it exerts combined positive inotropic and vasodilatory effects. Pimobendan: <\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\">Has proven efficacy in managing heart failure in dogs with DCM5 and degenerative mitral valve disease (DMVD)<\/span><span class=\"s2\"><sup>6<\/sup><\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Is currently recommended as standard of care for managing heart failure in dogs, along with furosemide and an angiotensin-converting enzyme (ACE) inhibitor.<\/span><\/li>\n<\/ul>\n<h3 class=\"p4\"><span class=\"s1\"><b>Degenerative Mitral Valve Disease<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">In DMVD, pimobendan significantly improved survival by a median of 267 days (approximately 8.9 months) in dogs with heart failure.<\/span><span class=\"s2\"><sup>6<\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">In 2009, the American College of Veterinary Internal Medicine published guidelines for the diagnosis and treatment of DMVD that advocate the use of pimobendan in stages C (past or present signs of heart failure) and D (refractory or end-stage heart failure).<\/span><span class=\"s2\"><sup>7<\/sup><\/span><span class=\"s1\"> This consensus statement and associated staging system provide veterinary practitioners with the tools to diagnose, stage, and schedule recheck evaluations that help owners manage their dogs\u2019 heart disease.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The use of pimobendan in preclinical DMVD is currently being investigated.<\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Dilated Cardiomyopathy<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">The benefits of pimobendan, and indications for its use, continue to expand as the results of clinical trials are published. In preclinical DCM in Doberman pinschers, pimobendan prolonged the time to onset of clinical signs of CHF or sudden death and extended survival compared with placebo.<\/span><span class=\"s2\"><sup>8<\/sup><\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Other Cardiac Diseases<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Pimobendan may be included in the management of heart failure in dogs with other diseases, most notably pulmonary hypertension and congenital heart disease, such as patent ductus arteriosus (PDA). <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Retrospective evaluation suggests pimobendan appears to be safe and well tolerated in cats with heart failure and cardiomyopathy,<\/span><span class=\"s2\"><sup>9, 10<\/sup><\/span><span class=\"s1\"> especially when characterized by systolic dysfunction.<\/span><span class=\"s2\"><sup>9<\/sup><\/span><span class=\"s1\"> Prospective evaluation is currently in progress.<\/span><\/p>\n<h2 class=\"p3\"><span class=\"s1\"><b>5. INTERVENTIONAL CARDIOLOGY<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Interventional procedures use minimally invasive techniques in the diagnosis and treatment of congenital and acquired cardiovascular disease. The number and type of procedures performed in veterinary medicine continue to expand and increase. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Pet owners have become familiar with minimally invasive options for themselves and, when appropriate and if given the option to have surgery or a catheter-based procedure, many prefer a minimally invasive procedure for their pets to avoid the incisions and recovery time associated with surgery.<\/span><\/p>\n<h3 class=\"p4\"><span class=\"s1\"><b>Patent Ductus Arteriosus<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Catheter-based procedures are a well-established treatment option for occluding PDA, one of the most common congenital heart diseases in dogs. Without ductal closure, most dogs with a PDA have a shortened life span and develop signs of left heart failure in the first year of diagnosis. Therefore, the diagnosis and closure of a PDA is important with regard to maintaining a dog\u2019s long-term health. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Minimally invasive closure of a PDA is made with an appropriately sized device, such as an embolization coil, Amplatzer vascular plug, or Amplatz canine ductal occluder (ACDO) (infinitimedical.com), typically via the right femoral artery. The ACDO is the first device developed specifically for dogs (<b>Figure 3<\/b>), and is a preferred method of PDA closure, resulting in shorter procedure times and higher ductal closure rates compared to other devices.<\/span><span class=\"s2\"><sup>11<\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Surgical ligation via thoracotomy is recommended for: <\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Small dogs weighing less than 2.5 kg, due to issues with vascular access<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">If the anatomy of the PDA is not amenable to device closure.<\/span><\/li>\n<\/ul>\n<div id=\"attachment_4789\" style=\"width: 424px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Screen-Shot-2015-06-18-at-1.49.46-PM.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4789\" class=\"wp-image-4789 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Screen-Shot-2015-06-18-at-1.49.46-PM-e1455813534631.png\" alt=\"Screen Shot 2015-06-18 at 1.49.46 PM\" width=\"414\" height=\"200\" \/><\/a><p id=\"caption-attachment-4789\" class=\"wp-caption-text\">Figure 3. Images obtained with fluoroscopy in a dog with a patent ductus arteriosus (PDA). An angiogram was performed with contrast through a catheter in the descending aorta to confirm location and anatomy of the PDA (A). A second injection followed the deployment and release of an Amplatz canine ductal occluder to document complete occlusion of the PDA (B). A measuring catheter is present in the esophagus in both images.<\/p><\/div>\n<h3><span class=\"s1\"><b>Other Cardiac Conditions<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Interventional vascular procedures are also available for: <\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Occlusion<\/b> of atrial and ventricular septal defects, portosystemic shunts, and arteriovenous malformations in various locations<\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Balloon valvuloplasty<\/b> of pulmonic valve stenosis, cor triatriatum, and subaortic stenosis<\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Heartworm extraction<\/b> through the jugular vein for dogs, cats, and ferrets with heartworm disease and high heartworm burdens, especially if caval syndrome or hemolysis is present. <\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">Interventional procedures are performed by specialists with appropriate training, and require specialized equipment, including fluoroscopy, a range of catheters, wires and devices, and imaging capabilities. Contact a local cardiologist for additional information regarding therapeutic options, cost, and prognosis.<\/span><\/p>\n<h2 class=\"p3\"><span class=\"s1\"><b>SUMMARY<\/b><\/span><\/h2>\n<ul class=\"ul1\">\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Digital radiography<\/b> has enhanced the ability to acquire, store, and transmit thoracic radiographic images, and is a valuable diagnostic tool when performing a cardiac evaluation.<\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Biomarker results<\/b> are a component of a diagnostic evaluation, and additional testing (eg, thoracic radiographs, electrocardiography, echocardiography) helps determine the clinical picture in each patient.<\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Technological advances<\/b> have allowed smartphones to become valuable tools in the diagnosis and monitoring of heart disease.<\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Pimobendan<\/b> is now part of standard heart failure therapy in dogs with DMVD and DCM. The benefits of pimobendan and indications for its use continue to expand as the results of clinical trials are published.<\/span><\/li>\n<li class=\"li1\"><b><\/b><span class=\"s1\"><b>Interventional cardiology<\/b> provides minimally invasive treatment options for a variety of acquired and congenital heart diseases.<\/span><\/li>\n<\/ul>\n<p class=\"p6\"><span class=\"s1\">ACDO = Amplatz canine ductal occluder; ACE = angiotensin-converting enzyme; CHF = congestive heart failure; DCM = dilated cardiomyopathy; DMVD = degenerative mitral valve disease; ECG = electrocardiogram; NT-proBNP = N-terminal pro\u2013B-type natriuretic peptide; PDA = patent ductus arteriosus; RRR = resting respiratory rate<\/span><\/p>\n<h3 class=\"p1\"><span class=\"s1\"><b>Disclosure Statement<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Dr. Saunders has received research funding and programmatic support from Boehringer Ingelheim Vetmedica (manufacturer of VETMEDIN) and IDEXX Laboratories (providers of Cardiopet proBNP Test).<\/span><\/p>\n<p class=\"p6\"><span class=\"s1\"><b>References<\/b><\/span><\/p>\n<ol class=\"ol1\">\n<li class=\"li6\"><span class=\"s1\">Hezzell MJ, Boswood A, Chang YM, et al. The combined prognostic potential of serum high-sensitivity cardiac troponin I and N-terminal pro\u2013B-type natriuretic peptide concentrations in dogs with degenerative mitral valve disease.<i> J Vet Intern Med<\/i> 2012; 26(2):302-311.<\/span><\/li>\n<li class=\"li6\"><span class=\"s1\">Oyama MA. Using cardiac biomarkers in veterinary practice. <i>Vet Clin North Am Small Anim Pract<\/i> 2013; 43(6):1261-1272.<\/span><\/li>\n<li class=\"li6\"><span class=\"s1\">Singletary GE, Rush JE, Fox PR, et al. Effect of NT-pro-BNP assay on accuracy and confidence of general practitioners in diagnosing heart failure or respiratory disease in cats with respiratory signs. <i>J Vet Intern Med<\/i> 2012; 26(3):542-546.<\/span><\/li>\n<li class=\"li6\"><span class=\"s1\">Singletary GE, Morris NA, O\u2019Sullivan ML, et al. Prospective evaluation of NT-proBNP assay to detect occult dilated cardiomyopathy and predict survival in Doberman Pinschers. <i>J Vet Intern Med<\/i> 2012; 26(6):1330-1336.<\/span><\/li>\n<li class=\"li6\"><span class=\"s1\">O\u2019Grady MR, Minors SL, O\u2019Sullivan ML, Horne R. Effect of pimobendan on case fatality rate in Doberman pinschers with congestive heart failure caused by dilated cardiomyopathy. <i>J Vet Intern Med<\/i> 2008; 22(4):897-904.<\/span><\/li>\n<li class=\"li6\"><span class=\"s1\">Haggstrom J, Boswood A, O\u2019Grady M, et al. Effect of pimobendan or benazepril hydrochloride on survival times in dogs with congestive heart failure caused by naturally occurring myxomatous mitral valve disease: The QUEST study. <i>J Vet Intern Med<\/i> 2008; 22(5):1124-1135.<\/span><\/li>\n<li class=\"li6\"><span class=\"s1\">Atkins C, Bonagura J, Ettinger S, et al. Guidelines for the diagnosis and treatment of canine chronic valvular heart disease. <i>J Vet Intern Med<\/i> 2009; 23(6):1142-1150.<\/span><\/li>\n<li class=\"li6\"><span class=\"s1\">Summerfield NJ, Boswood A, O\u2019Grady MR, et al. Efficacy of pimobendan in the prevention of congestive heart failure or sudden death in Doberman pinschers with preclinical dilated cardiomyopathy (The PROTECT Study). <i>J Vet Intern Med<\/i> 2012; 26(6):1337-1349.<\/span><\/li>\n<li class=\"li6\"><span class=\"s1\">Gordon SG, Saunders AB, Roland RM, et al. Effect of oral administration of pimobendan in cats with heart failure. <i>JAVMA<\/i> 2012; 241(1):89-94.<\/span><\/li>\n<li class=\"li6\"><span class=\"s1\">MacGregor JM, Rush JE, Laste NJ, et al. Use of pimobendan in 170 cats (2006\u20132010). <i>J Vet Cardiol <\/i>2011; 13(4):251-260.<\/span><\/li>\n<li class=\"li6\"><span class=\"s1\">Gordon SG, Saunders AB, Achen SE, et al. Transarterial ductal occlusion using the Amplatz\u00ae canine duct occluder in 40 dogs. <i>J Vet Cardiol<\/i> 2010; 12(2):85-92.<\/span><\/li>\n<\/ol>\n<p class=\"p1\"><span class=\"s1 author-bio\"><strong><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Ashley-B.-Saunders-2.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-8830\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/03\/Ashley-B.-Saunders-2.png\" alt=\"Ashley B. Saunders 2\" width=\"100\" height=\"125\" \/><\/a>Ashley B. Saunders<\/strong>, DVM, Diplomate ACVIM (Cardiology), is an associate professor of cardiology in the Department of Small Animal Clinical Sciences at Texas A&amp;M University College of Veterinary Medicine and Biomedical Sciences. Her interests include interventional cardiology and advanced imaging, heart failure management, and educational technology. She is the recipient of multiple teaching awards and is a Montague Center for Teaching Excellence Scholar.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ashley B.<\/p>\n","protected":false},"author":1,"featured_media":3043,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":235,"footnotes":""},"categories":[365],"tags":[13],"class_list":["post-1088","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-march-april-2014","tag-peer-reviewed","column-features","clinical_topics-cardiology"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Cutting Edge Cardiology: Five State-of-the-Art Developments | Today&#039;s Veterinary Practice<\/title>\n<meta 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