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Avanços no diagnóstico e tratamento da Insuficiência Cardíaca Congestiva decorrente da Degenerescência da válvula mitral em cães
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Abstract(s)
A degenerescência mixomatosa da válvula mitral é a doença cardíaca adquirida mais comum
em cães. A patofisiologia da doença está bem descrita. As válvulas afetadas pela degenerescência
mixomatosa passam por um processo de desarranjo estrutural microscópico que, em última instância,
leva às alterações macroscópicas que causam a falta de justaposição das cúspides mitrais e,
consequentemente, regurgitação mitral.
Em 2019, o American College of Veterinary Internal Medicine (ACVIM) publicou uma revisão
de consenso sobre os métodos de diagnóstico e de tratamento atualizados desta doença. O presente
trabalho consiste numa revisão bibliográfica dos artigos recentes que abordam o diagnóstico ou o
tratamento clínico da degenerescência mixomatosa da válvula mitral com o objetivo de elencar os
principais estudos publicados após o consenso da ACVIM (2019) até a presente data.
A maioria dos artigos foram resumidos e ordenados cronologicamente com o objetivo de
compilar informações sobre os mais recentes métodos de diagnósticos, desde exames imagiológicos
até biomarcadores cardíacos, entre outros. Da mesma forma foi possível listar os principais
tratamentos clínicos recomendados, como o diurético torasemida, ou novos estudos de eficácia de
moléculas já conhecidas. Estão também registados os últimos avanços no tratamento dietético, que
têm geralmente como tema comum o poder antioxidante de diferentes moléculas na MMVD.
Este estudo aborda, os métodos já existentes, como o índice vertebral cardíaco (VHS), o
tamanho vertebral do átrio esquerdo e a electrocardiografia, que foram aprofundados ou comparados
entre si. Novos valores de referência para alguns métodos mais adequados à raça foram propostos,
como por exemplo os valores do tamanho vertebral do átrio esquerdo e o tamanho vertebral
modificado do átrio esquerdo adaptados à morfologia do Cavalier King Charles Spaniel, ou os valores
ecocardiográficos para Chihuahuas. O diâmetro anteroposterior do átrio esquerdo faz parte da
abordagem diagnóstica possivel para a doença. Um novo score prognóstico baseado em quatro
medidas ecocardiográficas foi também estabelecido e será descrito (MINE score). Quanto aos
biomarcadores, a dimetilarginina mostrou bons resultados no diagnóstico da MMVD, enquanto os
estudos sobre a proteína da camada intermediária da cartilagem 1 não foram conclusivos. O
tratamento com pimobendan mais uma vez demonstrou a sua eficácia e também a sua segurança em
relação à função renal. A eficácia da torasemida como diurético não é inferior à da furosemida. Em
relação à alimentação, os estudos apoiam a suplementação de ácidos gordos omega 3 e
antioxidantes como a coenzima Q10 em pacientes cardíacos, enquanto a melatonina não tem
aparentemente nenhum efeito benéfico.
Myxomatous mitral valve disease is the most common acquired heart disease in small breed dogs. The pathophysiology of the disease is well described. Valves affected by myxomatous degeneration undergo a process of microscopic structural degeneration which ultimately leads to macroscopic alterations causing incomplete apposition of the mitral leaflets and, consequently, mitral regurgitation. In 2019, the American College of Veterinary Internal Medicine (ACVIM) published an updated consensus statement on the diagnostic and treatment methods for this disease. The present work consists of a literature review of articles discussing the diagnosis or clinical treatment of myxomatous mitral valve disease, with the aim of summarizing the key articles published after the ACVIM consensus (2019) up to the present date. Most of the articles were summarized and organized chronologically to compile information on the latest diagnostic methods, including imaging and cardiac biomarkers, among others. Similarly, the main clinical pharmacological treatments were identified, including new molecules such as the diuretic (like torasemide). The latest advancements in dietary treatment, which generally focus on the antioxidant power of different molecules in MMVD, are also documented. This study addresses, among other things, existing methods such as the vertebral heart score (VHS), left atrial size based on vertebral measurement, and electrocardiography, which have been further explored or compared with each other. New reference values more specific to certain breeds have been proposed, such as modified left atrial vertebral size adapted to the morphology of the Cavalier King Charles Spaniel or echocardiographic values for Chihuahuas. The anteroposterior diameter of the left atrium is part of the potential diagnostic approaches for the disease. A new prognostic score based on four echocardiographic measurements has also been established (MINE score). Regarding biomarkers, dimethylarginine has shown promising results in the diagnosis of MMVD, while studies on the protein intermedin-1 have been inconclusive. The effectiveness of pimobendan treatment has once again been demonstrated, along with its safety regarding for renal function. The efficacy of torasemide as a diuretic is comparable to that of furosemide. In terms of nutrition, studies support the supplementation of omega-3 fatty acids and antioxidants such as coenzyme Q10 in cardiac patients, while melatonin does not appear to have any beneficial effects.
Myxomatous mitral valve disease is the most common acquired heart disease in small breed dogs. The pathophysiology of the disease is well described. Valves affected by myxomatous degeneration undergo a process of microscopic structural degeneration which ultimately leads to macroscopic alterations causing incomplete apposition of the mitral leaflets and, consequently, mitral regurgitation. In 2019, the American College of Veterinary Internal Medicine (ACVIM) published an updated consensus statement on the diagnostic and treatment methods for this disease. The present work consists of a literature review of articles discussing the diagnosis or clinical treatment of myxomatous mitral valve disease, with the aim of summarizing the key articles published after the ACVIM consensus (2019) up to the present date. Most of the articles were summarized and organized chronologically to compile information on the latest diagnostic methods, including imaging and cardiac biomarkers, among others. Similarly, the main clinical pharmacological treatments were identified, including new molecules such as the diuretic (like torasemide). The latest advancements in dietary treatment, which generally focus on the antioxidant power of different molecules in MMVD, are also documented. This study addresses, among other things, existing methods such as the vertebral heart score (VHS), left atrial size based on vertebral measurement, and electrocardiography, which have been further explored or compared with each other. New reference values more specific to certain breeds have been proposed, such as modified left atrial vertebral size adapted to the morphology of the Cavalier King Charles Spaniel or echocardiographic values for Chihuahuas. The anteroposterior diameter of the left atrium is part of the potential diagnostic approaches for the disease. A new prognostic score based on four echocardiographic measurements has also been established (MINE score). Regarding biomarkers, dimethylarginine has shown promising results in the diagnosis of MMVD, while studies on the protein intermedin-1 have been inconclusive. The effectiveness of pimobendan treatment has once again been demonstrated, along with its safety regarding for renal function. The efficacy of torasemide as a diuretic is comparable to that of furosemide. In terms of nutrition, studies support the supplementation of omega-3 fatty acids and antioxidants such as coenzyme Q10 in cardiac patients, while melatonin does not appear to have any beneficial effects.
Description
Keywords
Degenerescência mixomatosa da válvula mitral Insuficiência cardíaca congestiva Cão Canina Diagnóstico Tratamento Revisão bibliográfica Mixomatous mitral valve disease Cardiac heart failure Dog Canine Diagnostic Treatment Bibliographic review