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Cardiomiopatia dilatada canina – da etiologia à terapêutica, o que há de novo?
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Advisor(s)
Abstract(s)
As doenças cardíacas são muito prevalentes na população canina e são responsáveis por uma
elevada morbilidade e mortalidade nesta espécie. Esta dissertação de mestrado integrado tem como
objetivo efetuar uma revisão bibliográfica no que respeita ao estado da arte sobre a cardiomiopatia
dilatada na espécie canina, desde a sua etiologia, apresentação clínica, diagnóstico e terapêutica.
A seguir à doença degenerativa da válvula mitral, a cardiomiopatia dilatada (CMD) é a patologia
cardíaca mais comum na prática clínica veterinária e caracteriza-se por uma dilatação das câmaras
cardíacas, redução da contratilidade do miocárdio e, consequentemente, uma disfunção sistólica e
diastólica. Esta doença é de evolução lenta e progressiva, levando à insuficiência cardíaca congestiva
(ICC) e a arritmias que podem culminar com a morte do animal.
A etiologia da CMD é geralmente desconhecida, no entanto existem diversos fatores
predisponentes para o seu desenvolvimento. Os fatores genéticos representam uma das principais
causas desta doença, como tem sido evidenciado nos últimos anos por múltiplos estudos que suportam
e comprovam o seu carácter hereditário, nomeadamente em linhas familiares de raça Doberman
Pinscher, tida classicamente como modelo de estudo desta patologia. O diagnóstico de CMD baseiase
essencialmente no uso da ecocardiografia, acompanhado da eletrocardiografia, da radiografia
torácica e de exames laboratoriais. Mais recentemente também a medicina nuclear tem sido aplicada
nesta área da clínica veterinária. O seu tratamento é fundamentalmente de suporte e tem como objetivo
controlar os sintomas da ICC, promover a qualidade de vida do animal e aumentar a sua sobrevivência.
Na CMD verifica-se que ocorrem alterações na dinâmica do cálcio e do ritmo da apoptose dos
cardiomiócitos, o que justifica um prognóstico reservado em animais tratados de forma paliativa. Tanto
em medicina veterinária como em medicina humana têm-se procurado formas de restabelecer a
funcionalidade cardíaca, sendo que a terapia génica, por transferência de genes está na vanguarda da
investigação translacional uma vez que há indícios de que permite alterar a distribuição do cálcio e
reduzir a apoptose dos cardiomiócitos. Neste sentido múltiplos estudos em animais e humanos estão
já em curso.
Heart diseases are very prevalent in canine population and are responsible for high morbidity and mortality in this specie. This master thesis aims to carry out a bibliographical review regarding the state of the art on dilated cardiomyopathy, focusing on etiology, clinical presentation, diagnosis and therapeutics. After mitral valve degenerative disease, dilated cardiomyopathy (DCM) is the most common cardiac pathology in veterinary clinical practice and is characterized by dilation of the cardiac chambers, reduction of myocardial contractility, and consequently systolic and diastolic dysfunction. This disease is of slow and progressive evolution, leading to congestive heart failure (CHF) and arrhythmias that can culminate in the death of the animal. The etiology of DCM is generally unknown, however there are several predisposing factors to its development. Genetic factors represent one of the main causes of this disease, as it has been evidenced in recent years by multiple studies that support and prove its hereditary nature, especially in family lines of Doberman Pinscher breed, classically considered as a model of this pathology. The diagnosis of DCM is based essentially on the use of echocardiography, accompanied by electrocardiography, thoracic radiography and laboratory tests. More recently also nuclear medicine has been applied in this area of veterinary clinics. Its treatment is essentially palliative and aims to control the symptoms of CHF, promote the quality of life of the animal and increase its survival. In DCM are described changes on calcium dynamics and on cardiomyocyte apoptosis rate which justify a guarded prognosis in symptomatic treated animals. There is an intensive investigation in both veterinary and human medicine in order to find more efficacious therapeutic strategies to restore cardiac function. Gene therapy, by gene transfer, is one of the more promising approaches for this disease and has been studies under a translational research point of view. There is evidence that it allows improvement on calcium distribution and reducing of cardiomyocytes apoptosis. In this sense multiple animal and human studies are already under way.
Heart diseases are very prevalent in canine population and are responsible for high morbidity and mortality in this specie. This master thesis aims to carry out a bibliographical review regarding the state of the art on dilated cardiomyopathy, focusing on etiology, clinical presentation, diagnosis and therapeutics. After mitral valve degenerative disease, dilated cardiomyopathy (DCM) is the most common cardiac pathology in veterinary clinical practice and is characterized by dilation of the cardiac chambers, reduction of myocardial contractility, and consequently systolic and diastolic dysfunction. This disease is of slow and progressive evolution, leading to congestive heart failure (CHF) and arrhythmias that can culminate in the death of the animal. The etiology of DCM is generally unknown, however there are several predisposing factors to its development. Genetic factors represent one of the main causes of this disease, as it has been evidenced in recent years by multiple studies that support and prove its hereditary nature, especially in family lines of Doberman Pinscher breed, classically considered as a model of this pathology. The diagnosis of DCM is based essentially on the use of echocardiography, accompanied by electrocardiography, thoracic radiography and laboratory tests. More recently also nuclear medicine has been applied in this area of veterinary clinics. Its treatment is essentially palliative and aims to control the symptoms of CHF, promote the quality of life of the animal and increase its survival. In DCM are described changes on calcium dynamics and on cardiomyocyte apoptosis rate which justify a guarded prognosis in symptomatic treated animals. There is an intensive investigation in both veterinary and human medicine in order to find more efficacious therapeutic strategies to restore cardiac function. Gene therapy, by gene transfer, is one of the more promising approaches for this disease and has been studies under a translational research point of view. There is evidence that it allows improvement on calcium distribution and reducing of cardiomyocytes apoptosis. In this sense multiple animal and human studies are already under way.
Description
Keywords
Cardiologia veterinária Cardiomiopatia dilatada primária Testes genéticos Terapia génica Veterinary cardiology Primary dilated cardiomyopathy Genetic tests Gene therapy