Serena Crosara

Introduction: Pimobendan has been shown to delay the onset of congestive heart failure and prolong survival in dogs affected by myxomatous mitral valve disease (MMVD). However, little information is available regarding its short-term echocardiographic effects in dogs with preclinical disease. The aim of this prospective multicenter observational study was to evaluate the effect of pimobendan on selected echocardiographic indices after 7 days of therapy in dogs with American College of Veterinary Internal Medicine stage B2 MMVD. Methods: Forty-two client-owned dogs received pimobendan orally at 0.25–0.3 mg/kg every 12 h and underwent echocardiographic examination before treatment initiation and after 7 days. Results: Significant reduction was observed in several indices of left atrial and left ventricular remodeling, including normalized left atrial diameter ( p < 0.001), left atrial-to-aortic ratio ( p < 0.001), maximal and minimal left atrial volumes ( p < 0.001 and p = 0.008, respectively), left atrial stroke volume ( p = 0.011), and normalized left ventricular internal diameters in diastole and systole (both p < 0.001). Significant decrease was also observed in fractional shortening ( p = 0.007), peak velocity of early diastolic transmitral flow (E) ( p = 0.001), E velocity-to-early diastolic myocardial peak velocity ratio ( p = 0.031), mitral-to-aortic velocity time integral ratio ( p = 0.045), and left ventricular early inflow-outflow index ( p < 0.001), whereas pulmonic velocity-time integral ( p < 0.001) and systolic myocardial peak velocity ( p < 0.001) significantly increased. No significant differences were detected for regurgitant volume, regurgitant fraction, ejection fraction, myocardial performance index, isovolumic relaxation time, E-to-isovolumic relaxation time ratio, E deceleration, or aortic velocity-time integral. At the 1-week re-evaluation, 22/42 dogs (52.4%) showed reverse remodeling, with echocardiographic indices returning to values within the range consistent with ACVIM stage B1. Discussion: These findings suggest that pimobendan administration is associated with early improvement in echocardiographic indices of left heart remodeling in dogs with ACVIM stage B2 MMVD and may reduce regurgitant volume shortly after treatment initiation.

Dogs with acute congestive heart failure (CHF) can develop acute kidney injury (AKI); the prevalence of this condition has not been defined. This study aimed to assess the occurrence of AKI (increase in serum creatinine (sCr) ≥ 0.3 mg/dL) within 48 h from admission in dogs with myxomatous mitral valve disease (MMVD) with acute CHF, and the role of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a predictive marker of AKI. This was a multicentric, prospective observational study. Thirty dogs were included. The types and dosages of the diuretics administered, as well as the serum and urinary chemistry, including uNGAL and uNGAL, to the urinary creatinine ratio (uNGALC), were determined at admission (T0) and after 24 (T24) and 48 (T48) hours of hospitalization. Nineteen dogs developed AKI. We found no statistically significant differences in sCr, uNGAL, uNGALC, diuretic dosage, or hours of hospitalization between dogs that developed AKI and those that did not. The urinary NGAL and uNGALC values were not statistically significantly different at any time point, while the sCr was higher at T24 and T48 than T0. Our findings suggest that AKI in MMVD dogs with CHF is primarily functional, driven by effective decongestion rather than severe tubular damage, with the benefits of decongestion outweighing transient increases in sCr.

Feline lower urinary tract disease (FLUTD) is a frequent diagnosis in cats, with bacterial causes constituting a minor percentage of cases. This observational study aimed to assess the diagnostic and therapeutic approaches to FLUTD among Italian veterinarians and explore variations in different workplaces. Data were collected via an anonymous survey completed by 317 veterinarians from small clinics (SC), large clinics (LC), and veterinary hospitals (VH). Results revealed that approximately half of respondents relied on clinical signs and urinalysis for diagnosis, while fewer incorporated abdominal ultrasound. Urine culture and sensitivity (UCS) testing was infrequently performed, primarily due to financial and logistical constraints, with higher compliance in VH practitioners. Antimicrobials were widely employed, with enhanced penicillins being the most prescribed class. The frequent empirical use of quinolones raises concern regarding gaps in antimicrobial stewardship. Despite some adherence to the ISCAID guidelines, discrepancies in diagnostic rigor, antimicrobial selection, and treatment duration were observed. Larger facilities demonstrated greater alignment with evidence-based practices, emphasizing the need for widespread education on appropriate antimicrobial use. This study underscores the importance of integrating guideline-based diagnostics and stewardship in managing feline urinary tract diseases.

Antimicrobials are frequently administered for therapeutic and prophylactic purposes in companion animals. Their use is closely monitored as related to antimicrobial resistance both in human and veterinary medicine. This retrospective study aimed to describe antimicrobial prescription by different clinical services in cats visited at the Veterinary Teaching Hospital of the University of Parma (VTH-UP) between January 2021 and December 2023. The antibiotic classes were divided according to the categorization of antibiotics adopted by the European Medicines Agency (EMA); EMA categories A and B were classified as Critically Important Antimicrobials (CIAs). Overall, 43.8%, 35.0%, and 35.0% of visited cats received an antimicrobial prescription in 2021, 2022, and 2023, respectively. Most of the prescriptions were Category C “Caution” antibiotics (49.0%, 54.0%, and 55.0% in 2021, 2022, and 2023, respectively). Category B “restrict” antibiotics represented 13.0%, 12.0%, and 11.0% of the total antimicrobials prescribed in 2021, 2022, and 2023, respectively. Penicillins associated with beta-lactam inhibitors were the most common antibiotics prescribed each year at the VTH-UP (32.0%, 31.3%, and 23.7% of total prescriptions in 2021, 2022, and 2023, respectively). Among CIAs, quinolones were the most common, with 12.1%, 11.2%, and 10.1% of the total prescriptions in 2021, 2022, and 2023, respectively. Culture and sensitivity tests (CSTs) were performed for 18.1% (85/470), 17.4% (73/420), and 23.0% (96/417) of the total prescriptions in 2021, 2022, and 2023, respectively. Considering only CIA prescriptions, CSTs were performed in 70.0% (49/70), 66.7% (38/57), and 70.9% (39/55) of CSTs in 2021, 2022, and 2023, respectively. Antimicrobial use varies considerably depending on the clinical service. The use of “restrict” antibiotics was very limited, and attention should be given to therapeutic and prophylactic use.

Background: Dogs with myxomatous mitral valve disease (MMVD) can experience progressive renal tubular damage and dysfunction. The prevalence of renal tubular damage is not known in dogs with stable MMVD. Objective: To evaluate renal tubular damage in dogs with stable MMVD by evaluation of urinary neutrophil gelatinase-associated lipocalin (NGAL). Animals: Ninety-eight MMVD dogs grouped according to the American College of Veterinary Internal Medicine (ACVIM) staging (group B1, n = 23; group B2, n = 27; group C + D, n = 48) and 46 healthy dogs. Methods: Multicenter prospective observational study. Serum and urine chemistry including NGAL reported as uNGAL concentration (uNGAL) and normalized with urinary creatinine (uNGALC) were compared between MMVD dogs and healthy controls, and among different MMVD ACVIM stages. Results: The MMVD dogs had significantly higher uNGAL and uNGALC (1204 pg/mL; range, 30-39 732 and 1816 pg/mg; range, 22-127 693, respectively) compared to healthy dogs (584 pg/mL; range, 56-4072 and 231 pg/mg; range, 15-2407, respectively; P = .002 and P < .0001, respectively). Both uNGAL and uNGALC increased with the increasing ACVIM stage (P = .001 and P < .001, respectively). Conclusions and Clinical Importance: Renal tubular damage is present in dogs with stable MMVD, as measured by increased uNGAL. This tubular damage is subclinical, occurs in all stages of MMVD even in the absence of azotemia, and increases with the severity of MMVD. Reno-protective approaches to manage MMVD dogs should be explored to slow the progression of renal tubular damage in these patients.