Giulia Arcuri

Feline cardiogenic arterial thromboembolism (ATE) is a severe complication of cardiac disease in cats, often causing severe clinical signs and poor prognosis. Despite its importance, standardized guidelines for prevention and treatment are lacking. This systematic review evaluated available evidence on preventive, acute, and chronic management strategies for feline cardiogenic ATE. A comprehensive search using PubMed, Scopus and Web of Science was performed, following PRISMA 2020 guidelines. Peer-reviewed studies investigating therapeutic interventions for ATE were included. Risk of bias was assessed using the SYRCLE tool. Nineteen studies involving 909 cats were included. Preventive therapy with clopidogrel and rivaroxaban improved survival. Acute multimodal treatment combining anticoagulant and antiplatelet drugs improved survival compared to monotherapy. Thrombolytic therapy showed some efficacy but had frequent severe complications. Long-term management with clopidogrel and rivaroxaban achieved the longest survival and lowest recurrence, while acetylsalicylic acid provided inconsistent benefits and more adverse effects. Eleven of the nineteen (58%) studies had high risk of bias due to small sample size and heterogeneous protocols. Current evidence supports dual therapy, particularly clopidogrel with rivaroxaban or enoxaparin, as the most effective and well-tolerated approach for prevention and treatment. Larger, standardized prospective trials are urgently needed to strengthen the evidence.

Atrial fibrillation (AF) and ventricular arrhythmias (VAs) are common pathological arrhythmias of dogs and are both associated with a poor prognosis in those with cardiac disease. This study aimed to assess the ability of 2 to 5 min electrocardiography (routine ECG) to detect the presence and severity of concomitant VAs in dogs with secondary AF. Continuous 24 h ECG monitoring (Holter) was used as the reference standard to identify VAs, quantify the number of premature ventricular ectopic complexes (VPCs) and evaluate the degree of their organization using a modified Lown–Wolf classification scale. In light of the Holter findings, VAs were classified as severe based on two criteria: the presence of more than 100 VPCs and a Lown–Wolf grade ≥ 4. Thirty-five dogs with secondary AF were included, where all exhibited VAs on Holter monitoring. Most dogs had severe VAs, according to both the VPC count (69%) and Lown–Wolf classification (77%). However, only 13 dogs (37%) had VAs detectable on routine ECG. A significant positive correlation was found between the presence of VAs on routine ECG and the severity of VAs identified via Holter. Nevertheless, the diagnostic accuracy of routine ECG in predicting severe VAs was only moderate (68.6% based on VPC count and 60% based on Lown–Wolf grade). Overall, a 2 to 5 min ECG appears to be a highly specific but relatively insensitive tool for detecting VAs in dogs with secondary AF.

Atrial fibrillation (AF) and ventricular arrhythmias (VAs) are common pathological arrhythmias of dogs and are both associated with a poor prognosis in those with cardiac disease. This study aimed to assess the ability of 2- to 5-minute electrocardiography (routine ECG) to detect the presence and severity of concomitant VAs in dogs with secondary AF. Continuous 24-hour ECG monitoring (Holter) was used as the reference standard to identify VAs, quantify the number of premature ventricular ectopic complexes (VPCs) and evaluate the degree of their organization using a modified Lown-Wolf classification scale. In light of the Holter findings, VAs were classified as severe based on two criteria: the presence of more than 100 VPCs and a Lown-Wolf grade ≥4. Thirty-five dogs with secondary AF were included; all exhibited VAs on Holter monitoring. Most dogs had severe VAs, according to both the VPCs count (69%) and Lown-Wolf classification (77%). However, only 13 dogs (37%) had VAs detectable on routine ECG. A significant positive correlation was found between the presence of VAs on routine ECG and the severity of VAs identified via Holter. Nevertheless, the diagnostic accuracy of routine ECG in predicting severe VAs was only moderate (68.6% based on VPCs count and 60% based on Lown-Wolf grade). Overall, a 2- to 5-minute ECG appears to be a highly specific but relatively insensitive tool for detecting VAs in dogs with secondary AF.

Galectin-3 (Gal-3) is a lectin associated with fibrosis and inflammation, and increased circulating concentrations are considered a risk factor for atrial fibrillation (AF) in humans. This retrospective study aimed to evaluate the serum concentration of Gal-3 in dogs with cardiac disease, both with and without AF. Dogs with AF associated with acquired heart diseases were selected, while cardiac healthy dogs and dogs with heart diseases but without AF served as controls. We statistically compared the serum concentration of Gal-3, which was assessed using a commercial canine-specific ELISA kit, among healthy dogs and dogs with heart disease with and without AF. Additionally, associations between Gal-3 and clinical and echocardiographic variables were evaluated. A total of 73 dogs were included, of which 17/73 (23.3%) were cardiac healthy and 56/73 (76.7%) had heart disease, with 26/56 (46.4%) having AF. No significant difference in Gal-3 concentration was found between cardiac healthy dogs (3.90 ± 1.65 ng/mL) and dogs with heart disease, either with or without AF (3.37 ± 1.04 ng/mL, p = 0.436 and 4.68 ± 1.80 ng/mL, p = 0.332, respectively). Gal-3 showed a significant positive correlation with age (r = 0.47, p < 0.001) and a negative correlation with body weight (r = −0.45, p < 0.001). The results of this study suggest that Gal-3 does not have an important role in the development of AF in dogs, but it is associated with advanced age.

Galectin-3 (Gal-3) is a lectin associated with fibrosis and inflammation, and increased circulating concentrations are considered a risk factor for atrial fibrillation (AF) in humans. This retrospective study aimed to evaluate the serum concentration of Gal-3 in dogs with cardiac disease, both with and without AF. Dogs with AF associated with congenital and acquired heart diseases were selected, while clinically healthy dogs and dogs with heart diseases but without AF served as controls. We statistically compared the serum concentration of Gal-3, assessed using a commercial canine-specific ELISA kit, among healthy dogs and dogs with heart disease with and without AF. Additionally, associations between Gal-3 and clinical and echocardiographic variables were evaluated. A total of 80 dogs were included, of which 17/80 (21.2%) were clinically healthy and 63/80 (78.8%) had heart disease, with 30/63 (47.6%) having AF. No significant difference in Gal-3 concentration was found between healthy dogs (3.90 ± 0.38 ng/mL) and dogs with heart disease, either with or without AF (3.45 ± 0.28 ng/mL, P=0.226 and 4.46 ± 0.27 ng/mL, P=0.286, respectively). Gal-3 showed a significant positive correlation with age (r=0.46, P < 0.001). The results of this study suggest that Gal-3 does not have predictive value for the development of AF in dogs, but it is associated with advanced age.

Different risk factors for atrial fibrillation (AF) development have been identified in numerous studies on humans, but this information is less clearly available on the dog. The aim of this systematic review is to determine the risk factors for AF in the dog. Following the PRISMA 2020 guidelines, we conducted a comprehensive search using the Web of Science and Scopus databases for articles reporting on cases of spontaneously occurring AF in dogs. The level of evidence was assessed using the Evidence Quality Grading System of the National Institute of Health. One thousand forty-three studies were initially identified, and twenty of them were included in this systematic review involving 2,359,275 dogs, of which 4807 showed spontaneously occurring AF. Genetics, for the Irish Wolfhound, increased body weight, and left atrial enlargement were the main risk factors for the development of AF in dogs with different cardiac diseases, particularly myxomatous mitral valve disease (MMVD) and dilated cardiomyopathy (DCM). However, some differences were found between these two cardiac diseases regarding additional risk factors. In particular, the presence of congestive heart failure and echocardiographic evidence of increased left atrial pressure or the presence of right atrial enlargement emerged as risk factors in dogs with MMVD or DCM, respectively. Furthermore, significant differences in risk factors were observed between dogs and humans. In particular, advanced age and male sex are not reliable indicators of an increased risk of AF in dogs.