心脏疾病

心脏解剖

心脏疾病是犬和猫最常见的疾病之一。

研究报告称,约 10% 的犬和 15% 的猫患有心脏疾病。大多数猫都患有心肌病。在犬中,小型犬有可能患上粘液瘤性二尖瓣疾病 (MMVD),大型犬容易患上扩张型心肌病。1– 4 

尽管猫犬患上心脏病后,在心脏衰竭之前通常看起来都很健康。疾病在早期阶段可能不会被发现,除非宠物在因非心脏原因而接受兽医检查期间确诊。1, 5, 6

美国兽医内科学会 (ACVIM) 为猫心肌病或犬粘液瘤性二尖瓣疾病确定了心脏疾病的四个分期。基于临床和超声心动图检查确定各个分期,再将各分期与管理临床体征的治疗方法相关联。准确判断心脏疾病的分期对于治疗和预后具有重要意义。1, 7  

心力衰竭是指当心脏无法再泵送充足的血液来满足身体需求时,会出现的临床体征。一旦发生充血性心力衰竭 (CHF),宠物的寿命就会显著缩短。4, 8, 9

继续阅读以了解相关研究,这些研究有助于兽医更好地预测心脏病进展或发现营养成分可对患有心脏病的宠物发挥的新作用。     

心脏解剖 < 1% of heart disease is congenital in mixed breed dogs and cats

大多数心脏病患猫患有肥厚型心肌病 (HCM),这是一种以左心室肥厚(并非因其他疾病引起)为特征的心肌疾病。如果不接受超声心动图检查,通常在疾病早期无法发现猫已患病,因为它们可能不会出现可疑的心脏杂音或临床症状,直到它们发生心力衰竭 (CHF) 或因主动脉血栓栓塞 (ATE) 而瘫痪。4 

HCM 患猫更可能为年纪较大的雄性,且收缩期杂音较大。同时,患猫大多为混种猫,但部分品种(如缅因猫和布偶猫)由于可能发生基因突变,面临的风险也较高。12

长毛黄猫
ACVIM 猫科心肌病分期

猫科心肌病的表现和预后差异极大。但是,大约 30% 会进展为心力衰竭。一般来说,左心房增大越严重,发生动脉血栓栓塞 (ATE) 和 CHF 的风险就越高。

护理发生 CHF 的猫,主要是管理临床体征(如肺水肿)和支持心脏功能。饮食建议的重点是保持猫的热量摄入,避免高钠饮食或零食,为了心脏健康可补充 omega-3 脂肪酸,并监测血清钾水平。7,13

小型犬

与患有早期心肌病的猫相似,患有早期粘液瘤性二尖瓣疾病的犬看起来也很健康。通常是在常规检查期间,听诊到左心尖收缩期杂音时发现 MMVD。1, 5   

 

 

ACVIM 犬 MMVD 分期

MMVD 的进展也难以预测,左心房增大是心脏疾病进展最可靠的指标之一。与早期 MMVD 患犬相比,充血性心力衰竭患犬的存活时间更短。8, 14–16

Purina 的研究

犬

生物标志物可以提供疾病进展的重要线索。对于 MMVD 等心脏疾病而言,分期进展是导致心力衰竭的风险因素。Purina 科学家研究了 MMVD 患犬的微 RNA,以评估新的生物标志物的潜力。

Purina 科学家分析了处于 MMVD 各个分期的犬(从正常犬到充血性心力衰竭患犬)的 277 种循环 miRNA 表达谱。17 

尽管还需要进一步的研究,但结果表明,某些循环 miRNA 可作为生物标志物,用于犬 MMVD 的诊断、预后或监测治疗反应。

微 RNA (miRNA) 是一种非编码小分子 RNA,是心脏疾病潜在的无创生物标志物。 

根据 ACVIM 针对 MMVD 患犬的分期指南,研究人员将 18 只不同品种的犬分为三组,每组六只。 

结果显示,处于 B、C 或 D 期的犬与处于 A 期的健康犬相比,有 11 种 miRNA 表达存在差异。 

在这 11 种存在差异表达的 miRNA 中,  
有 6 种 miRNA 在 B1/B2 期患犬与 C 或 D 期患犬之间存在显著差异。

MMVD 的严重程度越高,基因表达的变化也越大。

狗的分期

记忆要点

  • 美国兽医内科学会分类表为猫心肌病或犬粘液瘤性二尖瓣疾病确定了心脏疾病的四个分期。
  • 心脏疾病的进展可能无法预测,且在心脏疾病早期,宠物通常表现正常。
  • 发现新的 MMVD 生物标志物(如 miRNA )可能有助于此类心脏病患犬的早期诊断。

探索改善心脏健康的领域:

了解更多信息

  1. Keene, B. W., Atkins, C. E., Bonagura, J. D., Fox, P. R., Häggström, J., Fuentes, V. L., Oyama, M. A., Rush, J. E., Stepien, R., & Uechi, M. (2019). ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. Journal of Veterinary Internal Medicine33(3), 1127–1140.
  2. Buchanan, J.W. Prevalence of cardiovascular disorders. In: Fox P.R, Sisson D.D, Moise N.S, editors. Textbook of Canine and Feline Cardiology: Principles and Clinical Practice. 2nd ed. Philadelphia, PA: WB Saunders; 1999. pp. 457–470.
  3. Payne, J. R., Brodbelt, D. C., & Luis Fuentes, V. (2015). Cardiomyopathy prevalence in 780 apparently healthy cats in rehoming centres (the CatScan study). Journal of Veterinary Cardiology: the official journal of the European Society of Veterinary Cardiology17 Suppl 1, S244–S257.
  4. Fox, P. R., Keene, B. W., Lamb, K., Schober, K. A., Chetboul, V., Luis Fuentes, V., … Tachika Ohara, V. Y. (2018). International collaborative study to assess cardiovascular risk and evaluate long-term health in cats with preclinical hypertrophic cardiomyopathy and apparently healthy cats: The REVEAL Study. Journal of Veterinary Internal Medicine32(3), 930–943.
  5. Côté, E., Edwards, N.J., Ettinger, S.J., Fuentes, V.L., MacDonald, K.A., Scansen, B.A., Sisson, D.D., & Abbott, J.A. (2015). Management of incidentally detected heart murmurs in dogs and cats. Journal of Veterinary Cardiology, 17(4), 245–261.
  6. Loughran, K. A., Rush, J. E., Rozanski, E. A., Oyama, M. A., Larouche-Lebel, É., & Kraus, M. S. (2019). The use of focused cardiac ultrasound to screen for occult heart disease in asymptomatic cats. Journal of Veterinary Internal Medicine33(5), 1892–1901.
  7. Luis Fuentes, V., Abbott, J., Chetboul, V., Côté, E., Fox, P. R., Häggström, J., Kittleson, M. D., Schober, K., & Stern, J. A. (2020). ACVIM consensus statement guidelines for the classification, diagnosis, and management of cardiomyopathies in cats. Journal of Veterinary Internal Medicine, 34(3), 1062–1077.
  8. Borgarelli, M., & Buchanan, J.W. (2012). Historical review, epidemiology and natural history of degenerative mitral valve disease. Journal of Veterinary Cardiology, 14(1), 93–101.
  9. Rush, J. E., Freeman, L. M., Fenollosa, N. K., & Brown, D. J. (2002). Population and survival characteristics of cats with hypertrophic cardiomyopathy: 260 cases (1990–1999). Journal of the American Veterinary Medical Association220(2), 202–207.
  10. MacDonald, K. Feline cardiomyopathy. In: Smith, F.W.K., Tilley, L.P., Oyama, M.A., & Sleeper, M.M, editors. Manual of Canine and Feline Cardiology. 5th ed. Saint Louis, MO: Elsevier; 2016. pp. 153.
  11. Schrope, D. P. (2015). Prevalence of congenital heart disease in 76,301 mixed-breed dogs and 57,025 mixed-breed cats. Journal of Veterinary Cardiology: the official journal of the European Society of Veterinary Cardiology17(3), 192–202.
  12. Gil-Ortuño, C., Sebastián-Marcos, P., Sabater-Molina, M., Nicolas-Rocamora, E., Gimeno-Blanes, J. R., & Fernández Del Palacio, M. J. (2020). Genetics of feline hypertrophic cardiomyopathy. Clinical Genetics, 10.1111/cge.13743.
  13. Freeman, L. M. & Rush, J. Nutrition in Cardiovascular Disorders. In: Smith, F.W.K., Tilley, L.P., Oyama, M.A., & Sleeper, M.M, editors. Manual of Canine and Feline Cardiology. 5th ed. Saint Louis, MO.: Elsevier; 2016. Pp. 394–403.
  14. Ettinger, S. J., Benitz, A. M., Ericsson, G. F., Cifelli, S., Jernigan, A. D., Longhofer, S. L., Trimboli, W., & Hanson, P. D. (1998). Effects of enalapril maleate on survival of dogs with naturally acquired heart failure. The Long-Term Investigation of Veterinary Enalapril (LIVE) Study Group. Journal of the American Veterinary Medical Association213(11), 1573–1577.
  15. Häggström, J., Boswood, A., O'Grady, M., Jöns, O., Smith, S., Swift, S., … DiFruscia, R. (2008). 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. Journal of Veterinary Internal Medicine22(5), 1124–1135.
  16. Mattin, M. J., Boswood, A., Church, D. B., McGreevy, P. D., O'Neill, D. G., Thomson, P. C., & Brodbelt, D. C. (2015). Degenerative mitral valve disease: Survival of dogs attending primary-care practice in England. Preventive Veterinary Medicine122(4), 436–442.
  17. Li, Q., Freeman, L. M., Rush, J. E., & Laflamme, D. P. (2015). Expression Profiling of Circulating MicroRNAs in Canine Myxomatous Mitral Valve Disease. International Journal of Molecular Sciences16(6), 14098–14108.