Auswirkungen von PPID auf die kardiale Funktion anhand von Gewebedoppler, Speckle Tracking, EKG und Blutdruckmessung

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Effects of PPID on cardial function shown with tissue Doppler, speckle tracking, ECG and blood pressure measurement The synonym for PPID „Equine Cushing Syndrome“ is derived from the human cushing syndrome. Both of them show similar symptoms such as immunodeficiency, myasthenia, abnormal fat distribution, lethargy and diversified hair/fur growth. In contrast to equine medicine, studies in humans have been performed in which patients with Cushing Syndrome were examined by tissue Doppler, speckle tracking, ECG and blood pressure measurement. In addition, heart rate variability was investigated. Patients were found to have diastolic myocardial dysfunction with sub-clinical systolic dysfunction in addition to arterial hypertension. Heart rate variability was divergent. The main goal of the present study was to investigate cardiac function of horses with PPID. For this, velocity and deformation parameters of the interventricular septum and the leftventricular free wall were determined via tissue Doppler and speckle-tracking-Echocardiography. An electrocardiogram with following heart rate variability analysis was executed to evaluate the autonomic function. The excitement rate, transmitted via sinus node, gives feedback on the autonomic function. In addition, a blood pressure measurement was performed to detect a possible arterial hypertension. 28 horses with PPID were investigated during the primary examination. All of them were current or former patients of the „Klinik für Pferde der Freien Universität Berlin“. When compared to those from healthy horses, measurements indicated a beginning diastolic and systolic dysfunction. The systole displays a rising pressure and contraction of the ventricle. The subject group featured a reduced early diastolic peak velocity of the interventricular septum (PW: 12,18 ± 4,11 cm/s; c-GD: 7,75 ± 4,78 cm/s) and the leftventricular free wall (PW: 14,79 ± 5,79 cm/s; c-GD: 15,47 ± 4,62 cm/s), indicating a lowered relaxation through decreased elasticity of the myocardium. Furthermore, a reduced systolic peak velocity of the interventricular septum (PW: p = 0,002; c-GD: p = 0,011) was observed, suggesting a decreased contractility. Additionally, several animals indicated a reduced E/A-ratio. Through tissue Doppler analysis, a late diastolic peak velocity increase was diagnosed, which represents a known compensatory mechanism (IVS:PW: 8,07 ± 3,89 cm/s; c-GD: 3,41 ± 2,42 cm/s; LFW: PW: 13,14 ± 4,21 cm/s; c-GD: 9,73 ± 3,48 cm/s). Due to missing relaxation ability, the atrial contractile force rises to ensure a sufficient filling quantity. Similar results were observed by speckle tracking, though the late diastolic relaxation speed was not significantly increased (IVS_SR_A: p = 0,867; LFW_SR_A: p = 0,394). These findings resemble those in humans suffering from Cushing Syndrome. The analysis of heart rate variability indicated a raised parasympathetic activity in correlation with reduced LF/HF-ratio (0,67 ms2). The blood pressure was normotensiv. A follow-up check after three to seven months did not, show any significant improvements, despite a therapy Some parameters even indicated a further decline of the values, suggesting a progressive development of the disease. The current study demonstrates cardiac dysfunction and sympathovagal imbalance with raised parasympathetic activity in horses suffering from PPID. Hypertension was not observed in the study group. In future studies of PPID, younger patients should be investigated since the influence of age. Longitudinal strain analysis could be an interesting choice, since studies on small animals indicate that this parameter is more sensitive in early diagnosis of a dysfunction. Future studies should also include a higher number of cases.

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Judith Fisch

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Blutdruck Diagnoseverfahren Diagnoseverfahren Heart function Herzfrequenz Herzfunktion Herzkrankheiten Herzleistung PPID Pferde Ultraschall Ultraschall-Diagnose blood pressure cardiac output diagnostic techniques

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