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Myocardial insult and arrhythmias after acute hemorrhage in horses
Cristobal Navas de Solis1, Barbara L Dallap Schaer, Ray Boston
1Sections of Sports Medicine and Imaging, Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, PA, 19348; Universidad Autonoma de Barcelona, Bellaterra, Barcelona, Spain.
Insights
Acute hemorrhage in horses can cause cardiac injury, leading to elevated cardiac troponin I (cTnI) levels and arrhythmias. These findings indicate potential myocardial damage and are associated with poorer outcomes.
Area of Science:
- Veterinary Cardiology
- Equine Internal Medicine
- Cardiovascular Physiology
Background:
- Acute hemorrhage is a critical condition in horses.
- Cardiac troponin I (cTnI) is a biomarker for myocardial injury.
- Cardiac arrhythmias can complicate various disease states in horses.
Purpose of the Study:
- To investigate the association between acute hemorrhage and increased plasma cTnI concentrations or cardiac arrhythmias in horses.
- To characterize arrhythmias and their clinical course post-hemorrhage.
- To identify predictors of cTnI elevation and arrhythmias.
- To determine the prognostic value of cTnI and arrhythmias regarding outcome.
Main Methods:
- Prospective observational study conducted at a veterinary teaching hospital.
- Serial plasma cTnI concentrations and continuous ECGs were recorded in horses with acute hemorrhage (HG) and a control group (BDG).
- Clinicopathological variables including heart rate, packed cell volume, total plasma protein, lactate, and creatinine were analyzed.
Main Results:
- Horses with acute hemorrhage (HG) exhibited significantly increased plasma cTnI concentrations and a higher incidence of cardiac arrhythmias compared to the control group (BDG).
- A strong association was found between acute hemorrhage and elevated cTnI (P = 0.004) and the presence of arrhythmias (P = 0.026).
- Elevated cTnI and arrhythmias were associated with the need for treatment and poorer clinical outcomes.
Conclusions:
- Acute hemorrhage in horses leads to detectable myocardial injury, evidenced by elevated cTnI levels.
- Cardiac arrhythmias are a frequent complication in horses experiencing acute hemorrhage.
- cTnI measurement and ECG monitoring are valuable tools for assessing cardiac health and prognosis in horses with acute hemorrhage.
Objective:
The objectives of this investigation were to: (1) Determine if acute hemorrhage is associated with increased plasma cardiac troponin I (cTnI) concentration or cardiac arrhythmias, (2) to describe the types of arrhythmias and their clinical course in horses following acute hemorrhage, (3) to determine the ability of clinical or clinicopathological variables to predict an increase in cTnI concentration and the presence of arrhythmias, and (4) to determine the associations of cTnI and cardiac arrhythmias with outcome.
Design:
Prospective observational study.
Setting:
Large animal veterinary teaching hospital.
Animals:
Eleven client-owned adult horses admitted for treatment of acute hemorrhage (HG) and 4 adult horses undergoing controlled blood collection (BDG).
Methods:
Serial cTnI concentrations were measured and continuous ECGs were obtained from the HG and BDG groups. Statistical tests were used to determine associations among acute hemorrhage and plasma cTnI concentrations, the presence of cardiac arrhythmias, clinicopathologic data (heart rate [HR], packed cell volume [PCV], total plasma protein [TPP], plasma lactate, and plasma creatinine concentrations), and outcome.
Results:
Plasma cTnI concentration and ECG were within reference intervals at all time points in the BDG. All horses in the HG had increased cTnI (ranging from 0.1-29.9 ng/mL). Arrhythmias were detected in 8 of these horses. There was an association between acute hemorrhage and increased cTnI (P = 0.004, ρ = 0.77), and the presence of arrhythmias (P = 0.026, ρ = 0.64). There were associations among plasma cTnI concentration and the presence of arrhythmias (P = 0.005), arrhythmias requiring treatment (P = 0.036), and poor outcome (P = 0.024).
Conclusions:
Acute hemorrhage results in myocardial injury that can be detected by measuring cTnI concentration. Arrhythmias were frequent in hospitalized horses following acute hemorrhage.
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