key: cord-0686861-whl49xff
authors: Lakhdhir, Sarifa; Viall, Austin; Alloway, Elizabeth; Keene, Bruce; Baumgartner, Kristen; Ward, Jessica
title: Clinical presentation, cardiovascular findings, etiology, and outcome of myocarditis in dogs: 64 cases with presumptive antemortem diagnosis (26 confirmed postmortem) and 137 cases with postmortem diagnosis only (2004-2017)
date: 2020-05-29
journal: J Vet Cardiol
DOI: 10.1016/j.jvc.2020.05.003
sha: 9eddbb7e1b7353bd19ec0666caaa86c7f90b0ad9
doc_id: 686861
cord_uid: whl49xff

Abstract Introduction To describe presentation, cardiovascular abnormalities, etiology, and outcome of canine myocarditis in geographic areas not endemic for Trypanosoma or Leishmania. Animals Sixty-four (presumed antemortem diagnosis) and 137 (postmortem diagnosis only) client-owned dogs at two tertiary care facilities. Materials and Methods Medical records of dogs with clinical or histopathological diagnosis of myocarditis were reviewed retrospectively. Results Common examination findings in dogs with a presumed antemortem diagnosis included fever (21%) and heart murmur (19%). Median cardiac troponin I was 12.2 ng/mL (range 0.2-808.0 ng/mL), and troponin exceeded 1.0 ng/mL in 26/29 (90%) dogs. Ventricular ectopy was the most common arrhythmia (54%), while decreased left ventricular systolic function was the most common echocardiographic abnormality (56%). An infectious etiology was diagnosed in 35/64 (55%) dogs. Confirmed infectious etiologies included bacterial sepsis (n = 9) or extension of endocarditis (3), toxoplasmosis or neosporosis (3), parvovirus (2), and one case each of bartonellosis, trypanosomiasis, leptospirosis, and dirofilariasis. Median survival time was 4 days (range 0 - 828 days) for all dogs, versus 82 days for dogs who survived at least two weeks following diagnosis. Presence of pericardial effusion or azotemia were significant predictors of nonsurvival. The most common inflammatory infiltrate on histopathology was neutrophilic (47%), and 20/137 (15%) dogs had concurrent bacterial endocarditis on postmortem. Conclusions Bacterial infection was the most common confirmed etiology of myocarditis in this study. Prognosis for canine myocarditis is guarded and similar to that reported for infective endocarditis. Criteria for the antemortem diagnosis of canine myocarditis are suggested.

Myocarditis is a non-specific inflammatory disease of the myocardium. Its incidence in 65 the canine population is unknown, though a histopathologic diagnosis of myocarditis 66 was reported in 1.5% of dogs in a retrospective necropsy study [1] 73 toxins, immune-mediated diseases, trauma, heat stroke, hemodynamic shock, and 74 idiopathic myocarditis [1, 22, 33] . Literature pertaining to presentation, diagnosis, and 75 treatment of myocarditis in canines is limited, consisting mostly of single case reports 76 and small case series focused on a single causative etiology. There are no large-scale 77 studies reporting clinical features or outcome of myocarditis across multiple etiologies. 78 Definitive diagnosis of myocarditis is based on histopathology demonstrating 79 myocardial inflammation, with or sometimes without myocyte necrosis; therefore, 80 definitive antemortem diagnosis requires endomyocardial biopsy [34] [35] [36] . Though more 81 routinely performed in humans [36, 37] , this procedure is rarely performed in dogs due to 82 limited availability of expertise and specialized equipment, combined with procedural 83 and anesthetic risk. For this reason, the antemortem diagnosis of canine myocarditis is 84 generally presumptive and based on an individual clinician's interpretation of case 85 presentation and clinicopathologic information. Standardized antemortem diagnostic 86 criteria, as exist for canine endocarditis [38] , would be helpful to identify dogs with 87 suspected or possible myocarditis. 88 The primary objective of this study was to describe the clinical presentation, 89 diagnostic test results, suspected etiology, treatment, and outcome of dogs with a 90 presumptive diagnosis of myocarditis presenting to two tertiary care facilities. The two 91 tertiary care facilities were located in geographic areas not endemic to either 92 Trypanosoma cruzi or Leishmania infantum, the two vector-borne infectious diseases 93 most commonly linked to canine myocarditis. A second study objective was to compare 94 clinical findings between institutions and between etiologies of myocarditis. A third study 95 objective was to use these findings in conjunction with postmortem results in confirmed 96 myocarditis cases to propose criteria that can be utilized for the antemortem diagnosis 97 of canine myocarditis. (n = 12), Labrador retriever (n = 10), golden retriever (n = 5), boxer (n = 4), collie (n = 3), 153 bullmastiff (n = 2), Pembroke Welsh Corgi (n = 2), pointer (n = 2), Jack Russell terrier (n = 2), Cavalier King Charles spaniel (n = 2), beagle (n = 2), and one each of 18 155 additional breeds. There were no differences between institutions in terms of dog sex, 156 age, or weight. (3/64, 5%), dyspnea or tachypnea (2/64, 3%), and decreased intensity of heart sounds 179 (2/64, 3%). Location and timing of heart murmurs were further characterized in all 12 Table 1 . reported as mean ± standard deviation for normally-distributed data, and as median 6 (range) for non-normally-distributed data. cTnI, cardiac troponin I; E/A, ratio of early to 

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