Statistical Analysis with Missing Data

Muscular exercise requires transitions to and from metabolic rates often exceeding an order of magnitude above resting and places prodigious demands on the oxidative machinery and O2-transport pathway. The science of kinetics seeks to characterize the dynamic profiles of the respiratory, cardiovascular, and muscular systems and their integration to resolve the essential control mechanisms of muscle energetics and oxidative function: a goal not feasible using the steady-state response. Essential features of the O2 uptake (VO2) kinetics response are highly conserved across the animal kingdom. For a given metabolic demand, fast VO2 kinetics mandates a smaller O2 deficit, less substrate-level phosphorylation and high exercise tolerance. By the same token, slow VO2 kinetics incurs a high O2 deficit, presents a greater challenge to homeostasis and presages poor exercise tolerance. Compelling evidence supports that, in healthy individuals walking, running, or cycling upright, VO2 kinetics control resides within the exercising muscle(s) and is therefore not dependent upon, or limited by, upstream O2-transport systems. However, disease, aging, and other imposed constraints may redistribute VO2 kinetics control more proximally within the O2-transport system. Greater understanding of VO2 kinetics control and, in particular, its relation to the plasticity of the O2-transport/utilization system is considered important for improving the human condition, not just in athletic populations, but crucially for patients suffering from pathologically slowed VO2 kinetics as well as the burgeoning elderly population.

Oxygen Uptake Kinetics

https://www.vmedtechnology.com/Post-surgical%20deaths.pdf

The risk of death: the confidential enquiry into perioperative small animal fatalities.

Aims The aetiology of atrial fibrillation (AF) remains unknown in some patients. The aim of the study was to identify new risk factors for developing lone AF (LAF).

Methods and results A series of 107 consecutive patients younger than 65, seen in the emergency room for an episode of LAF of <48 h duration were included in the study. A group of 107 healthy volunteers matched for age and sex were recruited as controls. All subjects answered a validated questionnaire concerning leisure and occupational activities performed throughout their lifetimes to estimate accumulated hours of physical effort, classified in four levels of intensity. Demographic and echocardiographic measurements were also recorded. There were 69% of males and mean age was 48 ± 11 years. AF was paroxysmal in 57% and persistent in the remaining 43%. Patients with AF performed more hours of both moderate and heavy intensity physical activity. They also were taller, and had a larger left atria, ventricle, and body surface area. At the multivariable analysis, only moderate and heavy physical activity, height, and anteroposterior atrial diameter were independently associated with LAF.

Conclusions Accumulated lifetime physical activity, height, and left atrial size are risk factors for LAF in healthy middle-aged individuals.

Physical activity, height, and left atrial size are independent risk factors for lone atrial fibrillation in middle-aged healthy individuals.

Adverse respiratory events in anesthesia: A closed claims analysis

Murmurs and arrhythmias are commonly detected in equine athletes. Assessing the relevance of these cardiovascular abnormalities in the performance horse can be challenging. Determining the impact of a cardiovascular disorder on performance, life expectancy, horse and rider or driver safety relative to the owner's future expectations is paramount. A comprehensive assessment of the cardiovascular abnormality detected is essential to determine its severity and achieve these aims. This consensus statement presents a general approach to the assessment of cardiovascular abnormalities, followed by a discussion of the common murmurs and arrhythmias. The description, diagnosis, evaluation, and prognosis are considered for each cardiovascular abnormality. The recommendations presented herein are based on available literature and a consensus of the panelists. While the majority of horses with cardiovascular abnormalities have a useful performance life, periodic reexaminations are indicated for those with clinically relevant cardiovascular disease. Horses with pulmonary hypertension, CHF, or complex ventricular arrhythmias should not be ridden or driven.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jvim.12340

Recommendations for Management of Equine Athletes with Cardiovascular Abnormalities

Background Cats are commonly anaesthetized in veterinary practice, but recent figures describing the frequency of or risk factors for anaesthetic-related death are not available. The aims of this study were to address these deficiencies. Methods A nested case–control study was undertaken in 117 UK veterinary centres. All anaesthetic and sedation procedures and anaesthetic and sedation-related deaths (i.e. ‘cases') occurring within 48 h were recorded. Details of patient, procedure, and perioperative management were recorded for all cases and randomly selected non-deaths (controls). A detailed statistical model of factors associated with anaesthetic and sedation-related death was constructed. Results Between June 2002 and June 2004, 175 deaths were classified as anaesthetic and sedation-related and 14 additional deaths (with insufficient information to be excluded) were included for the estimation of risk. During the study, 79 178 anaesthetic and sedation procedures were recorded and the overall risk of anaesthetic and sedation-related death was 0.24% (95% CI 0.20–0.27). Factors associated with increased odds of anaesthetic-related death were poor health status (ASA physical status classification), increasing age, extremes of weight, increasing procedural urgency and complexity, endotracheal intubation, and fluid therapy. Pulse monitoring and pulse oximetry were associated with reduced odds. Conclusions The risk of anaesthetic-related death in cats appears to have decreased since the last published study in the UK. The results should aid the preoperative identification of cats at greatest risk. Greater care with endotracheal intubation and fluid administration are recommended, and pulse and pulse oximetry monitoring should be routinely implemented in cats.

Risk factors for anaesthetic-related death in cats: results from the confidential enquiry into perioperative small animal fatalities (CEPSAF)

Guided M-mode echocardiography was performed in seven 2-year-old Thoroughbreds before commencement of commercial flat-race training, and 18 weeks later, when all horses were either racing regularly (5 horses), or at racing fitness (2 horses). M-mode echocardiography was performed using a 2.5 MHz annular phased array ultrasound transducer and a Vingmed 800 Supervision echocardiograph. Images were obtained from the right hemithorax; a short axis view of the left ventricle (LV) at the level of the chordae tendinae was used to position the M-mode cursor. The following variables were measured: left ventricular (LV) internal diameter in diastole (LVIDd) and systole (LVIDs) and interventricular septal (IVS) and left ventricular free wall thickness (LVFW) in systole and diastole. The following variables were also calculated: LV fractional shortening (%FS), LV ejection fraction (EF), LV relative and mean wall thickness and muscle mass. Values before and after training were compared using a paired Student's t test. Training resulted in significant reductions in %FS and EF. Left ventricular internal diameter increased from 11.38 s.d = 0.58) cm before training to 12.16 (s.d. = 0.7) cm after training (P < 0.001). Calculated left ventricular mass also increased significantly (mean increase of 33% P < 0.001). Bodyweight was unchanged in the present study. Relative wall thickness was significantly increased in all horses, suggesting that eccentric cardiac hypertrophy occurs in response to commercial flat-race training. The mean post training value for relative wall thickness of 0.45 (s.d. = 0.05) for the horses in the present study is similar to that of human athletes in power/endurance disciplines.

https://beva.onlinelibrary.wiley.com/doi/pdf/10.1111/j.2042-3306.1999.tb05217.x

Cardiac responses to training in 2-year-old Thoroughbreds: an echocardiographic study

In order to assess the reliability and repeatability of transthoracic echocardiography for detecting serial changes in cardiac function in horses, day to day variability of a number of echocardiographic indices of ventricular function were studied. The variables investigated were, from 2-dimensional (2-D) and M-mode echocardiography - aortic diameter in systole (Aos), pulmonary artery diameter in systole (Pas), left ventricular internal diameter in systole (LLVIDs) and diastole (LLVIDd), and left ventricular fractional shortening (%FS) and estimated ejection fraction (EF). From pulsed Doppler echocardiography - maximum velocity (Vmax) and acceleration (dv/dtmax) of aortic and pulmonary arterial blood flow, left and right ventricular velocity time integral (AoVTI and PAVTI) and estimated cardiac output (COLV, and CORV), left and right ventricular ejection time (LVET and RVET) and pre-ejection period (LVPEP and RVPEP), and heart rate. Maximum velocity of early rapid right ventricular filling (ETV) and late right ventricular filling due to right atrial contraction (ATV) were measured. Maximum deceleration and time for deceleration of early rapid filling (dv/dtTV and dt TV) were also determined. Seven healthy mature Thoroughbred horses weighing 490-600 kg were studied. The horses' management regimes and environment were standardised and an echocardiographic examination was carried out on each horse at the same time every day for 6 consecutive days. Two statistical measures of repeatability were calculated for each variable: the intraclass correlation coefficient (rI) and the 95% confidence intervals for error free value of a single measurement. In general, the dimensions and indices of cardiac function derived from 2-D and M-mode echocardiography showed better repeatability for individual horses than did the indices derived from Doppler echocardiography. Overall the 95% confidence intervals for an error-free value of all variables derived from Doppler echocardiography were wide. This must be appreciated when attributing serial measured changes of Doppler echocardiographic variables in an individual animal to effects of a treatment or disease.

Measurement of cardiac function by transthoracic echocardiography: day to day variability and repeatability in normal Thoroughbred horses

Maximum oxygen uptake also appears to correlate to athletic performance in horses. In the Thoroughbred industry, there has long been an empirical theory that heart size is related to athletic performance, despite a lack of scientific evidence supporting this assertion. To investigate the relationship between peak oxygen consumption (VO2max) and cardiac size measured by echocardiography, guided M-mode and 2-dimensional echocardiography were performed in 17 conditioned Thoroughbreds with a range of VO2max from 126 to 217 ml/min/kg STPD (mean +/- s.d. 158 +/- 28 m/min/kg). Horses were age 2-10 years and weighed 430-510 kg. Echocardiography was performed using a Vingmed System V echocardiograph with a 2.25 MHz phased array ultrasound transducer. All images were obtained from the right hemithorax using a short axis view of the left ventricle (LV) at the level of the chordae tendinae. All horses were free from significant regurgitation at the aortic or mitral valves. Maximal oxygen uptake was measured during a standardised incremental treadmill exercise test to fatigue. Maximal oxygen uptake was correlated significantly with LVIDd (r = 0.71; P = 0.001), MWT (r = 0.72; P = 0.001), LV mass (r = 0.78; P = 0.0002) and LV short-axis area (r = 0.69; P = 0.003). When indices of heart size were indexed to bodyweight, the correlation between VO2max and indices of heart size were LVIDd (r = 0.57; P = 0.01), MWT (r = 0.44; P = 0.07), LV mass (r = 0.78; P = 0.0002) and LV short-axis area (r = 0.69; P = 0.003). The current study suggests there is a strong relationship between VO2max and measurements of left ventricular size in Thoroughbred horses when individuals with a range of VO2max are compared.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.2042-3306.2002.tb05467.x

L. E. Young

Papers

Recommendations for Management of Equine Athletes with Cardiovascular Abnormalities

Risk factors for anaesthetic-related death in cats: results from the confidential enquiry into perioperative small animal fatalities (CEPSAF)

Cardiac responses to training in 2-year-old Thoroughbreds: an echocardiographic study

Measurement of cardiac function by transthoracic echocardiography: day to day variability and repeatability in normal Thoroughbred horses

Heart size estimated by echocardiography correlates with maximal oxygen uptake