Efeito do tratamento com benazepril e carvedilol administrado de forma isolada e em associação com treinamento físico supervisionado sobre a evolução clínica de cães com insuficiência mitral crônica naturalmente adquirida / Effect of benazepril and carvedilol treatment alone and in association with a supervised physical training in the development of naturally acquired chronic mitral valve regurgitation in dogs

Mario Marcondes dos Santos

INTRODUCTION: Sympathetic activation is present in patients having chronic mitral valve regurgitation even in asymptomatic ones. However, the effect of beta- blockers and a physical training program to modulate this sympathetic activation during this valve disease is unknown. The objective of this study has been to evaluate the effect of carvedilol and a physical aerobic training in the development of chronic mitral valve regurgitation in an experimental model of the disease in dogs. Moreover, the objective sought for some death predict variables in these dogs. METHODS: 10 healthy dogs were selected to evaluate the normal parameters. The other 36 chronic valve mitral regurgitation dogs were divided into 3 sub-groups (I, II e III). From the beginning of the study (T0) to 6 months (T2) all of them received the conventional treatment (Benazepril and Digoxine, codeine, diuretic when necessary). In the sub-group II (n=10) and III (n=13) the carvedilol was added to the treatment during all the study. In the sub-group I (n=13) and II, after the first 3 months (T1) the physical supervised training was added. The main clinical variables (number of interoccurrences, body weight, quality of life estimated by FETCH questionnaire, heart rate, cardiac rhythm, functional classification of heart failure, systolic and diastolic blood pressure), laboratory variables (norepinephrine, troponin I, sodium, urea, creatinine) and echodopplercardiographic variables were evaluated. RESULTS: The analyzes of the clinic variables showed an improvement in the quality of life (FETCH) in all the sub-groups: (T0= 5,56±4,67 vs T2=2,67±3,12; p<0,05), II (T0= 11,29±5,12 vs T2= 3± 3,32; p,0,05); III (T0= 15,50±9,94 vs T1=5 ±3,21 e T0 vs T2=4,25± 2,82; p<0,05). The heart rate (beats/min) results showed differences (p=0,023) in the sub-groups I (T0=139,44±22,97 vs T2=126,67±12,25), II (T0=128,57±31,32 vs T2=117,14± 25,63) and III (T0=142,50±53,39 vs T2=117,75±28,92). However, the other clinic, laboratory and echodopplercardiographic variables did not show any differences. The group of animals that died in comparison with the survivor group showed high values in some variables, as follows: FETCH (23,67±9,66 vs 10,54±7,93; p<0,001), norepinephrine (684±378,12 vs 456,54±439,16 pg/ml; p=0,018) , troponin I (0,37 ±0,39 vs 0,09±0,14 ng/ml; p=0,007), heart rate (158,33 ±22,5 vs 137,29 ±36,62 beats/min; p=0,041), diastolic left ventricular dimension (4,06±1,26 vs 3,06±0,78 cm; p=0,024), systolic left ventricular dimension (2,19± 0,84 vs 1,60±0,51 cm; p= 0,041) and left atrium to aortic root ratio (2,04± 0,39 vs 1,52±0,25; p<0,001). The death group in its majority comprehended male dogs in functional classification III-IV having sympathetic cardiac rhythm. The selected death predict variables were: left atrium to aortic root ratio, FETCH and sympathetic cardiac rhythm. CONCLUSION: The association of carvedilol as well as supervised physical training with the conventional treatment in dogs having chronic mitral valve regurgitation provided the improvement in quality of life but not in survival time and a decrease in the heart rate. The selected death predict variables were: left atrium to aortic root ratio, FETCH and sympathetic cardiac rhythm.

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