| Background With the increase of domestic cat population,a variety of genetic diseases of domestic cats are more prominent,among which Feline Hypertrophic cardiomyopathy(FHCM)is a common clinical feline cardiomyopathy.When FHCM enters the clinical stage,Acute Pulmonary edema(APE)is often complicated,congestive heart failure and arterial thrombosis can occur in a short time,and sudden death is easy to occur in critical cases.Therefore,screening of rapid diagnostic indicators of APE secondary to FHCM has strong clinical significance.Drug therapy can relieve the symptoms of APE cats secondary to FHCM,but the therapeutic effect is not ideal.At present,oxygen therapy has been introduced to assist drug therapy to alleviate the symptoms of APE secondary to FHCM.The commonly used oxygen therapy methods include ordinary oxygen chamber and hyperbaric oxygen chamber.Among them,the ordinary oxygen chamber can meet the 24 h oxygen treatment,which can alleviate the symptoms of hypoxia in animals to a certain extent.Hyperbaric oxygen chamber treatment can further improve ischemia and hypoxia and relieve pulmonary edema to a greater extent on the basis of drug therapy and common oxygen chamber treatment.However,there is no research report on the efficacy of normal oxygen chamber and hyperbaric oxygen chamber with different pressure in the treatment of this disease.The purpose of this study was to screen the indicators for rapid diagnosis of APE secondary to FHCM in emergency department and explore the efficacy of hyperbaric oxygen chamber with different pressures on cats with APE secondary to FHCM.MethodExperiment 1 Epidemiological analysis and screening of rapid diagnostic indicators of acute pulmonary edema secondary to hypertrophic cardiomyopathy in cats.Clinical symptoms,chief complaint history,clinical examination indicators,hematology indicators and imaging indicators were collected from 63 cats diagnosed with APE secondary to FHCM and 30 healthy cats during physical examination from December 2019 to April 2022,including: Clinical examination indicators(RR for resting respiration,HR for heart rate,MAP for mean pressure,T for body temperature),blood routine(RBC count RBC,PCV for Hematocrit,WBC for WBC,Neutrophil count Gran for Lymph),inflammatory indicators(serum amyloid A SAA),Blood biochemical(alkaline phosphatase ALP,creatine kinase CK,alanine aminotransferase ALT,aspartate aminotransferase AST,creatinine Cr),blood biomarkers(serum lactate LAC,amino terminal brain natriuretic peptide precursor NT-pro BNP),Emergency cardiac ultrasound(left ventricular diaphragm wall and free wall thickness IVSD and LVFWd,left atrium and aorta longest axis ratio LA/AO,left ventricular ejection fraction and systolic fraction LVEF and LVFS),real-time pulmonary ultrasound(count of positive sites of pulmonary edema LUS positive sites,real-time pulmonary ultrasound score LUS score),Chest radiographs(TXR score for lung injury).To analyze the differences between the above indicators in sick and healthy cats,and screen the indicators that can rapidly diagnose FHCM secondary to APE in cats in emergency.Experiment 2 To observe the therapeutic effect of hyperbaric oxygen chamber on pulmonary edema secondary to hypertrophic cardiomyopathy in cats.Cats diagnosed with APE secondary to FHCM were divided into the normal oxygen chamber treatment group(NOCT,n=13)and the hyperbaric oxygen chamber treatment group(HOCT,n=50)according to the pet owners’ desire for treatment.In addition to using the same basic treatment drugs,the NOCT group was given 24 hours of oxygen inhalation in a general oxygen chamber(the oxygen chamber was set at 28℃with 50% humidity and 60% oxygen concentration),while the HOCT group was given0.20-0.30 mpa in accordance with the treatment recommendations of the hyperbaric oxygen chamber,with the temperature kept at 28℃ and the humidity kept at 50%.The oxygen concentration gradually rose to 100% after 10 min of chamber closure,and the pressure gradually rose to the preset target pressure within 30 min of chamber closure.The cases in the HOCT group were randomly divided into HOCT1 group(pressure value of hyperbaric chamber 0.20 MPa,n=15)and HOCT2 group(pressure value of hyperbaric chamber 0.25 MPa,n=17)and HOCT3 group(pressure value of hyperbaric oxygen chamber 0.30 MPa,n=18).Cats in the three groups received oxygen inhalation in ordinary oxygen chamber for 22 hours and hyperbaric oxygen chamber under different pressure for 2 hours.The four groups underwent the above treatment for 3days each.Blood biomarkers(LAC),clinical signs(RR,HR,MAP,T,mental state score,mortality assessment APPLE score,percutaneous oxygen saturation Sp O2)before and after treatment were collected and analyzed.Emergency cardiac ultrasound(IVSD,LVFWd,LA/AO,LVEF,LVFS),immediate pulmonary ultrasound(LUS positive site,LUS score),and chest(TXR score)were used to compare and analyze the differences and correlation of indicators within and between groups before and after treatment.ResultsIn experiment 1 In the emergency department,the cats with APE secondary to FHCM were mostly young and juvenile male British shorthair cats,who were treated for dyspnea and were seen in hospital with cyanosis of visible mucous membranes,melancholia,and hind limb motor disorders.RR,HR,MAP,LAC,NT-pro BNP,IVSD,LVFWd,LUS positive sites,LUS score and TXR scores were significantly different among groups(P<0.01),and there were significant differences among T groups(P<0.05).However,there were no significant differences in blood routine indexes,inflammatory indexes,biochemical indexes,LA/AO,LVEF and LVFS among groups(P>0.05).Among different types of pulmonary edema,disseminated pulmonary edema secondary to APE of FHCM was the most common,accounting for 71.43%.LUS score of pleural effusion was significantly higher than that of multifocal and multifocal pulmonary edema(P<0.05),TXR score was significantly higher than that of diffuse and multifocal pulmonary edema.In comparison of LUS positive sites,there were significant differences between diffuse pulmonary edema and multifocal pulmonary edema(P<0.05),and there were significant differences between focal pulmonary edema and pleural effusion(P<0.05).In experiment 2 There were significant changes in RR,HR,MAP,LAC,Sp O2,TXR score,LUS positive site,LUS score,mental state and APPLE index in HOCT group and NOCT group before and after treatment(P<0.01).T was significantly changed in HOCT group(P<0.05).There were no significant changes in emergency cardiac ultrasound indexes: IVSD,LVFWd,LA/AO,LVEF and LVFS(P >0.05).After treatment,MAP,APPLE score,Sp O2,LAC,LUS score and TXR score in HOCT1,HOCT2 and HOCT3 groups showed significant or extremely significant changes compared with NOCT group(P<0.05 or 0.01).The LUS positive sites and LUS score in HOCT3 group were significantly decreased compared with the other three groups(P<0.01),and the RR and Sp O2 in HOCT2 and HOCT3 groups were significantly lower than those in NOCT group(P<0.05).Correlation analysis showed that APPLE was positively correlated with TXR score,LUS score,LUS positive site,RR,mental state,LAC and HR(P<0.01),and APPLE was negatively correlated with Sp O2,T and MAP(P<0.01).LUS positive sites were significantly positively correlated with TXR score,LUS score,RR and LAC(P<0.01),significantly positively correlated with LA/AO(P<0.05),negatively correlated with Sp O2 and LVFS(P<0.01),and had no correlation with IVSD,LVFWd and LVEF(P>0.05).Conclusion(1)FHCM secondary APE cat common male young British shorthair cat,into the onset period will usually suddenly appear dyspnea,melancholia,blue mucous membranes and other symptoms.FCU,LUS score,TXR score,NT-pro BNP,LAC index can be used for rapid diagnosis of FHCM secondary APE cats;(2)Hyperbaric oxygen chamber treatment under different pressures showed good therapeutic effect on acute pulmonary edema secondary to hypertrophic cardiomyopathy in cats,and the best therapeutic effect was under 0.30 MPa pressure.(3)The area with the highest rate of edema elimination observed in LUS was LPh,which could be used as the key area to observe remission of APE in emergency. |
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