Abstract Background No study has described the computed tomographic (CT) sinonasal findings in a large cohort of referred sinonasal disease cases. Objectives To report the CT imaging findings in equine sinonasal disease and examine associations between case outcome and CT findings. Study Design Retrospective case series. Methods Data were collected from medical records from 19 equine hospitals on sinonasal disease cases which had undergone CT imaging. Case outcome was obtained from clinical records, and/or by contacting clients and referring veterinarians. Multivariable logistic regression analysis was used to examine variables at presentation associated with case outcome. Results The 1600 cases of sinonasal disease had unilateral sinusitis in 1457 and bilateral sinus disease in 143. The rostral maxillary sinuses (86.1% affected) and ventral conchal sinuses (74.8% affected) were most commonly involved. Fluid attenuation or distortion of the ventral nasal conchal bullae (NCB) was present in 21.3% and 39.3% of cases, respectively, and of the dorsal NCB, in 16.5% and 28.4% of cases, respectively. Hyperostosis (inflammatory thickening) of sinus‐related bones was mild in 35.5%, moderate in 19.8%, severe in 8.7%, and absent in 36.1% of cases. A total of 659 non‐fractured and 200 fractured apically infected teeth were found. The normal contralateral sinuses in 100 horses showed CT evidence of endodontic/apical infection in 114 cheek teeth. The multivariable model was built with data from 674 cases. Cases with apically infected non‐fractured (odds ratio [OR] 2.15, 95% confidence interval [CI] 1.41–3.29) or fractured teeth (OR 2.03, 95% CI 1.08–3.81) (i.e., dental sinusitis) had a higher likelihood of cure than those that did not. Cases with caudal group sinusitis (OR 0.48, 95% CI 0.29–0.80) or moderate or severe bone hyperostosis (OR 0.53, 95% CI 0.36–0.78) had a lower likelihood of cure than those without. Main Limitations Retrospective study with incomplete data available for some cases. Conclusions Maxillary cheek teeth endodontic/apical infection does not always cause sinusitis. Sinus bone hyperostosis and caudal group sinusitis are associated with a lower likelihood of cure, whereas apical infections are associated with a higher likelihood of cure.
Abstract Background No large study has described the signalment, pre‐referral management or clinical and nasal endoscopic findings in equine sinonasal disease. Objectives To explore associations between case outcome and signalment, pre‐referral treatments, clinical and nasal endoscopic variables in sinonasal disease. Study Design Retrospective case series. Methods Data were collected from medical records of 19 equine hospitals on sinonasal disease cases they had examined and which had undergone computed tomographic (CT) imaging. Case outcome was obtained from clinical records and/or by contacting clients and referring veterinarians. Multivariable logistic regression analysis was used to examine variables at presentation associated with case outcome. Results One thousand six hundred cases met inclusion requirements, including 1457 cases of unilateral and 143 cases of bilateral sinonasal disease. Most were chronic disorders (median duration 17.9 weeks). The most common antimicrobials administered pre‐referral were potentiated sulphonamides, doxycycline and procaine penicillin. Pre‐referral surgical treatments included maxillary cheek tooth extraction ( n = 234 teeth) in 201 horses (12.6%), sinoscopy (11.8%), nasofrontal sinus osteotomy (5.2%) and maxillary sinus osteotomy (3.6%). Nasal airflow was obstructed in 14.9%, and facial swelling was present in 26.9% of cases. Nasal endoscopy showed exudate at the sinonasal ostium in 65.8% of cases, and middle meatus abnormalities, including inspissated exudate, sequestra and sinonasal fistulae, were present in 44.6%. A multivariable model was built with data from 650 cases. Age at presentation greater than 12 years (odds ratio [OR] 0.53, 95% confidence interval [CI] 0.36–0.79), sinonasal disease of over 8 weeks duration (OR 0.63, 95% CI 0.42–0.94), nasofrontal sinusotomy prior to referral (OR 0.36, 95% CI 0.16–0.81) and presence of facial swelling or bilateral nasal discharge at presentation to a referral centre (OR 0.33, 95% CI 0.18–0.62) were significantly associated with a decreased chance of complete cure. Main Limitations This was a retrospective study with incomplete data for some cases. Conclusions Equine sinonasal disease cases aged over 12 years old, with disease of over 8 weeks duration or having had nasofrontal sinusotomy prior to referral had a decreased chance of complete cure following referral.
Abstract Cardiac arrhythmias are common in healthy athletic horses and may lead to poor athletic performance or exercise-associated sudden death. Early detection of high-risk horses is an important goal of cardiovascular diagnostics. We hypothesised that non-linear analysis of electrocardiogram disorderliness can be used to identify horses exhibiting intermittent ectopic atrial and ventricular heart rhythm abnormalities at exercise using brief, artifact-free recordings of normal sinus rhythm electrocardiograms collected at submaximal heart rates. In a convenience prospective cross-sectional study, ambulatory electrocardiograms were recorded using the Televet 100 or II devices from 110 Thoroughbred or Standardbred racehorses during routine training. Acceptable quality 60 s electrocardiogram strips with stable heart rate (20–120 beats per minute) were identified automatically. Disorderliness of the electrocardiograms was estimated using Lempel–Ziv’76 and ’78, and Titchener complexity, and Shannon, sample, and approximate entropy algorithms. Numerical estimates obtained by these algorithms were corrected to the heart rate. For the optimal performance recordings of 60–100 beats per minute should be used, with Lempel–Ziv ’76 complexity, R peak and ends of S and T peaks as fiducial points. The receiver operating curve analysis has demonstrated the area under curve of 0.86 for this combination, indicating acceptable differentiation between cases and controls.
Abstract Background Cardiac arrhythmias in healthy athletic horses are common. In horses, like in humans, arrhythmias that develop during exercise lead to poor athletic performance and are thought to lead to exercise-associated sudden death. Due to the intermittent nature and potential high risk associated with these arrythmias, early detection of high-risk horses is an important goal of cardiovascular diagnostics. We have demonstrated that non-linear methods assessing the disorderliness of equine electrocardiograms (ECG), using brief, artifact-free recordings of normal sinus rhythm ECG might be used to identify horses with past episodes of paroxysmal atrial fibrillation (PAF). Purpose We hypothesised that ECG complexity-based techniques might be productive in identification of horses exhibiting intermittent ectopic atrial and ventricular heart rhythm abnormalities triggered by pathophysiological mechanisms different from PAF. Methods In a convenience prospective cross-sectional study, ambulatory ECGs were recorded using the Televet 100 or II devices from 91 Thoroughbred or Standardbred racehorses during routine training sessions. During these sessions the heart rate exceeded 100 bpm for 15-20 minutes and was in the 60-100 bpm range for the rest of the time. Horses classified as cases had at least five premature depolarizations and/or at least one episode of complexity, including couplets, triplets, and/or supraventricular or ventricular tachycardia during high intensity exercise (heart rate > 180 beats per minute) or immediately after exercise; horses classified as cases had less than five premature complexes before, during, and after exercise. Acceptable quality 60-second ECG strips with stable heart rate (20-120 beats per minute) were identified automatically. Disorderliness of the ECG was estimated using Lempel-Ziv’76 and ’78, and Titchener complexity, and Shannon, sample, and approximate entropy algorithms, using several data preprocessing algorithms to highlight the role of individual fiducial points within the ECG waveform. Numerical values obtained by complexity estimation algorithms were corrected to the heart rate. Results We found that for optimal diagnostic performance recordings of 60-100 beats per minute should be used. The best-performing algorithm used Lempel-Ziv ’76 complexity, with R peak and ends of S and T peaks as fiducial points. The receiver operating curve analysis has demonstrated the area under curve of 0.86 for this combination, indicating acceptable differentiation between cases and controls, with sensitivity of 85.7% (confidence interval, CI 59.8-100%), specificity 83.3% (CI 73.9%-92.8%), positive predictive value of 37.5% (CI 13.8- 61.2%) and negative predictive value of 98.0% (CI 94.2-100%). Conclusions Our findings suggests that non-linear analysis could be a useful screening tool to identify racehorses that should undergo exercising ECGs to determine the frequency and severity of exercising cardiac arrhythmias.
