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Original Article
Abstract
Objectives The aim of this study was to evaluate, using echocardiography, the effects of oral administration of a
single dose of gabapentin on the physiologic variables (heart rate [HR], respiratory rate [RR] and systolic blood
pressure [SBP]) and systolic and diastolic cardiac function of healthy cats.
Methods This was a prospective, randomized and blinded study with 40 healthy cats aged between 6 months
and 2 years. The cats’ health status was assessed on the first appointment (T1) when they underwent a physical
examination, complete blood count, biochemical profile, assessment of physiologic variables and echocardiogram.
The echocardiogram was used to measure the left ventricle’s (LV) internal diameter during systole and diastole,
isovolumic relaxation time, transmitral flow, E-wave deceleration time and HR. The cats were randomly divided
into two groups: (1) a treatment group with 20 cats that received a single oral dose of gabapentin (100 mg/cat);
and (2) a control group with 20 cats that received a single oral dose of placebo. All variables of the physiologic
and echocardiographic variables were re-evaluated 1–3 weeks after T1 (T2), 90 mins after medication or placebo
administration.
Results There was no difference in the physiologic variables evaluated in both groups. The proportion of cats in
the treatment group that had their ventricular filling waves fused on T1 but did not have them fused on T2 was
significantly higher (45%) compared with cats in the control group (15%; P = 0.0384).
Conclusions and relevance There was no difference between the groups in regard to SBP, HR, RR and
echocardiographic variables. Gabapentin improved evaluation of diastolic function on echocardiogram because it
reduced the fusion of ventricular filling waves during the evaluation of the diastolic function of the LV. Gabapentin
did not cause adverse effects on the cardiovascular hemodynamics of young healthy cats.
1Post Graduation Program in Veterinary Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
2Graduation Program in Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
3Department of Statistics, Institute of Mathematics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
4Veterinary Teaching Hospital, School of Veterinary Medicine, Lutheran University of Brazil, Porto Alegre, Brazil
5Department of Animal Medicine, Faculty of Veterinary, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Corresponding author:
Fernanda VA da Costa DVM, MSc, PhD, Department of Animal Medicine, Faculty of Veterinary, Federal University of Rio Grande do
Sul, Av Bento Gonçalves, 9090, Porto Alegre, Rio Grande do Sul, 91540-000, Brazil
Email: fernanda.amorim@ufrgs.br
Veronezi et al e499
Assessment of the degree of relaxation/sedation, fraction (SSF) and the ejection fraction (SEF) of the LV.
and respiratory and heart rates From the apical four-chamber view, in the left parasternal
During the initial physical examination, the degree of window, along the longitudinal axis, the sample volume
relaxation/sedation was assessed to confirm an adequate of the pulsed Doppler was positioned between the tips
effect of gabapentin. Subjective assessment of patient of the mitral valve leaflets to measure the transmitral
behavior after gabapentin ingestion, such as adherence flow in diastole and to evaluate the diastolic function.
to restraint and degree of spontaneous mobility, was com- The early transmitral flow peak (E-wave), late transmitral
pared with baseline parameters at T1. Afterward, the RR flow peak (A-wave) and E-wave deceleration time (EDT)
was measured by inspecting and counting the respiratory were measured. The ratio between the E-wave value and
movements at a distance, without restraining the cat. HR the A-wave value (E:A) was recorded. In cats whose E-
was then determined through cardiac auscultation with and A-waves fused, the maximum velocity of the fused
a stethoscope. Restraint was kept to a minimum and the wave and its pressure gradient were obtained. From the
cat received a massage on the head, around the ears and five-chamber view, with the sample volume inside the LV,
under the chin. At this time, a pulmonary auscultation between the septal leaflet of the mitral valve and the LV
was also performed. For each variable, three consistent outflow, the transmitral and aortic flows were registered
measurements were performed, after excluding the first to obtain the isovolumic relaxation time (IVRT).
outliers, thus obtaining an average value. After obtaining the ventricular filling waves through
transmitral flow, the echocardiographic device calculated
Non-invasive assessment of SBP the distance between one E-wave and the next to estimate
SBP was measured by Doppler ultrasonography follow- the HR (HR-ECHO). The HR values measured by the
ing a previously reported protocol.11 Two people per- echocardiogram were also recorded and analyzed.
formed this procedure; however, the same experienced All the aforementioned variables were measured three
veterinarian measured the SBP in every cat. The cuff was times in order to calculate the mean values. The images
measured according to 30–40% of the circumference of were stored digitally and analyzed remotely.
the cat’s forelimb on the left thoracic limb. The cat was
gently restrained using a towel in a way that did not Statistical analysis
excessively restrict its movements, following a previ- A descriptive analysis was performed by calculating: (1)
ously reported protocol.12 Headphones were used to the mean ± SD of the quantitative variables; and (2) the
prevent the sound of the device from frightening the proportions of the qualitative variables. To compare both
cat. The first assessment of SBP was discarded. Then, groups, the difference (delta) between the quantitative
five additional assessments were performed that had variables in T1 and T2 was calculated and then a t-test was
consistent values, indicating that the variability between used to compare the means of the independent samples.
each was <20%. The mean value was then calculated and The Shapiro–Wilk test was used to assess the normality
recorded.11 of the distributions. The assumption of homoscedasticity
of the data was also verified. A binary qualitative variable
Echocardiography was created to label the ventricular filling waves as either
The echocardiographic examination was performed after ‘fused’ or ‘unfused’ in T1 and T2. Based on the new quali-
the assessment of the physiologic variables and the SBP. tative variables, a test to compare the proportions was
Both were performed at the Feline Medicine Service at the performed. The z-test for two independent proportions,
Universidade Federal do Rio Grande do Sul’s Veterinary which is equivalent to the χ2 independence test, was car-
Teaching Hospital. The same evaluator performed the ried out. As a decision criterion, the significance level was
examination using the same ultrasound device in all cases 5%. Statistical analysis was performed using IBM SPSS
(Siemens ACUSON P500 Ultrasound System; Siemens Statistics 18 (IBM).
Healthineers). A sector transducer at a frequency of
4–8 MHz was used. The cat’s thorax had been previ- Results
ously shaved, to improve visualization of the echocar- Forty-two cats were initially selected to participate in the
diographic images. The cat was first positioned in right study; however, two went on to be excluded. The reasons
lateral recumbency and then in left lateral recumbency for the exclusion were the presence of the phenotype of
on a table that was specifically designed for the echocar- hypertrophic cardiomyopathy and clinical suspicion of
diographic examination. The table had an opening in the pyometra. This resulted in a total of 40 cats that met the
center to allow the correct positioning of the transducer inclusion criteria. Of these 40 cats, 20 were female and
on the cat’s thorax. 20 were male. The cats’ mean age was 10 months (range
The LV variables were analyzed. In the right paraster- 6–24). The cats did not belong to any specific breed. Mean
nal window, along the transverse axis, the systolic and weight was 3.22 kg (range 2.065–5.32). Patients received
diastolic diameters of the LV were measured to obtain the capsule at home approximately 90 mins before the vet-
indicators of systolic function, such as the shortening erinary appointment (Table 1). Mean dose of gabapentin
Veronezi et al e501
Figure 1 Mean respiratory rate (RR), heart rate (HR), HR measured by the echocardiogram (HR-ECO) and systolic blood
pressure (SBP) in the treatment group (gabapentin, 20 cats) and the control group (placebo, 20 cats) at T1 (before treatment)
and T2 (after treatment)
e502 Journal of Feline Medicine and Surgery 24(12)
Table 2 Descriptive statistics for the echocardiographic sedation,17 which would be ineffective in overly nervous
variables in the treatment (gabapentin) and control and scared cats. A recent study evaluated the effects of
(placebo) groups at time 1 (T1; before treatment) and time oral trazodone before the assessment of physiologic and
2 (T2; after treatment)
echocardiographic variables,18 and did not reveal altera-
Variable Treatment group Control group (n=20)
tions in echocardiographic rates, although SBP decreased
(n = 20) significantly. The present study demonstrated the ben-
efits of administering gabapentin as an anxiolytic before
T1 the assessment of physiologic and echocardiographic
EDT (ms) 62.6 ± 25.9 (25–138) 59.9 ± 16.0 (33–83) variables.
IVRT (ms) 34 ± 9.4 (21–53) 34.6 ± 9.8 (21–58) Since most cats become stressed under echocardio-
LV_SSF (%) 59.5 ± 9.9 (43.3–76.9) 58.7 ± 7.0 (42.9–69.3) graphic examination, tachycardia is a common occur-
LV_SEF (%) 90.1 ± 6.6 (77.3–97.5) 90.2 ± 4.9 (77.6–97.1) rence, which leads to a partial or complete fusion of early
and late ventricular filling waves and an HR >170 bpm.
T2
In this study, an HR >180 bpm, measured by the echocar-
EDT (ms) 61.4 ± 19.9 (34–113) 65.5 ± 23.4 (28–125) diogram, resulted in partial or complete fusion of the
IVRT (ms) 39.2 ± 14.4 (17–71) 37.6 ± 7.1 (29–56) ventricular filling waves in most cats. The sum of the
LV_SSF (%) 58.0 ± 10.9 (36.3–75.8) 55.3 ± 8.9 (40.3–71.3) flow waves leads to interpretation errors and thus must
LV_SEF (%) 88.9 ± 7.6 (70.7–98.3) 87.6 ± 6.5 (73.6–97.0) be avoided in the assessment.19 Therefore, an anxiolytic
would be beneficial for cats that are agitated or scared,
Data are presented as mean ± SD (range)
EDT = E-wave deceleration time; IVRT = isovolumic relaxation time; because the calmer the cat, the lower the probability of
LV_SSF = left ventricular fractional shortening; LV_SEF = left ventricular fusing of ventricular filling waves (E and A).14,20
ejection fraction In this study, the proportion of cats in the treatment
group that had their ventricular filling waves fused in T1
but not in T2 was significantly higher (45%) compared
Table 3 Descriptive statistics of heart rate (HR) measured with cats in the control group (15%). Using gentle han-
with the stethoscope and the echocardiogram in treatment dling and minimal restraint on cats can help to allevi-
(gabapentin) and control (placebo) groups at time 1 ate stress and prevent E- and A-waves from fusing. The
(T1; before treatment) and time 2 (T2; after treatment)
anxiolytic effect can also be beneficial for agitated cats.19
Variables Treatment group Control group Both factors were considered in this study, which might
(n = 20) (n = 20) have contributed to the statistical difference between
both groups. In contrast, the decrease in HR was evi-
T1 T2 T1 T2 dent in both groups in T2, with no difference between
HR (bpm) 192 ± 16 185 ± 19 196 ± 22 188 ± 21 them, as attested by both the stethoscope examination
HR-ECHO (bpm) 199 ± 18 178 ± 21 199 ± 25 189 ± 29 and the echocardiogram. Nevertheless, the treatment
group showed a higher tendency of not fusing the ven-
Data are presented as mean ± SD tricular filling waves. A possible cause for this is that the
HR = heart rate;
HR obtained in the echocardiographic examination was
HR-ECHO = heart rate measured on echocardiography;
bpm = beats/min 10.3 bpm lower than the HR obtained with the stetho-
scope. The difference was not statistically significant,
but the decrease in HR must be considered because it
tone,8 since cats were already familiar with the clinic’s can influence the fusion of the ventricular filling waves.
environment and may have been less anxious at T2. According to Schober and Chetboul,19 the complete or
According to previous studies, other sedatives cause partial fusion of the ventricular filling waves can occur
considerable hemodynamic alterations that hinder correct with an HR >170 bpm. In the present study, the fusion
interpretation of the physiologic and echocardiographic of the ventricular filling waves was observed with an HR
variables.14–18 One study suggested that a combination >180 bpm in most cats in the treatment group. A recent
of butorphanol and ketamine resulted in a significant study demonstrated a slight decrease in HR after a 100 mg
increase in HR. Moreover, a combination of butorpha- dose of gabapentin.1 A decrease in HR, even if clinically
nol and acepromazine leads to a significant decrease irrelevant, might prevent the ventricular filling waves
in SBP.14 Acepromazine – a phenothiazine derivative – from fusing, which was evident in cats in the treatment
can cause paradoxical excitement and hypotension.15 group at T2.
Butorphanol could be used before the echocardiogram Gabapentin did not affect systolic function. A recent
since its agonist–antagonist effects cause sedation, anal- study demonstrated a decline in the systolic function of
gesia and low cardiorespiratory depression.16 However, if healthy cats that received sedative doses of gabapentin.
butorphanol is administered alone, it only provides light However, all the variables that were measured remained
Veronezi et al e503
within the existing reference intervals.8 Similarly, the pre- affect the cardiovascular hemodynamics of healthy
sent study found a slight decline in the systolic function young cats. Gabapentin improved the evaluation of the
of the LV in the treatment group. In this study, there was diastolic function on echocardiogram because it reduced
no difference between the two groups in relation to the the fusion of the ventricular filling waves during the eval-
EDT. Some researchers have argued that an increase in uation of the diastolic function of the LV. For this reason,
HR does not affect EDT in cats or humans.21,22 However, gabapentin can be considered as an anxiolytic for healthy
other researchers have reported an increase in HR fol- young cats before a veterinary visit and echocardiogram.
lowed by a decrease in EDT in cats and humans.23,24 In the
present study, it was not possible to prove the increase in Conflict of interest The authors declared no potential
EDT with the reduction in HR. The results of this study conflicts of interest with respect to the research, authorship,
are inconclusive regarding whether EDT really increases and/or publication of this article.
under the effect of gabapentin. A study with a larger sam-
ple of animals is necessary to validate the hypothesis. Funding This study was supported by grants from the
National Council for Scientific and Technological Development
A previous study reported that the higher the HR, the
(CNPq; grant number: 131701/2018-5).
lower the IVRT.19 This is because the sympathetic stimu-
lus – which results in tachycardia – might decrease the
Ethical approval The work described in this manuscript
diastolic filling time and thus increase the velocity of the involved the use of non-experimental (owned or unowned)
early diastolic elastic recoil of the LV.21 Based on this study animals. Established internationally recognized high standards
alone, it is not possible to confirm whether the increase (‘best practice’) of veterinary clinical care for the individual
in IVRT in T2 was caused by gabapentin, though it might patient were always followed and/or this work involved the
be related to a decrease in HR, which was seen in cats in use of cadavers. Ethical approval from a committee was there-
both groups. One study has claimed that HR does not fore not specifically required for publication in JFMS. Although
influence IVRT, but their study only had a small sample, not required, where ethical approval was still obtained, it is
diminishing its statistical power.24 IVRT varies with age: stated in the manuscript.
it is lower in young cats and higher in older cats.19 In this
study, it was unlikely that age affected the results since Informed consent Informed consent (verbal or written)
was obtained from the owner or legal custodian of all animal(s)
all cats were <2 years of age.
described in this work (experimental or non-experimental
This study has some limitations. First, a single measure-
animals, including cadavers) for all procedure(s) undertaken
ment of variables was performed after treatment, which (prospective or retrospective studies). No animals or people are
may not have corresponded to the peak of action of gabap- identifiable within this publication, and therefore additional
entin. Another point is that we analyzed a small number of informed consent for publication was not required.
healthy cats, and thus it cannot be assumed that gabapentin
will not have an effect on the physiologic and echocardio- ORCID iD Leandro Fadel https://orcid.org/0000-0002-
graphic variables of older cats or cats with heart disease. 7506-9307
In addition, owing to the small sample of the study, the Fernanda VA da Costa https://orcid.org/0000-0002-1031-7728
statistical power was reduced. Another limitation is that
the results of this study are based on a specific range of References
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