Abstract
In heartworm disease, several biomarkers of cardiopulmonary injury and inflammatory activity have been studied during the recent years. D-dimer is a fibrin degradation product present after a clot is degraded, which has been reported to provide support for the diagnosis of pulmonary thromboembolism in heartworm disease. Furthermore, concentrations increment with increased disease severity and during the adulticide treatment. This increase in concentration has proved to be valuable. Cardiac biomarkers troponin I, myoglobin and NT-proBNP demonstrated presence of myocardial injury and heart failure, especially in chronic infections, which in some cases, slightly improve after the adulticide treatment. An acute phase response in dogs with Dirofilaria immitis, characterized by variations of acute phase proteins (APP), has been reported, indicating inflammatory processes that could contribute to disease progression. Among them, C-reactive protein (CRP) increases according to the severity of the disease; and a strong correlation between pulmonary hypertension and CRP has been observed. In cats, little work has been done to ascertain the utility of these biomarkers in feline heartworm; the only published study in D. immitis–seropositive cats reported significantly higher concentrations in positive APP serum amyloid A, haptoglobin and ceruloplasmin.
Highlights
Canine heartworm Heartworm disease is a vector-borne disease caused by the nematode Dirofilaria immitis
The studies evaluating this biomarker showed that between 34.8% and 47% of dogs that tested positive for D. immitis antigen had D-dimer levels above the normal range, possibly due to the thromboembolic complications caused by the infection (Fig. 3) [29, 85, 86]
The results presented evidences of thromboembolisms and/or disseminated intravascular coagulation (DIC) in class III and IV dogs and, no less important, absence in classes I and II, and demonstrated the utility that this biomarker may have in the classification of the severity of the disease in dogs infected by D. immitis
Summary
Canine heartworm Heartworm disease is a vector-borne disease caused by the nematode Dirofilaria immitis. The infection is mainly characterized by the presence of adult worms in the pulmonary arteries. Worms that have died naturally or have been killed by adulticide treatments can produce pulmonary thromboembolism, granulomatous inflammation, arterial obstruction, and vasoconstriction. Hypoxia caused by ventilation-perfusion imbalance secondary to pulmonary thromboembolism and release of vasoactive substances by vascular endothelial cells results in a prolonged vasoconstrictive status. This entire situation leads towards a hypertensive state and, as consequences, development of pulmonary hypertension and increased afterload of the right ventricle, which can produce right-sided congestive heart failure [2,3,4]
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