Exercise-induced pulmonary hemorrhage (EIPH) occurs commonly in horses performing high-intensity exercise, particularly among racehorses.
The diagnosis is based on the detection of blood in the tracheal lumen after high-intensity exercise and/or the presence in the bronchoalveolar lavage fluid (BALf) of red blood cells or hemosiderophages.
EIPH is characterized by bleeding in the alveoli, veno-occlusive remodeling, and inflammation. Pulmonary vessels remodeling is characterized by excessive deposition of collagen, hypertrophy of the smooth muscles, intimal hyperplasia, and increased stiffness with reduced vascular compliance. All these changes predispose to other episodes of bleeding, consequent airways inflammation, and hypertension.
The Pulmonary Artery Stiffness (PAS) is a non-invasive echocardiographic index of pulmonary artery elasticity that allows to assess the structural features and function of the pulmonary vascular bed.
In human medicine, it is mainly used as an early predictor of pulmonary hypertension in patient with chronic pulmonary diseases, such as asthma, which can lead to remodeling of the pulmonary vessel wall over time.
In veterinary medicine, the feasibility of echocardiographic PAS measurement in horses by pulse-wave Doppler echocardiography was demonstrated. Moreover, PhD research conducted on PAS in asthma affected horses, showed significant higher PAS values in severe Equine Asthma affected horses compered to healthy subjects and mild Equine Asthma affected ones. Furthermore, the same study found a positive correlation in asthmatic horses between PAS and pulmonary artery diameter to aorta diameter ratio (PAD/AOD), an indirect index of pulmonary hypertension.
Therefore, the aims of this research are to evaluate PAS in racehorses with EIPH and detect differences between healthy and affected horses; to detect the correlation between PAS and the severity of EIPH; and to evaluate the association between PAS and pulmonary pressure measured invasively.
This study will be conducted on client-owned horses admitted to the University Hospital.
Inclusion criteria include racehorses in training and sport activity, in which a diagnosis of EIPH can be made by cytology of BALf.
Exclusion criteria include horses affected by pulmonary diseases, other than EIPH, and primary cardiac diseases. Furthermore, healthy horses will be selected according to the absence of history, clinical and instrumental signs of respiratory or cardiac diseases. BALf collection and cytology will be performed.
The hemosiderin content of pulmonary macrophages will be scored from 0 to 4 and the Total Hemosiderin Score (THS) will be calculated to diagnose EIPH and score it in different severity grades.
Echocardiography will be performed, and PAS will be measured non- invasively by pulse-wave Doppler echocardiography from the right parasternal short- axis view at the level of the pulmonary artery. Moreover, pulmonary artery pressure will be measured invasively by means of a flow-directed balloon catheter, connected with a pressure transducer, introduced into the pulmonary artery.
Statistical analyses will be performed to compare difference in PAS values between healthy horses and horses affected by EIPH.
Moreover, the evaluation of PAS values among different grades of EIPH will be performed. Finally, the possible correlation between PAS and pulmonary artery pressure in horses with EIPH, and PAS reference range in healthy horses will be detected.
MSc in Veterinary Medicine (February 2022) at the University of Milan. Her thesis regarded Strain and Shear Wave Elastography of parenchymatous and glandular organs in horses (Supervisor: Prof. Enrica Zucca).
After graduation, she attended the Equine Medicine Unit of the Veterinary Hospital (University of Milan UNIMI). The results of her degree’s thesis were presented at the LXXV SISVET Congress.
She obtained the professional license in July 2022. Deep interest in equine internal medicine, especially on cardiology and equine sport medicine.
Publications: Orcid ; IRIS-AIR
Supervisor Prof. Enrica Zucca
