As many of you are aware, we continue to investigate the link between receipt of unique/boutique diets and the development of dilated cardiomyopathy (DCM). Although the exact cause has not been elucidated, a correlation between diets primarily with ‘grain-free’, legume (peas, lentils), and potato-based food sources is apparent. In some patients, this may also involve a deficiency in taurine, however many affected patients have taurine levels that measure within the normal reference range. A genetic predisposition may also play a role.
Although the incidence and extent is variable, as noted in the most recent KSU scientific sessions, improvement in cardiac size and function can occur with timely recognition, diet change, taurine supplementation, and supportive therapies (see below). Unfortunately, some patients also progress despite corresponding treatments and succumb due to complications such as congestive heart failure (CHF) and/or significant arrhythmias. As a result, an awareness of this association with appropriate diagnostics and education to our clients is essential.
Case 1: Sequential right parasternal short axis images from Stella, a 6 year old FS Goldendoodle fed a grain-free diet for the prior 18 months. On the initial evaluation on 9/11/18, she demonstrates moderate left ventricular dilation and significantly reduced systolic function (FS = 10%). Following diet change, taurine supplementation, and pimobendan therapies, she demonstrated noticeable improvement approximately 4 months thereafter (FS = 17%).
Case 2: Right parasternal short axis images from Boone, a 4 year old MN Bloodhound fed a grain-free diet his whole life. On initial evaluation also on 9/11/2018, he demonstrated severe left ventricular dilation, ventricular arrhythmias, and left-sided congestive heart failure (FS = 8%). Despite diet change, taurine supplementation, treatment for CHF (furosemide, benazepril, pimobendan), and anti-arrhythmic therapy (mexiletine and sotalol), he progressed on a subsequent recheck evaluation (FS = 7%) and ultimately died suddenly due to a fatal arrhythmia.
What to do?
As the exact cause for this phenomenon remains unclear, additional data is necessary. For cases in which there is a known or suspected nutritional cause of dilated cardiomyopathy, the following steps are advised: