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Topic:Heart Rate

Heart rate in horses is a physiological parameter that reflects the number of heartbeats per minute. It is an important indicator of cardiovascular function and can be influenced by factors such as exercise, stress, excitement, and health status. Monitoring heart rate provides valuable insights into the horse's physical condition and can aid in assessing fitness levels or detecting potential health issues. In equine practice, heart rate is often measured using stethoscopes, heart rate monitors, or electrocardiograms. This page compiles peer-reviewed research studies and scholarly articles that explore the determinants, measurement techniques, and implications of heart rate variations in equine health and performance.
Pharmacokinetics and pharmacodynamics of intravenous romifidine and propranolol administered alone or in combination for equine sedation.
Veterinary anaesthesia and analgesia    February 23, 2017   Volume 44, Issue 1 86-97 doi: 10.1111/vaa.12410
Cenani A, Brosnan RJ, Madigan S, Knych HK, Madigan JE.Propranolol has been suggested for anxiolysis in horses, but its sedation efficacy and side effects, both when administered alone and in combination with α-adrenoceptor agonists, remain undetermined. This study aimed to document the pharmacokinetics and pharmacodynamics of propranolol, romifidine and their combination. Methods: Randomized, crossover study. Methods: Six adult horses weighing 561 ± 48 kg. Methods: Propranolol (1 mg kg; treatment P), romifidine (0.1 mg kg; treatment R) or their combination (treatment PR) were administered intravenously with a minimum of 1 week between treatment...
Effects of intravenous terbutaline on heart rate, arterial pressure and blood gases in anesthetized horses breathing air.
Veterinary anaesthesia and analgesia    February 23, 2017   Volume 44, Issue 1 70-76 doi: 10.1111/vaa.12377
Arcaro I, Fischer BL, Lascola KM, Clark-Price SC.To investigate the effects of intravenous (IV) administration of terbutaline on PaO, PaCO, pH, heart rate (HR) and arterial pressures in healthy, laterally recumbent horses breathing ambient air under total intravenous anesthesia (TIVA). Methods: Prospective experimental study. Methods: Eight healthy adult horses were enrolled. Six horses, four mares and two geldings weighing 433-624 kg, completed the study. Methods: Horses were sedated with xylazine (1.0 mg kg) IV for placement of arterial and venous catheters. Anesthesia was induced with midazolam (0.1 mg kg) and ketamine (2.2 mg kg) IV and ...
Monitoring training response in young Friesian dressage horses using two different standardised exercise tests (SETs).
BMC veterinary research    February 14, 2017   Volume 13, Issue 1 49 doi: 10.1186/s12917-017-0969-8
de Bruijn CM, Houterman W, Ploeg M, Ducro B, Boshuizen B, Goethals K, Verdegaal EL, Delesalle C.Most Friesian horses reach their anaerobic threshold during a standardized exercise test (SET) which requires lower intensity exercise than daily routine training. Objective: to study strengths and weaknesses of an alternative SET-protocol. Two different SETs (SETA and SETB) were applied during a 2 month training period of 9 young Friesian dressage horses. SETB alternated short episodes of canter with trot and walk, lacking long episodes of cantering, as applied in SETA. Following parameters were monitored: blood lactic acid (BLA) after cantering, average heart rate (HR) in trot and maximum H...
Horseback Riding Improves the Ability to Cause the Appropriate Action (Go Reaction) and the Appropriate Self-control (No-Go Reaction) in Children.
Frontiers in public health    February 6, 2017   Volume 5 8 doi: 10.3389/fpubh.2017.00008
Ohtani N, Kitagawa K, Mikami K, Kitawaki K, Akiyama J, Fuchikami M, Uchiyama H, Ohta M.There are many obvious health benefits to riding, including developing a strong core and legs, but there are also many less obvious benefits, such as increased confidence and introspection. Few studies have addressed the effects of horseback riding on children and the mechanisms underlying how riding affects humans. We examined the effects of horseback riding on the ability to distinguish Go/No-go tasks and solve arithmetic problems in children. Methods: The subjects were 34 boys and 72 girls, aged 10-12 years old, which were divided into three groups (horse riding, walking, and resting). Th...
Immunological, clinical, haematological and oxidative responses to long distance transportation in horses.
Research in veterinary science    January 31, 2017   Volume 115 78-87 doi: 10.1016/j.rvsc.2017.01.024
Padalino B, Raidal SL, Carter N, Celi P, Muscatello G, Jeffcott L, de Silva K.Horses are transported frequently and often over long distances. Transportation may represent a physiological stressor with consequential health and welfare implications. This study reports the effects of a long distance journey on immunological, clinical, haematological, inflammatory and oxidative parameters in an Experimental Group (EG) of ten horses, comparing them with six horses of similar age and breed used as a non-transported Control Group (CG). Clinical examination and blood sampling were performed twice on all horses: immediately after unloading for the EG, and at rest on the same da...
Effect of age on heart rate, blood lactate concentration, packed cell volume and hemoglobin to exercise in Jeju crossbreed horses.
Journal of animal science and technology    January 25, 2017   Volume 59 2 doi: 10.1186/s40781-017-0126-8
Kang OD, Park YS.This study aimed to analyze the on heart rate, blood lactate concentration, packed cell volume (PCV) and hemoglobin (Hb) response after conducting exercise in endurance horses. Methods: A total of 20 healthy 3-9-years-old Jeju crossbreed mares (5.95 ± 2.24 year) of age and 312.65 ± 13.59 kg of weight) currently participating the endurance competition were used. The field tests selected for the experiment was gallop (approximately 8.3 m/s) along the selected 2.5 km course (a natural forest trail, not artificial road; a closed loop course). The horses were divided into three groups...
Echocardiographic Assessment of Left Ventricular Function in Healthy Horses and in Horses with Heart Disease Using Pulsed-Wave Tissue Doppler Imaging.
Journal of veterinary internal medicine    January 21, 2017   Volume 31, Issue 2 556-567 doi: 10.1111/jvim.14641
Koenig TR, Mitchell KJ, Schwarzwald CC.Assessment of left ventricular (LV) function by tissue Doppler imaging (TDI) is not well established in horses with heart disease. Objective: To describe the use of pulsed-wave (PW) TDI for the assessment of LV function, establish reference intervals, investigate effects of mitral regurgitation (MR), aortic regurgitation (AR), and primary myocardial disease (MD), and provide proof of concept for the use of PW TDI in Warmblood horses with heart disease. Methods: Thirty healthy horses, 38 horses with MR, 25 with AR, 8 with MD. Methods: Echocardiograms were retrospectively analyzed. Reference int...
Influence of 2nd-degree AV blocks, ECG recording length, and recording time on heart rate variability analyses in horses.
Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology    January 20, 2017   Volume 19, Issue 2 160-174 doi: 10.1016/j.jvc.2016.10.006
Eggensperger BH, Schwarzwald CC.To assess the influence of 2nd-degree AV blocks (AVB) on RR interval-based heart rate variability (HRV) variables; to investigate the effect of using PP interval time series and of artifact filtering on HRV analyses; to investigate the influence of electrocardiogram (ECG) recording length and time of recording; and to calculate day-to-day variability and reference intervals of HRV variables. Methods: Thirty healthy adult horses. Methods: RR and PP interval time series were extracted from 10-h Holter ECGs and an automated filter was applied to the RR time series (RR). Time-domain HRV variables...
Influence of training and competitive sessions on peripheral β-endorphin levels in training show jumping horses.
Veterinary world    January 18, 2017   Volume 10, Issue 1 67-73 doi: 10.14202/vetworld.2017.67-73
Cravana C, Medica P, Ragonese G, Fazio E.To investigate the effects of training sessions on circulating β-endorphin changes in sport horses before and after competition and to ascertain whether competition would affect this response. Methods: A total of 24 trained jumping horses were randomly assigned to one of two training groups: Group A (competing) and Group B (not competing). To determined plasma β-endorphin concentrations, two pre- and post-competition training weeks at aerobic workout and two competitive show jumping event days at anaerobic workout were measured before, 5 and 30 min after exercise. Exercise intensity is descr...
Cardiac Mean Electrical Axis in Thoroughbreds-Standardization by the Dubois Lead Positioning System.
PloS one    January 17, 2017   Volume 12, Issue 1 e0169619 doi: 10.1371/journal.pone.0169619
da Costa CF, Samesima N, Pastore CA.Different methodologies for electrocardiographic acquisition in horses have been used since the first ECG recordings in equines were reported early in the last century. This study aimed to determine the best ECG electrodes positioning method and the most reliable calculation of mean cardiac axis (MEA) in equines. Methods: We evaluated the electrocardiographic profile of 53 clinically healthy Thoroughbreds, 38 males and 15 females, with ages ranging 2-7 years old, all reared at the São Paulo Jockey Club, in Brazil. Two ECG tracings were recorded from each animal, one using the Dubois lead posi...
Pharmacokinetics and selected pharmacodynamics of romifidine following low-dose intravenous administration in combination with exercise to quarter horses.
Journal of veterinary pharmacology and therapeutics    January 17, 2017   Volume 40, Issue 5 569-574 doi: 10.1111/jvp.12395
Knych HK, Stanley SD, McKemie DS, Steinmetz SJ.Romifidine is an alpha-2 adrenergic agonist used for sedation and analgesia in horses. As it is a prohibited substance, its purported use at low doses in performance horses necessitates further study. The primary goal of the study reported here was to describe the serum concentrations and pharmacokinetics of romifidine following low-dose administration immediately prior to exercise, utilizing a highly sensitive liquid chromatography-tandem mass spectrometry assay that is currently employed in many drug testing laboratories. An additional objective was to describe changes in heart rate and rhyt...
The effect of anesthetic drug choice on accuracy of high-definition oscillometry in laterally recumbent horses.
Veterinary anaesthesia and analgesia    January 11, 2017   Volume 44, Issue 3 589-593 doi: 10.1016/j.vaa.2016.08.006
Duke-Novakovski T, Ambros B, Feng C, Carr AP.To determine the accuracy of high-definition oscillometry (HDO) for arterial pressure measurement during injectable or inhalation anesthesia in horses. Methods: Prospective, clinical study. Methods: Twenty-four horses anesthetized for procedures requiring lateral recumbency. Methods: Horses were premedicated with xylazine, and anesthesia induced with diazepam-ketamine. Anesthesia was maintained with xylazine-ketamine-guaifenesin combination [TripleDrip (TD; n = 12) or isoflurane (ISO; n = 12)]. HDO was used to obtain systolic (SAP), mean (MAP) and diastolic (DAP) arterial pressures, and he...
Cardiopulmonary effects of pleural insufflation with CO2 during two-lung ventilation in dorsally recumbent anesthetized horses.
Veterinary anaesthesia and analgesia    January 10, 2017   Volume 44, Issue 3 483-491 doi: 10.1016/j.vaa.2016.07.004
Bohaychuk-Preuss KS, Carrozzo MV, Duke-Novakovski T.To record the cardiopulmonary effects of pleural CO2 positive pressure insufflation in anesthetized horses. Methods: Prospective study. Methods: Seven horses (mean ± standard deviation, 530.9 ± 68.1 kg) undergoing terminal surgery. Methods: Horses were sedated with xylazine. Anesthesia was induced with ketamine-propofol and maintained with isoflurane, positive pressure ventilation, detomidine infusion, and butorphanol with the horses in dorsal recumbency. Baseline measurements were cardiac output, heart rate, pulmonary and systemic arterial and right atrial blood pressures, body temperature,...
Oxytocin treatment does not change cardiovascular parameters, hematology and plasma electrolytes in parturient horse mares.
Theriogenology    December 24, 2016   Volume 91 69-76 doi: 10.1016/j.theriogenology.2016.12.028
Nagel C, Trenk L, Wulf M, Ille N, Aurich J, Aurich C.In mares, foaling is associated with changes in hematology, plasma electrolytes, blood pressure and heart rate and it has been hypothesized that these are induced by oxytocin. To test this hypothesis, mares (n = 8-14/group) were treated with oxytocin (OT; 20 I.U.) or saline (CON) at 1 h (test A) and 12 h after foaling (test B) and during first postpartum diestrus (test C). Heart rate, heart rate variability (HRV), atrioventricular blocks, salivary cortisol concentration, blood pressure, plasma electrolytes and blood count were determined. Heart rate decreased from test A to C (P < 0.001)...
Horses discriminate between facial expressions of conspecifics.
Scientific reports    December 20, 2016   Volume 6 38322 doi: 10.1038/srep38322
Wathan J, Proops L, Grounds K, McComb K.In humans, facial expressions are rich sources of social information and have an important role in regulating social interactions. However, the extent to which this is true in non-human animals, and particularly in non-primates, remains largely unknown. Therefore we tested whether domestic horses (Equus caballus) could discriminate between facial expressions of their conspecifics captured in different contexts, and whether viewing these expressions elicited functionally relevant reactions. Horses were more likely to approach photographic stimuli displaying facial expressions associated with po...
Appropriate threshold levels of cardiac beat-to-beat variation in semi-automatic analysis of equine ECG recordings.
BMC veterinary research    November 28, 2016   Volume 12, Issue 1 266 doi: 10.1186/s12917-016-0894-2
Flethøj M, Kanters JK, Pedersen PJ, Haugaard MM, Carstensen H, Olsen LH, Buhl R.Although premature beats are a matter of concern in horses, the interpretation of equine ECG recordings is complicated by a lack of standardized analysis criteria and a limited knowledge of the normal beat-to-beat variation of equine cardiac rhythm. The purpose of this study was to determine the appropriate threshold levels of maximum acceptable deviation of RR intervals in equine ECG analysis, and to evaluate a novel two-step timing algorithm by quantifying the frequency of arrhythmias in a cohort of healthy adult endurance horses. Results: Beat-to-beat variation differed considerably with he...
The effects of pre-anesthetic administration of xylazine on the cardiovascular responses to dobutamine in halothane anaesthetized horses.
Veterinary anaesthesia and analgesia    November 15, 2016   Volume 30, Issue 2 95-96 doi: 10.1046/j.1467-2995.2003.00132_13.x
McMurphy RM, Egger CM, Lillich JD.No abstract available
The effects of ephedrine on intramuscular blood flow and other cardiopulmonary parameters in halothane-anesthetized ponies.
Veterinary anaesthesia and analgesia    November 15, 2016   Volume 29, Issue 4 171-181 doi: 10.1046/j.1467-2995.2002.00095.x
Lee YL, Clarke KW, Alibhai HI, Song DY.To evaluate the effect of ephedrine on intramuscular blood flow and hemodynamic parameters during equine anesthesia. Methods: Prospective experimental study. Methods: Six healthy adult Welsh Mountain ponies (five males, one female, mean weight: 267 kg, range: 213-347 kg). Methods: Halothane-anesthetized ponies received an IV bolus of ephedrine (0.1 mg kg), followed 30 minutes later by a second IV ephedrine injection (0.2 mg kg). Changes in intramuscular blood flows (IMBF) in upper and lower triceps brachii were measured by laser Doppler flowmetry. Cardiopulmonary measurements were made at inte...
Aerosolized salbutamol (albuterol) improves PaO2 in hypoxaemic anaesthetized horses – a prospective clinical trial in 81 horses.
Veterinary anaesthesia and analgesia    November 15, 2016   Volume 29, Issue 4 212-218 doi: 10.1046/j.1467-2995.2002.00100.x
Robertson SA, Bailey JE.To compare the arterial pH and blood gas values, heart rate and mean arterial blood pressure, in hypoxaemic anaesthetized horses, before and after treatment, with a salbutamol (albuterol) aerosol. Methods: Eighty-one client-owned horses weighing between 114 and 925 kg. Fifty-seven underwent emergency abdominal surgery and 24 were anaesthetized for elective procedures. Methods: Pre-anaesthetic medication included xylazine, detomidine, butorphanol and morphine, alone or in various combinations. Induction of anaesthesia was achieved with guaifenesin and ketamine, diazepam and ketamine, or guaifen...
Hormonal, metabolic and physiological effects of laparoscopic surgery using a detomidine-buprenorphine combination in standing horses.
Veterinary anaesthesia and analgesia    November 15, 2016   Volume 30, Issue 2 71-79 doi: 10.1046/j.1467-2995.2003.00097.x
Van Dijk P, Lankveld D, Rijkenhuizen A, Jonker FH.To assess the hormonal, metabolic and physiological effects of laparascopic surgery performed under a sedative analgesic combination of detomidine and buprenorphine in standing horses. Methods: Prospective study. Methods: Eight healthy adult Dutch Warmblood horses and five healthy adult ponies undergoing laparoscopy were studied. Five healthy adult horses not undergoing laparoscopy were used as a control group. Methods: The sedative effect of an initial detomidine and buprenorphine injection was maintained using a continuous infusion of detomidine alone. The heart and respiratory rate, arteria...
Hormonal, metabolic and physiological effects of laparoscopic surgery using a detomidine-buprenorphine combination in standing horses.
Veterinary anaesthesia and analgesia    November 15, 2016   Volume 30, Issue 2 71-79 doi: 10.1046/j.1467-2995.2003.00097.x
Van Dijk P, Lankveld D, Rijkenhuizen A, Jonker FH.To assess the hormonal, metabolic and physiological effects of laparascopic surgery performed under a sedative analgesic combination of detomidine and buprenorphine in standing horses. Methods: Prospective study. Methods: Eight healthy adult Dutch Warmblood horses and five healthy adult ponies undergoing laparoscopy were studied. Five healthy adult horses not undergoing laparoscopy were used as a control group. Methods: The sedative effect of an initial detomidine and buprenorphine injection was maintained using a continuous infusion of detomidine alone. The heart and respiratory rate, arteria...
The cardiopulmonary effects of severe blood loss in anesthetized horses.
Veterinary anaesthesia and analgesia    November 15, 2016   Volume 30, Issue 2 80-86 doi: 10.1046/j.1467-2995.2003.00102.x
Wilson DV, Rondenay Y, Shance PU.To characterize the acute cardiopulmonary effects of severe hemorrhage in anesthetized horses. Methods: Prospective experimental study. Methods: Three geldings and six mares, aged 14.4 ± 2.7 years, weighing 486 ± 41 kg (range: 425-550 kg). Methods: Horses were anesthetized using xylazine, guaifenesin, ketamine and halothane or isoflurane. Cardiovascular variables, hematocrit, total solids, capillary refill time (CRT) and color of mucous membranes were measured as blood was collected from the carotid artery into sterile plastic bags. Arterial blood gas analysis was also performed. Results: Th...
Transcutaneous direct current cardioversion in a foal with lone atrial fibrillation.
Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology    November 1, 2016   Volume 19, Issue 1 99-105 doi: 10.1016/j.jvc.2016.09.002
Potter BM, Scansen BA, Dunbar LK, Reed SM, Toribio RE.There are rare published reports of atrial fibrillation (AF) in foals, all of which are associated with structural heart disease or within the adaptive period of newborns. This report describes a 3-month-old Thoroughbred filly with AF and a structurally normal heart on echocardiography. Medical cardioversion of the foal's AF was attempted with three 20mg/kg doses of quinidine sulfate therapy without success. Timed, transcutaneous, direct current cardioversion was successfully performed using adhesive patches on the midthorax in conjunction with intravenous procainamide at a total dose of 20mg/...
[Heart disease in sports horses: Current recommendations of the 2014 ACVIM / ECEIM consensus statement].
Schweizer Archiv fur Tierheilkunde    October 7, 2016   Volume 158, Issue 10 677-689 doi: 10.17236/sat00086
Schwarzwald C.Heart murmurs and arrhythmias are common in horses. Assessment of their clinical relevance concerning health, performance, safety and longevity of sports horses is of highest importance. A comprehensive cardiovascular examination is crucial for diagnosis and assessment of the severity of disease. Recently, an expert panel of the American College of Veterinary Internal Medicine (ACVIM) and the European College of Equine Internal Medicine (ECEIM) developed a consensus statement containing recommendations for sports horses with heart disease. This article summarizes the most relevant recommendati...
Pharmacokinetic and pharmacodynamics of xylazine administered to exercised thoroughbred horses.
Drug testing and analysis    September 13, 2016   Volume 9, Issue 5 713-720 doi: 10.1002/dta.2047
Knych HK, Stanley SD, McKemie DS, Arthur RM, Kass PH.There is limited data describing xylazine serum concentrations in the horse and no reports of concentrations beyond 24 hours. The primary goal of the study reported here was to update the pharmacokinetics of xylazine following intravenous (IV) administration in order to assess the applicability of current regulatory recommendations. Pharmacodynamic parameters were determined using PK-PD modeling. Sixteen exercised adult Thoroughbred horses received a single IV dose of 200 mg of xylazine. Blood and urine samples were collected at time 0 and at various times for up to 96 hours and analyzed...
Monty Roberts’ Public Demonstrations: Preliminary Report on the Heart Rate and Heart Rate Variability of Horses Undergoing Training during Live Audience Events.
Animals : an open access journal from MDPI    September 9, 2016   Volume 6, Issue 9 55 doi: 10.3390/ani6090055
Loftus L, Marks K, Jones-McVey R, Gonzales JL, Fowler VL.Effective training of horses relies on the trainer's awareness of learning theory and equine ethology, and should be undertaken with skill and time. Some trainers, such as Monty Roberts, share their methods through the medium of public demonstrations. This paper describes the opportunistic analysis of beat-to-beat (RR) intervals and heart rate variability (HRV) of ten horses being used in Monty Roberts' public demonstrations within the United Kingdom. RR and HRV was measured in the stable before training and during training. The HRV variables standard deviation of the RR interval (SDRR), root ...
The effect of relaxing massage on heart rate and heart rate variability in purebred Arabian racehorses.
Animal science journal = Nihon chikusan Gakkaiho    September 4, 2016   Volume 88, Issue 4 669-677 doi: 10.1111/asj.12671
Kowalik S, Janczarek I, Kędzierski W, Stachurska A, Wilk I.The objective of this study was to assess the effect of relaxing massage on the heart rate (HR) and heart rate variability (HRV) in young racehorses during their first racing season. In the study, 72 Purebred Arabian racehorses were included. The study was implemented during the full race season. The horses from control and experimental groups were included in regular race training 6 days a week. The horses from the experimental group were additionally subject to the relaxing massage 3 days a week during the whole study. HR and HRV were assumed as indicators of the emotional state of the horse...
Clinical, histopathological and metabolic responses following exercise in Arabian horses with a history of exertional rhabdomyolysis.
Veterinary journal (London, England : 1997)    August 24, 2016   Volume 216 196-201 doi: 10.1016/j.tvjl.2016.08.011
McKenzie EC, Eyrich LV, Payton ME, Valberg SJ.A previous report suggests a substantial incidence of exertional rhabdomyolysis (ER) in Arabian horses performing endurance racing. This study compared formalin histopathology and clinical and metabolic responses to a standardised field exercise test (SET) between Arabians with and without ER. Arabian horses with (n = 10; age 15.4 ± 5.6 years) and without (n = 9; 12.9 ± 6.1 years) prior ER were stall-rested for 24-48 h, after which paired ER and control horses were fitted with a telemetric ECG and performed a 47 min submaximal SET. Plasma glucose, lactate, electrolyte and...
Cardio-metabolic responses during horse riding at three different speeds.
European journal of applied physiology    August 2, 2016   Volume 116, Issue 10 1985-1992 doi: 10.1007/s00421-016-3450-7
Sainas G, Melis S, Corona F, Loi A, Ghiani G, Milia R, Tocco F, Marongiu E, Crisafulli A.The purpose of the present investigation was to study the metabolic demand and cardiovascular response during a typical horse riding session. Methods: To this aim, 19 (9 male, 10 female) riders, regularly participating in competitions, were enrolled. They underwent a preliminary, incremental exercise test on a cycle-ergometer to assess their anaerobic threshold (AT) and VO2max. Then, participants underwent a riding training session, which comprised periods of walking, trotting, and cantering for a total of 20 min. Oxygen uptake (VO2), carbon dioxide production (VCO2), and heart rate (HR) were...
Application of a combined global positioning and heart rate monitoring system in jumper horses during an official competition – A preliminary study.
Acta veterinaria Hungarica    June 28, 2016   Volume 64, Issue 2 189-200 doi: 10.1556/004.2016.019
Bazzano M, Giudice E, Rizzo M, Congiu F, Zumbo A, Arfuso F, Di Pietro S, Bruschetta D, Piccione G.The aim of this study was to investigate whether a combined global positioning system (GPS)/heart rate (HR) monitoring system is a valuable tool to assess, step by step, the physiological response of HR and its relationship with speed in healthy horses competing in an official show jumping class. Six mares performing a standardised warm-up and jumping course were monitored using a HR/GPS device. Venous blood lactate (BL), assessed before and after exercise, showed a significant increase (P = 0.0004) following the physical effort. One-way analysis of variance (ANOVA) showed significant changes ...
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