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Abstract
PRACTICAL RELEVANCE The feline cardiomyopathies are the most prevalent type of heart disease in adult domestic cats. Several forms have been identified (see Parts 2 and 3), with hypertrophic cardiomyopathy (HCM) being the most common. Clinically the cardiomyopathies are often indistinguishable. Cats with subclinical cardiomyopathy may or may not have characteristic physical examination findings (eg, heart murmur, gallop sound), or radiographic cardiomegaly. Cats with severe disease may develop signs of heart failure (eg, dyspnea, tachypnea) or systemic arterial thromboembolism (ATE; eg, pain and paralysis). Sudden death is possible. Treatment usually does not alter the progression from subclinical to clinical disease and often the treatment approach, once clinical signs are apparent, is the same regardless of the type of cardiomyopathy. However, differentiating cardiomyopathy from normal variation may be important prognostically. PATIENT GROUP Domestic cats of any age from 3 months upward, of either sex and of any breed, can be affected. Mixed-breed cats are most commonly affected but certain breeds are disproportionately prone to developing HCM. DIAGNOSTICS Subclinical feline cardiomyopathies may be suspected based on physical examination findings, thoracic radiographs and cardiac biomarker results but often the disease is clinically silent. The definitive clinical confirmatory test is echocardiography. Left heart failure (pulmonary edema and/or pleural effusion) is most commonly diagnosed radiographically, but point-of-care ultrasound and amino terminal pro-B-type natriuretic peptide (NT-proBNP) biomarker testing can also be useful, especially when the stress of taking radiographs is best avoided. KEY FINDINGS Knowledge of pathophysiological mechanisms helps the practitioner identify the feline cardiomyopathies and understand how these diseases progress and how they manifest clinically (heart failure, ATE). Existing diagnostic tests have strengths and limitations, and being aware of these can help a practitioner deliver optimal recommendations regarding referral. CONCLUSIONS Several types of feline cardiomyopathies exist in both subclinical (mild to severe disease) and clinical (severe disease) phases. Heart failure and ATE are the most common clinical manifestations of severe cardiomyopathy and are therapeutic targets regardless of the type of cardiomyopathy. The long-term prognosis is often guarded or poor once overt clinical manifestations are present. AREAS OF UNCERTAINTY Some cats with presumed cardiomyopathy do not have echocardiographic features that fit the classic cardiomyopathies (cardiomyopathy - nonspecific phenotype). Although no definitive treatment is usually available, understanding how cardiomyopathies evolve remains worthy of investigation.
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Affiliation(s)
- Mark D Kittleson
- School of Veterinary Medicine, Department of Medicine and Epidemiology, University of California, Davis, and Veterinary Information Network, 777 West Covell Boulevard, Davis, CA 95616, USA
| | - Etienne Côté
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
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O'Shaughnessy S, Crawford I, Arsevska E, Singleton D, Hughes D, Noble PJ, Hezzell M. Clinical findings associated with N-terminal pro-B-type natriuretic peptide measurement in dogs and cats attending first opinion veterinary practices. Vet Rec 2021; 191:e945. [PMID: 34558065 DOI: 10.1002/vetr.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/05/2021] [Accepted: 08/28/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Clinical findings associated with N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement in dogs and cats in primary practice, and their relevance to published measurement indications, have not been described. METHODS Using electronic health record data collected by the Small Animal Veterinary Surveillance Network, appointments in which NT-proBNP was measured were identified using keyword-based text filtering. For these appointments, clinical findings were manually identified from each patient's clinical narrative (CN) and their frequencies described. RESULTS CNs of 3510 appointments (357 dogs and 257 cats) from 99practices were evaluated. The most frequently recorded clinical findings in dogs were: heart murmur (n = 147, 41.2% (95% confidence interval (CI) = 36.1%-46.3%), coughing (n = 83, 23.2% (95% CI = 18.8%-27.6%)) and panting (n = 58, 16.2% (95% CI = 12.4%-20.0%)) and in cats: heart murmur (n = 143, 55.6% (95% CI = 49.5%-61.7%)), suspected thromboembolism (n = 88, 34.2% (95% CI = 28.4%-40.0%)) and weight loss (n = 53, 20.6% (95% CI = 15.7%-25.5%)). Dyspnoea and tachypnoea were infrequently reported in dogs (n = 29, 8.1% (95% CI = 5.3%-10.9%) and n = 21, 5.9% (95% CI = 3.5%-8.3%), respectively) and cats (n = 26, 10.1% (95% CI = 6.4%-13.8%) and n = 36, 14.0% (95% CI = 9.8%-18.2%), respectively). CONCLUSION Clinical findings referable to cardiac disease were recorded contemporaneously with NT-proBNP measurement and suggested both published and other indications (coughing (in dogs and cats), and serial measurements and thromboembolism (in cats)) for testing.
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Affiliation(s)
| | - India Crawford
- Bristol Veterinary School, University of Bristol, Langford, Bristol, UK
| | - Elena Arsevska
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK.,Campus International de Baillarguet, French Agricultural Research for Development (CIRAD), Montpellier, France
| | - David Singleton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - David Hughes
- Bristol Veterinary School, University of Bristol, Langford, Bristol, UK
| | - Peter-John Noble
- Bristol Veterinary School, University of Bristol, Langford, Bristol, UK
| | - Melanie Hezzell
- Bristol Veterinary School, University of Bristol, Langford, Bristol, UK
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3
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Seo J, Payne JR, Novo Matos J, Fong WW, Connolly DJ, Luis Fuentes V. Biomarker changes with systolic anterior motion of the mitral valve in cats with hypertrophic cardiomyopathy. J Vet Intern Med 2020; 34:1718-1727. [PMID: 32822105 PMCID: PMC7517492 DOI: 10.1111/jvim.15807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND N-terminal pro B-type natriuretic peptide (NT-proBNP) and cardiac troponin-I (cTnI) are biomarkers commonly evaluated in cats with suspected heart disease. Many cats with hypertrophic cardiomyopathy (HCM) have systolic anterior motion of the mitral valve (SAM), but its influence on circulating NT-proBNP or cTnI concentrations is currently unknown. HYPOTHESIS/OBJECTIVES Cats with HCM and SAM (HCMSAM+ ) have higher NT-proBNP and cTnI concentrations than do cats with HCM but without SAM (HCMSAM- ). ANIMALS One hundred forty cats with HCM: 70 with SAM and 70 without SAM. METHODS Retrospective case-to-case study. Cats were recruited if diagnosed with HCM by echocardiography and results were available for NT-proBNP or cTnI concentrations or both. Cats with SAM were matched to those without SAM for clinical presentation, left atrial (LA) size and left ventricular (LV) fractional shortening. RESULTS A total of 119 NT-proBNP and 123 cTnI results were available. The HCMSAM+ cats had higher median concentrations than did HCMSAM- cats for NT-proBNP (729 pmoL/L; interquartile range [IQR], 275-1467 versus 65 pmoL/L; IQR, 25-271; P < .001) and cTnI (0.27 ng/mL; IQR, 0.10-0.81 versus 0.07 ng/mL; IQR, 0.01-0.43; P = .002). In general linear models for both NT-proBNP and cTnI, the independent explanatory variables were SAM, congestive heart failure, maximal LV wall thickness, and LA size. CONCLUSIONS AND CLINICAL IMPORTANCE For cats with HCM and equivalent LA size and LV systolic function, those with SAM had higher NT-proBNP and cTnI concentrations than did those without SAM. Presence of SAM should be considered when interpreting biomarker concentrations in cats with HCM.
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Affiliation(s)
- Joonbum Seo
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Jessie Rosie Payne
- Langford Vets Small Animal Referral Hospital, University of Bristol, Bristol, United Kingdom
| | - Jose Novo Matos
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom.,Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Wesley Wynne Fong
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - David J Connolly
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Virginia Luis Fuentes
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
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Janson CO, Hezzell MJ, Oyama MA, Harries B, Drobatz KJ, Reineke EL. Focused cardiac ultrasound and point-of-care NT-proBNP assay in the emergency room for differentiation of cardiac and noncardiac causes of respiratory distress in cats. J Vet Emerg Crit Care (San Antonio) 2020; 30:376-383. [PMID: 32579274 DOI: 10.1111/vec.12957] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 10/14/2018] [Accepted: 10/31/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the accuracy of focused cardiac ultrasound (FOCUS) and point-of-care N-terminal proBNP assay in the emergency setting for differentiation of cardiac from noncardiac causes of respiratory distress in cats. DESIGN Prospective diagnostic accuracy study between 2014 and 2016. SETTING Emergency room at an urban university teaching hospital. ANIMALS Forty-one client-owned cats presenting for evaluation of respiratory distress. INTERVENTIONS Emergency clinicians made an initial diagnosis of noncardiac or cardiac cause of respiratory distress based on physical examination (PE) findings and history. The diagnoses were updated after performing FOCUS and point-of-care N-terminal B-type natriuretic peptide (POC-BNP). Reference standard diagnosis was determined by agreement of a board-certified cardiologist and critical care specialist with access to subsequent radiographs and echocardiograms. MEASUREMENTS AND MAIN RESULTS Forty-one cats were enrolled. Three cats with incomplete data and 1 cat with an uncertain reference standard diagnosis were excluded. The remaining 37 cats were used for analysis: 21 cardiac and 16 noncardiac cases. The ratio of left atrial to aortic root diameter (LA:Ao) measured by FOCUS was significantly correlated with LA:Ao measured by echocardiography (R = 0.646, P < 0.0001). Emergency clinicians correctly diagnosed 27 of 37 (73.0%), yielding a PE positive percent agreement = 76.2% (95% CI, 52.8-91.8%) and negative percent agreement = 68.8% (95% CI, 41.3-89.0%). Five noncardiac and 5 cardiac cats were misdiagnosed. Post FOCUS, overall percent agreement improved to 34 of 37 (91.9%), with positive percent agreement = 95.2% (95% CI, 76.2-99.9%) and negative percent agreement = 87.5% (95% CI, 61.7-98.5%). The POC-BNP yielded an overall percent agreement = 32/34 (94.1%), positive percent agreement = 100% (95% CI, 82.4-100.0%), and negative percent agreement = 86.7% (95% CI, 59.5-98.3%) in differentiating cardiac versus noncardiac cases. CONCLUSIONS FOCUS evaluation of basic cardiac structure and LA:Ao by trained emergency clinicians improved accuracy of diagnosis compared to PE in cats with respiratory distress. FOCUS and POC-BNP are useful diagnostics in the emergent setting.
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Affiliation(s)
- Cassandra Ostroski Janson
- Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melanie J Hezzell
- Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark A Oyama
- Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin Harries
- Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth J Drobatz
- Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica L Reineke
- Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Luis Fuentes V, Abbott J, Chetboul V, Côté E, Fox PR, Häggström J, Kittleson MD, Schober K, Stern JA. ACVIM consensus statement guidelines for the classification, diagnosis, and management of cardiomyopathies in cats. J Vet Intern Med 2020; 34:1062-1077. [PMID: 32243654 PMCID: PMC7255676 DOI: 10.1111/jvim.15745] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/14/2020] [Indexed: 12/24/2022] Open
Abstract
Cardiomyopathies are a heterogeneous group of myocardial disorders of mostly unknown etiology, and they occur commonly in cats. In some cats, they are well‐tolerated and are associated with normal life expectancy, but in other cats they can result in congestive heart failure, arterial thromboembolism or sudden death. Cardiomyopathy classification in cats can be challenging, and in this consensus statement we outline a classification system based on cardiac structure and function (phenotype). We also introduce a staging system for cardiomyopathy that includes subdivision of cats with subclinical cardiomyopathy into those at low risk of life‐threatening complications and those at higher risk. Based on the available literature, we offer recommendations for the approach to diagnosis and staging of cardiomyopathies, as well as for management at each stage.
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Affiliation(s)
- Virginia Luis Fuentes
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, United Kingdom
| | - Jonathan Abbott
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee, USA
| | - Valérie Chetboul
- Alfort Cardiology Unit (UCA), Université Paris-Est, École Nationale Vétérinaire d'Alfort, Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Maisons-Alfort cedex, France
| | - Etienne Côté
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | | | - Jens Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Mark D Kittleson
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Karsten Schober
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Joshua A Stern
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, California, USA
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Acute Respiratory Failure after Administration of Hydrogen Peroxide as an Emetic in a Cat. Case Rep Vet Med 2019; 2019:7242631. [PMID: 31662943 PMCID: PMC6791274 DOI: 10.1155/2019/7242631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/16/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE AND CASE SUMMARY This case report describes a 5-year-old domestic short-haired cat that was orally administered with 4 mL of 3% hydrogen peroxide by the owner after suspecting ingestion of a foreign body by the cat. Shortly after the administration, the cat developed severe respiratory distress. Thoracic radiography showed an interstitial-to-alveolar pulmonary pattern, while echocardiography and heart injury markers ruled out a cardiac origin. Intensive management with oxygen, diuretics, bronchodilators, and sedation resulted in survival of the cat without further respiratory complications. NEW AND UNIQUE INFORMATION PROVIDED To the best of our knowledge, this is the first report of a lung injury and acute respiratory failure after administration of hydrogen peroxide in a cat with successful management.
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7
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Ward JL, Lisciandro GR, Ware WA, Viall AK, Aona BD, Kurtz KA, Reina‐Doreste Y, DeFrancesco TC. Evaluation of point-of-care thoracic ultrasound and NT-proBNP for the diagnosis of congestive heart failure in cats with respiratory distress. J Vet Intern Med 2018; 32:1530-1540. [PMID: 30216579 PMCID: PMC6189386 DOI: 10.1111/jvim.15246] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/03/2018] [Accepted: 05/22/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The diagnosis of congestive heart failure (CHF) in cats is challenging. Point-of-care (POC) thoracic ultrasound and NT-proBNP testing are emerging tools that may aid in diagnosis. HYPOTHESIS/OBJECTIVES To assess the diagnostic accuracy of POC lung ultrasound (LUS), focused cardiac ultrasound (FCU), and NT-proBNP in predicting a final diagnosis of CHF. ANIMALS Fifty-one cats in respiratory distress. METHODS Blood NT-proBNP, LUS, and FCU evaluating left atrial (LA) size and presence of pericardial effusion (PCEFF) were performed in all cats. Lung ultrasound findings including pleural effusion (PLEFF), number of B-lines, and sub-pleural abnormalities were noted. Medical records were evaluated for final diagnosis. RESULTS Thirty-three of 51 (65%) cats were diagnosed with CHF. Lung ultrasound and blood NT-proBNP were significant predictors of CHF in a multivariate model. The LUS criterion that maximized accuracy for CHF diagnosis was presence of >1 site strongly positive for B-lines (>3 B-lines per site), resulting in sensitivity of 78.8%, specificity of 83.3%, and area under the curve (AUC) of 0.833. Subjective LA enlargement was 97.0% sensitive and 100% specific for CHF (AUC 0.985). Presence of PCEFF also was 100% specific, but only 60.6% sensitive, for CHF (AUC 0.803). A positive blood NT-proBNP test was 93.9% sensitive and 72.2% specific for the diagnosis of CHF (AUC 0.831). CONCLUSIONS AND CLINICAL IMPORTANCE Point-of-care diagnostic techniques of LUS, FCU, and NT-proBNP are useful to diagnose CHF in cats with respiratory distress.
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Affiliation(s)
- Jessica L. Ward
- Department of Veterinary Clinical SciencesCollege of Veterinary Medicine, Iowa State UniversityAmesIowa
| | | | - Wendy A. Ware
- Department of Veterinary Clinical SciencesCollege of Veterinary Medicine, Iowa State UniversityAmesIowa
| | - Austin K. Viall
- Department of Veterinary PathologyCollege of Veterinary Medicine, Iowa State UniversityAmesIowa
| | - Brent D. Aona
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
| | - Kari A. Kurtz
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
| | - Yamir Reina‐Doreste
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
| | - Teresa C. DeFrancesco
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
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Wurtinger G, Henrich E, Hildebrandt N, Wiedemann N, Schneider M, Hassdenteufel E. Assessment of a bedside test for N-terminal pro B-type natriuretic peptide (NT-proBNP) to differentiate cardiac from non-cardiac causes of pleural effusion in cats. BMC Vet Res 2017; 13:394. [PMID: 29262821 PMCID: PMC5738779 DOI: 10.1186/s12917-017-1319-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/12/2017] [Indexed: 12/20/2022] Open
Abstract
Background Cats with pleural effusion represent common emergencies in small animal practice. The aim of this prospective study was to investigate the diagnostic ability of a point-of-care ELISA (POC-ELISA) for the measurement of N-terminal pro B-type natriuretic peptide (NT-proBNP) to differentiate cardiac from non-cardiac disease in cats with pleural effusion. The sample material for use of this rapid test was either plasma or diluted pleural effusion. Twenty cats with moderate to severe pleural effusion were prospectively recruited. The cats were grouped into two groups, with or without congestive heart failure (CHF; N-CHF), after complete work-up. Blood and effusion were collected in EDTA tubes. Plasma and pleural effusion supernatants were transferred into stabilizer tubes and frozen. POC-ELISA for NT-proBNP was performed with plasma and diluted effusion (1:1). Quantitative NT-proBNP measurement was performed in plasma and diluted and undiluted effusions. Results Six cats were assigned to the CHF group. Of the 14 cats in the N-CHF group, 6 had concurrent cardiac abnormalities that were not responsible for the effusion. For the detection of CHF, the test displayed respective sensitivities and specificities of 100% and 79% in plasma and 100% and 86% in diluted pleural fluid. Receiver operating characteristic (ROC) analysis for quantitative NT-proBNP measurement of plasma and diluted and undiluted pleural effusions displayed areas under the curve of 0.98, sensitivities of 100% and specificities of 86%. The optimum cut-off was calculated at 399 pmol/l in plasma and 229 pmol/l in the diluted effusion and 467 pmol/l in the undiluted effusion. Conclusions POC-ELISA for NT-proBNP in both plasma and diluted pleural effusion was suitable to differentiate cardiac from non-cardiac causes of feline pleural effusion. According to our results, use of pleural effusion is feasible, but dilution of the effusion before measurement seems to improve specificity. Electronic supplementary material The online version of this article (10.1186/s12917-017-1319-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gabriel Wurtinger
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany.
| | - Estelle Henrich
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Nicolai Hildebrandt
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Nicola Wiedemann
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Matthias Schneider
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Esther Hassdenteufel
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
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Wurtinger G, Henrich E, Hildebrandt N, Wiedemann N, Schneider M, Hassdenteufel E. Assessment of a bedside test for N-terminal pro B-type natriuretic peptide (NT-proBNP) to differentiate cardiac from non-cardiac causes of pleural effusion in cats. BMC Vet Res 2017. [PMID: 29262821 DOI: 10.1186/s12917-017-1319-6.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cats with pleural effusion represent common emergencies in small animal practice. The aim of this prospective study was to investigate the diagnostic ability of a point-of-care ELISA (POC-ELISA) for the measurement of N-terminal pro B-type natriuretic peptide (NT-proBNP) to differentiate cardiac from non-cardiac disease in cats with pleural effusion. The sample material for use of this rapid test was either plasma or diluted pleural effusion. Twenty cats with moderate to severe pleural effusion were prospectively recruited. The cats were grouped into two groups, with or without congestive heart failure (CHF; N-CHF), after complete work-up. Blood and effusion were collected in EDTA tubes. Plasma and pleural effusion supernatants were transferred into stabilizer tubes and frozen. POC-ELISA for NT-proBNP was performed with plasma and diluted effusion (1:1). Quantitative NT-proBNP measurement was performed in plasma and diluted and undiluted effusions. RESULTS Six cats were assigned to the CHF group. Of the 14 cats in the N-CHF group, 6 had concurrent cardiac abnormalities that were not responsible for the effusion. For the detection of CHF, the test displayed respective sensitivities and specificities of 100% and 79% in plasma and 100% and 86% in diluted pleural fluid. Receiver operating characteristic (ROC) analysis for quantitative NT-proBNP measurement of plasma and diluted and undiluted pleural effusions displayed areas under the curve of 0.98, sensitivities of 100% and specificities of 86%. The optimum cut-off was calculated at 399 pmol/l in plasma and 229 pmol/l in the diluted effusion and 467 pmol/l in the undiluted effusion. CONCLUSIONS POC-ELISA for NT-proBNP in both plasma and diluted pleural effusion was suitable to differentiate cardiac from non-cardiac causes of feline pleural effusion. According to our results, use of pleural effusion is feasible, but dilution of the effusion before measurement seems to improve specificity.
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Affiliation(s)
- Gabriel Wurtinger
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany.
| | - Estelle Henrich
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Nicolai Hildebrandt
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Nicola Wiedemann
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Matthias Schneider
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
| | - Esther Hassdenteufel
- Small Animal Clinic (Internal Medicine), Justus-Liebig-University Giessen, Frankfurter Strasse 126, 35392 Giessen, Köln, Germany
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10
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Harris AN, Beatty SS, Estrada AH, Winter B, Bohannon M, Sosa I, Hanscom J, Mainville CA, Gallagher AE. Investigation of an N-Terminal Prohormone of Brain Natriuretic Peptide Point-of-Care ELISA in Clinically Normal Cats and Cats With Cardiac Disease. J Vet Intern Med 2017; 31:994-999. [PMID: 28617995 PMCID: PMC5508306 DOI: 10.1111/jvim.14776] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/02/2017] [Accepted: 05/06/2017] [Indexed: 12/14/2022] Open
Abstract
Background N‐terminal prohormone of brain natriuretic peptide (NT‐proBNP) concentrations may be increased in cats with various cardiac disorders. The point‐of‐care (POC) ELISA assay uses the same biologic reagents as the quantitative NT‐proBNP ELISA. Previous studies have evaluated the sensitivity and specificity of the POC ELISA in cats with cardiac disease. Objectives To prospectively evaluate the diagnostic utility of the POC ELISA in a select population of cats. Animals Thirty‐eight client‐owned cats presented to the University of Florida Cardiology Service for cardiac evaluation. Fifteen apparently healthy cats recruited as part of another study. Methods Physical examination and echocardiography were performed in all cats. The POC ELISA was assessed visually as either positive or negative by a reader blinded to the echocardiographic findings, and results were analyzed relative to quantitative assay results. Results Twenty‐six cats were diagnosed with underlying cardiac disease, and 27 cats were considered free of cardiac disease. Cats with cardiac disease included: 21 with hypertrophic cardiomyopathy, 2 with unclassified cardiomyopathy, 2 with restrictive cardiomyopathy, and 1 with 3rd degree atrioventricular (AV) block. The POC ELISA differentiated cats with cardiac disease with a sensitivity of 65.4% and specificity of 100%. Conclusions and Clinical Importance The POC NT‐proBNP ELISA performed moderately well in a selected population of cats. A negative test result cannot exclude the presence of underlying cardiac disease, and a positive test result indicates that cardiac disease likely is present, but further diagnostic investigation would be indicated for a definitive diagnosis.
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Affiliation(s)
- A N Harris
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - S S Beatty
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - A H Estrada
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - B Winter
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - M Bohannon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - I Sosa
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - J Hanscom
- IDEXX Laboratories, Inc, Westbrook, ME
| | | | - A E Gallagher
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
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11
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Harris AN, Estrada AH, Gallagher AE, Winter B, Lamb KE, Bohannon M, Hanscom J, Mainville CA. Biologic variability of N-terminal pro-brain natriuretic peptide in adult healthy cats. J Feline Med Surg 2017; 19:216-223. [PMID: 26767980 PMCID: PMC10816554 DOI: 10.1177/1098612x15623825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The biologic variability of N-terminal pro-brain natriuretic peptide (NT-proBNP) and its impact on diagnostic utility is unknown in healthy cats and those with cardiac disease. The purpose of this study was to determine the biologic variation of NT-proBNP within-day and week-to-week in healthy adult cats. Methods Adult cats were prospectively evaluated by complete blood count (CBC), biochemistry, total thyroxine, echocardiography, electrocardiography and blood pressure, to exclude underlying systemic or cardiac disease. Adult healthy cats were enrolled and blood samples were obtained at 11 time points over a 6 week period (0, 2 h, 4 h, 6 h, 8 h, 10 h and at weeks 2, 3, 4, 5 and 6). The intra-individual (coefficient of variation [CVI]) biologic variation along with index of individuality and reference change values (RCVs) were calculated. Univariate models were analyzed and included comparison of the six different time points for both daily and weekly samples. This was followed by a Tukey's post-hoc adjustment, with a P value of <0.05 being significant. Results The median daily and weekly CVI for the population were 13.1% (range 0-28.7%) and 21.2% (range 3.9-68.1%), respectively. The index of individuality was 0.99 and 1 for daily and weekly samples, respectively. The median daily and weekly RCVs for the population were 39.8% (range 17.0-80.5%) and 60.5% (range 20.1-187.8%), respectively. Conclusions and relevance This study demonstrates high individual variability for NT-proBNP concentrations in a population of adult healthy cats. Further research is warranted to evaluate NT-proBNP variability, particularly how serial measurements of NT-proBNP may be used in the diagnosis and management of cats with cardiac disease.
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Affiliation(s)
- Autumn N Harris
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Amara H Estrada
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Alexander E Gallagher
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Brandy Winter
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | | | - Mary Bohannon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
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12
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Häggström J, Luis Fuentes V, Wess G. Screening for hypertrophic cardiomyopathy in cats. J Vet Cardiol 2016; 17 Suppl 1:S134-49. [PMID: 26776573 DOI: 10.1016/j.jvc.2015.07.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/27/2015] [Accepted: 07/01/2015] [Indexed: 11/17/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common heart disease in cats, and it can lead to increased morbidity and mortality. Cats are often screened for HCM because of the presence of a heart murmur, but screening for breeding purposes has also become common. These cats are usually purebred cats of breeding age, and generally do not present with severe disease or with any clinical signs. This type of screening is particularly challenging because mild disease may be difficult to differentiate from a normal phenotype, and the margin for error is small, with potentially major consequences for the breeder. This article reviews HCM screening methods, with particular emphasis on echocardiography.
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Affiliation(s)
- Jens Häggström
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Box 7054, Uppsala, Sweden.
| | - Virginia Luis Fuentes
- The Royal Veterinary College, Department of Clinical Science and Services, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom
| | - Gerhard Wess
- Clinic of Small Animal Medicine, LMU University, Veterinaerstr. 13, 80539 Munich, Germany
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13
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Borgeat K, Connolly DJ, Luis Fuentes V. Cardiac biomarkers in cats. J Vet Cardiol 2016; 17 Suppl 1:S74-86. [PMID: 26776596 DOI: 10.1016/j.jvc.2015.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 07/16/2015] [Accepted: 08/06/2015] [Indexed: 12/15/2022]
Abstract
Cardiac biomarkers have been used in cats as part of the clinical assessment of heart disease for over a decade. They are widely available to practitioners through commercial reference laboratories. The evidence base for the use of cardiac biomarkers (primarily N-terminal pro-B type natriuretic peptide and cardiac troponin I) in cats is comprehensively reviewed in this article, focusing on each of six specific areas: distinguishing cardiac from non-cardiac causes of respiratory distress; measurement of cardiac biomarkers in urine and pleural fluid; identification of occult cardiomyopathy; effects of systemic disease on circulating concentrations of cardiac biomarkers; point-of-care biomarker testing, and the possible prognostic utility of cardiac biomarker measurement.
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Affiliation(s)
- K Borgeat
- Clinical Science and Services, Royal Veterinary College, Hatfield, United Kingdom; Highcroft Veterinary Referrals, Bristol, United Kingdom.
| | - D J Connolly
- Clinical Science and Services, Royal Veterinary College, Hatfield, United Kingdom
| | - V Luis Fuentes
- Clinical Science and Services, Royal Veterinary College, Hatfield, United Kingdom
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14
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Hezzell MJ, Rush JE, Humm K, Rozanski EA, Sargent J, Connolly DJ, Boswood A, Oyama MA. Differentiation of Cardiac from Noncardiac Pleural Effusions in Cats using Second-Generation Quantitative and Point-of-Care NT-proBNP Measurements. J Vet Intern Med 2016; 30:536-42. [PMID: 26813037 PMCID: PMC4913612 DOI: 10.1111/jvim.13831] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 10/15/2015] [Accepted: 12/29/2015] [Indexed: 12/30/2022] Open
Abstract
Background Pleural effusion is a common cause of dyspnea in cats. N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) measurement, using a first‐generation quantitative ELISA, in plasma and pleural fluid differentiates cardiac from noncardiac causes of pleural effusion. Hypothesis/Objectives To determine whether NT‐proBNP measurements using second‐generation quantitative ELISA and point‐of‐care (POC) tests in plasma and pleural fluid distinguish cardiac from noncardiac pleural effusions and how results compare to the first‐generation ELISA. Animals Thirty‐eight cats (US cohort) and 40 cats (UK cohort) presenting with cardiogenic or noncardiogenic pleural effusion. Methods Prospective cohort study. Twenty‐one and 17 cats in the US cohort, and 22 and 18 cats in the UK cohort were classified as having cardiac or noncardiac pleural effusion, respectively. NT‐proBNP concentrations in paired plasma and pleural fluid samples were measured using second‐generation ELISA and POC assays. Results The second‐generation ELISA differentiated cardiac from noncardiac pleural effusion with good diagnostic accuracy (plasma: sensitivity, 95.2%, specificity, 82.4%; pleural fluid: sensitivity, 100%, specificity, 76.5%). NT‐proBNP concentrations were greater in pleural fluid (719 pmol/L (134–1500)) than plasma (678 pmol/L (61–1500), P = 0.003), resulting in different cut‐off values depending on the sample type. The POC test had good sensitivity (95.2%) and specificity (87.5%) when using plasma samples. In pleural fluid samples, the POC test had good sensitivity (100%) but low specificity (64.7%). Diagnostic accuracy was similar between first‐ and second‐generation ELISA assays. Conclusions and clinical importance Measurement of NT‐proBNP using a quantitative ELISA in plasma and pleural fluid or POC test in plasma, but not pleural fluid, distinguishes cardiac from noncardiac causes of pleural effusion in cats.
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Affiliation(s)
- M J Hezzell
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - J E Rush
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA
| | - K Humm
- Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - E A Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA
| | - J Sargent
- Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - D J Connolly
- Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - A Boswood
- Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - M A Oyama
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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15
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Ferasin L, DeFrancesco T. Management of acute heart failure in cats. J Vet Cardiol 2015; 17 Suppl 1:S173-89. [DOI: 10.1016/j.jvc.2015.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 09/13/2015] [Accepted: 09/17/2015] [Indexed: 10/22/2022]
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16
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Evaluation of red blood cell distribution width in cats with hypertrophic cardiomyopathy. J Vet Cardiol 2015; 17 Suppl 1:S233-43. [DOI: 10.1016/j.jvc.2015.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 06/24/2015] [Accepted: 09/01/2015] [Indexed: 11/19/2022]
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17
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Solter PF, Oyama MA, Machen MC, Trafny DJ, Sisson DD. Detection by ELISA of C-terminal proBNP in plasma from cats with cardiomyopathy. Vet J 2015; 206:213-7. [PMID: 26324638 DOI: 10.1016/j.tvjl.2015.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/01/2015] [Accepted: 07/12/2015] [Indexed: 12/29/2022]
Abstract
The B-type natriuretic peptide prohormone (proBNP) is enzymatically cleaved into an inactive N-terminal peptide and a biologically active C-terminal peptide with many beneficial cardiorenal effects. The purpose of this study was to develop and test in cats with cardiomyopathy an immunoassay to quantify the concentrations of C-terminal proBNP in feline plasma. An anti-canine proBNP monoclonal antibody (UI-1021) was shown to have adequate binding affinity to proBNP 80-106 for use in a solid-phase immunoassay, and by epitope mapping to bind within positions 84-87 of feline proBNP. UI-1021 was paired with an affinity-purified rabbit polyclonal detection antibody to feline proBNP 100-106, in a sandwich ELISA with feline proBNP 80-106 standard. The linearity and analytical range and sensitivity of the assay were confirmed from 1.4 to 85 pmol/L. Spike recovery averaged 106.5% (95% confidence interval 78-135%). Within run and intra-assay coefficients of variation were <12%. A protease inhibitor mixture preserved proBNP 80-106 immunoreactivity for at least 5 days in plasma. Clinical verification of the ELISA was done using plasma from 13 cats with cardiomyopathy, whose C-terminal proBNP concentrations ranged from 1.7 to 78.8 pmol/L vs. <1.4-1.8 pmol/L in plasma from 18 healthy cats. Concentrations were found to be substantially lower than reported N-terminal proBNP concentrations, and similar to those of human heart failure patients where relative C-terminal BNP deficiencies have been proposed as contributory to the progression of the disease.
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Affiliation(s)
- Philip F Solter
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois Urbana-Champaign, USA.
| | - Mark A Oyama
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, USA
| | - Maggie C Machen
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, USA
| | - Dennis J Trafny
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, USA
| | - D David Sisson
- Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, USA
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18
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Mainville CA, Clark GH, Esty KJ, Foster WM, Hanscom JL, Hebert KJ, Lyons HR. Analytical validation of an immunoassay for the quantification of N-terminal pro-B-type natriuretic peptide in feline blood. J Vet Diagn Invest 2015; 27:414-21. [PMID: 26077545 DOI: 10.1177/1040638715588330] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP), a biomarker for heart stress detectable in blood, has been shown to have clinical utility in cats with heart disease. A second-generation feline enzyme-linked immunosorbent assay (Cardiopet® proBNP, IDEXX Laboratories Inc., Westbrook, Maine) was developed to measure NT-proBNP in routine feline plasma or serum samples with improved analyte stability. Results of the analytical validation for the second-generation assay are presented. Analytic sensitivity was 10 pmol/l. Accuracy of 103.5% was determined via serial dilutions of 6 plasma samples. Coefficients of variation for intra-assay, interassay, and total precision were in the ranges of 1.6-6.3%, 4.3-8.8%, and 10.1-15.1%, respectively. Repeatability across 2 lots for both serum and plasma had an average coefficient of determination (r(2)) of 0.99 and slope of 1.11. Stability of the analyte was found to be high. In serum samples held at 4°C for 24-72 hr, the mean percent recovery from time zero was ≥99%. In serum samples held at 25°C for 24 hr, the mean percent recovery from time zero was 91.9%, and for 48 hr, 85.6%. A method comparison of the first- and second-generation assays with a clinically characterized population of cats revealed no difference in the tests' ability to differentiate levels of NT-proBNP between normal cats and cats with occult cardiomyopathy (P < 0.001). Results from our study validate that the second-generation feline Cardiopet proBNP assay can measure NT-proBNP in routine feline plasma and serum samples with accuracy and precision.
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19
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Smith KF, Quinn RL, Rahilly LJ. Biomarkers for differentiation of causes of respiratory distress in dogs and cats: Part 1 - Cardiac diseases and pulmonary hypertension. J Vet Emerg Crit Care (San Antonio) 2015; 25:311-29. [DOI: 10.1111/vec.12318] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/22/2015] [Indexed: 12/18/2022]
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20
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Streitberger A, Modler P, Häggström J. Increased normalized pulmonary transit times and pulmonary blood volumes in cardiomyopathic cats with or without congestive heart failure. J Vet Cardiol 2015; 17:25-33. [PMID: 25837465 DOI: 10.1016/j.jvc.2014.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 09/15/2014] [Accepted: 09/26/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To estimate heart rate-normalized pulmonary transit times (nPTTs) in cardiomyopathic cats with or without congestive heart failure (CHF). To assess potential associations of echocardiographic variables and nPTT and to evaluate nPTT as a test for the presence of CHF. ANIMALS Forty-eight privately owned cats. METHODS nPTT was measured using echocardiography and the ultrasound contrast media SonoVue(®) in 3 groups of cats: healthy cats (group 1), cats with cardiomyopathy (CM) but without CHF (group 2), and cats with CM and CHF (group 3). Interrelations between pulmonary blood volume (PBV), nPTT, stroke volume (SV), and echocardiographic variables were investigated by means of linear univariate and multivariate analysis. RESULTS Median nPTT values in group 1, group 2, and group 3 were 3.63 (interquartile range [IQR], 3.20-4.22), 6.09 (IQR, 5.0-7.02), and 8.49 (IQR, 7.58-11.04), respectively. Values were significantly different between all 3 groups. Median PBVs in group 1, group 2, and group 3 were 27.94 mL (IQR, 21.02-33.17 mL), 42.83 mL (IQR, 38.46-50.36 mL) and 49.48 mL (IQR, 38.84-64.39 mL). SV, PBV, and shortening fraction <30% were significant predictors of nPTT. nPTT and left atrial to aortic root (LA:AO) ratio, not SV, were the main predictors of PBV. CONCLUSION nPTT may be useful as a test for the presence of CHF in cats with CM and as a measure of cardiac performance. nPTT and LA:AO ratios predict CHF with equal accuracy. Increased PBV is significantly associated with higher nPTT and LA:AO ratios.
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Affiliation(s)
- Andrea Streitberger
- Traunkreis Vet Clinic, Tierklinik Sattledt, Kirchdorferstraße 7, 4642 Sattledt, Austria.
| | - Peter Modler
- Traunkreis Vet Clinic, Tierklinik Sattledt, Kirchdorferstraße 7, 4642 Sattledt, Austria
| | - Jens Häggström
- Swedish University of Agricultural Sciences, Department of Clinical Sciences, P.O. Box 7070, 75007 Uppsala, Sweden
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Borgeat K, Sherwood K, Payne J, Luis Fuentes V, Connolly D. Plasma cardiac troponin I concentration and cardiac death in cats with hypertrophic cardiomyopathy. J Vet Intern Med 2014; 28:1731-7. [PMID: 25319115 PMCID: PMC4895638 DOI: 10.1111/jvim.12459] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 07/28/2014] [Accepted: 08/21/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The use of cardiac biomarkers to assist in the diagnosis of occult and symptomatic hypertrophic cardiomyopathy (HCM) in cats has been established. There is limited data describing their prognostic utility in cats with HCM. HYPOTHESIS Circulating concentrations of N-terminal B-type natriuretic peptide (NTproBNP) and cardiac troponin I (cTnI) predict cardiac death in cats with HCM. ANIMALS Forty-one cats diagnosed with HCM at a veterinary teaching hospital, between February 2010 and May 2011. METHODS Prospective investigational study. Plasma samples were collected from cats diagnosed with HCM and concentrations of NTproBNP and cTnI were analyzed at a commercial laboratory. Echocardiographic measurements from the day of blood sampling were recorded. Long-term outcome data were obtained. Associations with time to cardiac death were analyzed using Cox proportional hazards models. RESULTS When controlling for the presence/absence of heart failure and echocardiographic measures of left atrial size and function, cTnI > 0.7 ng/mL was independently associated with time to cardiac death. In univariable analysis, NTproBNP > 250 pmol/L was associated with cardiac death (P = .023), but this did not remain significant (P = .951) when controlling for the effect of clinical signs or left atrial size/function. CONCLUSIONS AND CLINICAL IMPORTANCE Plasma concentration of cTnI (cutoff >0.7 ng/mL) is a predictor of cardiac death in cats with HCM that is independent of the presence of heart failure or left atrial dilatation.
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Affiliation(s)
- K. Borgeat
- Royal Veterinary CollegeHatfieldUK
- Highcroft Veterinary ReferralsBristolUK
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22
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Oyama MA, Boswood A, Connolly DJ, Ettinger SJ, Fox PR, Gordon SG, Rush JE, Sisson DD, Stepien RL, Wess G, Zannad F. Clinical usefulness of an assay for measurement of circulating N-terminal pro-B-type natriuretic peptide concentration in dogs and cats with heart disease. J Am Vet Med Assoc 2014; 243:71-82. [PMID: 23786193 DOI: 10.2460/javma.243.1.71] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Mark A Oyama
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Trachsel D, Schwarzwald C, Grenacher B, Weishaupt M. Analytic validation and comparison of three commercial immunoassays for measurement of plasma atrial/A-type natriuretic peptide concentration in horses. Res Vet Sci 2014; 96:180-6. [DOI: 10.1016/j.rvsc.2013.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 10/19/2013] [Accepted: 10/26/2013] [Indexed: 10/26/2022]
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Humm K, Hezzell M, Sargent J, Connolly DJ, Boswood A. Differentiating between feline pleural effusions of cardiac and non-cardiac origin using pleural fluid NT-proBNP concentrations. J Small Anim Pract 2013; 54:656-61. [PMID: 24283418 DOI: 10.1111/jsap.12152] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether pleural fluid and urine amino terminal proB-type natriuretic peptide (NT-proBNP) can distinguish cardiac from non-cardiac causes of pleural effusion. METHODS Blood, urine and pleural fluid were prospectively collected from cats presenting with pleural effusion categorised as cardiac or non-cardiac in origin. NT-ProBNP concentrations were measured using a feline-specific enzyme-linked immunosorbent assay. Groups were statistically compared and receiver operating characteristic curves constructed to determine cut-offs to distinguish cardiac from non-cardiac pleural effusion in plasma, pleural fluid and urine. RESULTS Forty cats with pleural effusion (22 cardiac and 18 non-cardiac) were studied. NT-proBNP concentrations in plasma and pleural fluid were strongly correlated. Plasma (P<0·001) and pleural fluid (P<0·001) NT-proBNP concentrations and urinary NT-proBNT/creatinine ratios (P=0·035) were significantly higher in the cardiac group. After receiver operating characteristic curve analysis a plasma NT-proBNP cut-off of 214·3 pmol/mL was suggested [sensitivity=86·4% (95% CI: 66·7 to 95·3%), specificity=88·9% (95% CI: 67·2 to 96·9%)] and a pleural fluid NT-proBNP cut-off of 322·3 pmol/mL was suggested [sensitivity=100% (95% CI: 85·1 to 100%), specificity=94·4% (95% CI: 74·2 to 99·0%)]. No cut-off with adequate sensitivity and specificity for urinary NT-proBNP/creatinine ratios was suggested. CLINICAL SIGNIFICANCE Measurement of NT-proBNP in pleural fluid distinguishes cardiac from non-cardiac causes of pleural effusion in cats.
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Affiliation(s)
- K Humm
- Veterinary Clinical Sciences, The Royal Veterinary College, North Mymms, Hatfield
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25
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Ljungvall I, Rishniw M, Porciello F, Häggström J, Ohad D. Sleeping and resting respiratory rates in healthy adult cats and cats with subclinical heart disease. J Feline Med Surg 2013; 16:281-90. [PMID: 24170428 DOI: 10.1177/1098612x13508940] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sleeping and resting respiratory rates are commonly measured variables in patients with cardiac disease. However, little information is available on these variables in healthy client-owned cats or cats with subclinical heart disease (SHD). Therefore, we examined and characterized the sleeping respiratory rate (SRR) and resting respiratory rate (RRR) in 59 echocardiographically normal (EN) and 28 apparently healthy (AH) cats, and 54 SHD cats acquired by the cat owners in the home environment on eight to 10 separate occasions. The within-cat mean sleeping respiratory rate (SRRmean) in EN cats, AH cats and SHD cats with mild or moderate left atrial (LA) enlargement (as defined by quantiles of the ratio of the LA to the aorta [LA:AO]) was consistently <30 breaths/min; median SRRmean approximated 21 breaths/min. The SRRmean of SHD cats with severe LA enlargement sometimes exceeded 30 breaths/min, and was higher than SRRmean of other SHD cats (P <0.05). The within-cat mean resting respiratory rate was consistently higher than SRRmean (P <0.05). Age and geographic location, but not bodyweight, affected SRRmean in EN and AH cats. Within-cat SRR and within-cat RRR did not vary markedly from day-to-day, as evidenced by a low within-cat coefficient of variation. Data acquisition was considered easy or non-problematic by most participants. Our data provide useful guidelines for SRR and RRR, obtained in the home environment, in healthy cats and cats with SHD, and might prove useful in managing cats with clinical heart disease. Cats with SRRmean >30 breaths/min and cats with multiple SRR measurements >30 breaths/min likely warrant additional evaluation.
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Affiliation(s)
- Ingrid Ljungvall
- 1Department of Clinical Sciences, Swedish University of Agricultural Science, Uppsala, Sweden
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26
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Hassdenteufel E, Henrich E, Hildebrandt N, Stosic A, Schneider M. Assessment of circulating N-terminal pro B-type natriuretic peptide concentration to differentiate between cardiac from noncardiac causes of pleural effusion in cats. J Vet Emerg Crit Care (San Antonio) 2013; 23:416-22. [PMID: 23859335 DOI: 10.1111/vec.12074] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 06/02/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the diagnostic ability of blood N-terminal pro B-type natriuretic peptide (NT-proBNP) measurement to differentiate between congestive heart failure (CHF) and noncardiogenic causes for moderate to severe pleural effusion in cats. DESIGN Prospective observational study. SETTING University teaching hospital. ANIMALS Twenty-one cats with moderate to severe pleural effusion. INTERVENTIONS Venous blood sampling for NT-proBNP measurement. MEASUREMENT AND RESULTS According to the results of echocardiographic examination, cats were classified in a group with CHF (n = 11) or noncongestive heart failure (N-CHF, n = 10). NT-proBNP was measured via a feline-specific test in EDTA plasma with protease inhibitor. NT-proBNP was significantly (P < 0.0001) higher in the CHF group ( median 982 pmol/L, 355-1,286 pmol/L) than in the N-CHF group (median 69 pmol/L, 26 - 160 pmol/L) and discriminated exactly (area under the curve = 1.0, 95% confidence interval 1.0-1.0) between both groups. Optimum cut-off value considering all samples was 258 pmol/L. CONCLUSION In this small population of cats with pleural effusion, NT-proBNP was able to differentiate between cats with cardiogenic and noncardiogenic causes of effusion. With the currently recommended method of measurement (ie, EDTA plasma with protease inhibitor), a cut-off value of 258 pmol/L discriminates effectively between cats with and without CHF.
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Affiliation(s)
- Esther Hassdenteufel
- Department of Clinical Studies, Small Animal Clinic, University of Giessen, 35392, Giessen, Germany.
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27
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Menaut P, Connolly DJ, Volk A, Pace C, Luis Fuentes V, Elliott J, Syme H. Circulating natriuretic peptide concentrations in hyperthyroid cats. J Small Anim Pract 2012; 53:673-8. [PMID: 23146093 DOI: 10.1111/j.1748-5827.2012.01301.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the influence of thyroid function on natriuretic peptide concentration in hyperthyroid cats before and after treatment. METHODS Serum natriuretic peptide concentration was measured in 61 hyperthyroid cats recruited from first-opinion clinics before and after treatment. RESULTS Following successful treatment, total thyroxine, heart rate, systolic blood pressure and packed cell volume all decreased and bodyweight and creatinine concentrations increased. Furthermore, a significant (P < 0·001) decline in NT-proBNP concentration but not NT-proANP was identified. CLINICAL SIGNIFICANCE Thyroid function has a modest but significant effect on NT-proBNP concentration. Thyroid status should be taken into account when interpreting NT-proBNP concentrations in cats.
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Affiliation(s)
- P Menaut
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, North Mymms, Hertfordshire, UK
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Wess G, Daisenberger P, Mahling M, Hirschberger J, Hartmann K. Utility of measuring plasma N-terminal pro-brain natriuretic peptide in detecting hypertrophic cardiomyopathy and differentiating grades of severity in cats. Vet Clin Pathol 2011; 40:237-44. [PMID: 21434959 DOI: 10.1111/j.1939-165x.2011.00305.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cats with hypertrophic cardiomyopathy (HCM) often have no clinical signs or subtle signs. Measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) has been demonstrated in people to be highly specific for heart disease and also correlates with severity of HCM. NT-proBNP may also be valuable in detecting and grading HCM in cats, but results to date have been equivocal. OBJECTIVES The aims of this study were to evaluate NT-proBNP as a screening test for diagnosis of HCM in cats and determine an appropriate cut-off value and to determine if NT-proBNP concentrations correlated with severity of HCM in cats. METHODS Plasma NT-proBNP concentrations were measured in 201 cats using an ELISA designed for use in cats. Cats were classified using echocardiography as clinically healthy controls (n=99) or cats with equivocal (n=9), mild (n=15), moderate (n=17), or severe (n=61) HCM. RESULTS NT-proBNP concentrations (median; 25th-75th interquartile percentiles) in mildly (216.1; 87.6-392.5 pmol/L), moderately (282.7; 131.9-466.6 pmol/L), and severely (839.5; 655.3-1046.4 pmol/L) affected cats were significantly higher than those in healthy controls (18.9; 3.4-62.4 pmol/L). Concentrations in severely affected cats were significantly higher than in cats from other HCM groups. There was no significant difference between mild and moderate HCM. Cut-off values >49 pmol/L had a sensitivity of 97.8% and specificity of 66.7%; >100 pmol/L had a sensitivity of 92.4% and specificity of 93.9%; and >150 pmol/L had a sensitivity of 88% and a specificity of 100%. CONCLUSIONS NT-proBNP with a cut-off value of >100 pmol/L was useful in detecting even mild HCM. Cats with increased NT-proBNP concentrations should be examined by echocardiography.
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Affiliation(s)
- Gerhard Wess
- Clinic of Small Animal Medicine, Ludwig-Maximilians University, Munich, Germany.
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Nam SJ, Han SH, Kim HW, Hyun C. The Cardiac Biomarker Sodium-Calcium Exchanger (NCX-1) Can Differentiate between Heart Failure and Renal Failure: A Comparative Study of NCX-1 Expression in Dogs with Chronic Mitral Valvular Insufficiency and Azotemia. J Vet Intern Med 2010; 24:1383-7. [DOI: 10.1111/j.1939-1676.2010.0628.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Singh MK, Cocchiaro MF, Kittleson MD. NT-proBNP measurement fails to reliably identify subclinical hypertrophic cardiomyopathy in Maine Coon cats. J Feline Med Surg 2010; 12:942-7. [PMID: 21036088 DOI: 10.1016/j.jfms.2010.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2010] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to evaluate the value of measuring plasma NT-proBNP concentration as a screening tool in cats with varying severity of subclinical hypertrophic cardiomyopathy (HCM). Plasma NT-proBNP concentration was measured in 35 cats that had previously been classified as normal, equivocal, moderate HCM or severe HCM via echocardiography. No cat had ever been in congestive heart failure. Cats with severe HCM had a significantly higher NT-proBNP concentration compared to the other groups (P<0.0003), however, the sensitivity of NT-proBNP for diagnosing cats with severe disease was only 44% (cutoff≤100pmol/l) to 55% (cutoff≤40pmol/l). There was no significant difference in NT-proBNP concentration between normal, equivocal and moderate categories (sensitivity for detecting moderate HCM was 0%). Based on the results of this study, NT-proBNP concentration is not considered adequate as a screening test for detecting mild to moderate HCM in Maine Coon cats and it appears that it may miss many cats with severe HCM.
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Affiliation(s)
- Manreet K Singh
- Veterinary Medical Teaching Hospital, University of California, Davis, One Shields Avenue, Davis, CA, USA
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Beatty J, Barrs V. Pleural Effusion in the Cat: A Practical Approach to Determining Aetiology. J Feline Med Surg 2010; 12:693-707. [DOI: 10.1016/j.jfms.2010.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Practical relevance Diverse disease processes result in sufficient fluid accumulation within the pleural space to cause respiratory compromise. Determining the underlying aetiology is key to appropriate management. This review outlines a practical approach to cases of pleural effusion, focusing on early recognition and confirmation of pleural space disease, stabilisation of the patient and logical diagnostic investigation. It emphasises the importance of a holistic approach, incorporating fluid analysis with other clinical data to determine the underlying aetiology. Clinical challenges Cats with pleural effusion often have severe respiratory compromise at presentation. Careful handling and prompt and adequate stabilisation, incorporating supplemental oxygen and therapeutic thoracocentesis, is essential to avoid respiratory failure. The typical, stepwise approach to the case must be adapted and the clinician may have to proceed, at least initially, without the luxury of information gained from a full history and physical examination. The challenge is to juggle stabilisation, localisation and confirmation of pleural effusion, owner communication and minimally invasive examination while remaining vigilant for clues that allow ranking of the differentials to formulate a diagnostic plan. Evidence base Appropriately designed studies to determine the utility of diagnostic techniques in cases with confirmed aetiology are limited. The evidence supporting this review is grade II, III and IV, comprising a small number of prospective studies, several case series, reviews, extrapolation from other species, pathophysiological justification and combined clinical experience of those working in the field.
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Affiliation(s)
- Julia Beatty
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, University of Sydney, NSW 2006, Australia
| | - Vanessa Barrs
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, University of Sydney, NSW 2006, Australia
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Abstract
In feline medicine natriuretic peptides (NP), particularly NT-proBNP, have emerged as biomarkers with significant potential. Since the introduction of the commercial ELISA that enabled the convenient and accurate measurement of circulating N terminal ANP and BNP fragments research examining the utility of these peptides as an aid to the diagnosis of feline cardiovascular disease has accelerated. This article describes the results of these studies and tries to put them in the context of clinical practice by exploring the areas of agreement and controversy and explaining the influence of confounding factors on the interpretation of NP concentrations. Considerable further work is needed to fully evaluate the clinical utility of NP regarding their potential for diagnosis, prognosis, and guidance of treatment.
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Affiliation(s)
- David J Connolly
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hertfordshire AL9 7TA, UK.
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Collins SA, Patteson MW, Connolly DJ, Brodbelt DC, Torrance AG, Harris JD. Effects of sample handling on serum N-terminal proB-type natriuretic peptide concentration in normal dogs and dogs with heart disease. J Vet Cardiol 2010; 12:41-8. [DOI: 10.1016/j.jvc.2010.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Revised: 12/31/2009] [Accepted: 01/04/2010] [Indexed: 10/19/2022]
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