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Brown T, Defarges A, Monteith G, Appleby R, Bienzle D. Determination of the reference interval for urine kidney injury molecule-1 in 50 healthy cats. J Feline Med Surg 2024; 26:1098612X241238923. [PMID: 38647460 PMCID: PMC11103318 DOI: 10.1177/1098612x241238923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVES The aim of the present study was to establish a reference interval (RI) for urine kidney injury molecule-1 (KIM-1) in healthy cats. METHODS History, physical examination, blood pressure, and feline immunodeficiency virus and feline leukemia virus serology status were determined. A complete blood cell count, serum biochemical profile, urinalysis and kidney ultrasound were performed, and N-terminal pro-brain natriuretic peptide, total thyroxine (TT4) and urine KIM-1 were measured. An RI was calculated and the effect of age, sex, body condition score (BCS), blood pressure, symmetric dimethylarginine (SDMA), serum creatinine concentration (SCr), phosphorus, TT4, urine specific gravity (USG) and mid-sagittal kidney length on urine KIM-1 was evaluated using a general linear model. RESULTS Of 69 recruited cats, 50 met the inclusion criteria. There were 35 male cats and 15 female cats, with a median age of 4.3 years (range 1.0-12.3), median weight of 5.11 kg (range 2.52-8.45) and median BCS of 6/9 (range 3-8). The median serum concentrations were SDMA 11.0 µg/dl (range 2-14), SCr 88.5 µmol/l (range 47-136), phosphorus 1.41 mmol/l (range 0.8-2.2) and TT4 32.0 nmol/l (range 17-51). Median USG was 1.057 (range 1.035-1.076), mid-sagittal left kidney length was 3.50 cm (range 2.94-4.45) and mid-sagittal right kidney length was 3.70 cm (range 3.06-4.55). The derived RI for urine KIM-1 was 0.02-0.68. USG was a significant (P <0.001) predictor of urine KIM-1. Individually, age, sex, blood pressure, BCS, SDMA, SCr, phosphorus, TT4 and mid-sagittal kidney length were not significant predictors of urine KIM-1. In a multivariate model, if combined with USG, SDMA concentration was predictive (P = 0.030) of urine KIM-1. CONCLUSIONS AND RELEVANCE Urine concentration was significantly correlated with urine KIM-1, which will be an important consideration when interpreting findings in cats with potential kidney injury.
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Affiliation(s)
- Tori Brown
- Mississauga Oakville Veterinary Emergency Hospital, Oakville, ON, Canada
| | - Alice Defarges
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
| | - Gabrielle Monteith
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
| | - Ryan Appleby
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
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2
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Fries R. Hypertrophic Cardiomyopathy-Advances in Imaging and Diagnostic Strategies. Vet Clin North Am Small Anim Pract 2023; 53:1325-1342. [PMID: 37423845 DOI: 10.1016/j.cvsm.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most important and prevalent cardiac disease in cats. Due to the highly variable nature of HCM, a multimodal approach including physical examination, genetic evaluation, cardiac biomarkers, and imaging are all essential elements to appropriate and timely diagnosis. These foundational elements are advancing rapidly in veterinary medicine. Newer biomarkers such as galectin-3 are currently being researched and advances in tissue speckle-tracking and contrast-enhanced echocardiography are readily available. Advanced imaging techniques, such as cardiac MRI, are providing previously unavailable information about myocardial fibrosis and paving the way for enhanced diagnostic capabilities and risk-stratification in cats with HCM.
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Affiliation(s)
- Ryan Fries
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, 1008 West Hazelwood Drive, Urbana, IL 61802, USA.
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3
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Stern JA, Rivas VN, Kaplan JL, Ueda Y, Oldach MS, Ontiveros ES, Kooiker KB, van Dijk SJ, Harris SP. Hypertrophic cardiomyopathy in purpose-bred cats with the A31P mutation in cardiac myosin binding protein-C. Sci Rep 2023; 13:10319. [PMID: 37365215 PMCID: PMC10293195 DOI: 10.1038/s41598-023-36932-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
We sought to establish a large animal model of inherited hypertrophic cardiomyopathy (HCM) with sufficient disease severity and early penetrance for identification of novel therapeutic strategies. HCM is the most common inherited cardiac disorder affecting 1 in 250-500 people, yet few therapies for its treatment or prevention are available. A research colony of purpose-bred cats carrying the A31P mutation in MYBPC3 was founded using sperm from a single heterozygous male cat. Cardiac function in four generations was assessed by periodic echocardiography and measurement of blood biomarkers. Results showed that HCM penetrance was age-dependent, and that penetrance occurred earlier and was more severe in successive generations, especially in homozygotes. Homozygosity was also associated with progression from preclinical to clinical disease. A31P homozygous cats represent a heritable model of HCM with early disease penetrance and a severe phenotype necessary for interventional studies aimed at altering disease progression. The occurrence of a more severe phenotype in later generations of cats, and the occasional occurrence of HCM in wildtype cats suggests the presence of at least one gene modifier or a second causal variant in this research colony that exacerbates the HCM phenotype when inherited in combination with the A31P mutation.
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Affiliation(s)
- Joshua A Stern
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA, 95616, USA
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1038 William Moore Dr, Raleigh, NC, 27606, USA
| | - Victor N Rivas
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA, 95616, USA
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1038 William Moore Dr, Raleigh, NC, 27606, USA
| | - Joanna L Kaplan
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA, 95616, USA
| | - Yu Ueda
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1038 William Moore Dr, Raleigh, NC, 27606, USA
| | - Maureen S Oldach
- VCA Sacramento Veterinary Referral Center, 9801 Old Winery Place, Sacramento, CA, 95827, USA
| | - Eric S Ontiveros
- Rady Children's Institute for Genomic Medicine, 7910 Frost Street, San Diego, CA, 92123, USA
| | - Kristina B Kooiker
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, 98109, USA
| | - Sabine J van Dijk
- Department of Neurobiology, Physiology, and Behavior, University of California-Davis, One Shields Avenue, Davis, CA, 95616, USA
| | - Samantha P Harris
- Department of Neurobiology, Physiology, and Behavior, University of California-Davis, One Shields Avenue, Davis, CA, 95616, USA.
- Department of Physiology, College of Medicine-Tucson, University of Arizona, 313 Medical Research Building, 1656 E Mabel St., Tucson, AZ, 85724, USA.
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4
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Adamantos S, Safrany B. Current controversies in feline transfusion medicine. IN PRACTICE 2023. [DOI: 10.1002/inpr.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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5
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Côté E, Zwicker LA, Anderson EL, Stryhn H, Yu J, Andersen E. Effects of dexmedetomidine and its reversal with atipamezole on echocardiographic measurements and circulating cardiac biomarker concentrations in normal cats. J Am Vet Med Assoc 2022; 260:1-9. [PMID: 35175929 DOI: 10.2460/javma.21.06.0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the effects of dexmedetomidine (DXM) and its subsequent reversal with atipamezole (APM) on the echocardiogram and circulating concentrations of cardiac biomarkers in cats. ANIMALS 14 healthy cats. PROCEDURES Cats underwent echocardiography and measurements of circulating cTn-I and NT-proBNP concentrations before (PRE) and during (INTRA) DXM sedation (40 µg/kg IM) and 2 to 4 (2H POST) and 24 (24H POST) hours after reversal with APM. RESULTS Administering DXM significantly decreased heart rate, right ventricular and left ventricular (LV) outflow tract velocities, and M-mode-derived LV free-wall thickness; increased LV end systolic diameter and volume; and caused valvar regurgitation. While sedative effects resolved within 25 minutes of APM reversal, the evolution of echocardiographic changes was mixed: LV ejection fraction and mitral valvar regurgitation score were different at 2H POST than at both INTRA and PRE (partial return toward baseline), LV end-diastolic volume was different PRE to INTRA and INTRA to 2H POST but not different PRE to 2H POST (full return toward baseline), and M-mode-derived LV free-wall thickness was significantly different from PRE to INTRA and PRE to 2H POST (no return toward baseline). Serum cTn-I and plasma NT-proBNP concentrations increased significantly with DXM, which remained significant 2H POST. CLINICAL RELEVANCE Administration of DXM and APM reversal produced changes in echocardiographic results and in circulating cTn-I and NT-proBNP concentrations. Understanding these changes could help veterinarians differentiate drug effects from cardiac disease.
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Affiliation(s)
- Etienne Côté
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Lesley A Zwicker
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Erin L Anderson
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Henrik Stryhn
- Department Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Jenny Yu
- Department Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Erin Andersen
- Veterinary Teaching Hospital, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
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6
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Walker AL, Ueda Y, Crofton AE, Harris SP, Stern JA. Ambulatory electrocardiography, heart rate variability, and pharmacologic stress testing in cats with subclinical hypertrophic cardiomyopathy. Sci Rep 2022; 12:1963. [PMID: 35121794 PMCID: PMC8817045 DOI: 10.1038/s41598-022-05999-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/21/2022] [Indexed: 11/09/2022] Open
Abstract
The utility of ambulatory electrocardiography (AECG) to evaluate cats with subclinical hypertrophic cardiomyopathy (HCM) for arrhythmias and heart rate variability (HRV) is not well defined but may provide information regarding risk stratification. This prospective study used AECG to evaluate ectopy and HRV in subclinical HCM cats compared to healthy controls and is the first to implement a pharmacologic cardiac stress test. Twenty-three purpose-bred, Maine coon cross cats (16 HCM, 7 control) underwent 48-h of continuous AECG. Terbutaline (0.2-0.3 mg/kg) was administered orally at 24 and 36 h. Heart rate, ectopy frequency and complexity and HRV parameters, including standard deviation of normal R-R intervals (SDNN), were compared pre-terbutaline and post-terbutaline and across phenotype, genotype and sex. Genotype for an HCM-causative mutation was significantly associated with the frequency of supraventricular (P = 0.033) and ventricular (P = 0.026) ectopy across all cats. Seven HCM cats and zero healthy cats had a sinus arrhythmia. Mean heart rate was significantly higher post-terbutaline (p < 0.0001). HCM cats had significantly greater HRV compared to controls (SDNN: p = 0.0006). Male cats had significantly higher HRV (SDNN: p = 0.0001) and lower mean heart rates (p = 0.0001). HRV decreased post-terbutaline (SDNN: p = 0.0008) and changes in HRV observed between sexes were attenuated by terbutaline.
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Affiliation(s)
- Ashley L Walker
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California-Davis, 2108 Tupper Hall, Davis, CA, 95616-8732, USA
| | - Yu Ueda
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607, USA
| | - Amanda E Crofton
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California-Davis, 2108 Tupper Hall, Davis, CA, 95616-8732, USA
| | - Samantha P Harris
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, 85724, USA
| | - Joshua A Stern
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California-Davis, 2108 Tupper Hall, Davis, CA, 95616-8732, USA.
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7
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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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8
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Abstract
Practical relevance: Hypertrophic cardiomyopathy (HCM) is the most common form of feline
cardiomyopathy observed clinically and may affect up to approximately 15% of
the domestic cat population, primarily as a subclinical disease.
Fortunately, severe HCM, leading to heart failure or arterial
thromboembolism (ATE), only occurs in a small proportion of these cats. Patient group: Domestic cats of any age from 3 months upward, of either sex and of any
breed, can be affected. A higher prevalence in male and domestic shorthair
cats has been reported. Diagnostics: Subclinical feline HCM may or may not produce a heart murmur or gallop sound.
Substantial left atrial enlargement can often be identified radiographically
in cats with severe HCM. Biomarkers should not be relied on solely to
diagnose the disease. While severe feline HCM can usually be diagnosed via
echocardiography alone, feline HCM with mild to moderate left ventricular
(LV) wall thickening is a diagnosis of exclusion, which means there is no
definitive test for HCM in these cats and so other disorders that can cause
mild to moderate LV wall thickening (eg, hyperthyroidism, systemic
hypertension, acromegaly, dehydration) need to be ruled out. Key findings: While a genetic cause of HCM has been identified in two breeds and is
suspected in another, for most cats the cause is unknown. Systolic anterior
motion of the mitral valve (SAM) is the most common cause of dynamic left
ventricular outflow tract obstruction (DLVOTO) and, in turn, the most common
cause of a heart murmur with feline HCM. While severe DLVOTO is probably
clinically significant and so should be treated, lesser degrees probably are
not. Furthermore, since SAM can likely be induced in most cats with HCM, the
distinction between HCM without obstruction and HCM with obstruction (HOCM)
is of limited importance in cats. Diastolic dysfunction, and its
consequences of abnormally increased atrial pressure leading to signs of
heart failure, and sluggish atrial blood flow leading to ATE, is the primary
abnormality that causes clinical signs and death in affected cats. Treatment
(eg, loop diuretics) is aimed at controlling heart failure. Preventive
treatment (eg, antithrombotic drugs) is aimed at reducing the risk of
complications (eg, ATE). Conclusions: Most cats with HCM show no overt clinical signs and live a normal or
near-normal life despite this disease. However, a substantial minority of
cats develop overt clinical signs referable to heart failure or ATE that
require treatment. For most cats with clinical signs caused by HCM, the
long-term prognosis is poor to grave despite therapy. Areas of uncertainty: Genetic mutations (variants) that cause HCM have been identified in a few
breeds, but, despite valiant efforts, the cause of HCM in the vast majority
of cats remains unknown. No treatment currently exists that reverses or even
slows the cardiomyopathic process in HCM, again despite valiant efforts. The
search goes on.
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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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9
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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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Loughran K. Focused Cardiac Ultrasonography in Cats. Vet Clin North Am Small Anim Pract 2021; 51:1183-1202. [PMID: 34454727 DOI: 10.1016/j.cvsm.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Heart disease is a common cause of morbidity and mortality in cats. Focused cardiac ultrasonography (FCU) is a useful diagnostic tool for identifying heart disease in symptomatic and asymptomatic cats when performed by trained veterinarians. When used in conjunction with other diagnostics such as physical examination, blood biomarkers, electrocardiography, Global FAST, and other point-of-care ultrasonographic examinations, FCU may improve clinical decision making and help clinicians prioritize which cats would benefit from referral for complete echocardiography and cardiac consultation. This article reviews the definition, advantages, clinical indications, limitations, training recommendations, and a protocol for FCU in cats.
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Affiliation(s)
- Kerry Loughran
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104.
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11
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Franchini A, Abbott JA, Lahmers S, Eriksson A. Clinical characteristics of cats referred for evaluation of subclinical cardiac murmurs. J Feline Med Surg 2021; 23:708-714. [PMID: 33215949 PMCID: PMC10812197 DOI: 10.1177/1098612x20972058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to define the clinical characteristics of cats referred for evaluation of subclinical cardiac murmurs, and, secondarily, to identify predictors of echocardiographic identification of cardiac disease. METHODS One hundred and sixty-three apparently healthy cats with subclinical murmurs were retrospectively enrolled. Medical records of cats older than 1 year of age referred for the evaluation of subclinical murmurs were reviewed. Cats were considered healthy if clinical signs of systemic disease or cardiac disease were not reported and cats were not receiving cardiac medications. Logistic regression was used to identify clinical variables that predict echocardiographic identification of cardiac disease. RESULTS One hundred and eight cats (66.3%) had echocardiographic evidence of cardiac disease with hypertrophic cardiomyopathy being the most common (80.5%). Left atrial enlargement was uncommon; in 90% of cats with echocardiographically identified cardiac disease, the left atrial aortic ratio from two-dimensional echocardiography was <1.51. Cats with cardiac disease were more likely to be male (P = 0.016), weigh more (P <0.01) and have a murmur of intensity ⩾3/6 (P = 0.019) than cats without cardiac disease. Murmur intensity ⩾grade 3/6 (P = 0.01) and male sex (P = 0.01) were independent predictors of echocardiographic evidence of cardiac disease in multivariable analysis. CONCLUSIONS AND RELEVANCE The majority of cats referred for evaluation of subclinical cardiac murmurs have cardiac disease. Based on left atrial dimensions, cardiac disease is generally mild. Male sex and a loud cardiac murmur are associated with the identification of cardiac disease.
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Affiliation(s)
- Alessandra Franchini
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytech Institute and State University, Blacksburg, VA, USA
| | - Jonathan A Abbott
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Sunshine Lahmers
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytech Institute and State University, Blacksburg, VA, USA
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12
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Lu TL, Côté E, Kuo YW, Wu HH, Wang WY, Hung YW. Point-of-care N-terminal pro B-type natriuretic peptide assay to screen apparently healthy cats for cardiac disease in general practice. J Vet Intern Med 2021; 35:1663-1672. [PMID: 33993546 PMCID: PMC8295655 DOI: 10.1111/jvim.16156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/25/2022] Open
Abstract
Background Point‐of‐care (POC) N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) ELISA test has been evaluated for screening cats for cardiac disease in the referral veterinary setting but less is known about its use in general practice (GP). Objectives To evaluate the diagnostic utility of a POC NT‐proBNP ELISA in cats seen in GPs. Animals Two hundred and seventeen apparently healthy cats from 21 GPs. Methods This was a prospective, cross‐sectional study. Cardiac auscultation and POC NT‐proBNP ELISA were done by veterinarians at their GPs. After enrollment at GPs, cats were sent to a cardiology referral hospital for cardiac auscultation and echocardiographic diagnosis. Results were interpreted based on whether cats had normal or abnormal echocardiographic findings. Results Point‐of‐care NT‐proBNP ELISA results differentiated cats in the abnormal group from those in the normal group with a sensitivity of 43%, specificity of 96%. In cats with a heart murmur at GPs, POC NT‐proBNP ELISA results differentiated cats in the abnormal group from those in the normal group with a sensitivity of 71% and a specificity of 92%. Conclusion and Clinical Importance In apparently healthy cats in GPs, positive POC NT‐proBNP results are associated with heart disease, warranting an echocardiogram, but negative results do not reliably exclude heart disease. These results suggest POC NT‐proBNP is not an effective screening test for apparently healthy cats in GPs, although its performance is improved if it is used only in cats that have a heart murmur.
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Affiliation(s)
- Ta-Li Lu
- Cardiospecial Veterinary Hospital, Taipei, Taiwan, ROC
| | - Etienne Côté
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Yu-Wen Kuo
- Cardiospecial Veterinary Hospital, Taipei, Taiwan, ROC
| | - Hao-Han Wu
- Cardiospecial Veterinary Hospital, Taipei, Taiwan, ROC
| | - Wen-Yen Wang
- Cardiospecial Veterinary Hospital, Taipei, Taiwan, ROC
| | - Yong-Wei Hung
- Cardiospecial Veterinary Hospital, Taipei, Taiwan, ROC
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13
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Taylor S, Spada E, Callan MB, Korman R, Leister E, Steagall P, Lobetti R, Seth M, Tasker S. 2021 ISFM Consensus Guidelines on the Collection and Administration of Blood and Blood Products in Cats. J Feline Med Surg 2021; 23:410-432. [PMID: 33896248 PMCID: PMC10741281 DOI: 10.1177/1098612x211007071] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PRACTICAL RELEVANCE Blood and blood products are increasingly available for practitioners to use in the management of haematological conditions, and can be lifesaving and therapeutically useful for patients with anaemia and/or coagulopathies. It is important for feline healthcare that donors are selected appropriately, and transfusions of blood or blood products are given to recipients that will benefit from them. Complications can occur, but can be largely avoided with careful donor management and recipient selection, understanding of blood type compatibility, and transfusion monitoring. CLINICAL CHALLENGES Feline blood transfusion, while potentially a lifesaving procedure, can also be detrimental to donor and recipient without precautions. Cats have naturally occurring alloantibodies to red cell antigens and severe reactions can occur with type-mismatched transfusions. Blood transfusions can also transmit infectious agents to the recipient, so donor testing is essential. Finally, donors must be in good health, and sedated as appropriate, with blood collected in a safe and sterile fashion to optimise the benefit to recipients. Transfusion reactions are possible and can be mild to severe in nature. Autologous blood transfusions and xenotransfusions may be considered in certain situations. EVIDENCE BASE These Guidelines have been created by a panel of authors convened by the International Society of Feline Medicine (ISFM), based on available literature. They are aimed at general practitioners to provide a practical guide to blood typing, cross-matching, and blood collection and administration.
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Affiliation(s)
| | - Eva Spada
- Veterinary Transfusion Research Laboratory
(REVLab), Department of Veterinary Medicine (DIMEVET), University of Milan,
Italy
| | - Mary Beth Callan
- Department of Clinical Sciences and Advanced
Medicine, School of Veterinary Medicine, University of Pennsylvania,
USA
| | - Rachel Korman
- Cat Specialist Services, Underwood, Queensland,
Australia
| | - Ellie Leister
- Pet Intensive Care Unit, Underwood, Queensland,
Australia
| | - Paulo Steagall
- Department of Clinical Sciences, Faculty of
Veterinary Medicine, Universite de Montréal, QC, Canada
| | - Remo Lobetti
- Bryanston Veterinary Hospital, Johannesburg,
South Africa
| | | | - Séverine Tasker
- Bristol Veterinary School, University of
Bristol, Langford, UK; and Linnaeus Group, Shirley, UK
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14
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Gunther-Harrington CT, Sharpe AN, Vernau KM, Ueda Y, Montgomery EA, Surmick JD, Fernandez N, Ontiveros E, Walker AL, Stern JA. Reference intervals for radiographic, echocardiographic and N-terminal pro B-type natriuretic peptide values in healthy kittens. J Feline Med Surg 2021; 23:293-301. [PMID: 32812464 PMCID: PMC10812212 DOI: 10.1177/1098612x20946461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Assessment of heart size in kittens is important, and there is a need for reference intervals (RIs) to prevent misinterpretation of cardiomegaly in this patient population. The purpose of this study was to generate RIs for echocardiographic and radiographic quantification of cardiac size in healthy kittens. METHODS In total, 88 kittens aged 6-16 weeks were enrolled in this study. Physical examination, and radiographic and echocardiographic evaluations were performed without sedation. Thoracic radiographs and echocardiographic images were measured to establish RIs for vertebral heart score (VHS), cardiac thoracic ratio (CTR) and multiple echocardiographic variables. N-terminal pro B-type natriuretic peptide (NT-proBNP) was measured. Statistical correlations between echocardiographic parameters and age, body weight and sex were all evaluated and RIs were generated. RESULTS Low-grade heart murmurs were appreciated in 26/88 kittens (29.5%). Kittens had a median VHS of 9.5 vertebrae (95% RI 8.0-10.9) and a median CTR of 67.2% (95% RI 54.4-79.8%). Measured NT-proBNP levels were comparable to healthy adult cats with a median of 31 pmol/l (upper reference limit 75 pmol/l). Multiple moderate-to-strong correlations between body weight and age with various echocardiographic parameters were observed and allometric scaling was performed for body weight. RIs for echocardiographic parameters were generated based on patient weight using allometric scaling formulas. Tricuspid valve regurgitation was a common finding and was present in 37.5% (n = 33) of the kittens. CONCLUSIONS AND RELEVANCE This study establishes RIs for thoracic radiograph assessment, echocardiography and cardiac biomarkers in kittens, which fills a critical gap in the veterinary literature. The VHS reported in this study is higher than previously reported for adult cats.
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Affiliation(s)
| | - Ashley N Sharpe
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Karen M Vernau
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Yu Ueda
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Elizabeth A Montgomery
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Jennifer D Surmick
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Nicole Fernandez
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Eric Ontiveros
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Ashley L Walker
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Joshua A Stern
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
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15
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van Hoek IMJ, Laxalde J, Connolly DJ, Rush JE, Freeman LM. Echocardiographic, morphometric and biomarker changes in female cats followed from 6 to 24 months of life. J Feline Med Surg 2021; 23:278-286. [PMID: 32720562 PMCID: PMC10812201 DOI: 10.1177/1098612x20943684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate cardiac size and early growth through echocardiographic, body weight (BW), body condition score (BCS), morphometric and biomarker changes in cats followed from 6 to 24 months of age. METHODS Twenty-four female European shorthair colony cats were evaluated at birth for BW and at 6, 12, 18 and 24 months of age for BW, BCS, head length (HL) and head width (HW), N-terminal pro B-type natriuretic peptide (NT-proBNP), insulin-like growth factor-1 (IGF-1) and echocardiographic measurements. RESULTS BCS, HW, left ventricular free wall in diastole, left atrium diameter and aortic diameter increased significantly between 6 and 12 months, while BW, HL and interventricular septum in diastole increased significantly between 6, 12 and 18 months, and BW decreased significantly between 18 and 24 months. NT-proBNP decreased significantly between 6 and 12 months. IGF-1 increased significantly between 6 and 12 months but decreased significantly between 12 and 18 months. CONCLUSIONS AND RELEVANCE This study prospectively evaluated changes in echocardiographic measurements, BW, BCS, HL, HW, IGF-1 and NT-proBNP in cats during the first 2 years of life. Results show a comparable change over time for different variables. These findings contribute to the understanding of a possible relationship between cardiac measures and body size from young age through to adulthood.
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Affiliation(s)
| | | | - David J Connolly
- Department of Clinical Science and Services, Royal Veterinary College, London, UK
| | - John E Rush
- Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Lisa M Freeman
- Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
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16
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Updates on Laboratory Evaluation of Feline Cardiac Diseases. Vet Sci 2021; 8:vetsci8030041. [PMID: 33802401 PMCID: PMC8000286 DOI: 10.3390/vetsci8030041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
Laboratory tests can be altered in cardiovascular diseases and the investigation of specific tests or biomarkers may provide additional information about myocardial damage. Traditional laboratory tests, such as cell blood count, serum biochemistry, and coagulation, can be useful in investigating patients, but are not specific. However, markers like Troponin and Natriuretic Peptides may possibly furnish further data on myocardium damage and can be used in both studying and monitoring cats with cardiac disease. Moreover, the evaluation of the thyroid profile is very important as hyperthyroid cats concomitant cardiovascular diseases are very common and they can also be a direct consequence of endocrinopathy. The purpose of this manuscript is to provide the widest possible overview of what is present in the literature about the feline clinical pathology of heart diseases through a rational division of the main alterations of traditional tests and biomarkers.
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17
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Quimby J, Gowland S, Carney HC, DePorter T, Plummer P, Westropp J. 2021 AAHA/AAFP Feline Life Stage Guidelines. J Feline Med Surg 2021; 23:211-233. [PMID: 33627003 PMCID: PMC10812130 DOI: 10.1177/1098612x21993657] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The guidelines, authored by a Task Force of experts in feline clinical medicine, are an update and extension of the AAFP-AAHA Feline Life Stage Guidelines published in 2010. The guidelines are published simultaneously in the Journal of Feline Medicine and Surgery (volume 23, issue 3, pages 211-233, DOI: 10.1177/1098612X21993657) and the Journal of the American Animal Hospital Association (volume 57, issue 2, pages 51-72, DOI: 10.5326/JAAHA-MS-7189). A noteworthy change from the earlier guidelines is the division of the cat's lifespan into a five-stage grouping with four distinct age-related stages (kitten, young adult, mature adult, and senior) as well as an end-of-life stage, instead of the previous six. This simplified grouping is consistent with how pet owners generally perceive their cat's maturation and aging process, and provides a readily understood basis for an evolving, individualized, lifelong feline healthcare strategy. The guidelines include a comprehensive table on the components of a feline wellness visit that provides a framework for systematically implementing an individualized life stage approach to feline healthcare. Included are recommendations for managing the most critical health-related factors in relation to a cat's life stage. These recommendations are further explained in the following categories: behavior and environmental needs; elimination; life stage nutrition and weight management; oral health; parasite control; vaccination; zoonoses and human safety; and recommended diagnostics based on life stage. A discussion on overcoming barriers to veterinary visits by cat owners offers practical advice on one of the most challenging aspects of delivering regular feline healthcare.
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Affiliation(s)
- Jessica Quimby
- DVM, PhD, DACVIM, Co-Chair of 2021 AAHA/AAFP Feline Life Stage Guidelines Task Force The Ohio State University, Department of Veterinary Clinical Sciences, Columbus, Ohio, USA
| | - Shannon Gowland
- DVM, DABVP, Co-Chair of 2021 AAHA/AAFP Feline Life Stage Guidelines Task Force OVC Smith Lane Animal Hospital, Ontario Veterinary College, Guelph, Ontario, Canada
| | - Hazel C Carney
- DVM, MS, DABVP, WestVet Emergency and Specialty Center, Garden City, Idaho, USA
| | - Theresa DePorter
- DVM, MRCVS, DACVB, DECAWBM, Oakland Veterinary Referral Services, Bloomfield Hills, Michigan, USA
| | - Paula Plummer
- LVT, VTS (ECC, SAIM), Texas A&M University Veterinary Medical Teaching Hospital, College Station, Texas, USA
| | - Jodi Westropp
- DVM, PhD, DACVIM, University of California, Davis, School of Veterinary Medicine, Davis, California, USA
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18
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Quimby J, Gowland S, Carney HC, DePorter T, Plummer P, Westropp J. 2021 AAHA/AAFP Feline Life Stage Guidelines. J Am Anim Hosp Assoc 2021. [PMID: 33627003 DOI: 10.5326/jaaha-ms-7189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The guidelines, authored by a Task Force of experts in feline clinical medicine, are an update and extension of the AAFP-AAHA Feline Life Stage Guidelines published in 2010. The guidelines are published simultaneously in the Journal of Feline Medicine and Surgery (volume 23, issue 3, pages 211-233, DOI: 10.1177/1098612X21993657) and the Journal of the American Animal Hospital Association (volume 57, issue 2, pages 51-72, DOI: 10.5326/JAAHA-MS-7189). A noteworthy change from the earlier guidelines is the division of the cat's lifespan into a five-stage grouping with four distinct age-related stages (kitten, young adult, mature adult, and senior) as well as an end-of-life stage, instead of the previous six. This simplified grouping is consistent with how pet owners generally perceive their cat's maturation and aging process, and provides a readily understood basis for an evolving, individualized, lifelong feline healthcare strategy. The guidelines include a comprehensive table on the components of a feline wellness visit that provides a framework for systematically implementing an individualized life stage approach to feline healthcare. Included are recommendations for managing the most critical health-related factors in relation to a cat's life stage. These recommendations are further explained in the following categories: behavior and environmental needs; elimination; life stage nutrition and weight management; oral health; parasite control; vaccination; zoonoses and human safety; and recommended diagnostics based on life stage. A discussion on overcoming barriers to veterinary visits by cat owners offers practical advice on one of the most challenging aspects of delivering regular feline healthcare.
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Affiliation(s)
- Jessica Quimby
- DVM, PhD, DACVIM, Co-Chair of 2021 AAHA/AAFP Feline Life Stage Guidelines Task Force The Ohio State University, Department of Veterinary Clinical Sciences, Columbus, Ohio, USA
| | - Shannon Gowland
- DVM, DABVP, Co-Chair of 2021 AAHA/AAFP Feline Life Stage Guidelines Task Force OVC Smith Lane Animal Hospital, Ontario Veterinary College, Guelph, Ontario, Canada
| | - Hazel C Carney
- DVM, MS, DABVP, WestVet Emergency and Specialty Center, Garden City, Idaho, USA
| | - Theresa DePorter
- DVM, MRCVS, DACVB, DECAWBM, Oakland Veterinary Referral Services, Bloomfield Hills, Michigan, USA
| | - Paula Plummer
- LVT, VTS (ECC, SAIM), Texas A&M University Veterinary Medical Teaching Hospital, College Station, Texas, USA
| | - Jodi Westropp
- DVM, PhD, DACVIM, University of California, Davis, School of Veterinary Medicine, Davis, California, USA
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19
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Kormpou F, Gil-Morales C, Warren-Smith C, Hibbert A. Concurrent thoracic pathology identified with radiology in hyperthyroid cats referred for radioiodine therapy. J Feline Med Surg 2020; 22:966-976. [PMID: 32081073 PMCID: PMC10814410 DOI: 10.1177/1098612x19900408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Radioiodine (RAI) treatment for hyperthyroidism is becoming increasingly available in the UK. Pretreatment assessment is commonly performed, as patient handling is limited once RAI has been administered. The aims of this study were to determine the prevalence of thoracic pathology using thoracic radiography in hyperthyroid cats referred for RAI treatment and to determine the value of this technique pretreatment. METHODS The hospital databases were searched for hyperthyroid cats referred for RAI treatment at the Feline Centre, Langford Vets, between January 2012 and July 2016. Radiographs were reviewed by Diplomates of the European College of Veterinary Diagnostic Imaging at the time of treatment and each set of radiographs was subsequently reviewed by one radiologist for the study. Cardiorespiratory signs were recorded, if present, and any change in treatment plan or suitability for RAI treatment was documented. RESULTS Two hundred and fifty-two cats were included in the study. Thoracic pathology was identified in 77% (n = 194/252) of the cats, of which 59% (n = 115/194) had pulmonary abnormalities with bronchial and bronchointerstitial patterns most frequently; 57% (n = 111/194) had skeletal abnormalities and 43% (n = 84/194) had cardiac abnormalities, with mild-to-moderate cardiomegaly most prevalent. Other abnormalities included sternal lymphadenomegaly (7%; n = 13/194), mediastinal pathology (3%; n = 5/194), oesophageal pathology (2%; n = 4/194) and pleural space disease (0.5%; n = 1/194).Twelve cases (6%) had a change in their treatment plan as a result of thoracic radiographic abnormalities, of which five subsequently underwent RAI treatment. CONCLUSIONS AND RELEVANCE A low prevalence of significant thoracic pathology was identified on radiographs in hyperthyroid cats referred for RAI treatment. Incidental thoracic abnormalities were found much more commonly; hence, results of thoracic radiology need to be combined with the clinical picture, to decide whether further investigations or alterations to the treatment plan are required pre-RAI.
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Affiliation(s)
- Foteini Kormpou
- School of Veterinary Sciences, University of Bristol, Bristol, UK
| | | | | | - Angie Hibbert
- The Feline Centre, Langford Vets, University of Bristol, Bristol, UK
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20
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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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21
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Hori Y, Fujimoto E, Nishikawa Y, Nakamura T. Left ventricular outflow tract pressure gradient changes after carvedilol-disopyramide cotherapy in a cat with hypertrophic obstructive cardiomyopathy. J Vet Cardiol 2020; 29:40-46. [PMID: 32464577 DOI: 10.1016/j.jvc.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 04/08/2020] [Accepted: 04/20/2020] [Indexed: 12/13/2022]
Abstract
Disopyramide reduces the left ventricular outflow tract (LVOT) pressure gradient and improves symptoms in humans with hypertrophic obstructive cardiomyopathy (HOCM). However, the efficacy of disopyramide in cats has not been reported. We treated a cat with HOCM with carvedilol and disopyramide cotherapy and monitored the changes in LVOT flow velocity and N-terminal pro B-type natriuretic peptide (NT-proBNP) concentration. A 10-month-old neutered male Norwegian Forest cat was referred with a moderate systolic cardiac murmur. Echocardiography revealed thickening of the left ventricular wall, systolic anterior motion of the mitral valve leaflets, and turbulent aortic flow in the LVOT at systole. The LVOT flow velocity was 5.6 m/s. The plasma NT-proBNP concentration exceeded 1,500 pmol/L. The cat was diagnosed with HOCM and the β-blocker carvedilol was started and gradually increased to 0.30 mg/kg, bid. After 57 days, the LVOT flow velocity (4.8 m/s) and plasma NT-proBNP concentration (870 pmol/L) had decreased but remained elevated. Therefore, disopyramide was added at 5.4 mg/kg po bid and increased to 10.9 mg/kg po bid after 22 days. After 141 days of carvedilol and disopyramide treatment, the systolic anterior motion of the mitral valve leaflets had disappeared and the LVOT flow velocity and plasma NT-proBNP concentration had decreased to 0.7 m/s and 499 pmol/L, respectively. No adverse effect has been observed during the follow-up. Disopyramide might relieve feline LVOT obstruction after only partial response to a beta-blocker. Further large-scale studies are required to investigate the efficacy and safety of disopyramide use in cats with moderate to severe HOCM.
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Affiliation(s)
- Y Hori
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midori-machi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan.
| | - E Fujimoto
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midori-machi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan
| | - Y Nishikawa
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midori-machi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan
| | - T Nakamura
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midori-machi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan
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22
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Ferasin L, Kilkenny E, Ferasin H. Evaluation of N-terminal prohormone of brain natriuretic peptide and cardiac troponin-I levels in cats with systolic anterior motion of the mitral valve in the absence of left ventricular hypertrophy. J Vet Cardiol 2020; 30:23-31. [PMID: 32645686 DOI: 10.1016/j.jvc.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify the prevalence of systolic anterior motion of the mitral valve (SAM) in apparently healthy cats in the absence of left ventricular hypertrophy (LVH) and examine the relationship between specific cardiac biomarker concentrations and echocardiographic parameters in these individuals. ANIMALS eighty client-owned cats. MATERIALS AND METHODS retrospective study; inclusion criteria were the presence of SAM on conscious echocardiography and concurrent measurement of plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and serum cardiac troponin-I (cTnI). Cats were excluded if they had LVH, left atrial enlargement or systemic disease. The percentages of cats with NT-proBNP and cTnI concentrations above the normal reference range were calculated. The correlation between each biomarker concentration and left ventricular myocardial wall thickness, left atrial size and maximum left ventricular outflow tract velocity was evaluated. RESULTS Thirty-four of 80 patients with SAM showed no evidence of cardiac remodelling (LVH or left atrial enlargement). Of these patients, 30 of 34 had elevated NT-proBNP, and cTnI was elevated in 13 of 27 (48.1%) cats where this biomarker was measured in association with the NT-proBNP assay. A positive correlation was observed between concentration of plasma NT-proBNP and maximum left ventricular outflow tract velocity (rs = 0.67, p<0.0001). No significant correlations were found between the concentration of biomarkers and the remaining echocardiographic parameters. CONCLUSIONS SAM is frequently observed in cats even in the absence of cardiac remodelling, and these individuals often demonstrate elevated plasma NT-proBNP and serum cTnI concentrations. Plasma NT-proBNP elevation is correlated with the severity of the left ventricular outflow obstruction caused by SAM.
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Affiliation(s)
- L Ferasin
- Specialist Veterinary Cardiology Consultancy Ltd., Alton, Hampshire, United Kingdom.
| | - E Kilkenny
- Lumbry Park Veterinary Specialists, Alton, Hampshire, United Kingdom
| | - H Ferasin
- Specialist Veterinary Cardiology Consultancy Ltd., Alton, Hampshire, United Kingdom
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23
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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: 123] [Impact Index Per Article: 30.8] [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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24
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Hanås S, Holst BS, Höglund K, Häggström J, Tidholm A, Ljungvall I. Effect of feline characteristics on plasma N-terminal-prohormone B-type natriuretic peptide concentration and comparison of a point-of-care test and an ELISA test. J Vet Intern Med 2020; 34:1187-1197. [PMID: 32200578 PMCID: PMC7255655 DOI: 10.1111/jvim.15754] [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: 03/13/2019] [Accepted: 02/27/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Increased plasma concentration of N-terminal-prohormone B-type natriuretic peptide (NT-proBNP) can be detected in cats with cardiac disease. Potential effects of feline characteristics on NT-proBNP concentration may influence clinical usefulness. OBJECTIVES To evaluate potential effects of feline characteristics on NT-proBNP plasma concentration and to compare NT-proBNP plasma concentrations in healthy cats with results in hypertrophic cardiomyopathy (HCM) cats with or without left atrial enlargement (LAE) using an ELISA and a point-of-care test (POCT), and assess if POCT results reflect ELISA results. ANIMALS One hundred healthy cats of 3 breeds and 39 HCM cats were included. METHODS Diseases other than HCM were excluded by physical examination, blood pressure measurement, echocardiography, hematology, and serum biochemistry. RESULTS Higher NT-proBNP concentrations were found in males than in females in healthy (P = .005) and in HCM cats (P = .0021), but breed had no effect on NT-proBNP concentrations. Using ≥100 pmol/L as a cutoff for abnormal samples, ELISA and POCT had similar sensitivity (SE; 72 and 74%) and specificity (SP; 97 and 98%) for detecting cats with HCM, cats with HCM and LAE (SE, both 100%; SP, 97 versus 98%), and cats with HCM without LAE (SE, both 69%; SP, 97 versus 98%), respectively, when compared to healthy cats. CONCLUSIONS AND CLINICAL IMPORTANCE Breed had no effect on plasma NT-proBNP concentrations, but higher concentrations were found in male than in female cats. The ELISA and POCT had similar SE and SP for detecting HCM. Both tests could identify all HCM cats with LAE but not all HCM cats without LAE.
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Affiliation(s)
- Sofia Hanås
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.,Evidensia Specialist Animal Hospital Strömsholm, Sweden
| | - Bodil S Holst
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Katja Höglund
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Jens Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Anna Tidholm
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.,Anicura Albano Animal Hospital, Stockholm, Sweden
| | - Ingrid Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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van Hoek I, Hodgkiss-Geere H, Bode EF, Hamilton-Elliott J, Mõtsküla P, Palermo V, Pereira YM, Culshaw GJ, Ivanova A, Dukes-McEwan J. Associations among echocardiography, cardiac biomarkers, insulin metabolism, morphology, and inflammation in cats with asymptomatic hypertrophic cardiomyopathy. J Vet Intern Med 2020; 34:591-599. [PMID: 32045061 PMCID: PMC7096615 DOI: 10.1111/jvim.15730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 01/31/2020] [Indexed: 12/27/2022] Open
Abstract
Background Insulin, insulin‐like growth factor‐1 (IGF‐1), and inflammation possibly are involved in cats with asymptomatic hypertrophic cardiomyopathy (aHCM). Objectives To evaluate echocardiography, morphology, cardiac and inflammatory markers, insulin and IGF‐1 in cats with aHCM. Animals Fifty‐one client‐owned cats with aHCM. Methods Observational descriptive study. Variables (body weight [BW], body condition score [BCS], echocardiography, and serum concentrations of N‐terminal pro‐B‐type natriuretic peptide [NT‐proBNP], ultra‐sensitive troponin‐I [c‐TnI], serum amyloid A [SAA], insulin, glucose and IGF‐1) were evaluated for significant increases above echocardiography cutoff values and laboratory reference ranges, associations and effect of left atrial (LA) remodeling and generalized hypertrophy. Results Cats with aHCM had BCS ≥6/9 (P = .01) and insulin (P < .001), NT‐proBNP (P = .001) and cTn‐I (P < .001) above laboratory reference ranges. Associations were present between NT‐proBNP and maximum end‐diastolic interventricular septum thickness (IVSd; ρ = .32; P = .05), maximum end‐diastolic left ventricular free wall thickness;(ρ = .41; P = .01), LA/Aorta (ρ = .52; P = .001) and LA diameter (LA‐max; ρ = .32; P = .05); c‐TnI and LA/Aorta (ρ = .49; P = .003) and LA‐max (ρ = .28; P = .05); and SAA and number of IVSd regions ≥6 mm thickness (ρ = .28; P = .05). Body weight and BCS were associated with IGF‐1 (r = 0.44; P = .001), and insulin (ρ = .33; P = .02), glucose (ρ = .29; P = .04) and IGF‐1 (ρ = .32; P = .02), respectively. Concentrations of NT‐proBNP (P = .02) and c‐TnI (P = .01), and SAA (P = .02), were higher in cats with LA remodeling, and generalized hypertrophy, respectively. Conclusions and clinical importance Results suggest potential implications of insulin, IGF‐1, and inflammation in cats with aHCM, but it remains to be confirmed whether these findings represent a physiological process or a part of the pathogenesis and development of disease.
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Affiliation(s)
| | - Hannah Hodgkiss-Geere
- Department of Small Animal Clinical Science, Institute of Veterinary Science, Leahurst, University of Liverpool, Neston, UK
| | - Elizabeth F Bode
- Department of Small Animal Clinical Science, Institute of Veterinary Science, Leahurst, University of Liverpool, Neston, UK
| | - Julie Hamilton-Elliott
- Department of Small Animal Clinical Science, Institute of Veterinary Science, Leahurst, University of Liverpool, Neston, UK
| | - Paul Mõtsküla
- The Cardiology Clinic, Anderson Moores Veterinary Specialists, Hampshire, UK
| | - Valentina Palermo
- The Cardiology Clinic, Anderson Moores Veterinary Specialists, Hampshire, UK
| | - Yolanda M Pereira
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK
| | - Geoff J Culshaw
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK
| | - Anna Ivanova
- Center for statistics, University of Hasselt, Hasselt, Belgium
| | - Jo Dukes-McEwan
- Department of Small Animal Clinical Science, Institute of Veterinary Science, Leahurst, University of Liverpool, Neston, UK
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26
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Block CL, Oyama MA. Echocardiographic and biomarker evidence of plasma volume expansion after short-term steroids administered orally in cats. J Vet Intern Med 2019; 34:29-34. [PMID: 31816124 PMCID: PMC6979090 DOI: 10.1111/jvim.15678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/20/2019] [Indexed: 11/29/2022] Open
Abstract
Background Steroids administered PO and intramuscularly are associated with development of congestive heart failure in cats without prior signs of heart disease, but criteria to identify cats at increased risk for steroid‐induced heart failure are not established. Hypothesis Cats administered steroids PO for 5 to 7 days will develop increased N terminal pro‐B‐type natriuretic peptide (NT‐proBNP) concentration and heart size. Animals Ten client‐owned cats. Methods Observational cohort study. Cats intended to initiate at least a 5‐day course of steroids administered PO were consecutively recruited. Results Steroids administered PO to cats are not associated with differences in absolute concentration of NT‐proBNP (baseline: 49 pmol/L [range, 24‐1013]; after steroids: 85 pmol/L [range, 46‐1367]; P = .23), blood pressure (baseline: 145 mm Hg [range, 116‐163]; after steroids: 145 mm Hg [range, 115‐230]; P = .94), nor blood glucose concentration (baseline: 125 mg/dL [range, 92‐254]; after steroids: 144 mg/dL [range, 114‐307]; P = .43), but are associated with increased median left atrial dimension (baseline: 1.26 cm [range, 0.96‐2.03; after steroids: 1.38 [range, 1.03‐2.20]; P = .02) and mean left ventricular internal diameter (baseline: 1.55 cm [standard deviation—SD, 0.28; after steroids: 1.72 cm [SD, 0.28]; P = .03). Six of 10 (60%) cats had a percentile change in NT‐proBNP >60% after steroids, and 3 of 8 (38%) cats with baseline BNP <100 pmol/L had an NT‐proBNP >100 pmol/L after steroids. Conclusions and Clinical Importance Increased heart size and percentage change in individual NT‐proBNP concentration suggests plasma volume expansion secondary to steroids administered PO in cats. A serial assessment of an individual cat's change in NT‐proBNP might be clinically useful for judging risk for volume expansion.
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Affiliation(s)
- Chloё L Block
- Friendship Cardiology Specialists, Friendship Hospital for Animals, Washington, District of Columbia
| | - Mark A Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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27
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Khelik IA, Berger DJ, Mochel JP, Seo YJ, Palerme JS, Ware WA, Ward JL. Clinicopathologic, hemodynamic, and echocardiographic effects of short-term oral administration of anti-inflammatory doses of prednisolone to systemically normal cats. Am J Vet Res 2019; 80:743-755. [PMID: 31339769 DOI: 10.2460/ajvr.80.8.743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the clinicopathologic, hemodynamic, and echocardiographic effects of short-term administration of anti-inflammatory dosages of prednisolone to systemically normal cats. ANIMALS 10 cats with allergic dermatitis and 10 healthy control cats. PROCEDURES Cats with allergic dermatitis were randomly allocated to 2 groups and received 2 dosages of prednisolone (1 and 2 mg/kg/d, PO, for 7 days) in a crossover design followed by 9-day tapering and 14-day washout periods. Each prednisolone-treated cat was matched to a healthy control cat on the basis of sex, neuter status, age (± 1 year), and body weight (± 10%). Control cats received no treatment during the 35-day observation period. Clinicopathologic, echocardiographic, and hemodynamic variables were measured at baseline (day 0) and predetermined times during and after prednisolone administration and compared within and between the 2 treatment groups. RESULTS Prednisolone-treated cats had expected clinicopathologic alterations (mild increases in neutrophil and monocyte counts and serum concentrations of albumin, cholesterol, and triglycerides) but systolic arterial blood pressure; blood glucose, serum potassium, and cardiac biomarker concentrations; urinary sodium excretion; and echocardiographic variables did not differ significantly from baseline at any time. Statistically significant, albeit clinically irrelevant, increases in blood glucose and N-terminal pro-B-type natriuretic peptide concentrations were observed between baseline and the prednisolone pharmacokinetic steady state (7 days after initiation) only when the 2-mg/kg dosage was administered. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated short-term oral administration of anti-inflammatory dosages of prednisolone did not cause relevant hemodynamic, echocardiographic, or diabetogenic effects in systemically normal cats with allergic dermatitis.
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Loughran KA, Rush JE, Rozanski EA, Oyama MA, Larouche-Lebel É, Kraus MS. The use of focused cardiac ultrasound to screen for occult heart disease in asymptomatic cats. J Vet Intern Med 2019; 33:1892-1901. [PMID: 31317580 PMCID: PMC6766524 DOI: 10.1111/jvim.15549] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 06/19/2019] [Indexed: 12/13/2022] Open
Abstract
Background Focused cardiac ultrasound (FCU) helps detect occult heart disease in human patients. Hypothesis Focused cardiac ultrasound by a nonspecialist practitioner (NSP) will increase the detection of occult heart disease in asymptomatic cats compared with physical examination and ECG. Animals Three hundred forty‐three client‐owned cats: 54 excluded and 289 analyzed. Methods Multicenter prospective cohort study. Twenty‐two NSPs were trained to perform FCU. Cats without clinical signs of heart disease were recruited, and NSPs performed the following in sequential order: physical examination, ECG, FCU, and point‐of‐care N‐terminal pro‐B‐type natriuretic peptide assay (POC‐BNP). After each step, NSPs indicated yes, no, or equivocal as to whether they believed heart disease was present. The level of agreement between the NSP diagnosis and a blinded cardiologist's diagnosis after echocardiogram was evaluated using Cohen's kappa test. Results Cardiologist diagnoses included 148 normal cats, 102 with heart disease, and 39 equivocal ones. Agreement between NSP and cardiologist was slight after physical examination (kappa 0.253 [95% CI, 0.172‐0.340]), did not increase after ECG (0.256 [0.161‐0.345]; P = .96), increased after FCU (0.468 [0.376‐0.558]; P = .002), and the level of agreement was similar after POC‐BNP (0.498 [0.419‐0.580]; P = .67). In cats with mild, moderate, and marked occult heart disease, the proportion of cats having a NSP diagnosis of heart disease after FCU was 45.6%, 93.1%, and 100%, respectively. Conclusions and Clinical Importance Focused cardiac ultrasound performed by NSPs increased the detection of occult heart disease, especially in cats with moderate to marked disease. Focused cardiac ultrasound appears to be a feasible and useful tool to assist NSPs in the detection of heart disease in cats.
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Affiliation(s)
- Kerry A Loughran
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts.,Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John E Rush
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Elizabeth A Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Mark A Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Éva Larouche-Lebel
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marc S Kraus
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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29
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Hertzsch S, Roos A, Wess G. Evaluation of a sensitive cardiac troponin I assay as a screening test for the diagnosis of hypertrophic cardiomyopathy in cats. J Vet Intern Med 2019; 33:1242-1250. [PMID: 30990935 PMCID: PMC6524108 DOI: 10.1111/jvim.15498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/03/2019] [Indexed: 12/24/2022] Open
Abstract
Background Hypertrophic cardiomyopathy (HCM) is the most common cardiac disease in cats. However, most cats are not diagnosed until they develop congestive heart failure, arterial thromboembolism (ATE), or sudden cardiac death. Thus, an affordable screening test for early detection of HCM is desirable. Hypothesis/Objectives Evaluation of a sensitive cardiac troponin I (cTnI) assay as a screening test for HCM in cats and determination of a cutoff for its early detection. Animals One hundred sixty‐six client‐owned cats (male, n = 97) of various breeds were evaluated and classified using echocardiography as being healthy (n = 87), equivocal (n = 15), or having HCM (mild, n = 16; moderate, n = 10; severe, n = 34) or ATE (n = 4). Methods All cats were prospectively evaluated by echocardiography, and serum cTnI concentration was determined using the currently most sensitive assay (Siemens ADVIA Centaur TnI‐Ultra). Results The median cTnI concentration was significantly different between study groups (P < .000001). A cutoff of 0.06 ng/mL provided good discrimination between healthy cats and cats with HCM (sensitivity, 91.7%; specificity, 95.4%; area under the curve [AUC], 0.95; 95% confidence interval [CI], 0.899‐0.978). Even for asymptomatic cats with HCM, sensitivity and specificity for a cutoff of >0.06 ng/mL remained high at 87.8% and 95.4%, respectively (AUC, 0.93; 95% CI, 0.864‐0.964). Conclusions and clinical importance Cardiac troponin I can be used as a sensitive and specific screening test for the diagnosis of HCM in otherwise healthy cats (cutoff, >0.06 ng/mL). However, echocardiography is needed to confirm the diagnosis.
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Affiliation(s)
- S Hertzsch
- Clinic of Small Animal Medicine, Ludwig Maximilians University of Munich, Munich, Germany
| | - A Roos
- Clinic of Small Animal Medicine, Ludwig Maximilians University of Munich, Munich, Germany
| | - G Wess
- Clinic of Small Animal Medicine, Ludwig Maximilians University of Munich, Munich, Germany
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30
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Gehlen H, Shety T, El-Zahar H, Hofheinz I. Measurement of plasma endothelin-1 concentration in healthy horses and horses with cardiac disease during rest and after exercise. J Vet Med Sci 2019; 81:263-268. [PMID: 30606891 PMCID: PMC6395200 DOI: 10.1292/jvms.18-0325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Cardiac biomarkers are important tools for monitoring disease progress and can monitor progression of therapy. Endothelin-1 (ET-1) has been studied for its use as a cardiac biomarker in human and small animal medicine while in horses with cardiac disease it has not been evaluated yet. The objective of the present study was to determine the concentration of plasma ET-1 in healthy horses and compare it with ET-1 concentration in horses with cardiac disease during rest and after exercise. Fifty four horses admitted to the Equine Clinic of Free University of Berlin were used in the present study, of which 15 horses were clinically healthy with no evidence of cardiac disease (Group 1), 22 horses suffered from cardiac disease with normal heart dimensions (Group 2) and 17 horses with cardiac disease and enlarged heart diameters (Group 3). Clinical examination, electrocardiography and echocardiography were performed. Endothelin-1 concentration was determined using ET-1 ELISA kit. The concentration of plasma ET-1 was significantly increased in horses with cardiac disease and normal cardiac dimensions (Group 2) and in horses with cardiac disease and enlargement of the left atrium (Group 3) compared to its concentration in clinically healthy horses (Group 1). In addition, the concentration of plasma ET-1 after exercise was significantly increased in diseased horses compared to its concentration at rest. Detection of ET-1 plasma concentration in horses at rest may be useful for detecting horses with changes in left atrial cardiac dimensions.
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Affiliation(s)
- Heidrun Gehlen
- Equine Clinic, Free University of Berlin, 14163 Berlin, Germany
| | - Tarek Shety
- Animal Medicine Dept., Faculty of Veterinary Medicine, Zagazig University, Zagazig 44511, Egypt
| | - Heba El-Zahar
- Animal Medicine Dept., Faculty of Veterinary Medicine, Zagazig University, Zagazig 44511, Egypt
| | - Ina Hofheinz
- Equine Clinic, Free University of Berlin, 14163 Berlin, Germany
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31
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Robertson SA, Gogolski SM, Pascoe P, Shafford HL, Sager J, Griffenhagen GM. AAFP Feline Anesthesia Guidelines. J Feline Med Surg 2018; 20:602-634. [PMID: 29989502 PMCID: PMC10816483 DOI: 10.1177/1098612x18781391] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM The overarching purpose of the AAFP Anesthesia Guidelines (hereafter referred to as the 'Guidelines') is to make anesthesia and sedation safer for the feline patient. Scope and accessibility: It is noteworthy that these are the first exclusively feline anesthesia guidelines authored by an expert panel, making them particularly useful as an extensively referenced, practical resource for veterinary practice teams. Because much of the key content is presented in tabular or visual format, the Guidelines have a high level of accessibility and convenience that invites regular usage. While the recommendations in the Guidelines focus primarily on client-owned cats, the content is also applicable to community-sourced animals with an unknown medical history.
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Affiliation(s)
| | - Susan M Gogolski
- AMEDDC&S Department of Veterinary Science, 3630 Stanley Rd, Bldg 2618, Fort Sam Houston, TX 78234, USA
| | - Peter Pascoe
- Emeritus Professor, University of California, 1536 Notre Dame Drive, Davis, CA 95616, USA
| | - Heidi L Shafford
- Veterinary Anesthesia Specialists, PO Box 418, Clackamas, OR 97015, USA
| | - Jennifer Sager
- University of Florida Veterinary Hospital, College of Veterinary Medicine, 2015 SW 16th Avenue, Gainesville, FL 32610, USA
| | - Gregg M Griffenhagen
- Colorado State University Veterinary Teaching Hospital, 300 W Drake Rd, Fort Collins, CO 80523, USA
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32
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Heishima Y, Hori Y, Nakamura K, Yamashita Y, Isayama N, Kanno N, Katagi M, Onodera H, Yamano S, Aramaki Y. Diagnostic accuracy of plasma atrial natriuretic peptide concentrations in cats with and without cardiomyopathies. J Vet Cardiol 2018; 20:234-243. [PMID: 29807749 DOI: 10.1016/j.jvc.2018.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/13/2018] [Accepted: 04/25/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Plasma atrial natriuretic peptide (ANP) levels have been reported to be elevated in cats with cardiomyopathy. We investigated the diagnostic accuracy of plasma ANP concentration as an indicator of the severity of cardiomyopathies. ANIMALS This study included 78 control cats and 83 cats with various types of cardiomyopathy. METHODS This was a prospective multicentre study. Control cats were determined to have a normal heart, and diseased cats were diagnosed by echocardiography. Diseased cats were divided into asymptomatic cats without left atrial dilation (LAD), asymptomatic cats with LAD, and cats with heart failure. Plasma C-terminal ANP concentrations were measured using chemiluminescence. RESULTS The median plasma ANP concentration in controls was 43.3 (interquartile range, 33.0-56.3) pg/mL. Plasma ANP values were significantly higher in the cardiomyopathic cats with LAD and heart failure, but the values in cats without LAD were comparable to those in control cats. To distinguish cats with cardiomyopathy from controls, a plasma ANP concentration >77.5 pg/mL afforded sensitivity of 66.3% and specificity of 84.6%. Use of plasma ANP concentration >110.9 pg/mL to identify cats with LAD had a sensitivity of 73.6% and specificity of 93.5%. The areas under the receiver-operating characteristic curve were 0.80 and 0.86. CONCLUSIONS Plasma ANP concentrations were higher in cats with more advanced cardiomyopathy. Although assaying the ANP concentration alone may not help to diagnose cardiac disease, measuring provides additional information that is useful for assessing the severity of cardiomyopathies.
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Affiliation(s)
- Y Heishima
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midoricho, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan; Heisei Animal Hospital, 2-1-1 Futago-cho, Kasugai, Aichi 486-0955, Japan
| | - Y Hori
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midoricho, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan.
| | - K Nakamura
- Organization for Promotion of Tenure Track, University of Miyazaki, 1-1 Gakuenkibanadai-nishi, Miyazaki 889-2192, Japan
| | - Y Yamashita
- Ebisu Animal Hospital, 3-3-43 Nishitaga, Taihaku Ward, Sendai, Miyagi 982-0034, Japan
| | - N Isayama
- Uenonomori Animal Clinic, 1-5-11 Yanaka Taito Ward, Tokyo 110-0001, Japan
| | - N Kanno
- Department of Veterinary Medicine, Nihon University, 1866 Kameino, Fujisawa, Kanagawa 252-8510, Japan
| | - M Katagi
- Katagi Animal Hospital, 565-5 Matoba, Kawagoe, Saitama 350-1101, Japan
| | - H Onodera
- Onodera Animal Hospital, 1-10-4 Chuou, Rifu-cho, Miyagi 981-0104, Japan
| | - S Yamano
- Ueda Animal Clinic, 2-202 Ueda, Tenpaku Ward, Nagoya, Aichi 465-0051, Japan
| | - Y Aramaki
- Bay Veterinary Hospital, 5-6-7 Ujinanishi, Minami Ward, Hiroshima 734-0014, Japan
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Platelet Function Analyzer 100 and Brain Natriuretic Peptide as Biomarkers in Obstructive Hypertrophic Cardiomyopathy. Am J Cardiol 2018; 121:768-774. [PMID: 29397107 DOI: 10.1016/j.amjcard.2017.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/01/2017] [Accepted: 12/07/2017] [Indexed: 11/20/2022]
Abstract
To test dual blood biomarkers compared with electrocardiogram (ECG) for hypertrophic cardiomyopathy (HC) screening, we performed 3 analyses and cut-point assessments. First, we measured platelet function analyzer (PFA)-100 (n = 99) and normalized B-type natriuretic peptide (BNP) or NT-proBNP (BNP/upper limit of normal [ULN], n = 92) in 64 patients with HC and 29 normal controls (NCs). Second, from the regression equation between PFA and gradient (r = 0.77), we derived estimated PFA in a population of 189 patients with functional class I HC in whom measured BNP/ULN and ECG were available, and calculated single and dual biomarker sensitivity and specificity compared with ECG. Finally, we compared BNP/ULN in class I patients based on mutation and familial history status. In 42 patients with obstructive HC versus NCs, there was a slight overlap of PFA and BNP/ULN, but for the product of PFA × BNP/ULN, there was near-complete separation of values. Among patients with class I obstructive HC, estimated PFA × BNP/ULN had a sensitivity of 93% and a specificity of 100%; in latent and nonobstructive HC, sensitivity dropped to 61% and 72%; for ECG in obstructive, latent, and nonobstructive HC, sensitivity was 71%, 34%, and 67%. Functional class I patients with positive (n = 28) and negative (n = 36) sarcomere mutations and a positive (n = 71) or a negative (n = 109) family history had significant elevations of BNP/ULN versus NC, with no between-group differences. In conclusion, PFA and BNP were highly associated with obstructive HC and could potentially be used for screening; BNP was not uniquely elevated in patients with familial versus nonfamilial or mutation-positive versus mutation-negative HC.
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Hunt H, Cave N, Bridges J, Gedye K, Hill K. Plasma NT-proBNP and Cell-Free DNA Concentrations after Prolonged Strenuous Exercise in Working Farm Dogs. J Vet Intern Med 2018; 32:135-141. [PMID: 29197094 PMCID: PMC5787186 DOI: 10.1111/jvim.14835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/26/2017] [Accepted: 08/22/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration is increased in dogs with myocardial dysfunction, and cell-free DNA (cfDNA) increases in numerous disease states. In humans, both of these biomarkers can be altered after endurance exercise. OBJECTIVE To investigate the effect of prolonged strenuous exercise on circulating NT-proBNP and cfDNA concentrations in working farm dogs. ANIMALS Six healthy, privately owned working farm dogs (4 Huntaways and 2 heading dogs) from the same hill country farm in New Zealand. METHODS Prospective, nonrandomised cohort study. Venous blood samples were collected before and after the dogs worked over 4 days. Plasma NT-proBNP concentrations were measured by a commercially available ELISA assay and cfDNA concentrations were determined by fluorometry without prior DNA extraction. RESULTS The baseline (before work, Day 1) median plasma NT-proBNP concentration was 664 pmol/L. A linear mixed-effects model showed that work increased plasma NT-proBNP concentrations by 101 ± 9% (P < 0.001), but with each consecutive day of work, NT-proBNP concentrations declined by 16 ± 4% (P < 0.001). The baseline median plasma cfDNA concentration was 653 ng/mL, and plasma cfDNA concentrations increased by 138 ± 45 ng/mL after work (P = 0.004). CONCLUSIONS AND CLINICAL IMPORTANCE The plasma concentration of NT-proBNP in healthy Huntaways and heading dogs after work can exceed the upper limit of the reference range. Results in dogs sampled on the day of prolonged strenuous exercise should be interpreted with caution. Plasma concentrations of cfDNA also increase with exercise, but further studies are needed to establish reference ranges in healthy dogs.
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Affiliation(s)
- H. Hunt
- Institute of Veterinary, Animal and Biomedical SciencesMassey UniversityPalmerston NorthNew Zealand
| | - N. Cave
- Institute of Veterinary, Animal and Biomedical SciencesMassey UniversityPalmerston NorthNew Zealand
| | - J. Bridges
- Institute of Veterinary, Animal and Biomedical SciencesMassey UniversityPalmerston NorthNew Zealand
| | - K. Gedye
- Institute of Veterinary, Animal and Biomedical SciencesMassey UniversityPalmerston NorthNew Zealand
| | - K. Hill
- Institute of Veterinary, Animal and Biomedical SciencesMassey UniversityPalmerston NorthNew Zealand
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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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de Lima GV, Ferreira FDS. N-terminal-pro brain natriuretic peptides in dogs and cats: A technical and clinical review. Vet World 2017; 10:1072-1082. [PMID: 29062197 PMCID: PMC5639106 DOI: 10.14202/vetworld.2017.1072-1082] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/18/2017] [Indexed: 01/16/2023] Open
Abstract
Biomarkers are quantitative indicators of biological processes performed by an organ or system. In recent years, natriuretic peptides (NPs) have emerged as important tools in the diagnosis and therapeutic monitoring of heart diseases. Research has shown that serum and plasma levels of N-terminal pro brain NP (NT-proBNP) in dogs and cats are the only biomarkers that afford to diagnose and monitor congestive processes and, indirectly, the myocardial function of small animals. The present review discusses the peer-reviewed specialized literature about NT-proBNP and presents and compares the potential clinical applications of this NP in veterinary medicine of small animals, considering diagnosis, follow-up, and prognosis of myocardial or systemic diseases. The relevance of NT-proBNP is associated with sample stability, easy determination in laboratory, sensitivity, accuracy, and the possibility to analyze myocardial function. These advantages are specially important when NT-proBNP is compared with other cardiac biomarkers, mostly those that indicate the integrity of the myocardial cell. Fast NT-proBNP assays are marketed today and may be used in association with complementary tests. Together, these methods are an important source of information in differential diagnosis of heart and lung diseases as well in the early diagnosis of cardiopathy in dogs and cats, proving valuable tools in treatment and prognosis.
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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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Pierce KV, Rush JE, Freeman LM, Cunningham SM, Yang VK. Association between Survival Time and Changes in NT-proBNP in Cats Treated for Congestive Heart Failure. J Vet Intern Med 2017; 31:678-684. [PMID: 28370373 PMCID: PMC5435051 DOI: 10.1111/jvim.14690] [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: 08/09/2016] [Revised: 12/15/2016] [Accepted: 02/14/2017] [Indexed: 12/03/2022] Open
Abstract
Background Reductions in N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) concentrations after treatment have been associated with improved survival in people with congestive heart failure (CHF), but have not been reported in cats with CHF. Objectives To evaluate changes in NT‐proBNP concentrations in cats with CHF after treatment and determine whether serial NT‐proBNP measurements provide prognostic information. Animals Thirty‐one client‐owned cats. Methods Prospective, observational study in cats with new onset CHF secondary to cardiomyopathy. Concentrations of NT‐proBNP were measured within 4 hours of admission to the hospital, on the day of discharge, and at re‐evaluation 7–10 days later. Results Median NT‐proBNP concentrations decreased significantly from admission (1,713 pmol/L [range, 160–3,784 pmol/L]) to discharge (902 pmol/L [range, 147–3,223 pmol/L]); P = .005) and from admission to re‐evaluation (1,124 pmol/L [range, 111–2,727 pmol/L]; P = .024). Median survival time was 109 days (range, 1–709 days), with 5 cats still alive at the time of analysis. Cats with a larger percent decrease in NT‐proBNP from admission to discharge had a longer survival time (P = .048). Cats with evidence of active CHF at the time of re‐evaluation (P = .010) and cats whose owners had difficulty administering medications (P = .045) had shorter survival times. Conclusions and clinical importance Cats with a larger percent decrease in NT‐proBNP during hospitalization and no evidence of CHF at the time of re‐evaluation had longer survival times. Additional studies are needed to determine whether NT‐proBNP can help guide treatment in cats with CHF.
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Affiliation(s)
- K V Pierce
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - J E Rush
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - L M Freeman
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - S M Cunningham
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - V K Yang
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
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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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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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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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Fox PR, Schober KA. Management of asymptomatic (occult) feline cardiomyopathy: Challenges and realities. J Vet Cardiol 2016; 17 Suppl 1:S150-8. [PMID: 26776574 DOI: 10.1016/j.jvc.2015.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 03/15/2015] [Accepted: 03/17/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cardiomyopathy distinguishes a heterogeneous group of myocardial disorders that represent the most prevalent cause of feline heart disease. Etiology is uncertain and the natural history is presently unresolved. Hypertrophic cardiomyopathy is the most common of these conditions, and while the majority of affected cats are asymptomatic, a proportion is at risk to develop serious morbidities--the most devastating of which include congestive heart failure, arterial thromboembolism, and cardiac death. Predicting when or whether an asymptomatic cat might develop morbidity is hindered by lack of evidence-based clinical trials. Superimposed, these issues create an irresolvable predicament that presently confounds medical decision-making. METHODS Review of current perspectives for managing asymptomatic (occult) feline cardiomyopathy. RESULTS Complex pathophysiology and (likely) sarcomeric mutations give rise to heterogeneous cardiac phenotypes and variable clinical findings. Echocardiography remains the gold standard to clarify cardiac morphology. Frequently, however, detection of echocardiographic alterations--though often of unproven clinical significance--extrapolates by inference or implication a specter of disease, and with this, leads to a path of long-term treatment and testing. Presently, there is no proof that any particular therapy reduces morbidity or prolongs survival of cats affected with occult cardiomyopathy. Recently, however, evidence has accumulated to support the belief that certain prognostic indicators suggest risk for poor outcome. Accordingly, and in absence of evidence-based clinical trials, current practice has shifted to view therapy with the intent to target pathophysiology underlying documented or perceived clinical markers, whose presence portends high risk in certain patients. Affected animals and potentially siblings should be monitored using clinical testing that also takes into account age-related comorbidities. CONCLUSIONS Asymptomatic (occult) feline cardiomyopathy includes complex and heterogeneous diseases whose outcomes are challenging to predict. Review of available evidence-based treatment data leaves no uncertainties regarding drugs with established efficacy. There presently are none. Current management focuses upon identification of documented risk factors, individualized and tailored therapy, and cogent monitoring. Drugs most commonly considered in this paradigm include those that might reduce thromboembolic risk in cases with substantial left atrial enlargement or dysfunction, agents to counteract left ventricular remodeling, or medications that ameliorate systolic or diastolic dysfunction. Discovering reliable prognostic indicators may further improve stratification to identify patients at highest risk, or detect subsets that respond favorably. These issues shape the challenge to identify sensible preventative management and cost-effective, long-term monitoring strategies.
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Affiliation(s)
- Philip R Fox
- The Animal Medical Center, 510 East 62nd Street, New York, NY 10065, USA.
| | - Karsten A Schober
- Department of Veterinary Clinical Sciences, The Ohio State University, 601 Vernon L Tharp Street, Columbus, OH 43210, USA
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Abstract
Blood-based assays for various cardiac biomarkers can assist in the diagnosis of heart disease in dogs and cats. The two most common markers are cardiac troponin-I and N-terminal pro-B-type natriuretic peptide. Biomarker assays can assist in differentiating cardiac from noncardiac causes of respiratory signs and detection of preclinical cardiomyopathy. Increasingly, studies indicate that cardiac biomarker testing can help assess the risk of morbidity and mortality in animals with heart disease. Usage of cardiac biomarker testing in clinical practice relies on proper patient selection, correct interpretation of test results, and incorporation of biomarker testing into existing diagnostic methods.
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Affiliation(s)
- Mark A Oyama
- Section of Cardiology, Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104, USA.
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Luis Fuentes V. Heart disease: time to take cats seriously. J Vet Cardiol 2016; 17 Suppl 1:S2-5. [PMID: 26776578 DOI: 10.1016/j.jvc.2015.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/24/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Affiliation(s)
- V Luis Fuentes
- The Royal Veterinary College, Department of Clinical Science and Services, North Mymms, Hatfield, AL9 7TA, United Kingdom.
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Côté E, Edwards NJ, Ettinger SJ, Luis Fuentes V, MacDonald KA, Scansen BA, Sisson DD, Abbott JA. Management of incidentally detected heart murmurs in dogs and cats. J Vet Cardiol 2015; 17:245-61. [DOI: 10.1016/j.jvc.2015.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/06/2015] [Accepted: 05/11/2015] [Indexed: 11/27/2022]
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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: 19] [Impact Index Per Article: 2.1] [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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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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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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