Accuracy of history, physical examination, cardiac biomarkers, and biochemical variables in identifying dogs with stage B2 degenerative mitral valve disease

Wilshaw, Jenny; Rosenthal, Steven; Wess, Gerhard; Dickson, David; Bevilacqua, Luca; Dutton, Emily; Deinert, Michael; Abrantes, Ricardo; Schneider, Ingo; Oyama, Mark A.; Gordon, Sonya G.; Elliott, Jonathan; Xia, Dong; Boswood, Adrian

doi:10.1111/jvim.16083

Cited by 12 publications

(19 citation statements)

References 61 publications

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“…A left apical systolic murmur is the initial clinical finding in MMVD patients [ 45 , 46 ]. The findings align with previous research, suggesting that murmur intensity beyond III/VI often coincides with advanced stages of heart disease and may indicate an increased risk of adverse outcomes [ 38 , 42 , 47 ].…”

Section: Discussionsupporting

confidence: 90%

“…An alternative set of simple tests has been suggested for diagnosing dogs with preclinical stage MMVD (B2), including biomarker-based diagnostics and tailored therapeutic management to avoid sedation for radiography [ 38 ]. Echocardiography, considered the “gold standard”, requires specialised training [ 9 ] and has limited accessibility in first-opinion practice.…”

Section: Discussionmentioning

confidence: 99%

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Machine Learning Techniques for Canine Myxomatous Mitral Valve Disease Classification: Integrating Anamnesis, Quality of Life Survey, and Physical Examination

Engel-Manchado,

Montoya-Alonso,

Doménech

et al. 2024

Veterinary Sciences

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Myxomatous mitral valve disease (MMVD) is a prevalent canine cardiac disease typically diagnosed and classified using echocardiography. However, accessibility to this technique can be limited in first-opinion clinics. This study aimed to determine if machine learning techniques can classify MMVD according to the ACVIM classification (B1, B2, C, and D) through a structured anamnesis, quality of life survey, and physical examination. This report encompassed 23 veterinary hospitals and assessed 1011 dogs for MMVD using the FETCH-Q quality of life survey, clinical history, physical examination, and basic echocardiography. Employing a classification tree and a random forest analysis, the complex model accurately identified 96.9% of control group dogs, 49.8% of B1, 62.2% of B2, 77.2% of C, and 7.7% of D cases. To enhance clinical utility, a simplified model grouping B1 and B2 and C and D into categories B and CD improved accuracy rates to 90.8% for stage B, 73.4% for stages CD, and 93.8% for the control group. In conclusion, the current machine-learning technique was able to stage healthy dogs and dogs with MMVD classified into stages B and CD in the majority of dogs using quality of life surveys, medical history, and physical examinations. However, the technique faces difficulties differentiating between stages B1 and B2 and determining between advanced stages of the disease.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Machine Learning Techniques for Canine Myxomatous Mitral Valve Disease Classification: Integrating Anamnesis, Quality of Life Survey, and Physical Examination

Engel-Manchado,

Montoya-Alonso,

Doménech

et al. 2024

Veterinary Sciences

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“…We suspect that the increase in circulating natriuretic peptides occurred secondarily to the increase in SBP, as previously reported in the literature (Hussain et al, 2022;Jang et al, 2023), but it could also be indicative of cardiac stress (Bayes-Genis et al, 2023). Notably, some dogs showed NT-proBNP concentrations exceeding 900 pmol/L, a level commonly associated with structural heart disease in canines (Singletary et al, 2012;Wilshaw et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

A Preclinical Model of Obesity-Independent Metabolic Syndrome for Studying the Effects of Novel Antidiabetic Therapy Beyond Glycemic Control

Mochel,

Ward,

Blondel

et al. 2023

Preprint

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Accumulating data from several large, placebo-controlled studies suggests that sodium-glucose transporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 receptor (GLP-1) receptor agonists offer therapeutic benefits in the management of cardiovascular diseases, regardless of the patient's diabetic status. In addition to their effects on glucose excretion, SGLT2-inhibitors have a positive impact on systemic metabolism by reducing inflammation and oxidative stress, shifting metabolism towards ketone body production, and suppressing glycation end-product signaling. The aim of this study was to establish a non-invasive preclinical model of metabolic syndrome (MetS) to investigate the effects of novel antidiabetic therapies beyond glucose reduction, independent of obesity. Eighteen healthy adult Beagle dogs were fed isocalorically a Western diet (WD) adjusted from parameters of the National Health and Nutrition Examination Survey for ten weeks. Blood samples were collected at baseline (BAS1) when dogs were fed their regular diet, and then again after ten weeks of WD feeding (BAS2) for measurement of blood count and serum chemistry, lipoprotein profiling, fasting blood glucose, glucagon, insulin, NT-proBNP, BUN, creatinine, angiotensins and oxidative stress biomarkers. Blood pressure (BP) was measured at BAS1 and BAS2 using Doppler. Serum, urine and fecal metabolomics were derived by mass spectrometry to assess general metabolism, complex lipids and biogenic amines. Differences between BAS1 and BAS2 were analyzed using non-parametric Wilcoxon signed rank testing with continuity correction, as appropriate. Body weight changes did not exceed 13% after ten weeks of feeding with the WD. The isocaloric WD model induced significant variations in several markers of MetS, including (1) elevated BP, (2) increased fasting glucose levels, and (3) reduced HDL-cholesterol. It also triggered a significant decrease in circulating insulin, as well as an increase in circulating NT-proBNP levels and a decrease in serum bicarbonate levels. Marked and significant changes in overall metabolism, lipids, and biogenic amines were finally reported at BAS2. Short-term, isocaloric feeding with a WD in dogs replicates key biological features of MetS, while also causing low-grade metabolic acidosis and elevating natriuretic peptides. These findings support the use of the WD canine model for studying the metabolic effects of new antidiabetic therapies independent of obesity.

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“…In dogs, analytical and diagnostic validation has been investigated for an NT‐proBNP ELISA assay 6 (IDEXX, Westbrook, ME, USA) 7,8 . There are significant reported differences between human and dog NT‐proBNP, including reference values, diagnostic thresholds, and stability.…”

Section: Introductionmentioning

confidence: 99%

“…In dogs, analytical and diagnostic validation has been investigated for an NT-proBNP ELISA assay 6 (IDEXX, Westbrook, ME, USA). 7,8 There are significant reported differences between human and dog NT-proBNP, including reference values, diagnostic thresholds, and stability. Previously reported canine reference intervals have ranged up to 900 pmol/L in the general adult dog population, 9 with some breed variability in optimized decision thresholds; such F I G U R E 1 Production of NT-proBNP and BNP.…”

Section: Introductionmentioning

confidence: 99%

Analytical validation of a novel point‐of‐care immunoassay for canine N‐terminal pro‐brain natriuretic peptide analysis

Harr¹,

Gordon

Baumwart

et al. 2022

Veterinary Clinical Pathol

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Background N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) is a widely used point‐of‐care (POC) cardiac biomarker in human medicine. Canine NT‐proBNP is used less in veterinary medicine, possibly due to the lack of a POC canine NT‐proBNP assay resulting in temporal delay, increased degradation in transport, and high reported variability in the available assay. A new quantitative POC analyzer allows fast, onsite measurement of NT‐proBNP, minimizing preanalytical error and reducing variability. Objective We aimed to analytically validate an NT‐proBNP assay (Vcheck) according to American Society of Veterinary Clinical Pathology (ASVCP) and Clinical Laboratory Improvement Amendments (CLIA) specifications. Methods Archived and prospective plasma and serum samples were collected from male and female, client‐owned dogs of various breeds with cardiac abnormalities (n = 81) and a healthy control population (n = 225). Precision, accuracy, analytical sensitivity, and specificity, and other statistical analyses were performed. Results Imprecision was considered acceptable with a coefficient of variation ranging from 9% at 4000 pmol/L to 20% at 600 pmol/L. The lower limit of quantitation was 650 pmol/L based on repetitive measures evaluation. Comparison of the Vcheck assay with the Cardiopet NT‐proBNP assay revealed an excellent correlation with minimal bias when preanalytical factors were controlled. Significant degradation of NT‐proBNP occurred when current methods were used at refrigerated and room temperatures, which could change diagnostic and prognostic decision‐making. Age‐partitioned reference intervals have high reference values of 750 pmol/L and 1280 pmol/L for juvenile and adult dogs, respectively. Conclusions The Vcheck NT‐ProBNP assay provides analytically acceptable results. Onsite testing can minimize variability related to preanalytical error and provide clinically useful contemporaneous results. Samples should be centrifuged immediately and analyzed within 2 hours of collection.

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Accuracy of history, physical examination, cardiac biomarkers, and biochemical variables in identifying dogs with stage B2 degenerative mitral valve disease

Cited by 12 publications

References 61 publications

Machine Learning Techniques for Canine Myxomatous Mitral Valve Disease Classification: Integrating Anamnesis, Quality of Life Survey, and Physical Examination

Machine Learning Techniques for Canine Myxomatous Mitral Valve Disease Classification: Integrating Anamnesis, Quality of Life Survey, and Physical Examination

A Preclinical Model of Obesity-Independent Metabolic Syndrome for Studying the Effects of Novel Antidiabetic Therapy Beyond Glycemic Control

Analytical validation of a novel point‐of‐care immunoassay for canine N‐terminal pro‐brain natriuretic peptide analysis

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