Differentiating between feline pleural effusions of cardiac and non‐cardiac origin using pleural fluid NT‐proBNP concentrations

Abstract

OBJECTIVE: To assess whether pleural fluid and urine amino terminal proB-type natriuretic peptide (NT-proBNP) can distinguish cardiac from non-cardiac causes of pleural effusion.METHODS: Blood, urine and pleural fluid were prospectively collected from cats presenting with pleural effusion categorised as cardiac or non-cardiac in origin. NT-ProBNP concentrations were measured using a feline-specific enzyme-linked immunosorbent assay. Groups were statistically compared and receiver operating characteristic curves constructed to determine cut-offs to distinguish cardiac from non-cardiac pleural effusion in plasma, pleural fluid and urine.RESULTS: Forty cats with pleural effusion (22 cardiac and 18 non-cardiac) were studied. NT-proBNP concentrations in plasma and pleural fluid were strongly correlated. Plasma (P<0·001) and pleural fluid (P<0·001) NT-proBNP concentrations and urinary NT-proBNT/creatinine ratios (P=0·035) were significantly higher in the cardiac group. After receiver operating characteristic curve analysis a plasma NT-proBNP cut-off of 214·3 pmol/mL was suggested [sensitivity=86·4% (95% CI: 66·7 to 95·3%), specificity=88·9% (95% CI: 67·2 to 96·9%)] and a pleural fluid NT-proBNP cut-off of 322·3 pmol/mL was suggested [sensitivity=100% (95% CI: 85·1 to 100%), specificity=94·4% (95% CI: 74·2 to 99·0%)]. No cut-off with adequate sensitivity and specificity for urinary NT-proBNP/creatinine ratios was suggested.CLINICAL SIGNIFICANCE: Measurement of NT-proBNP in pleural fluid distinguishes cardiac from non-cardiac causes of pleural effusion in cats.

Plasma Cardiac Troponin I Concentration and Cardiac Death in Cats with Hypertrophic Cardiomyopathy

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ACVIM consensus statement guidelines for the classification, diagnosis, and management of cardiomyopathies in cats

“…Instead, a point‐of‐care NT‐proBNP assay provides rapid results while maintaining reasonable diagnostic accuracy in discriminating between cardiac and noncardiac causes of respiratory distress, and should be considered when point‐of‐care ultrasound examination is not available (LOE medium) . The point‐of‐care assay can be used on plasma or pleural fluid, the latter diluted 1:1 with saline for greater specificity …”

A clinical review of the pathophysiology, diagnosis, and treatment of pyothorax in dogs and cats

“…In cats with pleural effusion, the utility of blood and pleural N‐terminal pro‐B‐type natiuretic peptide (NT‐proBNP) concentrations in differentiating cardiac from noncardiac causes of pleural effusion has been evaluated . In general, plasma and pleura NT‐proBNP concentrations appear to be higher in cats with pleural effusion secondary to cardiac disease.…”