Effect of prespecified therapy escalation on plasma NT‐proBNP concentrations in dogs with stable congestive heart failure due to myxomatous mitral valve disease

Abstract

BackgroundTreatment targeted to achieve reduction in N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) improves outcomes in human congestive heart failure (CHF) patients.HypothesisA pre‐specified therapeutic algorithm that increased diuretic or pimobendan usage will reduce plasma NT‐proBNP concentrations in dogs with CHF secondary to myxomatous mitral valve disease (MMVD).AnimalsTwenty‐six dogs with clinically stable CHF secondary to MMVD.MethodsProspective, controlled before‐and‐after study. Dogs were examined up to 3 times over 21 days. Treatment was prescribed based on NT‐proBNP as follows: <1500 pmol/L at baseline, no treatment adjustment at any point during the study (group 1); ≥1500 pmol/L and creatinine ≤3.0 mg/dL at baseline or SC visits, treatment escalated according to the algorithm (group 2); ≥1500 pmol/L at baseline, no treatment adjustment (group 3).ResultsN‐terminal pro‐B‐type natriuretic peptide decreased significantly in group 2 (mean change = −1736 pmol/L (95% CI, −804 to −2668), P < .001) but not in groups 1 or 3 (623 pmol/L [–631 to 1877 pmol/L], P = .14 and 685 pmol/L [–304 to 1068 pmol/L], P = .46, respectively). Serum BUN and creatinine did not change significantly between visit 0 and visit 2 in group 1 (median = 23 mg/dL [range 13‐32] versus 19 mg/dL [12‐38], P = .72 and 1.15 mg/dL [0.70‐1.40] versus 0.95 mg/dL [0.70‐1.10], P = .10, respectively) or group 2 (28 mg/dL [18‐87] versus 43.5 mg/dL [21‐160], P = .092 and 1.10 mg/dL [0.90‐2.50] versus 1.55 mg/dL [0.90‐3.30], P = .062, respectively).Conclusions and Clinical ImportanceUse of this treatment escalation algorithm allows effective targeting of treatment for CHF in dogs against an objective criterion.

Management of Chronic Congestive Heart Failure Caused by Myxomatous Mitral Valve Disease in Dogs: A Narrative Review from 1970 to 2020

“…Furthermore, a study on a myostatin antagonist used to counteract cardiac cachexia secondary to CHF has also been published [ 388 ]. In recent years, the evaluation of NT-pro BNP levels following the cardiological treatment has gained a lot of interest; in fact, low levels of this molecule indicate a better prognosis [ 389 , 390 ]. Cohort studies in veterinary medicine are rarely carried out because of high costs and long-time needing; in the period considered for this narrative review, only two have been found in the literature [ 391 , 392 ].…”

Monitoring congestive heart failure

“…An observational study of dogs with CHF showed that those with lower plasma NT‐proBNP measurements following initial treatment for CHF had longer survival times (Wolf and others 2012). A second study showed that the use of a prespecified treatment algorithm results in decreases in plasma NT‐proBNP (Hezzell and others 2018). However, whether the use of this algorithm to guide therapy results in improved outcomes in dogs remains unknown.…”

What can changes in serial measurements tell us about prognosis in myxomatous mitral valve disease?

“…23 A pre-speciied treatment algorithm for CHF in dogs with MMVD, based on target reductions in circulating NT-proBNP measurements, has been demonstrated to be efective, although any inluence on prognosis remains untested. 24 However, an observational study suggested that the prognosis is better for dogs with CHF secondary to MMVD if circulating NT-proBNP measurements decrease in response to therapy. 25 In a study summarised on p 343 of this issue of Vet Record, Chan and colleagues measured short-term changes in cTnI following initiation of therapy for CHF secondary to MMVD.…”

“…Treatment with pimobendan has also been shown to result in decreases in heart size 23 . A pre‐specified treatment algorithm for CHF in dogs with MMVD, based on target reductions in circulating NT‐proBNP measurements, has been demonstrated to be effective, although any influence on prognosis remains untested 24 . However, an observational study suggested that the prognosis is better for dogs with CHF secondary to MMVD if circulating NT‐proBNP measurements decrease in response to therapy 25 …”