Point‐of‐care N‐terminal pro B‐type natriuretic peptide assay to screen apparently healthy cats for cardiac disease in general practice

Lu, Ta-Li; Côté, Étienne; Kuo, Yu-Wen; Wu, Haohan; Wang, Wen-Yen; Hung, Yong-Wei

doi:10.1111/jvim.16156

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…As an example, in one study approximately half the cats with subclinical HCM had a normal plasma NT-proBNP concentration (general practice population). 137 Other work suggests that cats in a referral population and with more advanced stages of subclinical HCM are more likely to have a higher plasma NT-proBNP concentration. 138 The quantitative NT-proBNP assay is most reliable when used to assess cats referred for a heart murmur, gallop rhythm or arrhythmia or when radiographic heart enlargement is detected.…”

Section: Diagnosismentioning

confidence: 99%

“… 138 The quantitative NT-proBNP assay is most reliable when used to assess cats referred for a heart murmur, gallop rhythm or arrhythmia or when radiographic heart enlargement is detected. 137 , 139 In general, a plasma NT-proBNP concentration >99 pmol/l suggests that mild to severe HCM is present, although this cut-off is less reliable in a general practice feline population. 137 , 139 Further evaluation via echocardiography is generally indicated if this sort of elevation is identified.…”

Section: Diagnosismentioning

confidence: 99%

“… 137 , 139 In general, a plasma NT-proBNP concentration >99 pmol/l suggests that mild to severe HCM is present, although this cut-off is less reliable in a general practice feline population. 137 , 139 Further evaluation via echocardiography is generally indicated if this sort of elevation is identified. However, owners should be made aware that some cats with a high NT-proBNP concentration, especially male cats, will have a normal echocardiogram.…”

Section: Diagnosismentioning

confidence: 99%

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The Feline Cardiomyopathies: 2. Hypertrophic cardiomyopathy

Kittleson

Côté

2021

Journal of Feline Medicine and Surgery

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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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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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The Feline Cardiomyopathies: 2. Hypertrophic cardiomyopathy

Kittleson

Côté

2021

Journal of Feline Medicine and Surgery

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“…Therefore, NT‐proBNP is a test best used to indicate when further workup is needed, rather than as a screening test; heart disease cannot be excluded with a normal NT‐proBNP value. This is due to the test's low sensitivity but high specificity (43 per cent and 96 per cent, respectively, using the point‐of‐care lateral flow assay, although the sensitivity increases in cats with a heart murmur [Lu and others 2021]).…”

Section: B‐type Natriuretic Peptide and N‐terminal Pro B‐type Natriur...mentioning

confidence: 99%

Interpreting cardiac biomarkers in small animal practice

Bode,

Lau

2023

In Practice

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Background: Cardiac troponin‐I (cTnI) and N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) are two cardiac biomarkers readily available on the market. These two biomarkers are useful diagnostic tools used in the right setting: differentiating cardiac and non‐cardiac causes of respiratory distress and providing prognosis prediction. However, these tests have their limitations and their results should be interpreted with these limitations in mind.Aim of the article: This article reviews the available evidence around the physiology of cTnI and NT‐proBNP – the commercially available assays – and discusses their indications, limitations and result interpretation for each biomarker. The emerging biomarker, microRNA, is also briefly discussed.

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The Feline Cardiomyopathies: 1. General concepts

Kittleson

Côté

2021

Journal of Feline Medicine and Surgery

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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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Point‐of‐care N‐terminal pro B‐type natriuretic peptide assay to screen apparently healthy cats for cardiac disease in general practice

Cited by 5 publications

References 24 publications

The Feline Cardiomyopathies: 2. Hypertrophic cardiomyopathy

The Feline Cardiomyopathies: 2. Hypertrophic cardiomyopathy

Interpreting cardiac biomarkers in small animal practice

The Feline Cardiomyopathies: 1. General concepts

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