Relationship of Plasma N‐terminal Pro‐brain Natriuretic Peptide Concentrations to Heart Failure Classification and Cause of Respiratory Distress in Dogs Using a 2nd Generation <scp>ELISA</scp> Assay

Fox, Philip R.; Oyama, Mark A.; Hezzell, Melanie J; Nguyenba, Thaibinh P.; DeFrancesco, Teresa C.; Lehmkuhl, Linda B.; Kellihan, Heidi B.; Bulmer, Barret J.; Gordon, Sonya G.; Cunningham, Suzanne M.; MacGregor, John; Stepien, Rebecca L.; Lefbom, Bonnie K.; Adin, Darcy B.; Lamb, Kenneth

doi:10.1111/jvim.12472

Cited by 40 publications

(39 citation statements)

References 39 publications

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“…In-hospital mortality remains high at 12%, and readmission, disability and death rates have also not lowered despite recent advances in the management of HF, posing a substantial global health care burden [9][10][11]. In order to change this dismal outlook, major efforts have been initiated in the last decade to promote effective treatment protocols in HF management, including careful choice of drug therapy regimen [12][13][14]. Inotropic agents are popular in current treatment guidelines for HF and dobutamine is recommended in parenteral therapy for inotropic support [15,16].…”

Section: Introductionmentioning

confidence: 99%

Retracted: rhBNP therapy can improve clinical outcomes and reduce in‐hospital mortality compared with dobutamine in heart failure patients: a meta‐analysis

Deng

Long

2015

Brit J Clinical Pharma

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Aims A meta‐analysis was performed to compare the therapeutic outcomes in patients treated for heart failure (HF) with recombinant human brain natriuretic peptide (rhBNP) and dobutamine. Methods PubMed, Embase and the Chinese Biomedical Database were exhaustively searched to identify studies relevant to this meta‐analysis. Eight cohort studies were found suitable for inclusion. Data regarding trial validity, methodological processes and clinical outcomes were extracted. Results Patients treated with rhBNP showed statistically significant reduction of in‐hospital mortality and re‐admission rates compared with the dobutamine treated patient group (both P < 0.05). Further, the rhBNP treated patient group showed higher survival outcomes, compared with dobutamine treated patients, when the post‐treatment follow‐up period was longer than 6 months (P < 0.05). Stratified analysis based on ethnicity showed a dramatic decrease of in‐hospital mortality among mixed race HF patients receiving rhBNP treatment (P < 0.05), but such decreases were not statistically significant in Asian and Caucasian populations (both P > 0.05). On the other hand, re‐admission rates were significantly lower in rhBNP treated Caucasian and mixed race populations (both P < 0.05). Notably, in rhBNP treated group, dose levels of 0.015 and 0.03 incrementally lowered the re‐admission rates, displaying dose effect, and the re‐admission rates at both rhBNP doses were significantly lower than the dobutamine treated group (both P < 0.05). Conclusions Our meta‐analysis results suggested that rhBNP therapy is associated with lower in‐hospital mortality and re‐admission rates in HF patients compared to the dobutamine regimen. Nevertheless, large scale prospective, randomized trials are necessary to confirm these findings.

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Section: Introductionmentioning

confidence: 99%

Retracted: rhBNP therapy can improve clinical outcomes and reduce in‐hospital mortality compared with dobutamine in heart failure patients: a meta‐analysis

Deng

Long

2015

Brit J Clinical Pharma

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“…6,7 Studies in humans have evaluated NT-proBNP-guided management of heart failure and found that care supported by BNP/NT-proBNP-guided therapy as an adjunct to standard treatment results in better outcomes (i.e, lower rate of adverse events). [6][7][8] Single-time measurement of NT-proBNP has a wide array of clinical applications in veterinary medicine, including the prediction of first onset CHF in dogs with degenerative mitral valve disease, 9 prognostication in dogs with acquired cardiac disease, 10 differentiation between cardiac and noncardiac causes of respiratory signs in cats 11 and dogs, 12-14 detection of occult cardiomyopathy in cats 15,16 and screening for occult dilated cardiomyopathy (DCM) in Doberman pinschers. 17,18 In addition, changes in NT-proBNP concentrations have been investigated in 1 study in dogs with degenerative mitral valve disease and CHF, although changes were not associated with survival, dogs with NT-proBNP concentrations <965 pmol/L at the time of re-evaluation had a longer survival time.…”

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confidence: 99%

Association between Survival Time and Changes in NT‐proBNP in Cats Treated for Congestive Heart Failure

Pierce

Freeman

Cunningham

et al. 2017

Veterinary Internal Medicne

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BackgroundReductions 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.ObjectivesTo evaluate changes in NT‐proBNP concentrations in cats with CHF after treatment and determine whether serial NT‐proBNP measurements provide prognostic information.AnimalsThirty‐one client‐owned cats.MethodsProspective, 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.ResultsMedian 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 importanceCats 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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“…14 In this earlier study, NT-proBNP was measured using the 1st-generation version of the ELISA, whereas measurements in our study were obtained using the 2nd-generation version of the assay, which is known to yield higher values compared with the 1st generation assay. 19 A scaling factor of 1.5 to achieve the threshold of 1500 pmol/L was derived by comparing cut-offs for differentiating cardiac from noncardiac causes of respiratory distress using the 1st-and 2nd-generation versions of the assay. 19,20 In the aforementioned previous study, NT-proBNP Studies in human patients have used a variety of treatment escalation strategies including introduction or uptitration of loop and thiazide diuretics, ACE inhibitors, spironolactone, digoxin, beta-blockers, and inodilators.…”

Section: Discussionmentioning

confidence: 99%

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

Hezzell

Block

Laughlin

et al. 2018

Veterinary Internal Medicne

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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.

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Relationship of Plasma N‐terminal Pro‐brain Natriuretic Peptide Concentrations to Heart Failure Classification and Cause of Respiratory Distress in Dogs Using a 2nd Generation ELISA Assay

Cited by 40 publications

References 39 publications

Retracted: rhBNP therapy can improve clinical outcomes and reduce in‐hospital mortality compared with dobutamine in heart failure patients: a meta‐analysis

Retracted: rhBNP therapy can improve clinical outcomes and reduce in‐hospital mortality compared with dobutamine in heart failure patients: a meta‐analysis

Association between Survival Time and Changes in NT‐proBNP in Cats Treated for Congestive Heart Failure

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

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