The use of focused cardiac ultrasound to screen for occult heart disease in asymptomatic cats

Abstract

Background Focused cardiac ultrasound (FCU) helps detect occult heart disease in human patients. Hypothesis Focused cardiac ultrasound by a nonspecialist practitioner (NSP) will increase the detection of occult heart disease in asymptomatic cats compared with physical examination and ECG. Animals Three hundred forty‐three client‐owned cats: 54 excluded and 289 analyzed. Methods Multicenter prospective cohort study. Twenty‐two NSPs were trained to perform FCU. Cats without clinical signs of heart disease were recruited, and NSPs performed the following in sequential order: physical examination, ECG, FCU, and point‐of‐care N‐terminal pro‐B‐type natriuretic peptide assay (POC‐BNP). After each step, NSPs indicated yes, no, or equivocal as to whether they believed heart disease was present. The level of agreement between the NSP diagnosis and a blinded cardiologist's diagnosis after echocardiogram was evaluated using Cohen's kappa test. Results Cardiologist diagnoses included 148 normal cats, 102 with heart disease, and 39 equivocal ones. Agreement between NSP and cardiologist was slight after physical examination (kappa 0.253 [95% CI, 0.172‐0.340]), did not increase after ECG (0.256 [0.161‐0.345]; P = .96), increased after FCU (0.468 [0.376‐0.558]; P = .002), and the level of agreement was similar after POC‐BNP (0.498 [0.419‐0.580]; P = .67). In cats with mild, moderate, and marked occult heart disease, the proportion of cats having a NSP diagnosis of heart disease after FCU was 45.6%, 93.1%, and 100%, respectively. Conclusions and Clinical Importance Focused cardiac ultrasound performed by NSPs increased the detection of occult heart disease, especially in cats with moderate to marked disease. Focused cardiac ultrasound appears to be a feasible and useful tool to assist NSPs in the detection of heart disease in cats.

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

“…Fortunately, with regard to therapeutic decision‐making, the requirement for diuretics in cats with CHF and the approach to management of ATE are similar regardless of the form of cardiomyopathy. A basic level of echocardiographic skill (eg, ability to detect moderate to severe left atrial enlargement) can be sufficient to identify the more advanced stages of cardiomyopathy . Other diagnostic tests may facilitate disease staging, identification of important comorbidities and establishing prognosis.…”

Joint virtual issue on recent advances in veterinary cardiac imaging

“…Advanced analysis of the geometry of the mitral valve by 3‐dimensional (3D) echocardiography also expands our understanding of the disease phenotype . Although advanced 3D echocardiography is limited primarily to research centers, point‐of‐care ultrasound was demonstrated to be a useful screening tool to overcome the challenges of detecting heart disease in cats by nonspecialists practitioners . The last 5 years also demonstrate an increased focus on the right ventricle, the side of the heart that has been largely ignored in the past.…”

“…12 Although advanced 3D echocardiography is limited primarily to research centers, point-of-care ultrasound was demonstrated to be a useful screening tool to overcome the challenges of detecting heart disease in cats by nonspecialists practitioners. 13 The last 5 years also demonstrate an increased focus on the right ventricle, [14][15][16] the side of the heart that has been largely ignored in the past. Further focus on the right ventricle has sought to improve our understanding of the utility of echocardiography to estimate pulmonary arterial pressure and enhanced our appreciation of pulmonary hypertension as a cause of morbidity in animals.…”

Joint virtual issue on recent advances in veterinary cardiac imaging

“…Advanced analysis of the geometry of the mitral valve by three‐dimensional echocardiography also expands our understanding of the disease phenotype . While advanced three‐dimensional echocardiography is limited primarily to research centers, point‐of‐care ultrasound was demonstrated to be a useful screening tool to overcome the challenges of detecting heart disease in cats by non‐specialists practitioners . The past 5 years also demonstrate an increased focus on the right ventricle, the side of the heart that has been largely ignored in the past.…”

“…12 While advanced three-dimensional echocardiography is limited primarily to research centers, point-of-care ultrasound was demonstrated to be a useful screening tool to overcome the challenges of detecting heart disease in cats by non-specialists practitioners. 13 The past 5 years also demonstrate an increased focus on the right ventricle, [14][15][16] the side of the heart that has been largely ignored in the past. Further focus on the right ventricle has sought to improve our understanding of the utility of echocardiography to estimate pulmonary arterial pressure and enhanced our appreciation of pulmonary hypertension as a cause of morbidity in animals.…”