Transient Myocardial Thickening in Cats Associated with Heart Failure

Background Hypertrophic cardiomyopathy (HCM) is the most common cardiac disease in cats. However, most cats are not diagnosed until they develop congestive heart failure, arterial thromboembolism (ATE), or sudden cardiac death. Thus, an affordable screening test for early detection of HCM is desirable. Hypothesis/Objectives Evaluation of a sensitive cardiac troponin I (cTnI) assay as a screening test for HCM in cats and determination of a cutoff for its early detection. Animals One hundred sixty‐six client‐owned cats (male, n = 97) of various breeds were evaluated and classified using echocardiography as being healthy (n = 87), equivocal (n = 15), or having HCM (mild, n = 16; moderate, n = 10; severe, n = 34) or ATE (n = 4). Methods All cats were prospectively evaluated by echocardiography, and serum cTnI concentration was determined using the currently most sensitive assay (Siemens ADVIA Centaur TnI‐Ultra). Results The median cTnI concentration was significantly different between study groups ( P < .000001). A cutoff of 0.06 ng/mL provided good discrimination between healthy cats and cats with HCM (sensitivity, 91.7%; specificity, 95.4%; area under the curve [AUC], 0.95; 95% confidence interval [CI], 0.899‐0.978). Even for asymptomatic cats with HCM, sensitivity and specificity for a cutoff of >0.06 ng/mL remained high at 87.8% and 95.4%, respectively (AUC, 0.93; 95% CI, 0.864‐0.964). Conclusions and clinical importance Cardiac troponin I can be used as a sensitive and specific screening test for the diagnosis of HCM in otherwise healthy cats (cutoff, >0.06 ng/mL). However, echocardiography is needed to confirm the diagnosis.

Section: Discussionmentioning

confidence: 99%

Evaluation of a sensitive cardiac troponin I assay as a screening test for the diagnosis of hypertrophic cardiomyopathy in cats

Hertzsch

Roos

Wess

2019

“…Median survival times are substantially shorter in cats with HCM that develop CHF or ATE compared to those with subclinical cardiomyopathy . Cats that develop CHF associated with stress, IV fluid therapy, general anesthesia, or extended‐release corticosteroid treatment might have longer survival times compared with cats that develop CHF in the absence of these factors . Factors associated with longer survival times after treatment for CHF include a greater decrease in NT‐proBNP concentrations during hospitalization and resolution of CHF at reexamination …”

Section: Prevalence and Natural Historymentioning

confidence: 99%

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

Fuentes

Abbott

Chetboul

et al. 2020

172

236

Consensus Statements of the American College of Veterinary Internal Medicine (ACVIM) provide the veterinary community with up-to-date information on the pathophysiology, diagnosis, and treatment of clinically important animal diseases. The ACVIM Board of Regents oversees selection of relevant topics, identification of panel members with the expertise to draft the statements, and other aspects of assuring the integrity of the process. The statements are derived from evidence-based medicine whenever possible and the panel offers interpretive comments when such evidence is inadequate or contradictory. A draft is prepared by the panel, followed by solicitation of input by the ACVIM membership that may be incorporated into the statement. It is then submitted to the Journal of Veterinary Internal Medicine, where it is edited before publication. The authors are solely responsible for the content of the statements. AbstractCardiomyopathies are a heterogeneous group of myocardial disorders of mostly unknown etiology, and they occur commonly in cats. In some cats, they are welltolerated and are associated with normal life expectancy, but in other cats they can result in congestive heart failure, arterial thromboembolism or sudden death.Cardiomyopathy classification in cats can be challenging, and in this consensus statement we outline a classification system based on cardiac structure and function (phenotype). We also introduce a staging system for cardiomyopathy that includes subdivision of cats with subclinical cardiomyopathy into those at low risk

“…Five of them had quantitative plasma [NT‐proBNP] >100 pmol/L (107, 142, 148, 203, 337); 4 of these values were in the POC's transition zone from negative to positive. Possible explanations for POC NT‐proBNP ELISA false negative results include echocardiographic abnormalities that were caused by transient myocardial thickening, 15 limitations of echocardiographic interpretation caused by intraobserver variability 16 and differences in RAAS and BNP activation among different cats. Test inaccuracy is possible, although the low median quantitative [NT‐proBNP] of 47 pmol/L in these cats suggests that the POC test effectively measures [NT‐proBNP] and that the inconsistency is not specific to the POC test, but rather is between echocardiographic results and [NT‐proBNP], whether POC or quantitative.…”

Section: Discussionmentioning

confidence: 99%

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

Côté

Kuo

et al. 2021

Background: Point-of-care (POC) N-terminal pro B-type natriuretic peptide (NT-proBNP) ELISA test has been evaluated for screening cats for cardiac disease in the referral veterinary setting but less is known about its use in general practice (GP).Objectives: To evaluate the diagnostic utility of a POC NT-proBNP ELISA in cats seen in GPs.Animals: Two hundred and seventeen apparently healthy cats from 21 GPs.Methods: This was a prospective, cross-sectional study. Cardiac auscultation and POC NT-proBNP ELISA were done by veterinarians at their GPs. After enrollment at GPs, cats were sent to a cardiology referral hospital for cardiac auscultation and echocardiographic diagnosis. Results were interpreted based on whether cats had normal or abnormal echocardiographic findings.Results: Point-of-care NT-proBNP ELISA results differentiated cats in the abnormal group from those in the normal group with a sensitivity of 43%, specificity of 96%. In cats with a heart murmur at GPs, POC NT-proBNP ELISA results differentiated cats in the abnormal group from those in the normal group with a sensitivity of 71% and a specificity of 92%. Conclusion and Clinical Importance:In apparently healthy cats in GPs, positive POC NT-proBNP results are associated with heart disease, warranting an echocardiogram, but negative results do not reliably exclude heart disease. These results suggest POC NT-proBNP is not an effective screening test for apparently healthy cats in GPs, although its performance is improved if it is used only in cats that have a heart murmur.