Utility of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) to distinguish between congestive heart failure and non-cardiac causes of acute dyspnea in cats |
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| Authors: | Philip R Fox Mark A Oyama Caryn Reynolds John E Rush Terri C DeFrancesco Bruce W Keene Clark E Atkins Kristin A MacDonald Karsten E Schober John D Bonagura Rebecca L Stepien Heidi B Kellihan Thaibinh P Nguyenba Linda B Lehmkuhl Bonnie K Lefbom N Sydney Moise Daniel F Hogan |
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| Institution: | 1. Caspary Institute, The Animal Medical Center, 510 East 62nd Street, New York, NY 10065, USA;2. University of Pennsylvania, School of Veterinary Medicine, 3850 Spruce Street, Philadelphia, PA 19104, USA;3. Tufts University, School of Veterinary Medicine, 200 Westboro Road, 200 West Borough Road, North Grafton, MA 01536, USA;4. North Carolina State University, College of Veterinary Medicine, 4700 Hillsborough Street, Raleigh, NC 27606, USA;5. Animal Care Center, 6470 Redwood Drive, Rohnert Park, CA 94928, USA;6. Ohio State University, College of Veterinary Medicine, 601 Vernon L. Tharp Street, Columbus, OH 43210, USA;7. University of Wisconsin, School of Veterinary Medicine, 2015 London Drive West, Madison, vWI 53711, USA;8. MedVet Associates Inc, 300 East Wilson Bridge Road, Worthington, OH 43085, USA;9. Chesapeake Veterinary Cardiology Associates, 6651 F Backlick Road, Springfield, VA 22150, USA;10. Cornell University, College of Veterinary Medicine, Campus Drive, Ithaca, NY 14853, USA;11. Purdue University, School of Veterinary Medicine, 625 Harrison Street, W. Lafayette, IN 47907, USA |
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| Abstract: | BackgroundCirculating plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration facilitates emergency diagnosis of congestive heart failure (CHF) in people. Its utility to discriminate between dyspneic cats with CHF vs. primary respiratory disease requires further assessment. Our objectives were to determine if NT-proBNP (1) differentiates dyspneic cats with CHF vs. primary respiratory disease; (2) increases with renal insufficiency; (3) correlates with left atrial dimension, radiographic cardiomegaly, and estimated left ventricular filling pressure (E/Ea).MethodsNT-proBNP was measured in 167 dyspneic cats (66 primary respiratory disease, 101 CHF) to evaluate (1) relationship with clinical parameters; (2) ability to distinguish CHF from primary respiratory disease; (3) optimal cut-off values using receiver operating characteristic (ROC) curve analysis.ResultsNT-proBNP (1) was higher (median and inter-quartile 25th–75th] percentile) in CHF (754 pmol/L; 437, 1035 pmol/L) vs. primary respiratory disease (76.5 pmol/L; 24, 180 pmol/L) cohorts (P < 0.001); (2) positively correlated in CHF cats with increased inter-ventricular septal end-diastolic thickness (ρ = 0.266; P = 0.007) and LV free wall thickness (ρ = 0.218; P = 0.027), but not with radiographic heart size, left atrial size, left ventricular dimensions, E/Ea ratio, BUN, creatinine, or thyroxine; (3) distinguished dyspneic CHF cats from primary respiratory disease at 265 pmol/L cut-off value with 90.2% sensitivity, 87.9% specificity, 92% positive predictive value, and 85.3% negative predictive value (area under ROC curve, 0.94).ConclusionsNT-proBNP accurately discriminated CHF from respiratory disease causes of dyspnea. |
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