Association of Plasma N‐Terminal Pro‐B‐Type Natriuretic Peptide Concentration with Mitral Regurgitation Severity and Outcome in Dogs with Asymptomatic Degenerative Mitral Valve Disease

Abstract

Background:The clinical outcome of dogs affected by degenerative mitral valve disease (MVD) without overt clinical signs is still poorly defined, and criteria for identification of animals that are at a higher risk of early decompensation have not yet been determined.Hypothesis: N-terminal pro-B-type natriuretic peptide plasma concentration (NT-proBNP) is correlated with mitral regurgitation (MR) severity and can predict disease progression in dogs with asymptomatic MVD.Animals: Seventy-two dogs with asymptomatic MVD, with or without heart enlargement (International Small Animal Cardiac Health Council: ISACHC classes 1a and 1b), and a control group of 22 dogs were prospectively recruited.Methods: Severity of MR was quantitatively assessed from the regurgitation fraction (RF) by the proximal isovelocity surface area method. Consequences of MR were evaluated from measurements of the left atrium/aorta ratio (LA/Ao), fractional shortening (FS), end-diastolic and end-systolic left ventricular volumes indexed to body surface area (EDVI and ESVI). The relevance of these echo-Doppler indices and NT-proBNP for prediction of outcome at 12 months was studied.Results: A significant correlation was found between NT-proBNP and RF, LA/Ao, FS, and EDVI (P o .05). NT-proBNP was higher in dogs with MVD (ISACHC classes 1a and 1b) compared with the control group (P 5 .025 and o .001, respectively). The difference was not significant when only dogs from ISACHC class 1a with RF o 30% were considered. Lastly, NT-proBNP was higher in dogs that underwent MVD decompensation at 12 months (P o .05).Conclusions and Clinical Importance: NT-proBNP is correlated with MVD severity and prognosis in dogs with asymptomatic MVD.

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

“…Other studies of dogs have reported relatively similar natriuretic peptide sensitivity and specificity with respective values ranging from 85 to 82.4%,28 86.4 to 80.8%,4 90 to 78%,5 and 85.5 to 81.3% 8. Our study confirmed the utility of measuring plasma [NT‐proBNP] to help discriminate cardiac from noncardiac causes of dyspnea, consistent with earlier reports 4, 5, 6, 7, 8, 27, 28…”

“…The predominantly small breed, middle to older age dogs in our study closely reflect the demographics of dogs at risk for these conditions 7, 18, 25, 27. The AUC for the ROC curve analysis to distinguish cardiac from noncardiac cause of respiratory distress was 0.84 (Fig 3).…”

Breed Differences in Natriuretic Peptides in Healthy Dogs

“…Increased plasma NP concentrations have been identified in dogs with dilated cardiomyopathy (DCM) 2, 3, 4, 5, 6, 7. Furthermore, NP concentrations have been shown to increase with increasing disease severity in dogs with myxomatous mitral valve disease (MMVD),3, 8, 9, 10, 11 and NT‐proBNP has been suggested to be predictive of outcome in dogs with MMVD 9, 12, 13, 14, 15, 16. Natriuretic peptides also have been found useful to distinguish CHF from respiratory disease 12, 17, 18, 19, 20.…”

The diagnostic significance of cardiac biomarkers in veterinary medicine

“…In veterinary medicine research on the potential significance and utility of NP determination has increased in the past few years. Circulating NP levels, especially NT-proBNP and BNP, have been shown to correlate with the severity of cardiac disease (class of heart failure), the degree of cardiac remodelling Chetboul et al, 2009;Wess et al, 2011), response to therapy, proglimit and one indicating clinically relevant myocardial damage) it appears that the dynamic monitoring of cTnI concentration could be more useful in assessing of myocardial dysfunction (Linklater et al, 2007). In contrast, cTnT assays are relatively uniform regarding cut-off concentrations and precision (Serra et al, 2010).…”

“…nosis of outcome (Chetboul et al, 2009;Moonarmart et al, 2011) and even differentiate cardiac from noncardiac conditions in dogs (DeFrancesco et al, 2007;Prošek et al, 2007;Fox et al, 2009). In cats, serum NP monitoring has proved to be clinically useful as an initial screening test for suspected cardiac disease (Connolly et al, 2008;Wess et al, 2011).…”