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Assessment of serum N-terminal pro-B-type natriuretic peptide concentration for differentiation of congestive heart failure from primary respiratory tract disease as the cause of respiratory signs in dogs

Mark A. Oyama DVM, DACVIM1, John E. Rush DVM, DACVIM, DACVECC2, Elizabeth A. Rozanski DVM, DACVIM, DACVECC3, Philip R. Fox DVM, DACVIM4, Caryn A. Reynolds DVM5, Sonya G. Gordon DVM, DACVIM6, Barret J. Bulmer DVM, DACVIM7, Bonnie K. Lefbom DVM, DACVIM8, Bill A. Brown DVM, DACVIM9, Linda B. Lehmkuhl DVM, DACVIM10, Robert Prosek DVM, DACVIM11, Michael B. Lesser DVM, DACVIM12, Marc S. Kraus DVM, DACVIM13, Maribeth J. Bossbaly DVM, DACVIM14, Gregg S. Rapoport DVM, DACVIM15, and Jean-Sebastien Boileau DVM, DACVIM16
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  • 1 Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.
  • | 2 Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536.
  • | 3 Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536.
  • | 4 The Animal Medical Center, 510 E 62nd St, New York, NY 10021.
  • | 5 Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.
  • | 6 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Texas A&M University, College Station, TX 77843.
  • | 7 Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331.
  • | 8 The Hope Center, 416 Maple Ave W, Vienna, VA 22151.
  • | 9 Veterinary Cardiology Consultants, Animal Emergency Center, 24255 Novi Rd, Novi, MI 48375.
  • | 10 MedVet Medical & Cancer Center for Pets, 300 E Wilson Bridge Rd, Worthington, OH 43085.
  • | 11 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608.
  • | 12 Advanced Veterinary Care Center, 15926 Hawthorne Blvd, Lawndale, CA 90260.
  • | 13 Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853.
  • | 14 Heartsound Consultants, 1900 W Old Lincoln Hwy, Langhorne, PA 19047.
  • | 15 Angell Animal Medical Center, 350 S Huntington Ave, Boston, MA 02130.
  • | 16 Fifth Avenue Veterinary Specialists, 1 W 15th St, New York, NY 10011.

Abstract

Objective—To determine whether serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration is useful in discriminating between cardiac and noncardiac (ie, primary respiratory tract disease) causes of respiratory signs (ie, coughing, stertor, stridor, excessive panting, increased respiratory effort, tachypnea, or overt respiratory distress) in dogs.

Design—Multicenter cross-sectional study.

Animals—115 dogs with respiratory signs.

Procedures—Dogs with respiratory signs were solicited for study. Physical examination, thoracic radiography, and echocardiography were used to determine whether respiratory signs were the result of cardiac (ie, congestive heart failure) or noncardiac (ie, primary respiratory tract disease) causes. Serum samples for NT-proBNP assay were obtained at time of admission for each dog. Receiver-operating characteristic curves were constructed to determine the ability of serum NT-proBNP concentration to discriminate between cardiac and noncardiac causes of respiratory signs.

Results—Serum NT-proBNP concentration was significantly higher in dogs with cardiac versus noncardiac causes of respiratory signs. In dogs with primary respiratory tract disease, serum NT-proBNP concentration was significantly higher in those with concurrent pulmonary hypertension than in those without. A serum NT-proBNP cutoff concentration > 1,158 pmol/L discriminated between dogs with congestive heart failure and dogs with primary respiratory tract disease with a sensitivity of 85.5% and a specificity of 81.3%.

Conclusions and Clinical Relevance—Measuring serum NT-proBNP concentration in dogs with respiratory signs helps to differentiate between congestive heart failure and primary respiratory tract disease as an underlying cause.

Abstract

Objective—To determine whether serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration is useful in discriminating between cardiac and noncardiac (ie, primary respiratory tract disease) causes of respiratory signs (ie, coughing, stertor, stridor, excessive panting, increased respiratory effort, tachypnea, or overt respiratory distress) in dogs.

Design—Multicenter cross-sectional study.

Animals—115 dogs with respiratory signs.

Procedures—Dogs with respiratory signs were solicited for study. Physical examination, thoracic radiography, and echocardiography were used to determine whether respiratory signs were the result of cardiac (ie, congestive heart failure) or noncardiac (ie, primary respiratory tract disease) causes. Serum samples for NT-proBNP assay were obtained at time of admission for each dog. Receiver-operating characteristic curves were constructed to determine the ability of serum NT-proBNP concentration to discriminate between cardiac and noncardiac causes of respiratory signs.

Results—Serum NT-proBNP concentration was significantly higher in dogs with cardiac versus noncardiac causes of respiratory signs. In dogs with primary respiratory tract disease, serum NT-proBNP concentration was significantly higher in those with concurrent pulmonary hypertension than in those without. A serum NT-proBNP cutoff concentration > 1,158 pmol/L discriminated between dogs with congestive heart failure and dogs with primary respiratory tract disease with a sensitivity of 85.5% and a specificity of 81.3%.

Conclusions and Clinical Relevance—Measuring serum NT-proBNP concentration in dogs with respiratory signs helps to differentiate between congestive heart failure and primary respiratory tract disease as an underlying cause.

Contributor Notes

Dr. Prosek's present address is Veterinary Specialists Inc, 91 NE 6th St, Homestead, FL 33030.

Supported by a research grant from Veterinary Diagnostics Institute, Irvine, Calif.

Drs. Oyama, Rush, and Fox previously consulted for Veterinary Diagnostics Institute, Irvine, Calif, and presently consult for IDEXX Laboratories, Westbrook, Me.

Presented in part at the American College of Veterinary Internal Medicine Forum, San Antonio, Tex, June 2008.

The authors thank Fe Wright and Carolyn Michel for technical assistance.

Address correspondence to Dr. Oyama (maoyama@vet.upenn.edu).