title: 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.
abstract: BACKGROUND
  Circulating 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/E(a)).
  
  
  METHODS
  NT-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.
  
  
  RESULTS
  NT-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 (rho=0.266; P=0.007) and LV free wall thickness (rho=0.218; P=0.027), but not with radiographic heart size, left atrial size, left ventricular dimensions, E/E(a) 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).
  
  
  CONCLUSIONS
  NT-proBNP accurately discriminated CHF from respiratory disease causes of dyspnea.
authors.affiliation: Caspary Institute, The Animal Medical Center, 510 East 62nd Street, New York, NY 10065, USA. philip.fox@amcny.org
authors.forename: Philip R
authors.initials: PR
authors.lastname: Fox
authors.forename: Mark A
authors.initials: MA
authors.lastname: Oyama
authors.forename: Caryn
authors.initials: C
authors.lastname: Reynolds
authors.forename: John E
authors.initials: JE
authors.lastname: Rush
authors.forename: Terri C
authors.initials: TC
authors.lastname: DeFrancesco
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Keene
authors.forename: Clark E
authors.initials: CE
authors.lastname: Atkins
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Macdonald
authors.forename: Karsten E
authors.initials: KE
authors.lastname: Schober
authors.forename: John D
authors.initials: JD
authors.lastname: Bonagura
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Stepien
authors.forename: Heidi B
authors.initials: HB
authors.lastname: Kellihan
authors.forename: Thaibinh P
authors.initials: TP
authors.lastname: Nguyenba
authors.forename: Linda B
authors.initials: LB
authors.lastname: Lehmkuhl
authors.forename: Bonnie K
authors.initials: BK
authors.lastname: Lefbom
authors.forename: N Sydney
authors.initials: NS
authors.lastname: Moise
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Hogan
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002371:Cat Diseases / Q000097:blood* / Q000175:diagnosis; D002415:Cats; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000662:veterinary; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000662:veterinary*; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000662:veterinary*; D012120:Respiration Disorders / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000662:veterinary*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain