title: The combined prognostic potential of serum high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide concentrations in dogs with degenerative mitral valve disease.
abstract: BACKGROUND
  Identification of factors associated with decreased survival in dogs with degenerative mitral valve disease (DMVD) will allow more accurate prognosis. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is negatively associated with survival in dogs with DMVD. In human patients, multimarker strategies provide superior risk stratification compared with single markers.
  
  
  OBJECTIVE
  High-sensitivity cardiac troponin I (hscTnI) and other clinical variables will be associated with survival time in dogs with DMVD. Measuring hscTnI and NT-proBNP in combination will be prognostically superior to measurement of either marker alone. The rate of change of these markers will vary according to cause of death.
  
  
  METHODS
  Client-owned dogs (n = 202) with DMVD of varying severity and age-matched healthy control dogs (n = 30) recruited from first opinion private practice.
  
  
  METHODS
  Prospective cohort study relating clinical variables at enrollment in dogs with DMVD to survival time (all-cause, cardiac, and noncardiac mortality). Multivariable Cox regression analysis was used to identify factors associated with survival. Measurements were obtained approximately every 6 months. Repeated measures models were constructed to assess changes over time.
  
  
  RESULTS
  hscTnI, LVEDDN, heart rate, and age were independently associated with decreased survival time (all-cause mortality). Survival times were shortest in dogs in which both serum hscTnI and NT-proBNP were increased. hscTnI and NT-proBNP increased more rapidly in dogs that died of cardiac disease.
  
  
  CONCLUSIONS
  Serum hscTnI has prognostic value in dogs with DMVD. Measurement of NT-proBNP and hscTnI is prognostically superior to measuring either alone. Serial measurement strategies provide additional prognostic information.
authors.affiliation: Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hertfordshire, UK. mhezzell@rvc.ac.uk
authors.forename: M J
authors.initials: MJ
authors.lastname: Hezzell
authors.forename: A
authors.initials: A
authors.lastname: Boswood
authors.forename: Y-M
authors.initials: YM
authors.lastname: Chang
authors.forename: W
authors.initials: W
authors.lastname: Moonarmart
authors.forename: K
authors.initials: K
authors.lastname: Souttar
authors.forename: J
authors.initials: J
authors.lastname: Elliott
mesh_terms: D000818:Animals; D015331:Cohort Studies; D004283:Dog Diseases / Q000097:blood* / Q000473:pathology; D004285:Dogs; D015150:Echocardiography, Doppler / Q000662:veterinary; D006349:Heart Valve Diseases / Q000097:blood / Q000473:pathology / Q000662:veterinary*; D008943:Mitral Valve / Q000473:pathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D019210:Troponin I / Q000097:blood*
chemical_list: D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain