title: 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.
abstract: BACKGROUND
  Cardiac biomarkers provide objective data that augments clinical assessment of heart disease (HD).
  
  
  OBJECTIVE
  Determine the utility of plasma N-terminal pro-brain natriuretic peptide concentration [NT-proBNP] measured by a 2nd generation canine ELISA assay to discriminate cardiac from noncardiac respiratory distress and evaluate HD severity.
  
  
  METHODS
  Client-owned dogs (n = 291).
  
  
  METHODS
  Multicenter, cross-sectional, prospective investigation. Medical history, physical examination, echocardiography, and thoracic radiography classified 113 asymptomatic dogs (group 1, n = 39 without HD; group 2, n = 74 with HD), and 178 with respiratory distress (group 3, n = 104 respiratory disease, either with or without concurrent HD; group 4, n = 74 with congestive heart failure [CHF]). HD severity was graded using International Small Animal Cardiac Health Council (ISACHC) and ACVIM Consensus (ACVIM-HD) schemes without knowledge of [NT-proBNP] results. Receiver-operating characteristic curve analysis assessed the capacity of [NT-proBNP] to discriminate between dogs with cardiac and noncardiac respiratory distress. Multivariate general linear models containing key clinical variables tested associations between [NT-proBNP] and HD severity.
  
  
  RESULTS
  Plasma [NT-proBNP] (median; IQR) was higher in CHF dogs (5,110; 2,769-8,466 pmol/L) compared to those with noncardiac respiratory distress (1,287; 672-2,704 pmol/L; P < .0001). A cut-off >2,447 pmol/L discriminated CHF from noncardiac respiratory distress (81.1% sensitivity; 73.1% specificity; area under curve, 0.84). A multivariate model comprising left atrial to aortic ratio, heart rate, left ventricular diameter, end-systole, and ACVIM-HD scheme most accurately associated average plasma [NT-proBNP] with HD severity.
  
  
  CONCLUSIONS
  Plasma [NT-proBNP] was useful for discriminating CHF from noncardiac respiratory distress. Average plasma [NT-BNP] increased significantly as a function of HD severity using the ACVIM-HD classification scheme.
authors.affiliation: The Animal Medical Center, New York, NY.
authors.forename: P R
authors.initials: PR
authors.lastname: Fox
authors.forename: M A
authors.initials: MA
authors.lastname: Oyama
authors.forename: M J
authors.initials: MJ
authors.lastname: Hezzell
authors.forename: J E
authors.initials: JE
authors.lastname: Rush
authors.forename: T P
authors.initials: TP
authors.lastname: Nguyenba
authors.forename: T C
authors.initials: TC
authors.lastname: DeFrancesco
authors.forename: L B
authors.initials: LB
authors.lastname: Lehmkuhl
authors.forename: H B
authors.initials: HB
authors.lastname: Kellihan
authors.forename: B
authors.initials: B
authors.lastname: Bulmer
authors.forename: S G
authors.initials: SG
authors.lastname: Gordon
authors.forename: S M
authors.initials: SM
authors.lastname: Cunningham
authors.forename: J
authors.initials: J
authors.lastname: MacGregor
authors.forename: R L
authors.initials: RL
authors.lastname: Stepien
authors.forename: B
authors.initials: B
authors.lastname: Lefbom
authors.forename: D
authors.initials: D
authors.lastname: Adin
authors.forename: K
authors.initials: K
authors.lastname: Lamb
mesh_terms: D000818:Animals; D003430:Cross-Sectional Studies; D004283:Dog Diseases / Q000097:blood* / Q000145:classification / Q000378:metabolism; D004285:Dogs; D004417:Dyspnea / Q000097:blood / Q000175:diagnosis / Q000662:veterinary*; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods / Q000662:veterinary*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000145:classification / Q000662:veterinary*; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Biomarkers; Canine; Heart disease; Respiratory distress