In this Issue:
- The CEO Corner
- Join Us on Facebook Live - discussing Grain-Free Dog Foods
- Grain-Free Dog Food Guidance - now on CVCA website
- Cardiology & Neurology Symposium - Only Practice Management Slots Remain
- Save the Date - Gaithersburg Dinner & Learn - Tuesday, October 23rd
- Article: Clinical Use of NT-proBNP in Cardiology, by Kristin Jacobs, DVM, Diplomate, ACVIM (Cardiology)
- Getting to Know CVCA - Frederick, MD Location - Get to Know Doctors, Team Leaders and Support Staff
- NEW Annapolis Hospital - Opening Fall 2018
- Client Handout Materials
- CVCA Featured Locations
- Payment Options and Flexibility
- Follow us on Social Media
The CEO Corner
Best,
Katie Newbold, CVCA CEO
What if you can not join us on Facebook Live during the Q & A? Look for the Facebook Live information on the CVCA Facebook page and submit your questions in the comment section. We will try hard to get all of the questions answered for you during the Facebook Live Stream. And, we will post the Facebook Live Stream when finished so you can view all of the questions and answers submitted.
Questions, please submit them to Elizabeth Hart, Marketing Associate, at elizabeth.hart@cvcavets.com.
Only Practice Management Slots Remain
Date: Sunday, October 14th, 2018
Please - If you registered for the event but can no longer attend - send an email to Denise Kessler, denise.kessler@cvcavets.com,CVCA Marketing Manager, so we can give your spot others.
THANK YOU TO OUR SPONSORS:
Joint Dinner & Learn - CVCA Cardiac Care for Pets and Veterinary Referral Associates
- When: Tuesday, October 23rd
- Time: 6:15 p.m.
- Where: Holiday Inn Gaithersburg
2 Montgomery Village Ave. Gaithersburg, MD 20879
- Doctors Presenting: Dr. Tim Cain and Dr. Mariana Crumley
- CE for: Veterinarians
The Clinical Use of NT-proBNP
The use of NT-proBNP has become an important part of veterinary cardiology. NT-proBNP can be used as a screening test for cardiac disease in asymptomatic patients and in dyspneic patients to help determine if the cause of the symptoms are cardiac or respiratory. Using these tests varies in different scenarios and varies among the different tests available. While in human medicine, NT-proBNP can be used to guide treatment in patients with congestive heart failure, that information is not available in veterinary medicine at this time.
What is BNP/NT-proBNP?
- A biomarker measured in blood
- Produced by the ventricle in response to tension (either increased pressure or volume)
- Released as proBNP and then cleaved to active C-terminal BNP and inactive metabolite NT-proBNP
- NT-proBNP is more stable and more accurately measured than BNP and the most recent generation of the NTproBNP test measure metabolites of NTproBNP that are more stable in serum than the previously measured hormones - no longer need special tubes!
- Diuretic, natriuretic, vasodilator, inhibits the Renin Angiotensin Aldosterone System
- Released early in course of heart disease
- Levels in blood correlate to severity of heart disease
- Test is species specific
Uses of NT-proBNP in Cats
Heart disease in cats is often silent. In multiple studies, ~ 30% of cats with arterial thromboembolism (ATE) have no previous evidence of heart disease and no auscultable abnormalities at time of the ATE. Fifteen percent of apparently healthy cats have echocardiographic left ventricular hypertrophy. It has become clear that auscultation alone is not enough to screen for heart disease in cats. Also, using NT-proBNP in addition to history and physical examination, improves practitioner confidence in radiograph interpretation.
When to use NT-proBNP in cats?
- Screening for HCM
- < 8 years of age, consider NT-proBNP every 2-3 years
- > 8 years of age, consider NT-proBNP as part of senior wellness profile
- Prior to anesthesia
- Consider in all cats 2 years of age or older, especially with abnormal auscultation
- NT-proBNP is preferred
- Truly normal cats have an NT-proBNP < 60 pmol/L (higher than this, should cause some concern with regards to anesthesia)
- Prefer NT-proBNP when possible, especially in asymptomatic cats. SNAP BNP may be used - interpretation is different.
|
Cardiopet BNP |
SNAP BNP |
Interpretation |
|
<100 pmol/L |
Negative |
Clinically significant heart disease unlikely. |
|
>100 pmol/L |
Abnormal |
Increased risk of heart disease. |
Cats with Respiratory Signs or Pleural Effusion
|
Cardiopet BNP |
SNAP BNP |
Interpretation |
|
<100 pmol/L |
Negative |
Not supportive of CHF |
|
100-270 pmol/L |
Abnormal |
CHF possible but patient may have occult CM with respiratory disease. |
|
>270 pmol/L |
Abnormal |
CHF likely but still possibility of occult C with respiratory disease. |
Take Home Points
SNAP BNP testing
- Abnormal test result - will see color change at ~ 150 pmol/L
- Screening - Strongest value is if test is Abnormal
- Some occult CM will be negative on SNAP BNP (see differences in cut-off values of Cardiopet BNP vs. SNAP BNP)
- Respiratory Signs - Strongest value is if test is Normal/Negative - where you have likely ruled out possibility of CHF
- Some cats with respiratory signs will be abnormal on SNAP BNP but have occult CM not CHF due to the difference in the cut-off
Remember: NT-proBNP can be increased by other diseases - most commonly in the cat: hyperthyroidism, severe renal disease and hypertension.
Uses of NT-proBNP in Dogs
Dilated Cardiomyopathy (DCM) is often silent/occult and radiographic cardiac enlargement is difficult to detect, especially with early disease. NT-proBNP can be used for screening for DCM in Doberman pinschers. The accuracy of using NT-proBNP as a screening test is improved to 91% when combined with Holter monitoring. It is important to note that levels of NT-proBNP in Dobermans with occult DCM are lower than the normal range for other breeds of dogs.
In contrast, degenerative mitral valve disease (DMVD) is the most common heart disease in dogs and is easily detected by a mitral murmur on physical examination. Also, radiographic heart enlargement is relatively easy to detect. There is evidence that NT-proBNP can be used in conjunction with echocardiography to predict the first onset of CHF
Screening for Heart Disease
|
|
NTproBNP Level |
Interpretation |
Recommendation |
|
Dogs with murmur and |
NTproBNP < 900 | Clinically significant heart disease likely. | Echo could be recommended. |
| NTproBNP > 900 | Clinically significant heart disease likely. | Recommend CVCA consult, consider thoracic radiographs if fluids or surgery indicated. | |
| Doberman | NTproBNP > 735 | Increased risk for occult DCM. |
Recommend CVCA consult. Recommend thoracic radiographs if fluids or surgery indicated. |
| Dogs < 20 kg with murmur consistent with MVD |
NTproBNP > 1,500 | Increased risk for patient to present in CHF within next 12 months. |
Strongly encourage CVCA consult. Recommend thoracic radiographs in the event fluids or surgery indicated. |
In contrast, As in cats, NT-proBNP can be used to help evaluate if respiratory signs are due to CHF vs. other (ie: respiratory disease, neoplasia, etc.). There is no SNAP BNP test available for dogs.
Dogs with Respiratory Signs
|
NTproBNP Level |
Interpretation |
Recommendation |
|
NTproBNP < 900 |
Unlikely that clinical signs are |
Consider further respiratory diagnostics. |
|
NTproBNP 900-1,800 |
Indicates presence of significant heart |
Further diagnostics recommended to |
|
NTproBNP >1,800 |
Indicates presence of significant heart disease with likelihood that signs are secondary to CHF. |
Recommend thoracic radiographs and treat supportively. If not responding appropriately, reevaluate for possible PHT. |
**** Some of the highest NT-proBNP values can be seen in patients with Pulmonary Hypertension - an elevated NT-proBNP means an echocardiogram is recommended, especially if not responding to CHF management ****
Remember - NT-proBNP can be increased by other diseases - most commonly in the dog: severe renal disease, pulmonary hypertension, Cushing’s disease, systemic hypertension.
See last page for Works Cited Sections for “Clinical Uses of NT-proBNP”
Frederick, MD Location - Get to Know CVCA Doctors, Team Leaders and Support Staff
CVCA Cardiac Care for Pets has been a staple in Frederick County. CVCA is independently owned and located:
- inside of CARE Veterinary Center in Frederick, MD
CVCA’s teams are committed to providing the best client service, experience and the highest level of patient care for each and every patient.
CVCA Frederick
 |
|
| Frederick Staff |
Kacie Schmitt Felber DVM, Diplomate, ACVIM (Cardiology) |
Kacie Schmitt Felber started out as a veterinary assistant at a mixed animal practice in high school. She always had a passion for animals and medicine, and her first job solidified her dream of becoming a veterinarian. She understands every patient and family is unique and strives to promote open communication as well as emotional and financial considerations when developing an optimal treatment plan for each case. Her cardiology interests include management of congestive heart failure, the use of cardiac biomarkers in the emergency setting, and the use of cardiac biomarkers in the management and prognosis of heart disease and congestive heart failure. Outside of work, she enjoys traveling with her husband, trying new restaurants and breweries, spending time on the water, spending time with friends and family, and horseback riding. She is a proud pet parent to Maxine, a 5 year old French Bulldog, Buckeye, a 6 year old Labrador, and Solo, a 26 year old Appendix mare.
- Casey, our Team Leader, started out working the equine field and made the transition to small animal specialty medicine in 2013. She enjoys spending her free time traveling, working on cars, and playing with her animals: two cats, two dogs, and a horse.
- Denise, our veterinary nurse, has been working in the veterinary industry for more than 10+ years. She is an avid animal lover with two guinea pigs, a Holland lop bunny and plans on adding a puppy in this Summer.
- Malek, our veterinary nurse, has been working in the veterinary field for the past 12 years, and originally went to school for sign language, but felt more passionate about veterinary medicine and changed careers. Enjoys hiking with his dogs, watching movies and collecting vinyl records.
Questions, contact the CVCA Frederick Team at cvcafrederick@cvcavets.com.
NEW Annapolis Hospital Opening Fall 2018
A new Chesapeake Veterinary Referral Center (CVRC) will be opening in the Fall of 2018. The new facility is being built next to the current hospital. And, the new facility will be larger to help meet the needs of the community. More information to come!
Client Handout Materials
In need of marketing materials, magnets, business cards, or other collateral?
Fill out the Supply Request Form to quickly request materials!
  Rockville, MD
CVCA in BluePearl Veterinary Partners
1 Taft Court
Rockville, MD 20850
|
Annapolis, MD CVCA in Chesapeake Veterinary Referral Center 808 Bestgate Road
Annapolis, MD 21401
Phone: 410-224-0039
|
|
Gaithersburg, MD CVCA in Veterinary Referral Associates
500 Perry Parkway
Gaithersburg, MD 20877
Phone: 240-361-3820
Fax: 240-361-3821 Email: cvcagaithersburg@cvcavets.com Website: www.cvcavets.com |
CVCA in CARE Veterinary Center 1080 West Patrick Street
Frederick, MD 21703 |
We Offer Payment Options and Flexibility
Works Cited Sections for “Clinical Uses of NT-proBNP”
1. Reynolds, CA, Brown DC, Rush JE, et al. Prediction of first onset of congestive heart failure in dogs with degenerative mitral valve disease: The PREDICT cohort study. J Vet Cardiol 2012; 14 (1); 193-202.
2. Singletary GE, Morris NA, O’Sullivan ML, et al. Prospective Evaluation of NT-proBNP Assay to Detect Occult Dilated Cardiomyopathy and Predict Survival in Doberman Pinschers. J Vet Int Med 2012;26 (6):1330–1336
3. Singletary GE, Rush JE, Fox PR, et al. Effect of NT-pro-BNP Assay on Accuracy and Confidence of General Practitioners in Diagnosing Heart Failure or Respiratory Disease in Cats with Respiratory Signs. J Vet Intern Med 2012; 26 (3):542–546
4. Paige CF, Abbott JA, Elvinger F, et al. Prevalence of cardiomyopathy in apparently healthy cats. J Am Vet Med Assoc. 2009 Jun 1;234(11):1398-403.
5. Hsu A, Kittleson MD, Palling A. Investigation into the use of plasma NT-proBNP concentration to screen for feline hypertrophic cardiomyopathy. J Vet Cardiol. 2009 May;11 Suppl 1:S63-70
6. Oyama MA, Rush JE, Rozanski EA, et al. 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. J Am Vet Med Assoc. 2009 Dec 1;235(11):1319-25
7. Fox PR, Oyama MA, Reynolds C, et al. 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. J Vet Cardiol. 2009 May;11 Suppl 1:S51-61.
8. Connolly DJ, Soares Magalhaes RJ, Fuentes VL, et al. Assessment of the diagnostic accuracy of circulating natriuretic peptide concentrations to distinguish between cats with cardiac and non-cardiac causes of respiratory distress. J Vet Cardiol. 2009 May;11 Suppl 1:S41-50.
9. Fox PR, Rush JE, Reynolds CE, et al. Multicenter evaluation of plasma N-terminal probrain natriuretic peptide (NT-pro BNP) as a biochemical screening test for asymptomatic (occult) cardiomyopathy in cats. J Vet Intern Med. 2011 Sep-Oct;25(5):1010-6
10. Fine DM, DeClue AE, Reinero CR. Evaluation of circulating amino terminal-pro-B-type natriuretic peptide concentration in dogs with respiratory distress attributable to congestive heart failure or primary pulmonary disease. J Am Vet Med Assoc. 2008 Jun 1;232(11):1674-9
11. Oyama MA, Fox PR, Rush JE, et al. Clinical utility of serum N-terminal pro-B-type natriuretic peptide concentration for identifying cardiac disease in dogs and assessing disease severity. J Am Vet Med Assoc. 2008 May 15;232(10):1496-503.
