In this Issue:
- The CEO Corner
- Grain-Free Dog Food Guidance - now on the CVCA website
- Veterinarian CE - RSVP - CVCA Dinner & Learn - Tuesday, November 6th
- Article: Clinical Use of NT-proBNP in Cardiology, by Kristin Jacobs, DVM, Diplomate, ACVIM (Cardiology)
- Get to Know CVCA Austin - Doctors, Team Leader and Support Staff
- Technician CE - 2018 AVES Technical Staff Symposium - Sunday, November 4th
- Supply Request Form
- Annual Pet Calendar Contest - Favorite Pet Photo - October 9th-October 26th
- Subscribe to the Murmur Newsletter
- Payment Options and Flexibility
- Follow us on Social Media
The CEO Corner
We are truly thrilled to be open in Austin for so many reasons! We are so excited to have partnered with Katie Meier of Austin Heart Vet to serve the Austin market. We know there is such a high need for cardiology in the area and are thrilled to be able to welcome Sara Bordelon from our Fairfax, Virginia location and we look forward to expanding further to ensure availability to all of our patients and primary care veterinarians in Austin and the surrounding areas.
The CVCA team is always seeking feedback on how we can improve our service to you and your patients as we are constantly striving to improve. Please visit our primary care veterinarian survey here or reach out to us anytime with questions or concerns.
We are so grateful for your continued support!
Best,
Katie Newbold, CVCA CEO
- When: Tuesday, November 6th
- Check-in: 6:00 p.m.
- Dinner: 6:30 p.m.
- Lectures: 7:00 p.m.
- Where: Courtyard by Marriott - The Liberty Room - Austin University Area | 5660 North IH 35 Austin, TX 78751
- CE credits: 2.0
- 2 Lectures:
- Dr. Bordelon - Radiographic Diagnosis of Canine Cardiac Disease
- Dr. Meier - Dilated Cardiomyopathy and Nutritional Cardiomyopathy
RSVP by Friday, November 2nd by clicking here: https://www.cvcavets.com/austin-dinner-n-learn/
Questions? Please contact Denise Kessler at denise.kessler@cvcavets.com or 571-334-6666
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”
Austin, Texas - Get to Know CVCA Doctors, Team Leader and Support Staff
CVCA Cardiac Care for Pets, located inside of Austin Veterinary Emergency & Specialty Center, is excited to be in opened in Austin! We are committed to providing the best client service, experience and the highest level of patient care for each and every patient.
CVCA Austin
Katie Meier Sara Beth Bordelon Austin Staff | Pictured from left to right: Dr. Bordelon, Beau,
DVM, Diplomate, ACVIM (Cardiology) DVM, MS, Diplomate, ACVIM (Cardiology) Shannah, Kendra, Cortney, Tara and Dr. Meier
Katie Meier graduated from the University of California at Davis School of Veterinary Medicine in 2003. She then went on to complete a year long rotating post graduate internship at Texas A&M College of Veterinary Medicine. She completed her residency in Cardiology at the University of Pennsylvania Matthew J. Ryan Veterinary Hospital in 2006. She achieved board certification in 2007 and is a Diplomate of the American College of Veterinary Internal Medicine, sub-specialty of Cardiology. In 2009, Dr. Meier founded Austin Heart Vet, a comprehensive veterinary cardiology practice in central Texas. By offering advanced diagnostics and therapeutics, Dr. Meier hopes to bring the highest quality of specialty care to the largest number of pet owners and patients as possible. In 2018, Dr. Meier merged her practice with CVCA and is excited to bring the best of both businesses to the Austin veterinary community. Special interests include arrhythmia diagnosis and management, diagnosis and interventional therapy for congenital heart disease, and long term management of congestive heart failure.
Sara Beth Bordelon obtained her DVM degree from Louisiana State University College of Veterinary Medicine in 2005. She completed a one-year rotating internship in Los Angeles, CA prior to beginning her Cardiology residency. She completed her Cardiology residency at Washington State University and became a Diplomate of the American College of Veterinary Internal Medicine (Cardiology) in July 2009. Dr. Bordelon joined CVCA in 2015 and spent three years in our Fairfax, VA location. Dr. Bordelon enjoys all aspects of cardiovascular disease but has a special interest in feline cardiac disease, management of arrhythmia's, diagnosis and management of congenital cardiac disease, and management of pulmonary arterial hypertension. In her free time, she enjoys reading, running, yoga, and spending time with her husband and two little boys. She looks forward to being close to family in the Austin area.
- Kendra, our Team Leader, has over 10 years of experience in the veterinary field with special interests in anesthesia, pharmacology, and animal behavior. She spends her free time painting, gaming, and gardening at home with her cat, Sherman.
- Tara, our Veterinary Technician, was born and raised in Texas and has been in the veterinary field for 6 years. She enjoys hiking, traveling and spending time with her Chihuahua mix, Junior and Bearded Dragon, Kohaku.
- Beau, our Veterinary Assistant began working with CVCA in 2006 in our Virginia location before moving to Austin in 2014. Beau is very happy to be back with the CVCA team in NW Austin. In his spare time, he enjoys being outdoors at the lake, hiking and camping!
- Cortney, our Veterinary Assistant, was born and raised in Austin TX. In her spare time, she loves going to the lake, hanging out with her 3 legged chihuahua, and the Dallas Cowboys.
- Shannah, our Veterinary Assistant, has worked in the veterinary field for 12 years, 4 being in Cardiology. In addition to being a hard working veterinary technician, she is an avid boater and enjoys weekends at the lake and camping with her family and dog.
- When: Sunday, November 4th
- Registration begins: 8:00 a.m.
- CE: 9 a.m - 5 p.m.
- Where: Sheraton Austin Hotel at The Capitol | 701 E 11th St. Austin, TX 78701
- For: Veterinary Technicians
- Lectures will cover surgery, dentistry, cardiology, emergency and critical care, neurology, and more!
- Lecture Topic:
- Cardiac Medications - by Sara Beth Bordelon, DVM, MS, Diplomate, ACVIM (Cardiology)
And, stop by the CVCA table to learn more about us!
**Update - registration is full. Questions? Please contact Ann Haraguchi, AVES Referral Coordinator Ann@AustinVets.com
In need of marketing materials, magnets, business cards, or other collateral?
Fill out the Supply Request Form to quickly request materials!
CVCA's Annual Pet Calendar Contest - October 9th to October 26th
- When: Starts October 9th @ 12 noon & Ends October 26th @ 12 noon
- Who's Eligible: Former and/or Current CVCA Clients
- How to Enter & How to Vote: https://www.cvcavets.com/pet-calendar-contest/
- Winners Announced: On or before October 31st.
Subscribe to the Murmur Quarterly e-Newsletter
Sign-up today, or share with a colleague, to receive cardiology articles sent directly to your inbox each quarter!
https://www.cvcavets.com/the-murmur-newsletter/
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.
