Retrospective evaluation of the incidence and prognostic significance of spontaneous echocardiographic contrast in relation to cardiac disease and congestive heart failure in cats: 725 cases (2006-2011).

OBJECTIVE: To determine whether the presence of spontaneous echocardiographic contrast (SEC) in cats with cardiomyopathy is associated with increased mortality. To establish whether specific types of cardiomyopathy are more often associated with SEC in an attempt to provide a risk-stratification scheme for cats with increased risk of thromboembolic events. DESIGN: Retrospective study 2006-2011. SETTING: Tertiary referral and teaching hospital. ANIMALS: Seven hundred twenty-five client-owned cats undergoing echocardiographic evaluation. MEASUREMENTS AND MAIN RESULTS: Patient characteristics, including age, breed, clinical signs, type of cardiovascular disease, presence of SEC, and survival time were recorded. Thyroxine, HCT, and blood pressure were recorded when available. Among cats diagnosed with cardiac abnormalities based on echocardiographic findings, those with SEC were at significantly increased risk of death as compared to those without SEC. Cats with dilated cardiomyopathy, unclassified cardiomyopathy, and hypertrophic cardiomyopathy were significantly more likely to have SEC compared to cats with other types of cardiac disease. CONCLUSIONS: Cats with cardiomyopathy and SEC have an increased risk of death compared to cats without SEC, although other previously identified factors such as the presence of congestive heart failure and increased left atrium to aorta ratio remain important determinants of mortality. Cats with hypertrophic cardiomyopathy, unclassified cardiomyopathy, and dilated cardiomyopathy may benefit from anticoagulant therapy due to the increased risk of SEC in these subpopulations.

Biomarkers for differentiation of causes of respiratory distress in dogs and cats: Part 1--Cardiac diseases and pulmonary hypertension.

OBJECTIVE: To review the current veterinary and relevant human literature regarding biomarkers of cardiac disease leading to respiratory compromise. DATA SOURCES: Veterinary and human medical literature: original research articles, scientific reviews, consensus statements, and recent textbooks. HUMAN DATA SYNTHESIS: Cardiac troponins (cTn) and natriuretic peptides are routinely used in human medicine. VETERINARY DATA SYNTHESIS: Although biomarkers should not be accepted in lieu of gold standard diagnostics, they may be useful in directing care in the stabilization process. Biomarkers of congestive heart failure (CHF) include natriuretic peptides, cTn, and endothelin. cTnI is useful in differentiating causes of pericardial effusion, but is unlikely to be useful in differentiating CHF from other causes of respiratory distress. The most extensively studied and promising cardiac biomarker is amino-terminal probrain natriuretic peptide, although a bedside test is not currently available. Other natriuretic peptides have also proven useful, but have lower availability. Endothelin is unlikely to be clinically useful. Although critically evaluated for their use in cardiac diseases, many of the biomarkers are affected by more than one type of respiratory or systemic disease. Several cardiac biomarkers are increased in cases of pulmonary hypertension (PH), but discerning CHF alone from PH or a combination of heart disease and PH is challenging when evaluating biomarkers alone. CONCLUSION: At this time, there are no point-of-care tests for biomarkers that can reliably differentiate among causes of dyspnea of cardiac origin in dogs and cats, although there are reference laboratory tests that show promise and future development of point-of-care tests that may be useful in certain situations.

Biomarkers for differentiation of causes of respiratory distress in dogs and cats: Part 2--Lower airway, thromboembolic, and inflammatory diseases.

OBJECTIVES: To review the current veterinary and relevant human literature regarding biomarkers of respiratory diseases leading to dyspnea and to summarize the availability, feasibility, and practicality of using respiratory biomarkers in the veterinary setting. DATA SOURCES: Veterinary and human medical literature: original research articles, scientific reviews, consensus statements, and recent textbooks. HUMAN DATA SYNTHESIS: Numerous biomarkers have been evaluated in people for discriminating respiratory disease processes with varying degrees of success. VETERINARY DATA SYNTHESIS: Although biomarkers should not dictate clinical decisions in lieu of gold standard diagnostics, their use may be useful in directing care in the stabilization process. Serum immunoglobulins have shown promise as an indicator of asthma in cats. A group of biomarkers has also been evaluated in exhaled breath. Of these, hydrogen peroxide has shown the most potential as a marker of inflammation in asthma and potentially aspiration pneumonia, but methods for measurement are not standardized. D-dimers may be useful in screening for thromboembolic disease in dogs. There are a variety of markers of inflammation and oxidative stress, which are being evaluated for their ability to assess the severity and type of underlying disease process. Of these, amino terminal pro-C-type natriuretic peptide may be the most useful in determining if antibiotic therapy is warranted. Although critically evaluated for their use in respiratory disorders, many of the biomarkers which have been evaluated have been found to be affected by more than one type of respiratory or systemic disease. CONCLUSION: At this time, there are point-of-care biomarkers that have been shown to reliably differentiate between causes of dyspnea in dogs and cats. Future clinical research is warranted to understand of how various diseases affect the biomarkers and more bedside tests for their utilization.