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Should we be screening cats for cardiomyopathy? If so, how?
Insights
Screening cats for hypertrophic cardiomyopathy (HCM) using the N-terminal-proBrain natriuretic peptide test can identify half of at-risk cases. However, its low sensitivity raises questions about routine screening effectiveness for preventing sudden death or heart failure.
Area of Science:
- Veterinary Cardiology
- Feline Medicine
- Diagnostic Testing
Background:
- Occult feline hypertrophic cardiomyopathy (HCM) poses a risk for sudden death or congestive heart failure (CHF) during routine procedures.
- Current screening methods for occult HCM in cats are limited, impacting clinical decision-making.
Purpose of the Study:
- To evaluate the utility of the feline N-terminal-proBrain natriuretic peptide (NT-proBNP) test as a screening tool for occult HCM in cats.
- To assess the sensitivity and practical implications of using the NT-proBNP test for identifying at-risk feline patients.
Main Methods:
- Analysis of the diagnostic performance of the feline NT-proBNP rapid test for detecting moderate-to-severe occult HCM.
- Consideration of test sensitivity, specificity, and implications of false positives and negatives in a low-prevalence population.
Main Results:
- The NT-proBNP test can correctly identify approximately 50% of cats with moderate-to-severe occult HCM.
- A proportion of non-HCM cats may test positive, requiring further echocardiographic evaluation.
- The low prevalence of HCM in the general cat population complicates the interpretation of screening benefits.
Conclusions:
- The current NT-proBNP test has limitations in sensitivity, potentially precluding its use as a definitive screening tool for feline HCM.
- Clinicians must weigh the benefit of identifying half of at-risk cats against the drawbacks of false positives and the test's overall accuracy.
- Further development of more sensitive and accurate screening tests for feline HCM is warranted.
Abstract:
Occult feline hypertrophic cardiomyopathy (HCM) can result in unexpected sudden death or congestive heart failure (CHF) following routine interventions such as anesthesia, fluid administration, or, potentially, administration of corticosteroids. Consequently, clinicians would like to be able to screen at-risk cats to detect occult HCM and either avoid the risky intervention or attempt to reduce the risk of death or CHF. Currently, the feline N-terminal-proBrain natriuretic peptide test is the only potential screening test for detecting occult HCM. However, some cardiologists have pointed out the poor sensitivity of the test precludes its use as a screening test. This interpretation appears somewhat flawed. Using the current rapid test will allow clinicians to correctly identify half of the cats with moderate-to-severe occult HCM. A small number of cats without HCM will also test positive, necessitating an ultimately needless echocardiographic evaluation to demonstrate their disease-free status. However, the low prevalence of HCM in the general cat population and the apparently much lower rate of adverse events than would be predicted brings into question whether clinicians should bother screening. Therefore, until a more sensitive and accurate screening test becomes available, clinicians will have to decide for themselves whether identifying half of the at-risk cats of sudden death and CHF with this test is better than identifying none of them.
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