Should we be screening cats for cardiomyopathy? If so, how?

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.