Making the clinic the heart of testingA quantitative NT-proBNP result allows veterinarians to quickly detect heart disease in-clinic September 20, 2021 By Frankie Bowers, DVM, MSA quantitative NT-proBNP result allows veterinarians to quickly detect heart disease in-clinic.Photo courtesy Bionote USA With the benefits of point-of-care testing more widely recognized, accepted, and sought after by veterinarians, new technologies to test the heart in-clinic are now available. An approach to detecting heart disease quickly gaining attention from veterinarians across the spectrum of veterinary disciplines—general, dental, and cardiac specialties—is NT-proBNP testing via a veterinary fluorescence immunoassay analyzer. Specifically, europium-detection, technology-based analyzers that are a good complement to a practice’s chemistry and hematology lab suite to close the gap on existing deficits in the suite. Quantitative immunoassay analyzers allow more biomarkers for various canine and feline diseases—including heart disease—to be tested on one machine in minutes and can often direct next steps and bridge the gap in diagnostic outcomes. NT-proBNP: The basics NT-proBNP is a great indicator of heart disease in both dogs and cats. Testing allows for identification of the cardiac biomarker pro-hormone (proBNP). Pro-hormone is produced by cardiac muscle cells and rises due to increased myocardial wall stress. NT-proBNP is correlated with heart size and systolic function. Upon release in the blood, it is cleaved into BNP and NT-proBNP. Of the two, NT-proBNP, due to its longer half-life and stability, is better suited as a diagnostic biomarker for diagnosing heart diseases. Several companies on the market have offered in-clinic feline cardiac testing with this biomarker for years—qualitatively. The fluorescence immunoassay analyzer provides in-clinic, quantitative NT-proBNP results for both dogs and cats for early diagnosis of heart disease, as well as distinguishing cardiac from respiratory disease. This test precisely quantifies the degree of elevation of NT-proBNP levels within minutes, allowing veterinarians to quickly prescribe decisive treatment plans related to cardiac issues without the need for an outside reference lab, which takes more time and potentially incurs a higher risk of sample degradation, affecting accuracy. Uncover hidden conditions before anesthesia Quantitative results from pre-operative heart screenings are especially helpful to veterinarians. It allows for a better assessment of the animal’s ability to handle anesthesia, how it is doing internally, can detect hidden heart abnormalities, and allows for calculation to determine the correct amount of IV fluids a pet will need for surgery. “We always listen to the heart, but issues can be present without being able to hear them. Recently, our practice began implementing NT-proBNP testing for all anesthetic cases. This test can identify undetected heart disease in minutes,” says Jennifer Mathis, DVM, CVPP, of Animal Dentistry Referral Services in Norwalk, Iowa. According to Randy Knick, president of sales and marketing at veterinary diagnostic analyzer manufacturer, Bionote USA, “We are seeing a bit of a migration among our veterinary partners with the approach to cardiac testing. We have veterinary clients who are currently requiring baseline bloodwork for all anesthetic patients over the age of six and are currently offering the NT-proBNP test as an option to add to the patient baseline. One practice we work with reports they will soon start requiring the NT-proBNP with the baseline to obtain more information for better treatment of their patients.” Test with predispositions NT-proBNP testing can be insightful for monitoring all geriatric cats and dogs, or those predisposed to heart failure or other cardiac issues such as those commonly occurring in certain breeds. Predisposed canine breeds include Cavalier King Charles spaniel, English springer spaniel, cocker spaniel, great Dane, Saint Bernard, Portuguese water dog, Irish wolfhound, boxer, and Doberman pinscher. In felines, special attention to heart health should be focused on Persian, Maine coon, rexes, sphynx, and ragdoll breeds. Put routine heart care to the test Some veterinarians are beginning to use the NT-proBNP in their general health and wellness exams for both canines and felines. Checking for markers indicating a pet’s heart condition makes sense when you can roll it into your point-of-care clinic lab for a fraction of the time and cost compared to sending samples to an outside reference lab. With in-clinic, quantitative NT-proBNP test results, serious states of declining patient health in the absence of symptoms conducive with a decline, can be unveiled within minutes. “Studies are still underway, but the NT-proBNP test result correlates with stage of mitral valve disease in dogs. Significantly, this helps not only for screening, but also monitoring. This diagnostic tool allows a quantitative biomarker to screen for heart changes just as one would screen for other internal organ changes on a blood panel,” said Mathis. Better care in a heartbeat With routine, predisposition or preanesthetic NT-proBNP screening, you can get to the heart of what you may be missing in your patients. In-clinic, quantitative detection of heart disease in patients can allow veterinarians to avoid complications, treat earlier, and improve quality of life. Frankie Bowers, DVM, MS, owns Animal Clinic of the Ozarks in Ozark, Missouri. Dr. Bowers, a University of Missouri graduate with an MS in veterinary medicine and surgery, has been in practice for 35 years.