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Focused cardiac ultrasound and point‐of‐care NT‐proBNP assay in the emergency room for differentiation of cardiac and noncardiac causes of respiratory distress in cats
Author(s) -
Janson Cassandra Ostroski,
Hezzell Melanie J.,
Oyama Mark A.,
Harries Benjamin,
Drobatz Kenneth J.,
Reineke Erica L.
Publication year - 2020
Publication title -
journal of veterinary emergency and critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.886
H-Index - 47
eISSN - 1476-4431
pISSN - 1479-3261
DOI - 10.1111/vec.12957
Subject(s) - medicine , emergency department , cats , respiratory distress , emergency medicine , natriuretic peptide , point of care testing , medical diagnosis , physical examination , cardiology , heart failure , radiology , pathology , psychiatry
Abstract Objective To assess the accuracy of focused cardiac ultrasound (FOCUS) and point‐of‐care N‐terminal proBNP assay in the emergency setting for differentiation of cardiac from noncardiac causes of respiratory distress in cats. Design Prospective diagnostic accuracy study between 2014 and 2016. Setting Emergency room at an urban university teaching hospital. Animals Forty‐one client‐owned cats presenting for evaluation of respiratory distress. Interventions Emergency clinicians made an initial diagnosis of noncardiac or cardiac cause of respiratory distress based on physical examination (PE) findings and history. The diagnoses were updated after performing FOCUS and point‐of‐care N‐terminal B‐type natriuretic peptide (POC‐BNP). Reference standard diagnosis was determined by agreement of a board‐certified cardiologist and critical care specialist with access to subsequent radiographs and echocardiograms. Measurements and Main Results Forty‐one cats were enrolled. Three cats with incomplete data and 1 cat with an uncertain reference standard diagnosis were excluded. The remaining 37 cats were used for analysis: 21 cardiac and 16 noncardiac cases. The ratio of left atrial to aortic root diameter (LA:Ao) measured by FOCUS was significantly correlated with LA:Ao measured by echocardiography ( R = 0.646, P < 0.0001). Emergency clinicians correctly diagnosed 27 of 37 (73.0%), yielding a PE positive percent agreement = 76.2% (95% CI, 52.8–91.8%) and negative percent agreement = 68.8% (95% CI, 41.3–89.0%). Five noncardiac and 5 cardiac cats were misdiagnosed. Post FOCUS, overall percent agreement improved to 34 of 37 (91.9%), with positive percent agreement = 95.2% (95% CI, 76.2–99.9%) and negative percent agreement = 87.5% (95% CI, 61.7–98.5%). The POC‐BNP yielded an overall percent agreement = 32/34 (94.1%), positive percent agreement = 100% (95% CI, 82.4–100.0%), and negative percent agreement = 86.7% (95% CI, 59.5–98.3%) in differentiating cardiac versus noncardiac cases. Conclusions FOCUS evaluation of basic cardiac structure and LA:Ao by trained emergency clinicians improved accuracy of diagnosis compared to PE in cats with respiratory distress. FOCUS and POC‐BNP are useful diagnostics in the emergent setting.