NT-proBNP in der Diagnostik bei Hunden mit Dyspnoe und asymptomatischen Hunden mit Herzgeräusch^[*]

Zusammenfassung

Gegenstand und Ziel: Der kardiale Funktionsmarker NT-proBNP zeigt eine Herzbelastung im Sinne eines myokardialen Wandstresses an. Ziel der Studie war, eigene Ergebnisse der NT-proBNP-Bestimmung bei gesunden Hunden, Hunden mit Dyspnoe sowie asymptomatischen Hunden mit Herzgeräusch auszuwerten und mit Literaturdaten zu vergleichen. Material und Methoden: Zwischen April und Dezember 2007 wurden 11 Hunde mit Dyspnoe nichtkardialer Genese, 18 Hunde mit Dyspnoe kardialer Genese und 22 asymptomatische Hunde mit Herzgeräusch sowie 12 klinisch gesunde Hunde als Kontrolltiere untersucht. Bei allen Tieren erfolgten eine kardiologische Untersuchung inklusive Echokardiographie und eine Bestimmung von NT-proBNP aus Serum, das binnen 30 Minuten nach der Entnahme eingefroren wurde. Ergebnisse: Gesunde Hunde wiesen einen medianen NT-proBNP-Wert von 240 pmol/l (Bereich 131–546 pmol/l) auf. Hunde mit Dyspnoe bei respiratorischer Grunderkrankung hatten einen medianen NT-proBNP-Wert von 876 pmol/l (Bereich 97–2614 pmol/l). Bei Patienten mit Dyspnoe nichtkardialer Genese bestand ein Unterschied zwischen Tieren mit bzw. ohne echokardiographische Hinweise einer pulmonalen Hypertension. Bei Hunden mit Dyspnoe und kardialer Grunderkrankung lag der mediane NT-proBNP Wert bei 2000 pmol/l (Bereich 137–2614 pmol/l). Niedrig normale Werte ergaben sich nur bei Hunden mit Perikarderguss. Asymptomatische Hunde mit einem Herzgeräusch wiesen einen medianen NT-proBNP-Wert von 698,5 pmol/l (Bereich 121–2614 pmol/l) auf. Deutlich erhöhte Werte fanden sich vor allem im Fall schwerer, aber noch asymptomatischer kongenitaler Herzerkrankungen. Schlussfolgerung und klinische Relevanz: NT-proBNP eignet sich gut als Ergänzung der kardiologischen Diagnostik zur Einschätzung der Herzbelastung. Die Interpretation muss im Zusammenhang mit dem klinischen Bild erfolgen, da Hunde mit schweren Arrhythmien, Sepsis oder Lungenembolie ebenfalls hohe NT-proBNP-Werte ohne kongestives Herzversagen aufweisen können. Es ergeben sich folgende Richtwerte: < 500 pmol/l: keine relevante kardiale Belastung; 500–900 pmol/l: mäßige kardiale Belastung; > 900 pmol/l: schwere kardiale Belastung.

Summary

Objective: The cardiac biomarker NT-proBNP indicates cardiac load in terms of myocardial wall stress. The objective of the study was to compare the results of NT-proBNP measurements in healthy dogs and dogs with dyspnea as well as asymptomatic dogs with heart murmur with the literature. Material and methods: Between April 2007 and December 2007 dogs with dys pnea of non-cardiac origin (n = 11), dogs with dyspnea of cardiac origin (n = 18) and asymptomatic dogs with heart murmur (n = 22) were included. Twelve clinically healthy dogs served as a control group. All animals underwent cardiologic examination including echocardiography and measurement of serum NTproBNP concentration. Serum was centrifuged and frozen within 30 minutes and was stored frozen until analysis was performed. Results: Median NT-proBNP concentration in healthy dogs was 240 pmol/l (range 131–546 pmol/l). Dogs with dyspnea and primary respiratory disease displayed a median NT-proBNP concentration of 876 pmol/l (range 97–2614 pmol/l). In patients with dyspnea of non-cardiac origin, there was a difference in the values of NT-proBNP of dogs with and without pulmonary hypertension diagnosed by echocardiography. Dogs with dyspnea of cardiac origin displayed a median NT-proBNP concentration of 2000 pmol/l (range 137–2614 pmol/l). Low normal NT-proBNP values were only found in patients with pericardial effusion. Median NT-proBNP concentration in asymptomatic dogs with heart murmur was 698.5 pmol/l (range 121–2614 pmol/l). Considerably increased values were particularly measured in asymptomatic patients with severe congenital heart disease. Conclusion and clinical relevance: NT-proBNP represents a useful additional diagnostic parameter in veterinary clinical cardiology to assess the severity of cardiac disease. Interpretation must take into consideration the clinical picture of the patient, as dogs with severe arrhythmias, sepsis and pulmonary thromboembolism may display high NT-proBNP levels without congestive heart failure. Our results indicate the following cut-off values: < 500 pmol/l: no relevant cardiac load; 500–900 pmol/l: moderate cardiac load; > 900 pmol/l: severe cardiac load.

Schlüsselwörter

Kardialer Funktionsmarker - Labordiagnostik - Dyspnoe - Herzerkrankung

Keywords

Cardiac biomarker - laboratory diagnostic - dyspnea - heart disease

^* Vorgestellt auf der DVG-Arbeitstagung Duisburg, 08. September 2007 und der DVG-Arbeitstagung Wiesloch, 27. April 2008.

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