Serial NT-proBNP and Myocardial Strain Imaging in Preclinical Dilated Cardiomyopathy

Dilated cardiomyopathy (DCM) is a common cardiac disease in dogs and consists of a preclinical period that is variable in duration between patients. Routine assessment involves echocardiographic and Holter monitoring, however investigations into how these tools may identify risk of heart failure or cardiac death are scarce. In human cardiology, the biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP) and myocardial strain imaging have been used as prognostic tools, with serial measurements considered to be superior in regard to risk assessment. This presentation will discuss the benefits and challenges of NT-proBNP and myocardial strain imaging. In dogs, NT-proBNP has been evaluated as a prognostic marker with some promising results, however serial measurements have not yet been reported in dogs with DCM. To date, myocardial strain imaging has been investigated as a diagnostic, but not prognostic, tool and serial strain parameters have not yet been explored in veterinary patients.

The results of a study will be shared in which serial NT-proBNP and echocardiographic measurements, including myocardial strain by speckle tracking echocardiography, were performed in 20 Doberman pinschers with preclinical DCM. Echocardiographic left atrial size, indices of systolic function, and the change in NT-proBNP were associated with cardiac outcome, whereas NT-proBNP at a single point in time was not predictive. Myocardial strain parameters were highly variable, did not change predictably over time, and did not assist in predicting outcome. These results should drive future investigations into the use of serial NT-proBNP and echocardiography as prognostic tools in a larger cohort of canine DCM patients.