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Evaluation of a sensitive cardiac troponin I assay as a screening test for the diagnosis of hypertrophic cardiomyopathy in cats

S. Hertzsch, A. Roos, G. Wess
Journal of veterinary internal medicine 2019 v.33 no.3 pp. 1242-1250
blood serum, breeds, cardiomyopathy, cat diseases, cats, confidence interval, death, echocardiography, heart failure, males, troponin I
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most common cardiac disease in cats. However, most cats are not diagnosed until they develop congestive heart failure, arterial thromboembolism (ATE), or sudden cardiac death. Thus, an affordable screening test for early detection of HCM is desirable. HYPOTHESIS/OBJECTIVES: Evaluation of a sensitive cardiac troponin I (cTnI) assay as a screening test for HCM in cats and determination of a cutoff for its early detection. ANIMALS: One hundred sixty‐six client‐owned cats (male, n = 97) of various breeds were evaluated and classified using echocardiography as being healthy (n = 87), equivocal (n = 15), or having HCM (mild, n = 16; moderate, n = 10; severe, n = 34) or ATE (n = 4). METHODS: All cats were prospectively evaluated by echocardiography, and serum cTnI concentration was determined using the currently most sensitive assay (Siemens ADVIA Centaur TnI‐Ultra). RESULTS: The median cTnI concentration was significantly different between study groups (P < .000001). A cutoff of 0.06 ng/mL provided good discrimination between healthy cats and cats with HCM (sensitivity, 91.7%; specificity, 95.4%; area under the curve [AUC], 0.95; 95% confidence interval [CI], 0.899‐0.978). Even for asymptomatic cats with HCM, sensitivity and specificity for a cutoff of >0.06 ng/mL remained high at 87.8% and 95.4%, respectively (AUC, 0.93; 95% CI, 0.864‐0.964). CONCLUSIONS AND CLINICAL IMPORTANCE: Cardiac troponin I can be used as a sensitive and specific screening test for the diagnosis of HCM in otherwise healthy cats (cutoff, >0.06 ng/mL). However, echocardiography is needed to confirm the diagnosis.