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Do you test for DCM

  • I do not test at all

    Votes: 11 33.3%
  • I holter and echo yearly

    Votes: 16 48.5%
  • I Cardiopet pro-BNP test

    Votes: 3 9.1%
  • tested for PDK4

    Votes: 9 27.3%
  • Other

    Votes: 3 9.1%

Early detection of DCM

8K views 35 replies 13 participants last post by  Fitzmar Dobermans 
#1 ·
I've been reading articles about this and maybe I shouldn't be but I was wondering if anyone here has tested for PDK4. I'm not sure if I should do this. I'm afraid if I do, and it comes back that G. does have that Gene that I will FREAK OUT! I spoke to a breeder who said if I have no plans of breeding that I shouldn't worry about it and I'd like to have others input on this as well.

Also has anyone done the Cardiopet pro-BNP test? If so do you feel it is an accurate way to early detect DCM and at what age do you suggest I start testing for this?

PS. I do plan to holter and echo.
 
#2 ·
I think we did had them test for it the last time we had a full blood panel done. It was a CARDIO pro-BNP and his levels came back within the normal range. This was done at 1 year old, and we will probably have it checked yearly in addition to the holter monitor.

I don't know much about the test other than it was recommended to me. It was only an extra $25 or so at my vet.
 
#3 ·
I echo/holter yearly and also do NTproBNP and UltraTroponin. Additionally, all of mine have had the PDK4 test.

The issue with the PDK4 test is that it has only isolated ONE gene. In humans, there are an estimated 20+ genes that cause DCM. Since we have seen well known dogs that were PDK4 negative drop dead of DCM we have to assume that there is more than one gene in Dobermans as well.

IMO-the PDK4 test should be done to support further research. I have not and likely will not use it as consideration for breeding simply because it's only focusing on the one gene. The more people that support this test for research, the greater chance that researchers have of isolating additional genes that could be more beneficial going forward.
 
#5 ·
Another issue with the PDK4 test is that BYB and the like do the test, and then advertise their dogs as "DCM negative" or "DCM clear", and never holter or echo their dogs.
 
#6 ·
You don't really think they should put money, time and care into their cash cows do you? I just read a thread, I think it was on DT even, where a BYB was forging vWD results!!! How friggin scandalous is that?!? Really you're forging a $65 test because that's too much money to put forth? It saddens me that they care so little not only for the dogs but to the people that they're selling their dogs to. I think the hardest thing about being a GOOD breeder would be to have even one unhealthy puppy. I know you can't prevent it and you do your best, but it must really sadden them to see the puppy unhealthy and to see the owners suffering. I know it would me, same reasons why I couldn't be a vet/tech or a teacher.., I'm much too sensitive. I'll stick with accounting.
 
#8 · (Edited)
We do holter and echo based on our cardio vet (Dr. Morris) reccomedation - see below:

Doberman Pinschers should have a baseline echocardiogram and 24 hour holter monitoring study between 1-2 years of age. From 2-4 years of age, annual echo and holter monitoring is suggested. From 4 years onward, in dogs used for breeding purposes, it is ideal to perform an echo and holter study every 6 months. Clinical research in Dobermans has shown that the24 hour holter test may provide the earliest indication in a Doberman with cardiomyopathy. This test maybe abnormal before the echocardiogram is abnormal in some dogs. More than 50 singular ventricular premature beats (VPC’s), or any couplets, triplets or runs of ventricular tachycardia found on a holter test, has been correlated with Dobermans that go on to experience sudden death or develop dilated cardiomyopathy and congestive heart failure later in life.

My cardio vet was one of the authors of the proBPN biomarker study, see link to publication below. In that study the proBPN assay was found to be useful in combination with holter monitoring:
http://www.massvetcardiology.com/Da...fe/dilatedcardiomyopa/nt-probnpdobes_2012.pdf

Holter monitoring is essential to early diagnosis of DCM and based on that we made the decision to purchase one for our Dobermans.
 
#9 · (Edited)
Here is an older article on UltraTroponin.

In very general terms, it detects cardiac necrosis within the test's reference range. This is suggestive of some kind of cardiac damage and signals further study via echo and holter.

Our cardiologist is hopeful that this may be an alternative for those who can't afford to undergo costly yearly echo/holter. It's a relatively inexpensive blood test. I do it to further promote research and because I think it's accurate enough to detect subtle changes that may not yet show itself on the echo/holter.

In the fight to understand DCM, its causes, why some get it and some don't, etc. I really believe it's important to utilize all the tools we have available. Maybe it won't happen in my lifetime, or even the next...but the more info and data we can gather on the disease from the breed population the better chance we have to understand how it mutates genetically, and more importantly, how to eliminate it.

Cardiac Troponin-I Concentration in Dogs with Cardiac Disease - Oyama - 2008 - Journal of Veterinary Internal Medicine - Wiley Online Library
 
#10 ·
I also wanted to note that if someone had already had the PDK4 test run for their dog and it later came down with some form of cardio, PLEASE PLEASE PLEASE contact Dr. Meurs' team at NCSU. They need this information to further their studies. If they aren't updated then they can't go back to look at your dog's info to see if there is something else genetically that could have caused the cardio.
 
#12 ·
G. is about 14mo. old (the grow so quickly :( ) I am going to set up a Vet visit for some skin issues she's having, everyone says it's a bug bite or allergies but I just like confirmation. At 14mo. is it a good idea to do any of these blood tests or is she still a bit too young?
 
#13 ·
Diagnostically she's too young for the cardiac testing. Our cardiologist recommends a baseline at 24 months. Her baseline is defined as echo, holter, NTproBNP, and UltraTroponin.

Since we echo/holter yearly this has been helpful to have. Especially with my rescue male whose heart has always measured slightly larger than average. Our cardiologist compares his previous year's measurements and says that it's his normal. Just one of many examples of why you should always bring past test data to a current appointment and how helpful it can be to have baseline and yearly records to compare to.
 
#17 · (Edited)
Cardiopet ProBNP is the name of the NTproBNP and is done by idexx. The ultratroponin has to be sent to Texas A&M the last time I checked.

ETA: Idexx charges $46.50 for the stand alone test. I usually do it at the same time that we do our annual CBC/Liver/Kidney panel and then it's an add on for $17.89. Of course, your vet is free to mark up after that if they want but mine doesn't.
 
#18 ·
Something to bear in mind is that PDK4 is not even a "DCM gene." It's just a completely unrelated mutation which has been noticed to occur in a statistically-significant number of American-bloodline Dobermans which develop DCM. There's not even an identified correlation between the PDK4 mutation and a statistically-significant elevated incidence of DCM in the European Doberman cohort.

All this test means is that there was likely one popular bloodline responsible for both the mutation and ONE hereditary factor (of many) that cause DCM, and it's fairly widespread.

There is no absolute, "If your dog tests positive, it will develop this type of DCM" conclusion which may be reached, nor should anyone conclude that there's any such result as "clear of DCM".

The only context in which this test should be used is to help broaden the sample set and understanding of one potential cause. At worst, it creates unnecessary anxiety with a positive result, and bad breeders tend to use negative results to instill an utterly false sense of confidence in gullible buyers who don't understand the science.

I can't say I'm sold on the predictive value of the Holter unless there's already cause for concern. The value of Holter Monitoring in humans is pretty well-researched, and there's been a pretty common theme outlined:

--Imaging techniques (echocardiograms) are best, hands-down, for identifying the physical changes to the heart that are cause for concern.
--Holter Monitoring (ambulatory ECG) is great, in conjunction with imaging diagnostics, to understand more about what's going on and how a heart condition is progressing, WHEN such a condition has been identified.
--HM is not particularly useful as a positive predictive diagnostic tool that sudden cardiac death is imminent, but it may be useful as a NEGATIVE predictive diagnostic tool to identify patients at low risk of sudden cardiac death (again, in conjunction with other diagnostics).

Also, SCD is not a huge concern of mine. It kills some Dobes, sure, but that's a relatively small problem compared to congestive heart failure that comes on slowly as a result of DCM.

The bottom line is that the purpose, scope, and implications of tests need to be understood and leveraged appropriately. They should not be done in ignorance, just to feel good about having done them or to satisfy a checklist.

My testing plan is to continue as I have been-- regular screenings where the vet just listens for abnormalities. Periodic echocardiograms to have a specialist see if there's something to be concerned about. As far as Holter, I'd certainly do that if there was a cause for concern from an Echo, to better understand the problem. If no concerns are presenting, I wouldn't bother, because the best result is simply inconclusive as far as DCM. The worst, which is the typical result, is inconclusive on both DCM and SCD risks.
 
#22 ·
--Imaging techniques (echocardiograms) are best, hands-down, for identifying the physical changes to the heart that are cause for concern.
--Holter Monitoring (ambulatory ECG) is great, in conjunction with imaging diagnostics, to understand more about what's going on and how a heart condition is progressing, WHEN such a condition has been identified.

As far as Holter, I'd certainly do that if there was a cause for concern from an Echo, to better understand the problem. If no concerns are presenting, I wouldn't bother, because the best result is simply inconclusive as far as DCM. The worst, which is the typical result, is inconclusive on both DCM and SCD risks.
I'm going to slightly, and very respectfully, disagree with your opinion. And that's based solely on previous experience with another dog. While I agree 100% that echo's are the best tool-- it's only a short 2-3 minute view. My previous male had normal echos (at first). However, he was throwing arrhythmias on the holter. Unfortunately, because of the short 2-3 minute view of the echo it was never picked up on that particular echo. If we hadn't done the holter we wouldn't have had a clue since he was exhibiting no physical signs at that time.

I think the combination of both gives us a more accurate picture. Some dogs exhibit normal echo's while throwing vpcs the entire time. Some show dilation or regurgitation or valve insufficienies on echo but have normal holters. And for me, that's the crappiest part of this disease. It can present entirely different in any dog.

This is where I really the see the value in NTproBNP and Ultratroponin. It's another key to the puzzle in that the reference range can indicate that a dog with a value over that range is exhibiting some type of damage to the heart and can clue you in that further diagnostic study is needed. Suppose the echo and holter came back normal but the NTProBNP/Ultratroponin shows a high value. In theory, we would wait another year to echo/holter on a dog that presented normal, but with higher NTProBNP/Ultratroponin values that may be a dog that I would retest again in 6 months or so.


I test for almost everything that has a reliable test. I do this specifically because I understand the value of cumulative information in the case of genetic tests and the fact that tests like echos and Holters are most informative as a record over time.
Agree 1000%, Bug. Cumulative. That's the key word. The value of these tests is being able to track that data from year to year.
 
#20 ·
That's an interesting paper, and the statement in the conclusion that, once a potential genetic predisposition has been identified, that an individual should be more closely monitored for warning signs of heart disease, is an appropriate way to handle test result.

The primary reason I think breeders should assist with genetic studies is that they're better suited to track these things in their dogs, in a way that may be highly reliable at associating a genetic disorder with a particular bloodline. It's in their own best interests, as well as those of their customers, to do their part in increasing the sample sizes so that there's a chance of more accurate genetic diagnostics being developed, which absolutely have the potential to put the brakes on a damaging genetic disease.

These tests often start out as best guesses for relatively uncommon mutations which can be identified consistently and associated with a particular disorder, even if they're not actually mutations that directly cause the disorder. Looking at many genotypes for a particular correlated mutation may actually lead to identifying a cause or at least improve the potential for other diagnostic discoveries.

In other words, it's not about the individual dogs being tested, at that level, the test isn't too useful and it's nothing to brag or worry about. It's really about what testing many individuals, then following them throughout their lives, and what that tells researchers about trends in the breed as a whole.
 
#21 ·
I test for almost everything that has a reliable test. I do this specifically because I understand the value of cumulative information in the case of genetic tests and the fact that tests like echos and Holters are most informative as a record over time.

I test for PDK4, early, because it's a genetic test which only needs to be done once. Even thought it's not predictive it is one more bit of information. I've been testing my dogs since the test was first available--they have all been negative.

I now have the ProBNP run whenever I do a complete senior panel (once a year at least from a year on)--as an add-on it's cheap. All of those have been negative.

I start doing yearly echocardiograms and Holters between two and three. At around five/six or if there is any indication that there may be a developing problem I start doing an echo and Holter every six months. The dogs cardiologist recommends starting echos no earlier than 2 because the heart is typically not mature earlier than tat and often will produce wacky results.

Cardio testing by echo and Holter is most informative if you have results over time.

It's entirely probable that classic DCM/CHF and sudden cardiac arrest are two phenomenon which may or may not be related. I lost my last dog to sudden death a couple of weeks shy of10 years. We (his cardiologist and I) knew, because of his bi yearly Holters that he was having issues with electrical functions of the heart and they were increasing. So the sudden death was not exactly unexpected. The ultrasounds were still pretty normal--and he was in grey area when it comes to deciding if he was actually in occult DCM or not.
 
#24 ·
I just ordered the PDK4 test from Vetgen. Does anyone know if the results of this test can change to a preexisting condition with Insurance? I was going to wait until G. was about 18mo. or so before getting pet insurance and now I'm wondering if I should go ahead and get it. Can the test results allow the ins. companies to now say she had a preexisting condition if she does test positive?
 
#25 ·
I'm not 100% sure. You might call the insurance provider and ask. I do know that my insurance states that they can review my veterinary file at any time. SO, if it's not in any veterinary history I would think that they might not know.

I would call and ask. I like to keep things on the "up and up" when it comes to insurance.
 
#27 · (Edited)
I would get the insurance. Then after the waiting period get the tests done. Just to be safe and no questions.
Treating DCM will run into the Thousands of Dollars.
We do have pet insurance since they were puppies.
Our Boy Stryker was diagnosed at 6yrs old with DCM July 10, 2015 by a Holter then an Echo
We have spent over $3,000 so far. Meds, Cardiologist, trip down to North Carolina State Vet School, 2 Holistic/Integrative Vets, phone consultations. This does not include all of the supplements he is on.
 
#28 ·
Also:
For baselines I would start to Holter at 2yrs every year up to age 5yrs. Then Holter every 6 months after age 5yrs. Sometimes a Holter will not show any arrhymias or be under the 50 allowed for large breed dogs, for that one 24 hr period. Maybe look into a 2 day or up to a 5 day Holter?
Blood tests (Troponin T and I Proteins, NT Pro BNP) starting at 2 yrs. then every year after.
Echo's starting at 2 yrs. then every year.

In 30% of Dobes the first sign of DCM is sudden death!!!!!!!!!!!!!!!!!!!
 
#30 ·
I know people who claim to "not want to know" because they feel like it's waiting for the other shoe to drop if you test and get anything other than perfect results.

Your own original question about doing the PDK4 test (genetic) is a good example--you thought you'd "freak" out if it came up positive. It's more complex than positive versus negative. It's a gene test and at best it's got three possible results--two genes that aren't right, one OK gene and one not OK gene or two OK genes. But because cardio in the Doberman is a complex polygenetic disease that one test doesn't tell you if the dog will or will not end up with DCM progressing to CHF or will end up dying suddenly from arrhythmias. It's a combination of all of the as yet unidentified genetic components that ultimately determine whether the dog lives or dies from any form of cardiomyopathy.

I always want to know whatever there is to know. I know because my very first Dobe did have DCM which had already progressed to fairly advanced CHF when he was 9 that the more you know and now with much better diagnostics and treatment plans the longer you get to have the dog and the more comfortable the dog will be for his life span. That first dog of mine was born in 1959--no one was really diagnosing cardio in Dobes and the only thing available for treatment in 1969 was Lasix--when that no longer controlled the fluid accumulation we euthanized him--I am no believer in letting my pets "die naturally". What that usually means is that they die with no treatment. If they can't be comfortable and live a comfortable life I will sadly let them go.

Not all people want to know and not all people believe in the kind of final intervention that I think is the kindest way to treat one of my pet/companions.
 
#36 ·
I tested several of my dogs when the PDK test first came out - purely for research reasons. I have not tested my youngest dog for this and probably won't... especially as she is not being bred.

I do a baseline Cardiac ultrasound between age 2-3, and normally don't do another one for a couple of years (I would if it was indicated). The first holter is done by age 4. I don't usually do the holter every year as I don't own one.... but again, I would if it was indicated.

I make suggestions to all of my puppy people about tests they should be doing and what tests to ask their vet for. Unfortunately, most pet people choose not to test, and I can't make them. I send out emails with the results of my personal dogs testing results - and make testing suggestions in those emails. It is all I can do. I ask that people let me know results of any tests that they do so that I can update my records. The only puppy families that have ever gotten heart testing done are show people .... and I've done some of those myself on dogs that I co-own. The saying "you can lead a horse to water, but you can't make it drink", applies to health testing with dogs for sure!
 
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