Comparison of six commercial antigen kits for detection of Dirofilaria immitis infections in canines with necropsy-confirmed heartworm status

•Five patient-side dog heartworm (Dirofilaria immitis) kits had ≥97.5% sensitivity and 94% specificity.•Five patient-side dog heartworm (Dirofilaria immitis) kits had ≥98% agreement between tests.•The dog heartworm (Dirofilaria immitis) test sensitivity and specificity were 98% and 96% for one heartworm ELISA. Patient-side test kits for detecting antigenemia in dogs associated with sexually mature female heartworms (Dirofilaria immitis) have been available for three decades, and these tests are continually updated and improved. To define the sensitivity (Se) and specificity (Sp) of contemporary antigen detection tests against cardiopulmonary D. immitis burden, we evaluated five patient-side kits—Anigen Rapid One Step® (Bio note), SNAP® 4Dx Plus Test Kit (IDEXX), WITNESS® Heartworm Canine Heartworm Antigen Test Kit (Zoetis), VetScan® Canine Heartworm Rapid Test (Abaxis), and Solo Step® CH Canine Heartworm Antigen Test (Heska), and one microplate ELISA (DiroCHEK®; Zoetis), using archived canine sera divided into five subclasses of female worms (0, 1–5, 6–20, 21–40, and >40). The patient-side tests were performed once, side-by-side according to each manufacturer’s protocol by personnel blinded to the D. immitis status of each dog. The overall Se and Sp of the patient-side kits was ≥97.5 and =94.0%, respectively. For samples from dogs with 1–5, 6–20, and 21–40 D. immitis, the Se was between 96 and 100%, with a slight increase in Se in dogs with ≥41 worms. The agreement between tests for all subclasses of D. immitis burden was between 99 and 100%. The Se and Sp for the ELISA compared with the necropsy results of dogs was 99 and 96%, respectively. Agreement between each patient-side test and the ELISA was between 97 and 100%. All commercially available tests can give practitioners excellent patient-side information, allowing them to make informed decisions on the need for additional diagnostic work-up before instituting new or continuing D. immitis prophylaxis.