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Introduction/objectives: The objectives were to conduct a survey of cardiologists on their recent experiences with cats that have dilated cardiomyopathy (DCM) and to retrospectively review individual cases of feline DCM., Animals, Materials and Methods: Part one: A survey was distributed to cardiologists with questions regarding caseload and clinical management of cats with DCM diagnosed over the past two years. Part two: Cardiologists completing the survey were invited to submit data from cats recently diagnosed with DCM. Data on signalment, clinical signs, diet, echocardiographic measurements and outcome were recorded., Results: Part one: From 52 completed surveys, many cardiologists responded that measuring and supplementing taurine and recommending a diet change in cats with DCM are common practices. Few (15%) cardiologists reported an increase in the number of feline DCM cases over the past two years, although some had cases that improved even if taurine deficiency was not present. Part two: Twenty of 37 (54%) cats ate low pea/lentil (low PL) diets, and 14/37 (38%) ate high PL diets at the time of diagnosis; three had incomplete diet information. Two of 13 cats (15%) in which taurine was measured had levels below the reference range. After adjusting for other variables, cats eating high PL diets that changed diets after diagnosis had a significantly longer survival time than that of cats eating high PL diets that did not change diets after diagnosis (P = 0.025)., Conclusions: Additional research is warranted to determine whether there could be a possible association between diet and DCM in cats., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: The United States Food and Drug Administration is investigating possible diet-associated dilated cardiomyopathy (DCM) in dogs and cats., Objectives: To retrospectively review DCM cases for signalment, diet information, echocardiographic changes, and survival., Animals: Client-owned dogs (n = 71)., Methods: Medical records of dogs diagnosed with DCM between January 1, 2014 and September 30, 2018 were reviewed. Dogs were grouped into "traditional" or "nontraditional" diet categories and whether or not diet was changed after diagnosis., Results: For dogs eating nontraditional diets, those that had their diets changed had a larger percentage decrease in normalized systolic left ventricular internal dimension (P = .03) and left atrial:aorta ratio (P < .001) compared to those that did not have their diets changed. Survival time was significantly longer for dogs with DCM eating nontraditional diets that had their diets changed (median survival, 337 days; range, 9-1307 days) compared to dogs eating nontraditional diets that did not have their diets changed (median survival, 215 days; range, 1-852 days; P = .002)., Conclusions and Clinical Importance: Dogs with DCM eating nontraditional diets can experience improvement in cardiac function after diet change but additional research is needed to examine possible associations between diet and DCM., (© 2020 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Background: Reductions in N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations after treatment have been associated with improved survival in people with congestive heart failure (CHF), but have not been reported in cats with CHF., Objectives: To evaluate changes in NT-proBNP concentrations in cats with CHF after treatment and determine whether serial NT-proBNP measurements provide prognostic information., Animals: Thirty-one client-owned cats., Methods: Prospective, observational study in cats with new onset CHF secondary to cardiomyopathy. Concentrations of NT-proBNP were measured within 4 hours of admission to the hospital, on the day of discharge, and at re-evaluation 7-10 days later., Results: Median NT-proBNP concentrations decreased significantly from admission (1,713 pmol/L [range, 160-3,784 pmol/L]) to discharge (902 pmol/L [range, 147-3,223 pmol/L]); P = .005) and from admission to re-evaluation (1,124 pmol/L [range, 111-2,727 pmol/L]; P = .024). Median survival time was 109 days (range, 1-709 days), with 5 cats still alive at the time of analysis. Cats with a larger percent decrease in NT-proBNP from admission to discharge had a longer survival time (P = .048). Cats with evidence of active CHF at the time of re-evaluation (P = .010) and cats whose owners had difficulty administering medications (P = .045) had shorter survival times., Conclusions and Clinical Importance: Cats with a larger percent decrease in NT-proBNP during hospitalization and no evidence of CHF at the time of re-evaluation had longer survival times. Additional studies are needed to determine whether NT-proBNP can help guide treatment in cats with CHF., (Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

Objectives: To evaluate the responsiveness and optimal timing of a validated health-related quality of life questionnaire, and to assess the relationship between quality of life, severity of disease, and N-terminal pro B-type natriuretic peptide (NT-proBNP) in cats with acute congestive heart failure (CHF)., Animals: Thirty client-owned cats with acute CHF., Methods: Echocardiography, International Small Animal Cardiac Health Council (ISACHC) stage, and NT-proBNP were assessed in cats within 36 h of admission. The Cats' Assessment Tool for Cardiac Health (CATCH) Questionnaire (range of 0-80, with 80 being the worst possible score) was completed by cat owners and ISACHC stage was assessed at the time of hospital discharge, 3 days after discharge, and 7-14 days after discharge. NT-proBNP concentration was reassessed 7-14 days after discharge., Results: The ISACHC stage at time of admission improved significantly by reevaluation 7-14 days after discharge (P < 0.001). The decrease in median NT-proBNP concentration from time of admission (655 pmol/L; range, 188 to >1500 pmol/L) to reevaluation (583 pmol/L; range, 41 to >1500 pmol/L) was not significant (P = 0.59). Median CATCH score was 26 (range, 0-70) at baseline, 19 (range, 0 to 61) at discharge, and 19 (range, 2-49) 7-14 days after discharge (P = 0.89). CATCH scores did not correlate with NT-proBNP concentrations or ISACHC stage., Conclusions: These results suggest that the CATCH questionnaire requires further refinement for uses requiring a responsive instrument in cats with acute CHF., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objective: To prospectively evaluate the diagnostic accuracy of a point-of-care (POC) N-terminal pro-B-type natriuretic peptide (NT-proBNP) ELISA to assess the likelihood of moderate to severe occult heart disease (OcHD) in a clinical population of cats suspected to have heart disease., Animals: One hundred and forty-six asymptomatic client-owned cats with a heart murmur, gallop rhythm, arrhythmia, or cardiomegaly., Methods: Physical examination, blood pressure measurement and echocardiography were performed prospectively. Point-of-care ELISA was visually assessed as either positive or negative by a reader blinded to the echocardiographic results., Results: Forty-three healthy cats, 50 mild OcHD, 31 moderate OcHD, 6 severe OcHD, and 16 cats equivocal for OcHD were examined. Cats with OcHD included 65 with hypertrophic cardiomyopathy, 6 with restrictive or unclassified cardiomyopathy, 1 with arrhythmogenic right ventricular cardiomyopathy, and 15 with non-cardiomyopathic forms of heart disease. Point-of-care ELISA differentiated cats with moderate or severe OcHD with sensitivity/specificity of 83.8%/82.6% and overall accuracy of 82.9%. Positive POC ELISA increased likelihood of moderate or severe OcHD by a factor of 4.8 vs. those that tested negative. Point-of-care ELISA differentiated cats with moderate or severe cardiomyopathic OcHD with sensitivity/specificity of 88.6%/81.3% and overall accuracy of 83.2%., Conclusion: In a select sample of cats referred for cardiac evaluation, positive POC NT-proBNP ELISA increases likelihood of moderate to severe OcHD while negative POC NT-proBNP ELISA result excludes moderate to severe OcHD., (Copyright © 2014 Elsevier B.V. All rights reserved.)

n-3 fatty acids have some benefits in humans and dogs with cardiac disease, and plasma n-3 fatty acid concentrations have been shown to be decreased in dogs with congestive heart failure (CHF). However, there are no published studies reporting fatty acid concentrations in cats with cardiac disease. Therefore, the goal of this study was to compare serum fatty acid concentrations in normal cats and cats with hypertrophic cardiomyopathy (HCM), and determine if fatty acid concentrations correlate with left atrial size or the presence of CHF. Serum fatty acid concentrations were measured in normal cats and cats with HCM by gas chromatography. Twenty-three cats with HCM and 20 healthy controls were enrolled. Compared with healthy controls, cats with HCM had higher concentrations of palmitic acid (P = 0.01), docosahexanoic acid (DHA; P = 0.001) and total n-3 fatty acids (P = 0.03), and lower concentrations of linoleic acid (P = 0.03). Among cats with HCM, there were no differences in plasma fatty acid concentrations, and no association between left atrial dimension and fatty acid concentrations. Cats with HCM have some alterations in plasma fatty acids compared with healthy controls. Given the higher plasma concentrations of DHA, DHA supplementation is unlikely to have benefits in terms of correcting a deficiency; however, other effects of DHA or of supplementation of EPA warrant further investigation., (© ISFM and AAFP 2013.)

Background: Diet might influence progression of hypertrophic cardiomyopathy (HCM)., Objective: To investigate whether diet composition could alter clinical, biochemical, or echocardiographic variables in cats with HCM., Animals: Twenty-nine cats with HCM (International Small Animal Cardiac Health Council stage 1b) examined at a university teaching hospital., Methods: Randomized, placebo-controlled trial. After physical examination, echocardiogram, and blood collection, cats were randomized to 1 of 3 diets, which varied in carbohydrate and fat content and ingredients. Measurements were repeated after 6 months., Results: There were no significant differences among the 3 groups at baseline. After 6 months, there were no significant changes in the primary endpoints, left ventricular free wall (Group A, P = .760; Group B, P = .475; Group C, P = .066) or interventricular septal thickness in diastole (Group A, P = .528; Group B, P = .221; Group C, P = .097). Group A had significant increases in BUN (P = .008) and cholesterol (P = .021), while Group B had significant increases in BUN (P = .008), cholesterol (P = .007), and triglycerides (P = .005), and significant decreases in NT-proBNP (P = .013) and hs-troponin I (P = .043). Group C had significant decreases in body weight (P = .021), left atrial dimension (P = .035), interventricular septal thickness in systole (P = .038), and liver enzymes (P = .034-.038)., Conclusions and Clinical Importance: These data suggest that diet might influence some clinical, biochemical, and echocardiographic variables in cats with HCM., (Copyright © 2014 by the American College of Veterinary Internal Medicine.)

An interplay between growth, glucose regulation and hypertrophic cardiomyopathy (HCM) may exist, but has not been studied in detail. The purpose of this study was to characterize morphometric features, insulin-like growth factor-1 (IGF-1) and glucose metabolism in Maine Coon cats with HCM. Body weight, body condition score (BCS), head length and width, and abdominal circumference were measured in Maine Coon cats >2 years of age. Echocardiography and thoracic radiography (for measurement of humerus length, and fourth and twelfth vertebrae length) were also performed. Blood was collected for biochemistry profile, DNA testing, insulin and IGF-1. Sixteen of 63 cats had HCM [myosin binding protein C (MYBPC)+, n = 3 and MYBPC-, n = 13] and 47/63 were echocardiographically normal (MYBPC+, n = 17 and MYBPC-, n = 30). There were no significant differences in any measured parameter between MYBPC+ and MYBPC- cats. Cats with HCM were significantly older (P <0.001), heavier (P = 0.006), more obese (P = 0.008), and had longer humeri (P = 0.02) compared with the HCM- group. Cats with HCM also had higher serum glucose (P = 0.01), homeostasis model assessment (HOMA) and IGF-1 (P = 0.01) concentrations, were from smaller litters (P = 0.04), and were larger at 6 months (P = 0.02) and at 1 year of age (P = 0.03). Multivariate analysis revealed that age (P <0.001), BCS (P = 0.03) and HOMA (P = 0.047) remained significantly associated with HCM. These results support the hypothesis that early growth and nutrition, larger body size and obesity may be environmental modifiers of genetic predisposition to HCM. Further studies are warranted to evaluate the effects of early nutrition on the phenotypic expression of HCM.

Objective: To describe a unique cause of septic pericarditis in a cat and detail the successful case management strategy., Case Summary: A 6-year-old sexually intact female Ragdoll cat was evaluated for a 7-day history of progressive lethargy, anorexia, and vaginal discharge. Thoracic radiographs revealed a markedly globoid cardiac silhouette and pleural effusion while the initial echocardiogram showed moderate volume pericardial effusion. Following pericardiocentesis, cytologic evaluation of the pericardial effusion revealed septic suppurative inflammation with intra- and extracellular Gram-negative rod-shaped bacteria. Abdominal ultrasound demonstrated a moderate amount of echogenic uterine fluid accumulation with a right-sided uterine horn mass. After stabilization with pericardiocentesis, IV fluid therapy and IV antimicrobials, the cat underwent ovariohysterectomy and partial pericardiectomy. Histopathology confirmed a diagnosis of pyometra and septic pericarditis. Uterine and pericardial fluid bacterial culture yielded Escherichia coli with identical antimicrobial sensitivity spectrums., New or Unique Information Provided: Septic pericarditis is a rare cause of pericardial effusion in the cat. Previous reported cases have either suggested the cause to be secondary to transient bacteremia resulting from a local infection seeding the pericardium or for the cause to remain unknown. To the authors' knowledge, this is the first veterinary report of septic pericarditis resulting from hematogeneously spread bacteria originating from a urogenital infection. It is also the first report of successful surgical management of septic pericarditis in the cat., (© Veterinary Emergency and Critical Care Society 2012.)

Objective: To develop, validate, and evaluate a questionnaire (Cats' Assessment Tool for Cardiac Health [CATCH] questionnaire) for assessing health-related quality of life in cats with cardiac disease., Design: Prospective study., Animals: 275 cats with cardiac disease., Procedures: The questionnaire was developed on the basis of clinical signs of cardiac disease in cats. A CATCH score was calculated by summing responses to questionnaire items; possible scores ranged from 0 to 80. For questionnaire validation, owners of 75 cats were asked to complete the questionnaire (10 owners completed the questionnaire twice). Disease severity was assessed with the International Small Animal Cardiac Health Council (ISACHC) classification for cardiac disease. Following validation, the final questionnaire was administered to owners of the remaining 200 cats., Results: Internal consistency of the questionnaire was good, and the CATCH score was significantly correlated with ISACHC classification. For owners that completed the questionnaire twice, scores were significantly correlated. During the second phase of the study, the CATCH score ranged from 0 to 74 (median, 7) and was significantly correlated with ISACHC classification., Conclusions and Clinical Relevance: Results suggested that the CATCH questionnaire is a valid and reliable method for assessing health-related quality of life in cats with cardiac disease. Further research is warranted to test the tool's sensitivity to changes in medical treatment and its potential role as a clinical and research tool.

Hypothesis/objectives: To describe the therapeutic use of pimobendan in cats, describe the patient population to which it was administered, document potential side effects and report the clinical course following administration of pimobendan in conjunction with standard heart failure therapy. It is hypothesized that cats with advanced heart disease including congestive heart failure from a variety of causes will tolerate pimobendan with a minimum of side effects when used in treatment in conjunction with a variety of other medications., Animals, Materials and Methods: One hundred and seventy client owned cats with naturally occurring heart disease, one hundred and sixty four of which had congestive heart failure. Medical records were reviewed and owners and referring veterinarians were contacted for follow-up data. Data collected included pimobendan dose, other medications administered concurrently, data collected at physical examination, presence or absence of heart failure, adverse effects, classification of heart disease, echocardiographic data and survival time. The data were analyzed for significance between the initial visit and any follow-up visits., Results: All cats were treated with pimobendan. The median pimobendan dose was 0.24 mg/kg q 12 h. Pimobendan was used in combination with multiple concurrent medications including angiotensin converting enzyme inhibitors, diuretics and anti-thrombotics. Five cats (3.0%) had potential side effects associated with pimobendan. One cat (0.6%) had presumed side effects severe enough to discontinue pimobendan use. Median survival time for 164 cats with congestive heart failure after initiation of pimobendan was 151 days (range 1-870)., Conclusion: Pimobendan appears to be well tolerated in cats with advanced heart disease when used with a variety of concurrent medications. Randomized controlled studies need to be performed to accurately assess whether it is efficacious for treatment of congestive heart failure in cats., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: Owners' perceptions and priorities regarding quality of life (QoL) are important considerations given the unknown efficacy of many commonly administered medications, stress of hospital visits, difficulties providing home care, and personal choices including euthanasia., Objective: To describe the relative importance of quality versus quantity of life to owners of cats with heart disease., Animals: Two hundred and thirty-nine cats with heart disease., Methods: Prospective questionnaire-based clinical study. Cat owners completed a questionnaire to identify important parameters when assessing their cat's QoL, the relative importance of quality versus quantity of life, and willingness to trade survival time for QoL. Variables associated with these parameters were evaluated with multivariate analyses., Results: Appetite, owner interaction, sleep patterns, and litterbox habits were deemed important to QoL. Concern over pet suffering was significantly greater than concern over life expectancy. Ninety-three percent of owners were willing to trade survival time for good QoL; 57% of these were willing to trade up to 6 months. On multivariate analysis, the only factor significantly (P=.002) associated with willingness to trade 6 months was study site. Owner concern regarding stress of administering medications at home increased with number and frequency of medications., Conclusions and Clinical Relevance: These results indicated that QoL is more important to owners of cats with heart disease than longevity. The various priorities and concerns of cat owners should be taken into account in order to provide optimal care., (Copyright © 2010 by the American College of Veterinary Internal Medicine.)