Retrospective evaluation of the safety and tolerability of pimobendan in cats with obstructive vs nonobstructive cardiomyopathy

Ward, Jessica; Kussin, Efrem Z; Tropf, Melissa A.; Tou, Sandra; DeFrancesco, Teresa C.; Keene, Bruce W.

doi:10.1111/jvim.15920

Cited by 5 publications

(6 citation statements)

References 38 publications

(62 reference statements)

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“… 190 This finding is corroborated by the fact that pimobendan can be safely administered to cats with HCM, even those with SAM. 191 , 192 If pimobendan did have potent positive inotropic properties in cats, it would be expected to worsen SAM and probably worsen the clinical status of any cat with HCM. Instead it appears to be safe to administer to most cats with HCM and it does not worsen SAM.…”

Section: Treatmentmentioning

confidence: 99%

The Feline Cardiomyopathies: 2. Hypertrophic cardiomyopathy

Kittleson

Côté

2021

Journal of Feline Medicine and Surgery

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Practical relevance: Hypertrophic cardiomyopathy (HCM) is the most common form of feline cardiomyopathy observed clinically and may affect up to approximately 15% of the domestic cat population, primarily as a subclinical disease. Fortunately, severe HCM, leading to heart failure or arterial thromboembolism (ATE), only occurs in a small proportion of these cats. Patient group: Domestic cats of any age from 3 months upward, of either sex and of any breed, can be affected. A higher prevalence in male and domestic shorthair cats has been reported. Diagnostics: Subclinical feline HCM may or may not produce a heart murmur or gallop sound. Substantial left atrial enlargement can often be identified radiographically in cats with severe HCM. Biomarkers should not be relied on solely to diagnose the disease. While severe feline HCM can usually be diagnosed via echocardiography alone, feline HCM with mild to moderate left ventricular (LV) wall thickening is a diagnosis of exclusion, which means there is no definitive test for HCM in these cats and so other disorders that can cause mild to moderate LV wall thickening (eg, hyperthyroidism, systemic hypertension, acromegaly, dehydration) need to be ruled out. Key findings: While a genetic cause of HCM has been identified in two breeds and is suspected in another, for most cats the cause is unknown. Systolic anterior motion of the mitral valve (SAM) is the most common cause of dynamic left ventricular outflow tract obstruction (DLVOTO) and, in turn, the most common cause of a heart murmur with feline HCM. While severe DLVOTO is probably clinically significant and so should be treated, lesser degrees probably are not. Furthermore, since SAM can likely be induced in most cats with HCM, the distinction between HCM without obstruction and HCM with obstruction (HOCM) is of limited importance in cats. Diastolic dysfunction, and its consequences of abnormally increased atrial pressure leading to signs of heart failure, and sluggish atrial blood flow leading to ATE, is the primary abnormality that causes clinical signs and death in affected cats. Treatment (eg, loop diuretics) is aimed at controlling heart failure. Preventive treatment (eg, antithrombotic drugs) is aimed at reducing the risk of complications (eg, ATE). Conclusions: Most cats with HCM show no overt clinical signs and live a normal or near-normal life despite this disease. However, a substantial minority of cats develop overt clinical signs referable to heart failure or ATE that require treatment. For most cats with clinical signs caused by HCM, the long-term prognosis is poor to grave despite therapy. Areas of uncertainty: Genetic mutations (variants) that cause HCM have been identified in a few breeds, but, despite valiant efforts, the cause of HCM in the vast majority of cats remains unknown. No treatment currently exists that reverses or even slows the cardiomyopathic process in HCM, again despite valiant efforts. The search goes on.

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Section: Treatmentmentioning

confidence: 99%

The Feline Cardiomyopathies: 2. Hypertrophic cardiomyopathy

Kittleson

Côté

2021

Journal of Feline Medicine and Surgery

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“…Juvenile cats with early onset and severely affected disease status also commonly demonstrated LVOTO. As seen in Table S1, cats that were heterozygous or homozygous for the A31P mutation had median aortic flow velocities at or above 2 m/sec, constituting LVOTO in these genotype groups compared to wildtype cats with a median of 1.4 m/sec [21][22][23]55 .…”

Section: Resultsmentioning

confidence: 99%

Hypertrophic cardiomyopathy in purpose-bred cats with the A31P mutation in cardiac myosin binding protein-C

Stern

Rivas

Kaplan

et al. 2023

Sci Rep

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We sought to establish a large animal model of inherited hypertrophic cardiomyopathy (HCM) with sufficient disease severity and early penetrance for identification of novel therapeutic strategies. HCM is the most common inherited cardiac disorder affecting 1 in 250–500 people, yet few therapies for its treatment or prevention are available. A research colony of purpose-bred cats carrying the A31P mutation in MYBPC3 was founded using sperm from a single heterozygous male cat. Cardiac function in four generations was assessed by periodic echocardiography and measurement of blood biomarkers. Results showed that HCM penetrance was age-dependent, and that penetrance occurred earlier and was more severe in successive generations, especially in homozygotes. Homozygosity was also associated with progression from preclinical to clinical disease. A31P homozygous cats represent a heritable model of HCM with early disease penetrance and a severe phenotype necessary for interventional studies aimed at altering disease progression. The occurrence of a more severe phenotype in later generations of cats, and the occasional occurrence of HCM in wildtype cats suggests the presence of at least one gene modifier or a second causal variant in this research colony that exacerbates the HCM phenotype when inherited in combination with the A31P mutation.

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“…1,3,4 Evidence suggests that cats with heart disease that also have or later develop DM may be more likely to subsequently develop HF than those that do not. 8,10 This case report describes DM and HF presenting as comorbidities, including ante-and post-mortem findings. We would like to raise the question of whether feline diabetic cardiomyopathy exists as a phenomenon.…”

Section: Discussionmentioning

confidence: 98%

“… 10 In a study of 260 cats treated for CHF, 19 (7.3%) had concurrent DM, making it the third most common comorbidity after CKD and hyperthyroidism. 8 This is a striking observation because the prevalence of DM is higher than that seen in the general feline population. There is convincing evidence that feline hyperthyroidism causes cardiac pathology and that renal failure can predispose to heart disease by inducing hypertension.…”

Section: Introductionmentioning

confidence: 96%

“… 7 In a 2020 study of 260 cats treated for CHF in two US University veterinary hospitals, 19 (7.3%) had concurrent DM, making it the third most common comorbidity after chronic kidney disease (CKD) and hyperthyroidism. 8 Furthermore, it should be remembered that there may be under-representation of diabetes in some feline heart disease studies, as exclusion criteria often include diabetes, other endocrinopathies or other systemic diseases.…”

Section: Introductionmentioning

confidence: 99%

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Necropsy findings in a cat with diabetes mellitus and heart failure

Dobromylskyj¹,

Little²

2021

Journal of Feline Medicine and Surgery Open Reports

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Case summary A 7-year-old male neutered domestic shorthair cat, previously diagnosed and treated for diabetes mellitus (DM), subsequently presented in heart failure (HF). Echocardiography revealed biatrial and biventricular dilation with poor myocardial function, and a left atrial-to-aortic ratio of 1.95:1. There was caudal vena cava dilation, hepatomegaly and ascites. The HF was treated with furosemide for 5 weeks, but thereafter the cat presented recumbent and moribund, and was euthanased. Post-mortem findings included dilation of all four cardiac chambers with an increased heart weight. Microscopic examination of the heart revealed mild, predominantly interstitial or perivascular fibrosis throughout most of the myocardium, with small-to-medium-sized foci of replacement fibrosis within the left ventricular free wall and interventricular septum. There was evidence of myocyte degeneration, but myofibre disarray was mild and there was minimal evidence of inflammation. Relevance and novel information Cardiac disease is common in cats and while HF is less common, it is a frequent cause of clinical signs and death. DM is a relatively common feline endocrinopathy. This case report describes DM and HF presenting as comorbidities, including detailed ante- and post-mortem findings. The case, and the epidemiology of these conditions, raise the question of whether a form of diabetic cardiomyopathy exists in cats, as it appears to do in humans.

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Retrospective evaluation of the safety and tolerability of pimobendan in cats with obstructive vs nonobstructive cardiomyopathy

Cited by 5 publications

References 38 publications

The Feline Cardiomyopathies: 2. Hypertrophic cardiomyopathy

The Feline Cardiomyopathies: 2. Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy in purpose-bred cats with the A31P mutation in cardiac myosin binding protein-C

Necropsy findings in a cat with diabetes mellitus and heart failure

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