Feline myocardial disease: 2: Diagnosis, prognosis and clinical management

Clinical challengesThe diagnosis, prognosis and clinical management of feline myocardial disease (cardiomyopathy, CM) represent controversial areas in veterinary cardiology. Diagnosis is challenging primarily because of the complex classification of feline CM, which is based on a variety of structural and functional phenotypes. Similarly, prognosis is strongly dependent on the underlying aetiology and stage of the disease, which are often unrecognised. These challenges underline the importance of a thorough clinical evaluation of the patient and understanding of the underlying pathophysiological mechanisms in order to select the most appropriate treatment and provide the highest standards of care.Patient groupAlthough a genetic predisposition has been demonstrated in some feline pedigrees (ie, Maine Coons, Ragdolls), CM can potentially affect all breeds and different age groups.AudienceGeneral practitioners, as well as specialists in small animal medicine, cardiology and pathology, deal with feline CM cases on a regular basis.DiagnosticsDiagnosis of feline CM is primarily based on echocardiographic examination. However, even the most sophisticated techniques present important limitations because they do not necessarily identify the primary cause of the disease or recognise the precise origin of an end-stage myocardial disease. Thoracic radiography remains one of the most useful tools for identifying changes consistent with congestive heart failure. Novel diagnostic techniques include cardiac magnetic resonance imaging, positron emission tomography and genetic tests.Evidence baseAlthough knowledge of feline CM remains fairly rudimentary, important discoveries have been made in the past few years. Evidence-based studies have significantly improved understanding of genetic predisposition, biomarkers and response to pharmacological treatments. Hopefully, many of the unsolved questions raised in this article will find a definitive answer in the near future.