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Observational Study
. 2018 May;32(3):930-943.
doi: 10.1111/jvim.15122. Epub 2018 Apr 16.

International collaborative study to assess cardiovascular risk and evaluate long-term health in cats with preclinical hypertrophic cardiomyopathy and apparently healthy cats: The REVEAL Study

Philip R Fox  1 , Bruce W Keene  2 , Kenneth Lamb  3 , Karsten A Schober  4 , Valerie Chetboul  5 , Virginia Luis Fuentes  6 , Gerhard Wess  7 , Jessie Rose Payne  6 , Daniel F Hogan  8 , Alison Motsinger-Reif  9 , Jens Häggström  10 , Emilie Trehiou-Sechi  5 , Deborah M Fine-Ferreira  11 , Reid K Nakamura  12 , Pamela M Lee  1 , Manreet K Singh  13 , Wendy A Ware  14 , Jonathan A Abbott  15 , Geoffrey Culshaw  16 , Sabine Riesen  17 , Michele Borgarelli  18 , Michael B Lesser  12 , Nicole Van Israël  19 , Etienne Côté  20 , John E Rush  21 , Barret Bulmer  22 , Roberto A Santilli  23 , Andrea C Vollmar  24 , Maribeth J Bossbaly  25 , Nadine Quick  7 , Claudio Bussadori  26 , Janice M Bright  27 , Amara H Estrada  28 , Dan G Ohad  29 , Maria Josefa Fernández-Del Palacio  30 , Jenifer Lunney Brayley  31 , Denise S Schwartz  32 , Christina M Bové  33 , Sonya G Gordon  34 , Seung Woo Jung  13 , Paola Brambilla  35 , N Sydney Moïse  36 , Christopher D Stauthammer  37 , Rebecca L Stepien  38 , Cecilia Quintavalla  39 , Christophe Amberger  40 , Ferenc Manczur  41 , Yong-Wei Hung  42 , Remo Lobetti  43 , Marie De Swarte  44 , Alice Tamborini  44 , Carmel T Mooney  44 , Mark A Oyama  45 , Andrey Komolov  46 , Yoko Fujii  47 , Romain Pariaut  48 , Masami Uechi  49 , Victoria Yukie Tachika Ohara  50
Affiliations
Observational Study

International collaborative study to assess cardiovascular risk and evaluate long-term health in cats with preclinical hypertrophic cardiomyopathy and apparently healthy cats: The REVEAL Study

Philip R Fox et al. J Vet Intern Med. 2018 May.

Erratum in

Abstract

Background: Hypertrophic cardiomyopathy is the most prevalent heart disorder in cats and principal cause of cardiovascular morbidity and mortality. Yet, the impact of preclinical disease is unresolved.

Hypothesis/objectives: Observational study to characterize cardiovascular morbidity and survival in cats with preclinical nonobstructive (HCM) and obstructive (HOCM) hypertrophic cardiomyopathy and in apparently healthy cats (AH).

Animals: One thousand seven hundred and thirty client-owned cats (430 preclinical HCM; 578 preclinical HOCM; 722 AH).

Methods: Retrospective multicenter, longitudinal, cohort study. Cats from 21 countries were followed through medical record review and owner or referring veterinarian interviews. Data were analyzed to compare long-term outcomes, incidence, and risk for congestive heart failure (CHF), arterial thromboembolism (ATE), and cardiovascular death.

Results: During the study period, CHF, ATE, or both occurred in 30.5% and cardiovascular death in 27.9% of 1008 HCM/HOCM cats. Risk assessed at 1, 5, and 10 years after study entry was 7.0%/3.5%, 19.9%/9.7%, and 23.9%/11.3% for CHF/ATE, and 6.7%, 22.8%, and 28.3% for cardiovascular death, respectively. There were no statistically significant differences between HOCM compared with HCM for cardiovascular morbidity or mortality, time from diagnosis to development of morbidity, or cardiovascular survival. Cats that developed cardiovascular morbidity had short survival (mean ± standard deviation, 1.3 ± 1.7 years). Overall, prolonged longevity was recorded in a minority of preclinical HCM/HOCM cats with 10% reaching 9-15 years.

Conclusions and clinical importance: Preclinical HCM/HOCM is a global health problem of cats that carries substantial risk for CHF, ATE, and cardiovascular death. This finding underscores the need to identify therapies and monitoring strategies that decrease morbidity and mortality.

Keywords: arterial thromboembolism; asymptomatic; congestive heart failure; epidemiology; incidence; outcome; survival.

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Figures

Figure 1
Figure 1
Age distribution for 1006 of the 1008 cats with obstructive and nonobstructive hypertrophic cardiomyopathy recorded at the time of diagnosis. In 2 cats, age was not recorded
Figure 2
Figure 2
Most prevalent breeds in feline study populations. HCM, nonobstructive hypertrophic cardiomyopathy; HOCM, obstructive hypertrophic cardiomyopathy
Figure 3
Figure 3
Kaplan‐Meier survival curves estimating percentage of 430 cats with nonobstructive (HCM) compared with 578 cats with the obstructive (HOCM) form of hypertrophic cardiomyopathy that have not yet experienced morbidity (Y‐axis) from CHF (top) or ATE (bottom) against time (X‐axis)
Figure 4
Figure 4
Percentage of 1008 cats with nonobstructive (HCM, n = 430) and obstructive (HOCM, n = 578) hypertrophic cardiomyopathy at risk for cardiovascular mortality, by age quartile when diagnosed and assessed 1, 5, and 10 years after study entry. Q, age quartile; yrs., years
Figure 5
Figure 5
Kaplan‐Meier survival curves estimating percentage of 1008 cats with nonobstructive (HCM, n = 430) and obstructive (HOCM, n = 578) forms of hypertrophic cardiomyopathy that have not yet experienced cardiovascular death (Y‐axis) compared with 722 AH against time (Y‐axis). NA, median not estimable
Figure 6
Figure 6
Kaplan‐Meier survival curves estimating percentage of 430 cats with nonobstructive (HCM) compared with 578 cats with the obstructive form (HOCM) of hypertrophic cardiomyopathy that have not yet experienced cardiovascular death (Y‐axis) against time (X‐axis). NA, median not estimable
Figure 7
Figure 7
Kaplan‐Meier survival curves estimating the percentage of 430 cats with nonobstructive (HCM) compared with 578 cats with obstructive (HOCM) hypertrophic cardiomyopathy that have not yet experienced cardiovascular death (Y‐axis) for CHF (A), or ATE (B) against time (X‐axis). NA, median not estimable
Figure 8
Figure 8
Kaplan‐Meier survival curves estimating the EFS proportion and PES proportion (Y‐axis) against time (X‐axis). Event‐free survival group‐A comprised a cohort of 140 cats with preclinical hypertrophic cardiomyopathy who died on the day of their first recorded CHF/ATE morbidity. Event‐free survival group‐B comprised a cohort of 119 cats with preclinical hypertrophic cardiomyopathy who survived more than one day after their first recorded CHF/ATE morbidity. Postevent survival was calculated for these 119 cats. *P = .101; **P < .0001; SD, standard deviation
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References

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    1. Liu SK, Fox PR. Cardiovascular pathology In: Fox PR, Sisson DD, Moise NS, eds. Textbook of Canine and Feline Cardiology Principles and Clinical Practice. 2nd ed. Philadelphia, PA: WB Saunders; 1999:817–844.
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