Is Treatment of Feline Hypertrophic Cardiomyopathy Based in Science or Faith?

Abstract

Evaluation of the therapeutic strategies chosen for these hypothetical cases of HCM suggests that cardiologists or clinicians with a strong interest in cardiology often prescribe treatments knowing that little documented evidence supports their decisions.

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

“…In addition, echocardiography facilitated recognition of systolic anterior motion of the mitral valve (SAM) and LVOTO, characteristics of the obstructive form (HOCM) of this disease. Insofar as common clinicopathologic features shared by humans and cats with hypertrophic cardiomyopathy were known, and in the absence of epidemiologic data in cats, dynamic LVOTO became regarded as a target variable for treatment in veterinary medicine . Our study contributes a fresh clinical perspective to the natural history of preclinical hypertrophic cardiomyopathy and counters this former perception.…”

“…Whereas the obstructive form of the disease (HOCM) in humans is a major determinant of negative outcome including progressive cardiovascular disability, equivalent risk has not been established in affected cats. Nevertheless, by inference drawn from data in humans, the notion has lingered that HOCM confers a similar negative prognosis in cats and, by extension, signifies a target for pharmacotherapy …”

The genetic basis of hypertrophic cardiomyopathy in cats and humans

“…125,126 For instance, by analogy with treatment of other human diseases, strategies can be used that seek to stabilize misfolded but otherwise functional proteins such as the case for mutations in the cystic fibrosis chloride channel gene or that target the UPS using drugs under development for cancer and neurodegenerative disorders. 127,128 While it is true that genetic screening can remove the A31P and R820W alleles from cat populations by selective breeding, HCM remains the most common cause of heart failure in cats.…”

Effects of clopidogrel therapy on whole blood platelet aggregation, the Plateletworks® assay and coagulation parameters in cats with asymptomatic hypertrophic cardiomyopathy: a pilot study

“…Veterinary cardiologists regularly initiate an antiplatelet therapy for primary prevention of CATE in cats when the LA is moderately or severely enlarged (Rishniw & Pion 2011;Hogan & Brainard 2015), although scientific evidence to support this therapy is lacking. Clopidogrel gained more interest for veterinary use, because it seemed to be safe and effective in reducing in vitro platelet aggregation in healthy cats (Hogan et al 2004a) and healthy dogs (Brainard et al 2010).…”

“…CATE originates from dislodgement of left atrial (LA) or left auricular appendage thrombi. Antiplatelet drugs such as acetylsalicylic acid (aspirin) and clopidogrel are widely used to prevent the occurrence or recurrence of CATE in cats with cardiomyopathies (Rishniw & Pion 2011, Hogan & Brainard 2015. Clopidogrel is an antiplatelet drug that irreversibly inhibits adenosine diphosphate (ADP) receptors (P2Y 12 ) on the platelet membrane (Lerner et al 2000).…”