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, Bruce W. Keene, Kenneth Lamb, Karsten A. Schober, Valerie Chetboul, Virginia Luis Fuentes, Gerhard Wess, Jessie Rose Payne, Daniel F. Hogan, Alison Motsinger-Reif, Jens Häggström, Emilie Trehiou-Sechi, Deborah M. Fine-Ferreira, Reid K. Nakamura, Pamela M. Lee, Manreet K. Singh, Wendy A. Ware, Jonathan A. Abbott, Geoffrey Culshaw, Sabine RiesenMichele Borgarelli, Michael B. Lesser, Nicole Van Israël, Etienne Côté, John E. Rush, Barret Bulmer, Roberto A. Santilli, Andrea C. Vollmar, Maribeth J. Bossbaly, Nadine Quick, Claudio Bussadori, Janice M. Bright, Amara H. Estrada, Dan G. Ohad, Maria Josefa Fernández-Del Palacio, Jenifer Lunney Brayley, Denise S. Schwartz, Christina M. Bové, Sonya G. Gordon, Seung Woo Jung, Paola Brambilla, N. Sydney Moïse, Christopher D. Stauthammer, Rebecca L. Stepien, Cecilia Quintavalla, Christophe Amberger, Ferenc Manczur, Yong Wei Hung, Remo Lobetti, Marie De Swarte, Alice Tamborini, Carmel T. Mooney, Mark A. Oyama, Andrey Komolov, Yoko Fujii, Romain Pariaut, Masami Uechi, Victoria Yukie Tachika Ohara

Research output: Contribution to journalArticlepeer-review

93 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)930-943
Number of pages14
JournalJournal of veterinary internal medicine
Issue number3
StatePublished - May 1 2018

Bibliographical note

Publisher Copyright:
Copyright © 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.


  • arterial thromboembolism
  • asymptomatic
  • congestive heart failure
  • epidemiology
  • incidence
  • outcome
  • survival


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