Scott D Gibson 1, Bianca N Lourenço 1, Metzere Bierlein De la Rosa 2, Amanda E Coleman 1, Chris McLaughlin 2, Allison Arne 1, Tonya L Harris 2, Christianna Ziccardi 1, Shelly L Vaden 2

Background
Cardiac murmurs are commonly detected during physical examinations in cats, but their clinical significance varies. While echocardiography is the gold standard for evaluating heart disease, its routine use in cats with murmurs but no clinical signs remains debated. This study aimed to assess the diagnostic yield of echocardiography in cats with and without murmurs and to determine the prevalence of clinically significant heart disease in these populations.

Methods
This retrospective study reviewed records from 1,083 client-owned cats that underwent echocardiography, stratified by the presence or absence of auscultable murmurs. Data collected included signalment, reason for echocardiographic referral, echocardiographic findings, and classification of heart disease as clinically significant or not. Clinically significant disease was defined based on structural abnormalities likely to require treatment or associated with risk of clinical progression.

Results
Of 745 cats with murmurs, 56% had clinically significant heart disease, compared to only 11% of 338 cats without murmurs. Hypertrophic cardiomyopathy (HCM) was the most common diagnosis. Among cats with murmurs, 60% of those referred solely for murmur evaluation had clinically significant disease, suggesting high diagnostic yield in this group. In contrast, the likelihood of detecting significant heart disease in cats without murmurs and no other clinical indication for echocardiography was low.

Limitations
The retrospective nature and selection bias due to referral-based sampling limit the generalizability of results. Auscultation findings were not standardized across examiners, potentially affecting murmur classification. Additionally, the study did not assess long-term outcomes or treatment responses.

Conclusions
Echocardiography has substantial diagnostic value in cats with murmurs, even in the absence of other clinical signs, supporting its use in this population. Conversely, routine echocardiographic screening in cats without murmurs may yield limited benefit unless other risk factors are present. These findings can guide veterinarians in prioritizing echocardiography referrals based on murmur presence.

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