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Cardiomiopatias em Felinos - Avanços no Diagnóstico e Tratamento
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Advisor(s)
Abstract(s)
As cardiomiopatias felinas representam a principal causa de mortalidade cardíaca em gatos, exigindo
abordagens diagnósticas e terapêuticas atualizadas. Sua similaridade fisiopatológica com a
cardiomiopatia humana ressaltou seu potencial para estudos translacionais, permitindo avanços
simultâneos nas medicinas veterinária e humana, especialmente em genética e terapias
personalizadas. Esta revisão bibliográfica tem como objetivo sintetizar os progressos publicados após
o consenso ACVIM de 2020 para esta patologia, destacando inovações no diagnóstico e tratamento,
com ênfase na CMH. Foram selecionados 120 artigos das bases PubMed, ResearchGate e Google
Scholar, garantindo uma análise atualizada.
Geneticamente, foram identificadas novas mutações em raças até então não afetadas, enquanto
microRNAs associados à hipertrofia e fibrose miocárdica reproduziram mecanismos descritos em
humanos, sugerindo um perfil genético dinâmico e em constante evolução. Entre os biomarcadores, o
NT-ProBNP e a troponina I cardíaca mantiveram relevância clínica para monitoramento da doença,
complementados por marcadores emergentes. Na imagem, a inteligência artificial elevou a precisão
radiográfica, enquanto a ecocardiografia permaneceu como padrão-ouro. A eletrocardiografia e a
monitorização Holter destacaram-se na deteção de arritmias, complementando a estratificação de
risco. Terapeuticamente, o sirolimus, primeiro fármaco aprovado pela FDA (2025) para estágios
subclínicos preencheu uma lacuna crítica no maneio precoce ao retardar a hipertrofia via inibição da
via mTOR. O carvedilol superou o atenolol em casos selecionados, e inibidores de miosina emergiram
como opções promissoras. Diuréticos como a torasemida e protocolos de furosemida subcutânea,
além de anticoagulantes como a rivaroxabana, otimizaram o controle de complicações. O pimobendan
manteve seu perfil seguro mesmo em casos de obstrução.
Os avanços pós-2020 reforçaram a necessidade de abordagens integradas, combinando genética,
biomarcadores e imagem para diagnóstico precoce. Contudo, a heterogeneidade fenotípica e a
escassez de ensaios clínicos de longo prazo limitaram a aplicação universal dessas inovações. Um
entendimento mais profundo da relação genótipo-fenótipo mostrou-se crucial para direcionar terapias
futuras.
Feline cardiomyopathies represented the main cause of cardiac mortality in cats, requiring updated diagnostic and therapeutic approaches. Their pathophysiological similarity to human cardiomyopathy highlighted their potential for translational studies, enabling simultaneous advances in veterinary and human medicine, especially in genetics and personalized therapies. This literature review aimed to synthesize the progress published after the 2020 ACVIM consensus, highlighting innovations in diagnosis and treatment, with an emphasis on hypertrophic cardiomyopathy. 120 articles were selected from PubMed, ResearchGate, and Google Scholar databases, ensuring an updated analysis. Genetically, new mutations were identified in breeds previously unaffected, while microRNAs associated with myocardial hypertrophy and fibrosis replicated mechanisms described in humans, suggesting a dynamic and constantly evolving genetic profile. Among biomarkers, NT-ProBNP and cardiac troponin I maintained clinical relevance for disease monitoring, complemented by emerging markers. In imaging, artificial intelligence has elevated radiographic precision, while echocardiography remained the gold standard. Electrocardiography and Holter monitoring stood out in arrhythmia detection, complementing risk stratification. Therapeutically, sirolimus, the first FDA-approved drug (2025) for subclinical stages, filled a critical gap in early management by delaying hypertrophy through inhibition of the mTOR pathway. Carvedilol outperformed atenolol in selected cases, and myosin inhibitors emerged as promising options. Diuretics such as torasemide and subcutaneous furosemide protocols, along with anticoagulants like rivaroxaban, optimized complication control. Pimobendan maintained its safe profile even in cases with obstruction. Post-2020 advances reinforced the need for integrated approaches, combining genetics, biomarkers, and imaging for early diagnosis. However, phenotypic heterogeneity and the scarcity of long-term clinical trials limited the universal application of these innovations. A deeper understanding of the genotype-phenotype relationship proved crucial for guiding future therapies.
Feline cardiomyopathies represented the main cause of cardiac mortality in cats, requiring updated diagnostic and therapeutic approaches. Their pathophysiological similarity to human cardiomyopathy highlighted their potential for translational studies, enabling simultaneous advances in veterinary and human medicine, especially in genetics and personalized therapies. This literature review aimed to synthesize the progress published after the 2020 ACVIM consensus, highlighting innovations in diagnosis and treatment, with an emphasis on hypertrophic cardiomyopathy. 120 articles were selected from PubMed, ResearchGate, and Google Scholar databases, ensuring an updated analysis. Genetically, new mutations were identified in breeds previously unaffected, while microRNAs associated with myocardial hypertrophy and fibrosis replicated mechanisms described in humans, suggesting a dynamic and constantly evolving genetic profile. Among biomarkers, NT-ProBNP and cardiac troponin I maintained clinical relevance for disease monitoring, complemented by emerging markers. In imaging, artificial intelligence has elevated radiographic precision, while echocardiography remained the gold standard. Electrocardiography and Holter monitoring stood out in arrhythmia detection, complementing risk stratification. Therapeutically, sirolimus, the first FDA-approved drug (2025) for subclinical stages, filled a critical gap in early management by delaying hypertrophy through inhibition of the mTOR pathway. Carvedilol outperformed atenolol in selected cases, and myosin inhibitors emerged as promising options. Diuretics such as torasemide and subcutaneous furosemide protocols, along with anticoagulants like rivaroxaban, optimized complication control. Pimobendan maintained its safe profile even in cases with obstruction. Post-2020 advances reinforced the need for integrated approaches, combining genetics, biomarkers, and imaging for early diagnosis. However, phenotypic heterogeneity and the scarcity of long-term clinical trials limited the universal application of these innovations. A deeper understanding of the genotype-phenotype relationship proved crucial for guiding future therapies.
Description
Keywords
Avanços Biomarcadores Cardiomiopatias felinas Inteligência artificial mTOR Mutações genéticas Advances Artificial intelligence Biomarkers Feline cardiomyopathies Genetic mutations