Evaluation of a quality-of-life tool for dogs with diabetes mellitus.

BACKGROUND: Diabetes mellitus (DM) management primarily focuses on improvement in blood glucose concentrations and clinical signs. A tool to assess the psychological and social impact of DM and its treatment on quality of life (QoL) previously has only been validated for feline DM. HYPOTHESIS/OBJECTIVES: To validate a diabetic pet and owner-centered individualized measure of impact of DM (DIAQoL-pet) for diabetic dogs and their owners. ANIMALS/SUBJECTS: A total of 101 owners of insulin-treated diabetic dogs were recruited to complete the DIAQoL-pet. METHODS: Discussions and pilot surveys with clinicians and owners of diabetic pets led to the design of 29 specific DM-associated QoL questions. Each item was scored according to impact frequency and perceived importance. An Item-Weighted-Impact-Score (IWIS) for each item was calculated, as was an Average-Weighted-Impact-Score (AWIS) by averaging all IWISs. Principal component analysis and Cronbach's α calculation assessed the measure's reliability. RESULTS: The DIAQoL-pet showed high reliability (Communalities ≥0.5; Cronbach's α 0.85). The AWIS was -2.74 ± 1.7 (mean ± SD). Areas reported as most negatively impacting QoL included: "worry" (IWIS ± SD: -5.92 ± 4.3), "difficulties leaving dog with friends or family" (-5.68 ± 5.1), "worry vision" (-5.58 ± 4.6), "boarding difficulties" (-5.18 ± 5.2), "worry hypoglycemia" (-4.95 ± 4.3), "social life" (-4.82 ± 4.4), "costs" (-4.11 ± 4.7), and "future care"(-4.07 ± 4.6). Eighty-four percent of owners reported negative impact of DM on QoL. CONCLUSIONS AND CLINICAL IMPORTANCE: The DIAQoL-pet proved robust when used by owners of insulin-treated diabetic dogs and identified specific areas most negatively impacting dogs' and their owners' QoL. This tool could be used as an additional assessment parameter in clinical and research settings.

Evaluation of a quality-of-life tool for cats with diabetes mellitus.

BACKGROUND: Success in management of diabetes mellitus (DM) is defined as improvement of blood glucose concentrations and clinical signs. However, the psychological and social impact of DM and its daily treatment regimen on quality of life (QoL) of both animal and owner is uncertain. HYPOTHESIS/OBJECTIVES: To design, validate, and apply a diabetic pet and owner-centered, individualized measure of impact of DM (DIAQoL-pet). ANIMALS/SUBJECTS: Two hundred and twenty-one owners of insulin-treated diabetic cats were recruited to complete the DIAQoL-pet. METHODS: Discussions and pilot surveys with clinicians and owners of diabetic cats led to the design of 29 specific DM-associated QoL questions. Owners of diabetic cats completed the finalized survey. Each item was scored according to impact frequency and perceived importance. An item-weighted impact score (IWIS) for each item was calculated, as was an average-weighted impact score (AWIS) by averaging all IWISs. Principal component analysis and Cronbach's α calculation assessed the measure's reliability. Two overview questions measured overall QoL and diabetes-dependent QoL. RESULTS: The DIAQoL-pet showed high reliability (Cronbach α 0.83). The AWIS was -1.76 ± 2.4 (mean ± SD). Areas reported as most negatively impacting QoL included: "boarding difficulties" (IWIS ± SD: -4.67 ± 5.3), "owner wanting more control" (-4.34 ± 4.7), "difficulties leaving cat with friends or family" (-4.21 ± 4.7), "worry" (-4.10 ± 3.9), "worry hypo" (-3.67 ± 3.5), "social life" (-3.48 ± 3.9), "costs" (-3.04 ± 3.8), and "work life" (-3.03 ± 3.7). Forty-one percent of owners believed their cat's life would be "a little better" without DM. CONCLUSIONS AND CLINICAL IMPORTANCE: The DIAQoL-pet proved robust and identified specific areas most negatively impacting on diabetic cats and their owners' QoL. This tool warrants further investigation for use in clinical or research settings.

Interpretation by clinicians of probability expressions in cytology reports and effect on clinical decision-making.

BACKGROUND: Cytology often is used to obtain a diagnosis, such as that of malignant neoplasia. When a diagnosis is uncertain, pathologists often express probability using qualitative terms, such as "probable," that have imprecise meanings. HYPOTHESIS: Terms expressing probability are interpreted variably by veterinary practitioners and affect decisions regarding treatment and euthanasia. ANIMALS: None. METHODS: An online survey of members of the Veterinary Information Network was conducted. Veterinarians were asked to assign percentage probabilities to 18 modifiers of a diagnosis of lymphoma. They also were asked to select their most likely clinical action based on a diagnosis of lymphoma qualified one of 4 modifiers. Results were analyzed using descriptive and nonparametric methods. Percentage probabilities were analyzed by ANOVA after variance stabilization. RESULTS: For 871 valid surveys, probabilities assigned to the 18 modifiers overlapped substantially, with medians (interquartile range) of 50% (50-70%) for "possible," 66% (66-85%) for "probable," and 70% (70-90%) for "consistent with." More (P < .001) veterinarians (50.4%) chose to initiate treatment with a diagnosis of "consistent with lymphoma" as compared with "probable" (14.6%) or "possible" (1.6%) lymphoma. For clients considering euthanasia if the diagnosis was cancer, more (P < .001) veterinarians recommended euthanasia with a diagnosis of "consistent with lymphoma" (62.5%) as compared with "probable" (35.3%), or "possible" (2.0%) lymphoma. CONCLUSIONS AND CLINICAL IMPORTANCE: Probability expressions are interpreted variably yet have a major impact on clinical decision-making, including the decision to recommend euthanasia. Standardized terminology could improve decision-making and enhance clinical outcome.

Familial hypertrophic cardiomyopathy in maine coon cats: an animal model of human disease.

BACKGROUND: A naturally occurring animal model of familial hypertrophic cardiomyopathy (FHCM) is lacking. We identified a family of Maine coon cats with HCM and developed a colony to determine mode of inheritance, phenotypic expression, and natural history of the disease. METHODS AND RESULTS: A proband was identified, and related cats were bred to produce a colony. Affected and unaffected cats were bred to determine the mode of inheritance. Echocardiography was used to identify affected offspring and determine phenotypic expression. Echocardiograms were repeated serially to determine the natural history of the disease. Of 22 offspring from breeding affected to unaffected cats, 12 (55%) were affected. When affected cats were bred to affected cats, 4 (45%) of the 9 were affected, 2 (22%) unaffected, and 3 (33%) stillborn. Findings were consistent with an autosomal dominant mode of inheritance with 100% penetrance, with the stillborns representing lethal homozygotes that died in utero. Affected cats usually did not have phenotypic evidence of HCM before 6 months of age, developed HCM during adolescence, and developed severe HCM during young adulthood. Papillary muscle hypertrophy that produced midcavitary obstruction and systolic anterior motion of the mitral valve was the most consistent manifestation of HCM. Cats died suddenly (n=5) or of heart failure (n=3). Histopathology of the myocardium revealed myocardial fiber disarray, intramural coronary arteriosclerosis, and interstitial fibrosis. CONCLUSIONS: HCM in this family of Maine coon cats closely resembles the human form of FHCM and should prove a valuable tool for studying the gross, cellular, and molecular pathophysiology of the disease.

The effectiveness of taurine and levocarnitine in dogs with heart disease.

In this article, the current state of knowledge of the potential role of taurine and L-carnitine deficiency and supplementation in the genesis and management of cardiovascular disease in dogs is presented. There is limited direct evidence to support the recommendations found in this article or elsewhere in the literature. The temptation to "do something" for our patients can be overwhelming. Whether it be the administration of drugs or prescribing nutraceuticals or prescription diets, the veterinarian should strongly consider the source of the information, the strength of the evidence presented, the financial costs to the owner, and the potential risks and benefits to the patient.

Results of the multicenter spaniel trial (MUST): taurine- and carnitine-responsive dilated cardiomyopathy in American cocker spaniels with decreased plasma taurine concentration.

Fourteen American Cocker Spaniels (ACS) with dilated cardiomyopathy (DCM) were studied to determine if individuals of this breed with DCM are systemically taurine- or carnitine-deficient and to determine if they are responsive to taurine and carnitine supplementation. American Cocker Spaniels with DCM were identified using echocardiography, and plasma was analyzed for taurine and carnitine concentrations. Each dog was randomly assigned to receive either taurine and carnitine supplementation or placebos. Echocardiograms and clinical examinations were repeated monthly for 4 months. During this period, the investigators and owners were blinded with respect to the treatment being administered. Each dog was weaned off its cardiovascular drugs (furosemide, digoxin, and an angiotensin converting enzyme inhibitor) if an echocardiographic response was identified. At the 4-month time period, each investigator was asked to decide whether he or she thought his or her patient was receiving placebo or taurine/carnitine, based on presence or absence of clinical and echocardiographic improvement. Unblinding then occurred, and dogs receiving placebos were switched to taurine and carnitine supplementation and followed monthly for 4 additional months. All dogs were reexamined 6 months after starting supplementation; survival time and cause of death were recorded for each dog. Data from 3 dogs were not included because of multiple protocol violations. Each dog had a plasma taurine concentration < 50 nmol/mL (mean +/- SD for the group 15 +/- 17 nmol/ mL) at baseline; normal range, 50-180 nmol/mL. The plasma taurine concentration did not exceed 50 nmol/mL at any time in the dogs receiving placebos (n = 5), but increased to 357 +/- 157 nmol/mL (range 140-621 nmol/mL) during taurine and carnitine supplementation (n = 11). Plasma carnitine concentration was within, only slightly below, or slightly above reported limits of normality at baseline (29 +/- 15 mumol/L); did not change during placebo administration; and increased significantly during supplementation (349 +/- 119 mumol/L; n = 11). Echocardiographic variables did not change during placebo administration. During supplementation, left ventricular end-diastolic and end-systolic diameters, and mitral valve E point-to-septal separation decreased significantly in both groups. Shortening fraction increased significantly but not into the normal range. Echocardiographic variables remained improved at 6 months. All dogs were successfully weaned off furosemide, an angiotensin converting enzyme inhibitor, and digoxin once an echocardiographic response was identified. Nine of the dogs have died since the onset of the study in 1992. One dog died of recurrence of DCM and heart failure 31 months after starting supplementation; six dogs died of noncardiac causes. Two dogs developed degenerative mitral valve disease and died of complications of this disease. Dogs less than 10 years of age lived for 46 +/- 11 months, whereas dogs older than 10 years of age lived for 14 +/- 7 months. Two of the 11 dogs were alive at the time of publication, having survived for 3.5 and 4.5 years, respectively. We conclude that ACS with DCM are taurine-deficient and are responsive to taurine and carnitine supplementation. Whereas myocardial function did not return to normal in most dogs, it did improve enough to allow discontinuation of cardiovascular drug therapy and to maintain a normal quality of life for months to years.

Taming the silicon dragon.

This article is an introduction to how computers work. Although many can begin to use this tool without any formal knowledge of its components or how they work together, only a functional understanding of these aspects can really unleash the power and capabilities available and allow you to proceed without fear that some mysterious force will come up and "eat the data" or somehow cause some other damage to the system. Through an inspection of the terminology, anatomical dissection, and physiology of our imagined "silicon dragon," we can appreciate the qualities of the beast, dispell our fears, and take real control of this potentially awesome tool. Although the basic information is perforce, quite technical in nature, the article is meant both to be readable and also provide a reference for terms and concepts mentioned both elsewhere in this issue, as well as generally. It is especially useful to be refreshed on these terms and concepts when considering an initial purchase or upgrade of computer equipment.

On-line veterinary communities: the time is now or I've got a modem: what should I do with it? Where should I point it?

Veterinary medicine has until recently existed as a small and geographically diffuse group of professionals. Communicating with significant numbers of colleagues to confer on cases or business related issues on a regular basis has been limited primarily to those in academia. Isolation has prevented the individual practice from significantly affecting the policies of national suppliers or the politics of organized veterinary medicine through a large unified voice. Although only a small percentage of the profession is on-line, the building of on-line communities of veterinarians is currently changing the rules in these areas. Considering when, why, and how to venture into the world of on-line veterinary medicine is only part of the issue we face as a profession. Choosing to keep a sense of community as the centerpiece of on-line veterinary interactions is critical to ensuring that on-line veterinary medicine, above all, serves the best interests of the practicing veterinarian.

Distance learning in veterinary medicine: enhancing interactivity in continuing education.

Technological advances have made distance veterinary continuing education a reality. Distance interactive continuing education programs using computer and modern are currently being offered via Veterinary Information Network (VIN) on the America Online (AOL) computer network and the Network of Animal Health (NOAH) on CompuServe. Using over 500 hours of course experience on VIN as an example, this article describes the technology involved in delivering online instruction including electronic mail, asynchronous bulletin board interactions, electronic library files, and realtime interactive discussions. These formats take advantage of the standard features of the network AOL are mixed with links to Worldwide Web sites, print and electronic publications, and even coordinated with "offline" meetings. The paradigm of learning is somewhat different than traditional "offline" or "onsite" meetings in that learning takes place over a period of 2 to 20 weeks, allowing the participating veterinarian to interact with instructors while applying the information in practice. Continual learning is encouraged as participants are allowed to participate in a course offered in sequential years. The successful online instructors tend to take advantage of electronic communications to encourage instructor-participant and participant-participant interactivity. The majority of course participants seek an additional challenge or greater interactivity in their continuing education experience; however, some veterinarians seek distance continuing education for practical reasons, including the ability to pursue additional education without leaving a solo practice, temporary or permanent physical disabilities, family considerations, or military service. Distance learning is a viable educational format, the role for which will evolve as technology and the base of experience with it expands.

Submaximal exercise testing using lactate threshold and venous oxygen tension as endpoints in normal dogs and in dogs with heart failure.

Twelve normal dogs and 7 dogs with experimentally induced heart failure were chronically instrumented to measure hemodynamic variables and blood gas tensions at rest and during graded treadmill exercise. Three groups of 4 normal dogs each (group 1, 15 to 20 kg; group 2, 21 to 30 kg; group 3, 31 to 40 kg) were exercised on a treadmill at a 16% grade at 1, 2, and 3 miles per hour, and at a 22% and a 26% grade at 3 miles per hour (5 total exercise levels) until blood lactate concentration increased to a value greater than 1 mmol/L. Blood lactate concentration and blood gas tensions were measured 5 and 15 minutes after starting exercise, and cardiac output was measured between 8 and 10 minutes of exercise. Results indicated that the same exercise protocol could be used for dogs ranging in size from 15 to 40 kg. Blood lactate concentration increased in normal dogs at varying workloads, but always at or above a workload of 3 miles per hour at a 16% grade. Dogs with class IV heart failure always experienced an increase in blood lactate concentration when walked at 1 mile per hour at a 16% grade for 5 minutes. A femoral vein PO2 between 21 and 24 mm Hg in normal dogs, and between 16 and 22 mm Hg in dogs with heart failure was always associated with an increase in blood lactate concentration. The primary problem with this exercise protocol was the unwillingness of some dogs to walk on the treadmill during the preselection phase. We conclude that we have devised a submaximal exercise test that can be used to evaluate exercise capability in dogs ranging in size from 15 to 40 kg, that the described exercise protocol can be used to identify decreased flow reserve in dogs with class IV heart failure induced by rapid ventricular pacing, and that either femoral vein oxygen tension or blood lactate concentration can be used as the endpoint for submaximal exercise testing in dogs.

Plasma taurine concentrations in normal dogs and in dogs with heart disease.

Plasma taurine concentrations were determined in 76 dogs with dilated cardiomyopathy (DCM), 28 dogs with acquired valvular disease (AVD), and 47 normal (control) dogs. The data were collected at 2 referral centers, The Animal Medical Center, New York, NY (AMC), and the University of California, Davis (UCD), and the studies were conducted independently. Different anticoagulants (sodium citrate at AMC and lithium heparin at UCD) were used to collect the plasma samples. Paired analysis of samples showed a significant difference in plasma taurine concentrations, depending on the anticoagulant used. Consequently, results from each clinic were analyzed separately. Plasma taurine concentrations were significantly higher in dogs with AVD (median, 133 nmol/mL; range, 25 to 229 nmol/mL) than in control dogs (median, 63 nmol/mL; range 44 to 224 nmol/mL) and dogs with DCM (median, 72 nmol/mL; range, 1 to 247 nmol/mL) at AMC (P < .001). The number of dogs with AVD at UCD was too small to draw meaningful conclusions. At UCD, the median plasma taurine concentration was 98 nmol/mL (range, 28-169 nmol/mL) in dogs with AVD, 75 nmol/mL (range, 0.1-184 nmol/mL) in dogs with DCM, and 88 nmol/mL (range 52-180 nmol/mL) in control dogs. There were no significant differences in plasma taurine concentrations between dogs with DCM and the control dogs at either hospital. Congestive heart failure and administration of cardiac medication had no significant effect on plasma taurine concentrations. Plasma taurine concentration was low (< 25 nmol/mL) in 17% (13/76) of the dogs with DCM. Seven of the 13 dogs with low plasma taurine concentrations were Cocker Spaniels or Golden Retrievers.(ABSTRACT TRUNCATED AT 250 WORDS)

The natural clinical history of canine congenital subaortic stenosis.

The demographics and natural clinical history of canine congenital subaortic stenosis (SAS) were evaluated by retrospective analysis of 195 confirmed cases (1967 to 1991), 96 of which were untreated and available for follow-up evaluation. Of these, 58 dogs had left ventricular outflow systolic pressure gradients available for assessment of severity. All 195 dogs were used for demographic analysis. Breeds found to be at increased relative risk included the Newfoundland (odds ratio, 88.1; P < .001), Rottweiler (odds ratio, 19.3; P < .001), Boxer (odds ratio, 8.6; P < .001), and Golden Retriever (odds ratio, 5.5; P < .001). Dogs with mild gradients (16 to 35 mm Hg) and those that developed infective endocarditis or left heart failure were diagnosed at older ages than those with moderate (36 to 80 mm Hg) and severe (> 80 mm Hg) gradients. Of 96 untreated dogs, 32 (33.3%) had signs of illness varying from fatigue to syncope; 11 dogs (11.3%) developed infective endocarditis or left heart failure. Exercise intolerance or fatigue was reported in 22 dogs, syncope in 11 dogs, and respiratory signs (cough, dyspnea, tachypnea) in 9 dogs. In addition, 21 dogs (21.9%) died suddenly. Sudden death occurred mainly in the first 3 years of life, primarily but not exclusively, in dogs with severe obstructions (gradient, > 80 mm Hg; odds ratio, 16.0; P < .001). Infective endocarditis (6.3%) and left heart failure (7.3%) tended to occur later in life and in dogs with mild to moderate obstructions.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of thyroid hormone and thyroid dysfunction on the cardiovascular system.

Thyroid disease is common in veterinary practice. The heart, especially the myocardium, is sensitive to thyroid hormone, and deficiencies or excesses can alter cardiovascular function. Observed changes result from direct effects upon the myocardium and indirect effects that result from effects upon the vasculature and peripheral tissues. Clinically significant cardiovascular abnormalities related to hypothyroidism are rare. If present, they are primarily manifest as reduced left ventricular pump function, as apparent echocardiographically, or arrhythmias. Hyperthyroidism is common in the cat and infrequently encountered in dogs. Clinically significant cardiovascular manifestations are common and often dramatic. Hyperdynamic systolic function and mild myocardial hypertrophy are common manifestations which may lead to overt congestive and high output heart failure. If signs of congestive heart failure or significant arrhythmias are not evident, specific therapy need only be directed toward restoration of the euthyroid state. In most cases the cardiovascular changes associated with thyroid dysfunction are completely reversible.

Balloon dilation of congenital subaortic stenosis in the dog.

Balloon dilation during cardiac catheterization was evaluated for the treatment of congenital subaortic stenosis (SAS) in nine dogs. Under general anesthesia, bilateral cardiac catheterization was performed through the right jugular vein and carotid artery. Thermodilution cardiac output, and left ventricular and aortic root pressures and angiograms were obtained before and after balloon dilation. Balloons measuring 18-20 mm in diameter and 30-40 mm in length were positioned across the stenosis and three inflations 4-5 minutes apart were performed. There was no significant change in cardiac output, aortic pressure, or degree of aortic regurgitation after balloon dilation. For the entire group balloon dilation resulted in significant decreases in left ventricular systolic pressure (-61.2 +/- 37.2 mm Hg [mean change +/- SD], range -14 to -123), mean systolic pressure gradient (-39.6 +/- 24.4 mm Hg, range -8.4 to -72.2), and peak systolic pressure gradient (-64.3 +/- 46.5 mm Hg, range -17 to -143). Calculated left ventricular outflow cross-sectional area increased significantly (+.4 +/- .5 cm2, range -.06 to + 1.30). Clinical signs improved in the five symptomatic dogs. Individual hemodynamic responses varied widely, but the magnitude of improvement correlated with the severity of obstruction. Three dogs showed a decrease of 60% or greater (> or = 100 mm Hg), and six dogs showed a decrease of 25-50% (17-71 mm Hg) in peak systolic gradient after balloon dilation. Complications were frequent but most were transient and manageable. These preliminary results suggest that balloon dilation can acutely decrease outflow resistance in dogs with SAS and may be effective therapy for some affected dogs.

The acute haemodynamic effects of captopril in dogs with heart failure.

The acute effects of three doses of captopril (12.5, 25, and 50 mg [approximately 0.5, 1.0, and 2.0 mg/kg]) on several haemodynamic variables and plasma aldosterone concentration were investigated in four dogs with experimentally produced heart failure (rapid ventricular pacing) and one dog with dilated cardiomyopathy. Haemodynamic variables were measured with a Swan-Ganz thermodilution catheter and an indwelling carotid artery catheter at baseline and 1, 2, and 4 h after drug administration. A statistically significant (P < 0.05) decrease in peripheral vascular resistance was observed 1 and 2 h following the 12.5 mg dose. A significant and large enough decrease in peripheral vascular resistance to produce a significant decrease in mean systemic arterial blood pressure was observed 1 and 2 h after administering 25 and 50 mg of captopril. A mild but significant increase in cardiac output was observed 1 h after each dose. The drug effect on systemic arterial blood pressure lasted less than 4 h. No statistically significant changes were observed for the group in pulmonary capillary wedge pressure, right atrial blood pressure, or plasma aldosterone concentration at any time. We conclude that the acute haemodynamic benefits provided by captopril administration were mild and due primarily to arteriolar dilation. Doses of approximately 1-2 mg/kg produced slightly greater arteriolar dilation than an approximate dose of 0.5 mg/kg. The drug effect was short-lived, lasting less than 4 h.

Increased serum growth hormone concentration in feline hypertrophic cardiomyopathy.

Serum growth hormone concentration was measured by radioimmunoassay in 31 cats with hypertrophic cardiomyopathy, 38 normal cats, and 35 cats with other cardiac disease. Cats with hypertrophic cardiomyopathy had a significantly increased serum growth hormone concentration when compared with normal cats and cats with other cardiac disease. The serum growth hormone concentration in cats with hypertrophic cardiomyopathy was less than that previously reported in cats with growth hormone secreting pituitary tumors. Pituitary tumors were not identified in eight of the cats with hypertrophic cardiomyopathy examined at necropsy. An increased serum growth hormone concentration may be measured in cats with hypertrophic cardiomyopathy but it is unclear if the increased serum growth hormone concentration is a cause or effect of hypertrophic cardiomyopathy.

Clinical findings in cats with dilated cardiomyopathy and relationship of findings to taurine deficiency.

Between October 1986 and September 1988, 37 cats with moderate to severe idiopathic myocardial failure (dilated cardiomyopathy) were evaluated prospectively. Low plasma taurine concentration and diet history including foods that can cause taurine deficiency were documented in most of the cats. Comparison with a retrospectively studied population of 33 cats with dilated cardiomyopathy diagnosed between 1980 and 1986 demonstrated that the clinical and historical findings in the 33 retrospectively studied cats were similar to those in the 37 cats studied prospectively. Clinical findings in the 2 groups were also similar to findings previously reported in the literature. Because clinical findings and diet history were similar in the prospective and retrospective groups, we believe that many cats in the latter group had diet-induced taurine deficiency. These findings support the conclusion that most cases of dilated cardiomyopathy in cats have a common etiopathogenesis related to diet and as such are preventable.

Response of cats with dilated cardiomyopathy to taurine supplementation.

Between October 1986 and September 1988, 37 cats with moderate to severe idiopathic myocardial failure (dilated cardiomyopathy) were evaluated. Clinical management of these cats was similar to that described in the literature, except that it also included administration of 500 or 1,000 mg of the sulfur amino acid, taurine per day. Early death (death within the first 30 days of treatment) occurred in 14 (38%) cats. One cat was lost to follow-up evaluation. Twenty-two cats (59%) had marked clinical and echocardiographic improvement and survived longer than 240 days. In all but 1 cat, the observed improvement in echocardiographic measurements persisted. Hypothermia and thromboembolism were positively associated with an increased risk of early death. Administration of digoxin did not significantly affect survival. All 22 cats that survived greater than 30 days remained clinically stable despite withdrawal of all medications except taurine. Administration of taurine was eventually discontinued in 20 of the 22 cats and adequate taurine intake was thereafter provided for in the food. The clinical response and 1-year survival rate of 58% (21 of 36 cats with a known outcome) in the taurine-treated group represents a marked improvement, compared with a 1-year survival rate of 13% (4 of 31 cats with a known outcome) in a retrospectively evaluated population of 33 cats with dilated cardiomyopathy.