Cardiovascular biomarkers in feline hypertrophic cardiomyopathy phenotype: evidence from the last decade

The hypertrophic cardiomyopathy (HCM) phenotype is the most common feline cardiovascular condition, characterized by myocardial hypertrophy and variable hemodynamic changes, with diagnosis primarily based on echocardiography. However, cardiovascular biomarkers have gained increasing importance in the diagnostic assessment of the HCM phenotype. This systematic review aimed to evaluate the utility of cardiovascular-related biomarkers in the diagnosis of HCM in cats, in order to determine their clinical potential and utility. A systematic search was conducted in PubMed, Scopus, and Web of Science over a last decade (January 2015 - June 2025). Study selection was performed by a single reviewer, and risk-of-bias assessment by two reviewers using the Joanna Briggs Institute (JBI) tools. Studies providing relevant data on the use of cardiovascular biomarkers in cats with the HCM phenotype were included. Data regarding study design, population characteristics, biomarker type, and clinical associations were extracted and analyzed. Out of 220 initially screened studies, 63 met the inclusion criteria and the majority were considered of high methodological quality with low risk of bias. The most frequently reported biomarkers were N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI), both commonly associated with clinical status, echocardiographic findings, and prognostic risk. Other emerging biomarkers, including molecular and genetic markers related to myocardial remodeling and fibrosis, demonstrated potential clinical utility, although further investigation is still required. Overall, despite robust scientific evidence, biomarkers play an adjunctive role in the evaluation of the feline HCM phenotype. Echocardiography remains the gold standard for definitive diagnosis.