{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T00:54:19Z","timestamp":1793235259115,"version":"4.5.0"},"reference-count":125,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Vet. Sci."],"abstract":"<jats:p>The hypertrophic cardiomyopathy (HCM) phenotype is closely associated with arterial thromboembolism (ATE). The pathophysiology of ATE is linked to activation of Virchow\u2019s triad, characterized by endothelial injury, blood stasis, and hypercoagulability. Together, these factors create a prothrombotic microenvironment that may precede overt clinical manifestations. Although spontaneous echocardiographic contrast (SEC) is widely used in clinical practice as a marker of thromboembolic risk, it should be regarded as a late finding. This review explores the early activation of Virchow\u2019s triad in cats with HCM phenotype, with emphasis on atrial remodeling, hemodynamic alterations, and endothelial dysfunction preceding detectable SEC. Evidence suggests that changes in left atrial appendage dynamics contribute to localized stasis, while systemic mechanisms, including platelet activation, thrombin generation, and inflammatory processes, promote a hypercoagulable state. Additionally, the presence of SEC should be interpreted as a biomarker of blood stasis rather than a causal factor. Reliance on SEC for thrombotic risk assessment reflects limitations in identifying the pre-thrombotic state, particularly due to the lack of standardized biomarkers for routine clinical use. Therefore, improved thromboembolic risk stratification in cats with HCM phenotype is needed. Overall, thrombogenesis in cats with cardiac disease is a dynamic, multifactorial, and progressive process that begins prior to detectable echocardiographic changes. A clearer understanding of these mechanisms may enable earlier identification of high-risk patients and support preventive therapeutic strategies. This review analyzes the early activation of Virchow\u2019s triad in cats with HCM phenotype and its relationship with atrial thrombus formation, with emphasis on thrombogenic mechanisms preceding SEC and their implications for ATE.<\/jats:p>","DOI":"10.3389\/fvets.2026.1870206","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T17:49:58Z","timestamp":1783014598000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Early activation of Virchow\u2019s triad in feline hypertrophic cardiomyopathy: beyond spontaneous echo contrast and insights into translational thromboembolism"],"prefix":"10.3389","volume":"13","author":[{"given":"Felipe Gaia","family":"de Sousa","sequence":"first","affiliation":[{"name":"Department of Veterinary Clinic and Surgery, Veterinary School, Federal University of Minas Gerais \u2013 UFMG","place":["Belo Horizonte, Minas Gerais, Brazil"]},{"name":"VETHEART \u2013 Cardiovascular Physiology and Veterinary Cardiology Research Group","place":["Belo Horizonte, Minas Gerais, Brazil"]},{"name":"National Institute of Science and Technology in Nanobiopharmaceutics \u2013 INCT NanoBiofar","place":["Belo Horizonte, Minas Gerais, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruthnea Aparecida L\u00e1zaro","family":"Muzzi","sequence":"additional","affiliation":[{"name":"VETHEART \u2013 Cardiovascular Physiology and Veterinary Cardiology Research Group","place":["Belo Horizonte, Minas Gerais, Brazil"]},{"name":"Department of Veterinary Medicine, Faculty of Animal Science and Veterinary Medicine, Federal University of Lavras \u2013 FZMV\/UFLA","place":["Lavras, Minas Gerais, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto Baracat","family":"de Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Department of Veterinary Clinic and Surgery, Veterinary School, Federal University of Minas Gerais \u2013 UFMG","place":["Belo Horizonte, Minas Gerais, Brazil"]},{"name":"VETHEART \u2013 Cardiovascular Physiology and Veterinary Cardiology Research Group","place":["Belo Horizonte, Minas Gerais, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael Resende","family":"Faleiros","sequence":"additional","affiliation":[{"name":"Department of Veterinary Clinic and Surgery, Veterinary School, Federal University of Minas Gerais \u2013 UFMG","place":["Belo Horizonte, Minas Gerais, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzane Lilian","family":"Beier","sequence":"additional","affiliation":[{"name":"Department of Veterinary Clinic and Surgery, Veterinary School, Federal University of Minas Gerais \u2013 UFMG","place":["Belo Horizonte, Minas Gerais, Brazil"]},{"name":"VETHEART \u2013 Cardiovascular Physiology and Veterinary Cardiology Research Group","place":["Belo Horizonte, Minas Gerais, Brazil"]},{"name":"National Institute of Science and Technology in Nanobiopharmaceutics \u2013 INCT NanoBiofar","place":["Belo Horizonte, Minas Gerais, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1720886","DOI":"10.3389\/fvets.2025.1720886","article-title":"Linking clinical and imaging diagnostic assessments of the feline hypertrophic cardiomyopathy phenotype","volume":"12","author":"de Sousa","year":"2025","journal-title":"Front Vet Sci"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1111\/jvim.15745","article-title":"ACVIM consensus statement guidelines for the classification, diagnosis, and management of cardiomyopathies in cats","volume":"34","author":"Luis Fuentes","year":"2020","journal-title":"J Vet Intern Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1016\/j.cvsm.2023.05.012","article-title":"Predicting development of hypertrophic cardiomyopathy and disease outcomes in cats","volume":"53","author":"Novo Matos","year":"2023","journal-title":"Vet Clin N Am - Small Anim Pract"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"S244","DOI":"10.1016\/j.jvc.2015.03.008","article-title":"Cardiomyopathy prevalence in 780 apparently healthy cats in rehoming centres (the CatScan study)","volume":"17","author":"Payne","year":"2015","journal-title":"J Vet Cardiol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1900","DOI":"10.1111\/jvim.16576","article-title":"Natural history of hypertrophic cardiomyopathy in cats from rehoming centers: the CatScan II study","volume":"36","author":"Novo Matos","year":"2022","journal-title":"J Vet Intern Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"S318","DOI":"10.1016\/j.jvc.2015.09.008","article-title":"Risk factors associated with sudden death vs. congestive heart failure or arterial thromboembolism in cats with hypertrophic cardiomyopathy","volume":"17","author":"Payne","year":"2015","journal-title":"J Vet Cardiol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2572","DOI":"10.1111\/jvim.15609","article-title":"Long-term incidence and risk of noncardiovascular and all-cause mortality in apparently healthy cats and cats with preclinical hypertrophic cardiomyopathy","volume":"33","author":"Fox","year":"2019","journal-title":"J Vet Intern Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1111\/jvim.15122","article-title":"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","volume":"32","author":"Fox","year":"2018","journal-title":"J Vet Intern Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"3320","DOI":"10.3390\/ani14223320","article-title":"Differences in the impact of left ventricular outflow tract obstruction on intraventricular pressure gradient in feline hypertrophic cardiomyopathy","volume":"14","author":"Hirose","year":"2024","journal-title":"Animals"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1191211","DOI":"10.3389\/fvets.2023.1191211","article-title":"Comparative study of myocardial function in cases of feline hypertrophic cardiomyopathy with and without dynamic left-ventricular outflow-tract obstruction","volume":"10","author":"Saito","year":"2023","journal-title":"Front Vet Sci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.jvc.2020.05.001","article-title":"Evaluation of N-terminal prohormone of brain natriuretic peptide and cardiac troponin-I levels in cats with systolic anterior motion of the mitral valve in the absence of left ventricular hypertrophy","volume":"30","author":"Ferasin","year":"2020","journal-title":"J Vet Cardiol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"2982","DOI":"10.1111\/jvim.17203","article-title":"Longitudinal assessment of systolic anterior motion of the mitral valve in cats with hypertrophic cardiomyopathy","volume":"38","author":"Seo","year":"2024","journal-title":"J Vet Intern Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1718","DOI":"10.1111\/jvim.15807","article-title":"Biomarker changes with systolic anterior motion of the mitral valve in cats with hypertrophic cardiomyopathy","volume":"34","author":"Seo","year":"2020","journal-title":"J Vet Intern Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1177\/1098612X211021819","article-title":"The feline cardiomyopathies: 1. General concepts","volume":"23","author":"Kittleson","year":"2021","journal-title":"J Feline Med Surg"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1177\/1098612X211020162","article-title":"The feline cardiomyopathies: 2. Hypertrophic cardiomyopathy","volume":"23","author":"Kittleson","year":"2021","journal-title":"J Feline Med Surg"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"289","DOI":"10.3390\/vetsci12030289","article-title":"Clinical-diagnostic and therapeutic advances in feline hypertrophic cardiomyopathy","volume":"12","author":"Gaia de Sousa","year":"2025","journal-title":"Vet Sci"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"aalaf037","DOI":"10.1093\/jvimsj\/aalaf037","article-title":"Accuracy of combined signalment, physical examination and cardiac biomarkers in screening cats with asymptomatic murmurs for cardiac disease","volume":"40","author":"Carter","year":"2026","journal-title":"J Vet Intern Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.jvc.2024.05.003","article-title":"Clinical signs associated with severe ST segment elevation in three cats with a hypertrophic cardiomyopathy phenotype","volume":"54","author":"Seo","year":"2024","journal-title":"J Vet Cardiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"12263","DOI":"10.1038\/s41598-025-96245-7","article-title":"Cardiomyopathy and thrombogenesis in cats through left atrial morphological and fluid dynamics analysis","volume":"15","author":"Pons","year":"2025","journal-title":"Sci Rep"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.1111\/jvim.12215","article-title":"Prognostic indicators in cats with hypertrophic cardiomyopathy","volume":"27","author":"Payne","year":"2013","journal-title":"J Vet Intern Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/1098612X241257878","article-title":"Feline aortic thromboembolism: recent advances and future prospects","volume":"26","author":"Guillaumin","year":"2024","journal-title":"J Feline Med Surg"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"168","DOI":"10.3121\/cmr.2009.866","article-title":"Virchow\u2019s contribution to the understanding of thrombosis and cellular biology","volume":"8","author":"Kumar","year":"2010","journal-title":"Clin Med Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"173","DOI":"10.37547\/ijmscr\/Volume05Issue11-32","article-title":"Mechanism of the Virchow\u2019s triad in the development of thrombosis","volume":"5","author":"Zabixullaevich","year":"2025","journal-title":"Int J Med Sci Clin Res"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1016\/j.cvsm.2023.06.002","article-title":"Preventing cardiogenic thromboembolism in cats: literature gaps, rational recommendations, and future therapies","volume":"53","author":"Shaverdian","year":"2023","journal-title":"Vet Clin N Am - Small Anim Pract"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"8776","DOI":"10.3390\/ijms26188776","article-title":"Are procoagulant platelets an emerging therapeutic target? A general review with an emphasis on their clinical significance in companion animals","volume":"26","author":"Shaverdian","year":"2025","journal-title":"Int J Mol Sci"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1016\/j.cvsm.2017.05.001","article-title":"Feline cardiogenic arterial thromboembolism: prevention and therapy","volume":"47","author":"Hogan","year":"2017","journal-title":"Vet Clin North Am - Small Animal Pract"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"S306","DOI":"10.1016\/j.jvc.2015.10.004","article-title":"Secondary prevention of cardiogenic arterial thromboembolism in the CAT: the double-blind, randomized, positive-controlled feline arterial thromboembolism; clopidogrel vs. aspirin trial (FAT CAT)","volume":"17","author":"Hogan","year":"2015","journal-title":"J Vet Cardiol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2460\/javma.24.09.0584","article-title":"Therapy with clopidogrel or rivaroxaban has equivalent impacts on recurrence of thromboembolism and survival in cats following cardiogenic thromboembolism: the SUPERCAT study","volume":"263","author":"Brainard","year":"2025","journal-title":"J Am Vet Med Assoc"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1630","DOI":"10.3390\/ani15111630","article-title":"Evolving FATE: a new lens on the pathogenesis and management of feline cardiogenic arterial thromboembolism","volume":"15","author":"Yeh","year":"2025","journal-title":"Animals"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1111\/vec.12509","article-title":"Retrospective evaluation of the incidence and prognostic significance of spontaneous echocardiographic contrast in relation to cardiac disease and congestive heart failure in cats: 725 cases (2006-2011)","volume":"26","author":"Peck","year":"2016","journal-title":"J Vet Emerg Crit Care (San Antonio)"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"487","DOI":"10.24425\/pjvs.2024.151743","article-title":"Assessment of left atrial size, left atrial volume and left ventricular function, and its relation to spontaneous echocardiographic contrast in cats with hypertrophic cardiomyopathy: a preliminary study","volume":"27","author":"Colakoglu","year":"2024","journal-title":"Pol J Vet Sci"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"892377","DOI":"10.3389\/fvets.2022.892377","article-title":"Platelet priming and activation in naturally occurring thermal burn injuries and wildfire smoke exposure is associated with intracardiac thrombosis and spontaneous echocardiographic contrast in feline survivors","volume":"9","author":"Tan","year":"2022","journal-title":"Front Vet Sci"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1111\/j.1939-1676.2006.tb02831.x","article-title":"Assessment of left atrial appendage flow velocity and its relation to spontaneous echocardiographic contrast in 89 cats with myocardial disease","volume":"20","author":"Schober","year":"2006","journal-title":"J Vet Intern Med"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1055\/a-2688-6741","article-title":"Left atrial spontaneous echo contrast: pathogenesis, detection, and modelling","author":"Melidoro","year":"2025","journal-title":"Thromb Haemost"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/S0140-6736(09)60040-4","article-title":"Mechanisms of thrombogenesis in atrial fibrillation: Virchow\u2019s triad revisited","volume":"373","author":"Watson","year":"2009","journal-title":"Lancet"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"11447","DOI":"10.3390\/ijms252111447","article-title":"The basic principles of pathophysiology of venous thrombosis","volume":"25","author":"Schulman","year":"2024","journal-title":"Int J Mol Sci"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1016\/0735-1097(94)90644-0","article-title":"Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo","volume":"23","author":"Fatkin","year":"1994","journal-title":"JACC"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1038\/s41569-018-0110-0","article-title":"Platelet biology and functions: new concepts and clinical perspectives","volume":"16","author":"van der Meijden","year":"2019","journal-title":"Nat Rev Cardiol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/j.hoc.2017.11.001","article-title":"Hypercoagulability and vascular disease","volume":"32","author":"Taher","year":"2018","journal-title":"Hematol Oncol Clin North Am"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1186\/s13578-024-01314-5","article-title":"Revisiting Virchow\u2019s triad: exploring the cellular and molecular alterations in cerebral venous congestion","volume":"14","author":"Zhou","year":"2024","journal-title":"Cell Biosci"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1016\/j.jvsv.2019.02.011","article-title":"Virchow\u2019s triad in \u201csilent\u201d deep vein thrombosis","volume":"7","author":"Lurie","year":"2019","journal-title":"J Vasc Surg Venous Lymphat Disord"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"144","DOI":"10.3390\/cells14020144","article-title":"The link between venous and arterial thrombosis: is there a role for endothelial dysfunction?","volume":"14","author":"Donadini","year":"2025","journal-title":"Cells"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"S276","DOI":"10.21037\/cdt.2017.09.01","article-title":"Deep vein thrombosis: pathogenesis, diagnosis, and medical management","volume":"7","author":"Stone","year":"2017","journal-title":"Cardiovasc Diagn Ther"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1111\/jvim.12249","article-title":"Arterial thromboembolism in 250 cats in general practice: 2004-2012","volume":"28","author":"Borgeat","year":"2014","journal-title":"J Vet Intern Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"105942","DOI":"10.1016\/j.rvsc.2025.105942","article-title":"Diagnostic and prognostic significance of platelet large cell count and ratio in cats across stages of hypertrophic cardiomyopathy","volume":"197","author":"Algan","year":"2025","journal-title":"Res Vet Sci"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"727","DOI":"10.7150\/ijms.50167","article-title":"Thromboembolism in patients with hypertrophic cardiomyopathy","volume":"18","author":"Liu","year":"2021","journal-title":"Int J Med Sci"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1093\/ehjci\/jeaf033","article-title":"Left atrial remodelling and function in various left ventricular hypertrophic phenotypes","volume":"26","author":"De Raffele","year":"2025","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1186\/s12968-017-0420-0","article-title":"Left atrial structure and function in hypertrophic cardiomyopathy sarcomere mutation carriers with and without left ventricular hypertrophy","volume":"19","author":"Farhad","year":"2017","journal-title":"J Cardiovasc Magn Reson"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"2167","DOI":"10.1111\/echo.14539","article-title":"Prognostic significance of left ventricular end diastolic pressure using E\/E\u2019 in patients with hypertrophic cardiomyopathy","volume":"36","author":"Badran","year":"2019","journal-title":"Echocardiography"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1186\/s12872-022-02532-w","article-title":"Left atrial dysfunction may precede left atrial enlargement and abnormal left ventricular longitudinal function: a cardiac MR feature tracking study","volume":"22","author":"Zhou","year":"2022","journal-title":"BMC Cardiovasc Disord"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"396","DOI":"10.14740\/cr1690","article-title":"Detection of left atrial Remodeling by three-dimensional echocardiography in symptomatic patients known to had non-obstructive hypertrophic cardiomyopathy","volume":"15","author":"Elkareem","year":"2024","journal-title":"Cardiol Res"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1177\/1098612X20938651","article-title":"Risk indictors in cats with preclinical hypertrophic cardiomyopathy: a prospective cohort study","volume":"23","author":"Ironside","year":"2021","journal-title":"J Feline Med Surg"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1016\/j.ahj.2004.07.017","article-title":"Left atrial volumetric remodeling is predictive of functional capacity in nonobstructive hypertrophic cardiomyopathy","volume":"149","author":"Sachdev","year":"2005","journal-title":"Am Heart J"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1186\/s12917-020-02557-3","article-title":"Assessment of left atrial function in feline hypertrophic cardiomyopathy by using two- dimensional speckle tracking echocardiography","volume":"16","author":"Kiatsilapanan","year":"2020","journal-title":"BMC Vet Res"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.acvd.2020.06.004","article-title":"Left atrial dysfunction as marker of poor outcome in patients with hypertrophic cardiomyopathy","volume":"114","author":"Essayagh","year":"2021","journal-title":"Arch Cardiovasc Dis"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1016\/j.cvsm.2017.05.002","article-title":"Asymptomatic hypertrophic cardiomyopathy: diagnosis and therapy","volume":"47","author":"Luis Fuentes","year":"2017","journal-title":"Vet Clin N Am - Small Anim Pract"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1080\/23144599.2023.2196853","article-title":"Assessment of left atrial myocardial deformation using two-dimensional speckle-tracking echocardiography in cats with cardiogenic and non-cardiogenic arterial thromboembolism","volume":"11","author":"Tosuwan","year":"2023","journal-title":"Int J Vet Sci Med"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"4046","DOI":"10.14202\/vetworld.2025.4046-4055","article-title":"Left atrial stiffness as a novel echocardiographic parameter of atrial dysfunction in cats with hypertrophic cardiomyopathy: a two-dimensional speckle-tracking study","volume":"18","author":"Tohthong","year":"2025","journal-title":"Vet World"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"277","DOI":"10.3390\/vetsci13030277","article-title":"Comparative study of speckle tracking echocardiography in Normal and hypertrophic cardiomyopathy cats","volume":"13","author":"Jeong","year":"2026","journal-title":"Vet Sci"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"10319","DOI":"10.1038\/s41598-023-36932-5","article-title":"Hypertrophic cardiomyopathy in purpose-bred cats with the A31P mutation in cardiac myosin binding protein-C","volume":"13","author":"Stern","year":"2023","journal-title":"Sci Rep"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"5148","DOI":"10.1007\/s00330-018-5519-7","article-title":"Biatrial performance in children with hypertrophic cardiomyopathy: CMR study","volume":"28","author":"Mazurkiewicz","year":"2018","journal-title":"Eur Radiol"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"4006","DOI":"10.26355\/eurrev_202305_32306","article-title":"Evaluation and implications of mitral regurgitation using cMRI in patients with hypertrophic cardiomyopathy","volume":"27","author":"Muresan","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"924","DOI":"10.21037\/cdt-20-461","article-title":"Contemporary narrative review on left atrial strain mechanics in echocardiography: cardiomyopathy, valvular heart disease and beyond","volume":"11","author":"Jain","year":"2021","journal-title":"Cardiovasc Diagn Ther"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"46198","DOI":"10.31083\/rcm46198","article-title":"Left atrial reservoir strain in cardiovascular and systemic disease: advances and clinical applications from physiology to practice","volume":"26","author":"Sonaglioni","year":"2025","journal-title":"Rev Cardiovasc Med"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"e0245934","DOI":"10.1371\/journal.pone.0245934","article-title":"Hemodynamic determinants of left atrial strain in patients with hypertrophic cardiomyopathy: a combined echocardiography and CMR study","volume":"16","author":"Tayal","year":"2021","journal-title":"PLoS One"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/s12968-021-00793-6","article-title":"Incremental value of left atrial booster and reservoir strain in predicting atrial fibrillation in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance study","volume":"23","author":"Raman","year":"2021","journal-title":"J Cardiovasc Magn Reson"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s12872-023-03069-2","article-title":"Predictive value of left atrial strain analysis in adverse clinical events in patients with hypertrophic cardiomyopathy: a CMR study","volume":"23","author":"Tian","year":"2023","journal-title":"BMC Cardiovasc Disord"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.3390\/ani15091313","article-title":"Relationship between cardiac troponin I concentration and myocardial function in hypertrophic cardiomyopathy cats with or without left ventricular outflow tract obstruction","volume":"15","author":"Satomi","year":"2025","journal-title":"Animals"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"106441","DOI":"10.1016\/j.tvjl.2025.106441","article-title":"Evaluation of some cardiac biomarkers in cats with primary and secondary cardiomyopathies","volume":"314","author":"Abdelhaleem","year":"2025","journal-title":"Vet J"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.jvc.2023.06.003","article-title":"Galectin-3 as a novel biomarker in cats with hypertrophic cardiomyopathy","volume":"48","author":"Stack","year":"2023","journal-title":"J Vet Cardiol"},{"key":"ref71","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1161\/CIRCEP.111.965541","article-title":"Left atrial wall stress distribution and its relationship to electrophysiologic remodeling in persistent atrial fibrillation","volume":"5","author":"Hunter","year":"2012","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"ref72","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1038\/s44161-025-00651-z","article-title":"Left atrial wall shear stress correlates with fibrosis in patients with atrial fibrillation","volume":"4","author":"Adamopoulos","year":"2025","journal-title":"Nat Cardiovasc Res"},{"key":"ref73","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1007\/s10237-019-01268-5","article-title":"The impact of wall thickness and curvature on wall stress in patient-specific electromechanical models of the left atrium","volume":"19","author":"Augustin","year":"2020","journal-title":"Biomech Model Mechanobiol"},{"key":"ref74","doi-asserted-by":"publisher","first-page":"250","DOI":"10.3389\/fphys.2018.00250","article-title":"Left ventricular wall stress is sensitive marker of hypertrophic cardiomyopathy with preserved ejection fraction","volume":"9","author":"Zhao","year":"2018","journal-title":"Front Physiol"},{"key":"ref75","doi-asserted-by":"publisher","first-page":"2649","DOI":"10.1016\/j.jacc.2020.03.064","article-title":"Evaluation of mavacamten in symptomatic patients with nonobstructive hypertrophic cardiomyopathy","volume":"75","author":"Ho","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"ref76","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.tvjl.2014.11.018","article-title":"Myocardial collagen deposition and inflammatory cell infiltration in cats with pre-clinical hypertrophic cardiomyopathy","volume":"203","author":"Khor","year":"2015","journal-title":"Vet J"},{"key":"ref77","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1177\/0300985819837717","article-title":"Feline hypertrophic cardiomyopathy: the consequence of cardiomyocyte-initiated and macrophage-driven remodeling processes?","volume":"56","author":"Kitz","year":"2019","journal-title":"Vet Pathol"},{"key":"ref78","doi-asserted-by":"publisher","first-page":"20169","DOI":"10.1038\/s41598-020-76809-5","article-title":"Micro-computed tomography (micro-CT) for the assessment of myocardial disarray, fibrosis and ventricular mass in a feline model of hypertrophic cardiomyopathy","volume":"10","author":"Novo Matos","year":"2020","journal-title":"Sci Rep"},{"key":"ref79","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1177\/03009858211062631","article-title":"Feline hypertrophic cardiomyopathy: reduced microvascular density and involvement of CD34+ interstitial cells","volume":"59","author":"Rodr\u00edguez","year":"2022","journal-title":"Vet Pathol"},{"key":"ref80","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.5455\/OVJ.2025.v15.i3.16","article-title":"Myocardial expression of connexin 43 in cats with hypertrophic and restrictive cardiomyopathy phenotype","volume":"15","author":"Oleynikov","year":"2025","journal-title":"Open Vet J"},{"key":"ref81","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1016\/j.rvsc.2021.03.027","article-title":"Myocardial transcription of inflammatory and remodeling markers in cats with hypertrophic cardiomyopathy and systemic diseases associated with an inflammatory phenotype","volume":"136","author":"Fonfara","year":"2021","journal-title":"Res Vet Sci"},{"key":"ref82","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1111\/jvim.12325","article-title":"Platelet activation in cats with hypertrophic cardiomyopathy","volume":"28","author":"Tablin","year":"2014","journal-title":"J Vet Intern Med"},{"key":"ref83","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.jvc.2004.11.001","article-title":"Doppler echocardiographic assessment of left atrial appendage flow velocities in normal cats","volume":"7","author":"Schober","year":"2005","journal-title":"J Vet Cardiol"},{"key":"ref84","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1007\/s10741-023-10298-2","article-title":"Assessment of left atrial appendage function by echocardiography","volume":"28","author":"Ito","year":"2023","journal-title":"Heart Fail Rev"},{"key":"ref85","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1093\/europace\/euz212","article-title":"The left atrial appendage in humans: structure, physiology, and pathogenesis","volume":"22","author":"Karim","year":"2020","journal-title":"Europace"},{"key":"ref86","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.jcpa.2021.09.001","article-title":"Correlation of histopathological changes in the left atrium and left atrial appendage with the degree of dilation in cats","volume":"189","author":"Grassinger","year":"2021","journal-title":"J Comp Pathol"},{"key":"ref87","first-page":"1251","article-title":"The left atrial appendage: anatomy, function, and noninvasive evaluation","volume-title":"JACC: Cardiovascular Imaging","author":"Beigel","year":"2014"},{"key":"ref88","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1111\/jvim.15976","article-title":"Effects of pimobendan on left atrial transport function in cats","volume":"35","author":"Kochie","year":"2021","journal-title":"J Vet Intern Med"},{"key":"ref89","doi-asserted-by":"publisher","first-page":"110134","DOI":"10.1016\/j.compbiomed.2025.110134","article-title":"Modelling of thrombus formation, growth and embolisation in the left atrial appendage under atrial fibrillation","volume":"191","author":"Lo Presti","year":"2025","journal-title":"Comput Biol Med"},{"key":"ref90","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1111\/j.1939-1676.2008.0098.x","article-title":"Hypercoagulability in cats with cardiomyopathy","volume":"22","author":"Stokol","year":"2008","journal-title":"J Vet Intern Med"},{"key":"ref91","doi-asserted-by":"publisher","first-page":"41","DOI":"10.3390\/vetsci803","article-title":"Updates on laboratory evaluation of feline cardiac diseases","volume":"8","author":"Gavazza","year":"2021","journal-title":"Vet Sci"},{"key":"ref92","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1111\/j.1939-165X.2008.00062.x","article-title":"Platelet function in clinically healthy cats and cats with hypertrophic cardiomyopathy: analysis using the Platelet Function Analyzer-100","volume":"37","author":"Jandrey","year":"2008","journal-title":"Vet Clin Pathol"},{"key":"ref93","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1111\/vcp.12641","article-title":"Analytical validation of platelet microparticle quantification in cats","volume":"47","author":"Cremer","year":"2018","journal-title":"Vet Clin Pathol"},{"key":"ref94","doi-asserted-by":"publisher","first-page":"1480756","DOI":"10.3389\/fvets.2024.1480756","article-title":"A novel technique to characterize procoagulant platelet formation and evaluate platelet procoagulant tendency in cats by flow cytometry","volume":"11","author":"Shaverdian","year":"2024","journal-title":"Front Vet Sci"},{"key":"ref95","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1111\/jvim.16676","article-title":"Circulating neutrophil extracellular traps in cats with hypertrophic cardiomyopathy and cardiogenic arterial thromboembolism","volume":"37","author":"Li","year":"2023","journal-title":"J Vet Intern Med"},{"key":"ref96","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1177\/1098612X251376773","article-title":"Evaluation of neutrophil:lymphocyte and platelet:neutrophil ratios and their prognostic utility in cats with hypertrophic cardiomyopathy and cardiogenic arterial thromboembolism","volume":"27","author":"Yoon","year":"2025","journal-title":"J Feline Med Surg"},{"key":"ref97","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1111\/j.1939-165x.2007.tb00203.x","article-title":"Evaluation of coagulation markers in the plasma of healthy cats and cats with asymptomatic hypertrophic cardiomyopathy","volume":"36","author":"B\u00e9dard","year":"2007","journal-title":"Vet Clin Pathol"},{"key":"ref98","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1055\/s-0039-1697956","article-title":"Fibrin clot properties and thrombin generation in hypertrophic cardiomyopathy","volume":"120","author":"Rubi\u015b","year":"2020","journal-title":"Thromb Haemost"},{"key":"ref99","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1111\/j.1939-165X.2011.00302.x","article-title":"Viscoelastic coagulation testing: technology, applications, and limitations","volume":"40","author":"Mcmichael","year":"2011","journal-title":"Vet Clin Pathol"},{"key":"ref100","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1111\/vcp.12916","article-title":"Establishment of a reference interval for a novel viscoelastic coagulometer and comparison with thromboelastography in healthy cats","volume":"49","author":"Rosati","year":"2020","journal-title":"Vet Clin Pathol"},{"key":"ref101","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.tvjl.2018.11.002","article-title":"Characteristics of hyperfibrinolysis in dogs and cats demonstrated by rotational thromboelastometry (ROTEM)","volume":"242","author":"Sigrist","year":"2018","journal-title":"Vet J"},{"key":"ref102","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/j.rvsc.2015.03.005","article-title":"Reference intervals for thromboelastometry with the ROTEM\u00ae delta in cats","volume":"100","author":"D\u00f6derlein","year":"2015","journal-title":"Res Vet Sci"},{"key":"ref103","first-page":"1","volume-title":"Tromboelastometry (ROTEM) in Maine Coon breed cats carriers and no carriers of A31P mutation in the MYBPC3 gene for hipertrofic myocardiopathy","author":"Assun\u00e7\u00e3o","year":"2019"},{"key":"ref104","doi-asserted-by":"publisher","first-page":"775","DOI":"10.2460\/ajvr.73.6.775","article-title":"Kaolin-activated thromboelastography in echocardiographically normal cats","volume":"73","author":"Hall","year":"2012","journal-title":"Am J Vet Res"},{"key":"ref105","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1186\/s12917-017-1278-y","article-title":"Preliminary reference intervals and the impact of citrate storage time for thrombelastography in cats including delta and the velocity curve","volume":"13","author":"Engelen","year":"2017","journal-title":"BMC Vet Res"},{"key":"ref106","doi-asserted-by":"publisher","first-page":"2045","DOI":"10.1111\/jvim.17050","article-title":"Viscoelastic coagulation monitoring parameters in cats with acute arterial thromboembolism","volume":"38","author":"Johnson","year":"2024","journal-title":"J Vet Intern Med"},{"key":"ref107","doi-asserted-by":"publisher","first-page":"e70250","DOI":"10.1111\/jvim.70250","article-title":"Applicability of global hemostatic tools for evaluation of Hemostatic state and detection of thrombosis in cats with cardiomyopathies","volume":"39","author":"Langhorn","year":"2025","journal-title":"J Vet Intern Med"},{"key":"ref108","doi-asserted-by":"publisher","first-page":"29768675231208426","DOI":"10.1177\/29768675231208426","article-title":"Review of Thromboelastography (TEG): medical and surgical applications","volume":"18","author":"Whitton","year":"2023","journal-title":"Ther Adv Pulm Crit Care"},{"key":"ref109","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1182\/hematology.2020000090","article-title":"\u201cTEG talk\u201d: expanding clinical roles for thromboelastography and rotational thromboelastometry","volume":"2020","author":"Selby","year":"2020","journal-title":"Hematology Am Soc Hematol Educ Program"},{"key":"ref110","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1308\/rcsann.2025.0091","article-title":"Thromboelastography and clinical outcomes in peripheral arterial disease: a systematic review and narrative synthesis","volume":"108","author":"Broomfield","year":"2026","journal-title":"Ann R Coll Surg Engl"},{"key":"ref111","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1016\/j.jvs.2021.11.037","article-title":"A systematic review of thromboelastography utilization in vascular and endovascular surgery","volume":"75","author":"Kim","year":"2022","journal-title":"J Vasc Surg"},{"key":"ref112","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1186\/s13054-014-0549-2","article-title":"Rotational thromboelastometry predicts thromboembolic complications after major non-cardiac surgery","volume":"18","author":"Hincker","year":"2014","journal-title":"Crit Care"},{"key":"ref113","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1186\/s12873-025-01381-y","article-title":"Clinical utility of thromboelastography in patients with COVID-19: a prospective observational study","volume":"25","author":"Sai","year":"2025","journal-title":"BMC Emerg Med"},{"key":"ref114","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1186\/s13054-020-03260-3","article-title":"Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study","volume":"24","author":"Shah","year":"2020","journal-title":"Crit Care"},{"key":"ref115","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1051\/ject\/2023017","article-title":"A ROTEM-guided algorithm aimed to reduce blood product utilization during neonatal and infant cardiac surgery","volume":"55","author":"Naguib","year":"2023","journal-title":"J Extra Corpor Technol"},{"key":"ref116","doi-asserted-by":"publisher","first-page":"R65","DOI":"10.1530\/ERP-18-0083","article-title":"Left atrial spontaneous echo contrast: relationship with clinical and echocardiographic parameters","volume":"6","author":"Ito","year":"2019","journal-title":"Echo Res Pract"},{"key":"ref117","doi-asserted-by":"publisher","first-page":"788","DOI":"10.5281\/zenodo.10795591","article-title":"Automated spontaneous echo contrast detection using a multisequence attention convolutional neural network HHS public access","volume":"50","author":"Huang","year":"2024","journal-title":"Ultrasound Med Biol"},{"key":"ref118","doi-asserted-by":"publisher","first-page":"1849432","DOI":"10.1155\/cdr\/1849432","article-title":"Does spontaneous Echo contrast in the left atrial appendage increase thromboembolism risk after left atrial appendage closure? A retrospective study on its impact on device-related thrombosis and arterial thromboembolic events","volume":"2025","author":"Zhang","year":"2025","journal-title":"Cardiovasc Ther"},{"key":"ref119","doi-asserted-by":"publisher","first-page":"723280","DOI":"10.3389\/fcvm.2021.723280","article-title":"Left atrial spontaneous echo contrast and ischemic stroke in patients undergoing percutaneous left atrial appendage closure","volume":"8","author":"Wang","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"ref120","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/0735-1097(96)00131-3","article-title":"Integrated backscatter for quantification of left atrial spontaneous echo contrast","volume":"28","author":"Klein","year":"1996","journal-title":"JACC"},{"key":"ref121","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1177\/1098612X211013736","article-title":"Dual therapy with clopidogrel and rivaroxaban in cats with thromboembolic disease","volume":"24","author":"Lo","year":"2022","journal-title":"J Feline Med Surg"},{"key":"ref122","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1161\/ATVBAHA.110.202978","article-title":"Rivaroxaban: a new oral factor Xa inhibitor","volume":"30","author":"Perzborn","year":"2010","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"ref123","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1111\/jvim.14568","article-title":"Platelet activation and clopidogrel effects on ADP-induced platelet activation in cats with or without the A31P mutation in MYBPC3","volume":"30","author":"Li","year":"2016","journal-title":"J Vet Intern Med"},{"key":"ref124","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1177\/1098612X16648182","article-title":"Assessment of platelet function in healthy cats in response to commonly prescribed antiplatelet drugs using three point-of-care platelet function tests","volume":"19","author":"Ho","year":"2017","journal-title":"J Feline Med Surg"},{"key":"ref125","doi-asserted-by":"publisher","first-page":"1390","DOI":"10.1111\/jvim.16727","article-title":"Synergistic inhibitory effects of clopidogrel and rivaroxaban on platelet function and platelet-dependent thrombin generation in cats","volume":"37","author":"Lo","year":"2023","journal-title":"J Vet Intern Med"}],"container-title":["Frontiers in Veterinary Science"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fvets.2026.1870206\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T17:50:01Z","timestamp":1783014601000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fvets.2026.1870206\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":125,"alternative-id":["10.3389\/fvets.2026.1870206"],"URL":"https:\/\/doi.org\/10.3389\/fvets.2026.1870206","relation":{},"ISSN":["2297-1769"],"issn-type":[{"value":"2297-1769","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]},"article-number":"1870206"}}