Fetch keynote spotlights murmur triage in dogs with MMVD

A keynote at Fetch Kansas City brought canine cardiology back to the primary care exam room, focusing on one of the most common and most consequential findings in small animal practice: the newly detected murmur. In his August 28, 2026, session, “The Murmur Matters: Addressing Mitral Valve Disease in Primary Care,” Brian A. Scansen, DVM, MS, DACVIM (Cardiology), walked attendees through how to evaluate heart murmurs in dogs, with particular attention to myxomatous mitral valve disease and the decision points that shape staging, diagnostics, and treatment. (dvm360.com)

The topic lands squarely in a long-running clinical tension. MMVD is the most common heart disease in dogs, yet the first murmur often appears before clinical signs, leaving primary care veterinarians to decide whether they’re hearing an incidental finding, an early marker of progressive disease, or a patient who already meets criteria for additional imaging and medical management. According to dvm360’s conference coverage, Scansen’s talk centered on that handoff moment: distinguishing benign from pathologic murmurs based on presentation and risk factors, deciding whether radiographs are sufficient or an echocardiogram is needed, and applying current evidence-based guidance without unnecessarily alarming the pet parent. (dvm360.com)

That framing is consistent with Scansen’s earlier comments to dvm360 this year about why murmurs are still missed in practice. In an April 30, 2026, interview, he said time pressure, suboptimal listening conditions, incomplete auscultation, and clinician hearing limitations can all contribute to missed murmurs. He also noted that some dogs may have no outward signs early in the course of disease, meaning earlier detection can create an opportunity to intervene before congestive heart failure develops. (dvm360.com)

The treatment threshold most clinicians are trying to identify is stage B2 MMVD, where cardiac enlargement is present before clinical signs. The pivotal EPIC trial remains the key evidence base here. In that randomized, blinded, placebo-controlled multicenter study, dogs with preclinical MMVD and cardiomegaly that received pimobendan had an estimated median time to the primary endpoint of 1,228 days, compared with 766 days in the placebo group. Investigators concluded that pimobendan prolonged the preclinical period by about 15 months. Enrollment criteria required a systolic murmur of at least grade 3/6 over the mitral area, plus echo and radiographic evidence of enlargement, including LA/Ao at least 1.6, LVIDDN at least 1.7, and vertebral heart sum greater than 10.5. (pmc.ncbi.nlm.nih.gov)

That helps explain why Scansen’s keynote appears to have emphasized radiographic thresholds and staging discipline rather than a reflexive “murmur equals medication” approach. The conference listing described his session as focused on mitral valve disease in primary care, and dvm360’s article specifically said he reviewed the radiographic cutoffs that help determine who starts therapy. The practical message for GPs is that auscultation is the start of the pathway, not the endpoint: a murmur should trigger a structured workup that separates dogs needing monitoring from those who now meet evidence-based criteria for treatment or referral. (dvm360.com)

Industry and clinical interest in earlier murmur detection also appears to be growing. In the April dvm360 interview, Scansen discussed AI-assisted auscultation as a possible tool to support murmur detection in busy practices, suggesting that the field is looking not only at what to do after a murmur is found, but also at how to reduce missed opportunities to find one in the first place. That’s not the same as replacing clinical judgment, but it does reflect a broader push toward more standardized frontline cardiac screening. (dvm360.com)

Why it matters: For veterinary professionals, this keynote reinforces a core point in canine cardiology: the biggest management gains often come before heart failure, but only if staging is accurate. Overcalling a soft murmur can lead to unnecessary cost and anxiety for the pet parent. Undercalling or missing a meaningful murmur can delay imaging, staging, and, in the right dog, pimobendan therapy that may buy meaningful time before CHF. In practical terms, that means primary care teams need a repeatable approach to auscultation, a clear threshold for thoracic radiographs versus echocardiography, and confidence in explaining next steps without overstating risk. (dvm360.com)

What to watch: dvm360 said a full recap of the keynote is forthcoming, which may provide more detail on Scansen’s diagnostic workflow and communication recommendations. Longer term, watch for continued discussion around frontline murmur detection tools, referral timing, and whether newer studies further refine which asymptomatic dogs benefit most from earlier intervention. (dvm360.com)