A comprehensive review on cardiovascular biomarkers in animals: Bridging conventional diagnostics and precision medicine

Introduction

In veterinary medicine, cardiac problems are a significant clinical issue that impact horses, dogs, cats, and animals that produce food. Cardiomyopathies, myocarditis, degenerative valve disease, irregular heartbeats, and congenital abnormalities are common disorders. Traditionally, a physical examination and imaging methods like radiography, electrocardiography, and echocardiography are used to make the diagnosis. While successful, these procedures need specialist equipment and may fail to identify early myocardial injury (Pierce, 2025) [21] . Biomarkers are measurable biological substances that show whether a bodily process is normal or abnormal. They offer information on neurohormonal activation, inflammatory reactions, mechanical stress, and cardiac cell damage in cardiovascular medicine. Biomarkers like natriuretic peptides and cardiac troponins are well-established in human medicine. As research has demonstrated their applicability across animal species, their use in veterinary practice has grown (Prošek et al., 2007, Scansen & Drees, 2020, De lima & Ferreira, 2017) [23,27,6] . The need for quick, inexpensive, and minimally intrusive methods is reflected in the growing interest in biomarker-based diagnostics. Prior research in veterinary medicine has shown that biomarkers can identify cardiac involvement even when there are no obvious clinical symptoms. Biomarkers have been utilized to identify myocarditis and performance-limiting cardiac injury in horses, while they help differentiate heart illness from respiratory conditions in dogs and cats (Smith et al., 2015) [32] . Biomarker research has expanded to encompass genetic, metabolic, and RNA-based indicators in addition to protein markers thanks to recent technology advancements. These advancements point to a move toward more predictive and customized veterinary diagnostics. This review's goals are to provide an overview of the state of the art regarding cardiovascular biomarkers in animals, explain their molecular underpinnings and practical applications, and consider potential future directions (Gavazza et [10,19,20] .

Materials and Methods

Data Synthesis

The implementation of cardiovascular biomarkers in veterinary medicine requires on a structured understanding of their kinds, release mechanisms, diagnostic and prognostic importance, species-specific utility, methodological limits, and potential advances. A thorough synthesis of these elements is made possible by a systematic examination of the literature, which supports evidence-based interpretation in clinical practice.

2.1a Categories of Cardiac Biomarkers

Veterinary cardiovascular biomarkers are broadly classified into four major categories: 2.1a.1 Indicators of Myocardial Injury: The extremely specific indicators of cardiomyocyte injury are cardiac troponins (cTnI and cTnT). Their release is directly indicative of myocardial involvement and is brought on by necrosis, apoptosis, ischemia, or inflammatory damage (Langhorn & Willesen, 2016) [12] .

2.1a.2 Indicators of Cardiac Overload or Stretch:

Ventricular wall stress causes the release of B-type natriuretic peptide (BNP) and NT-proBNP, which represent pressure or volume overload. These indicators correlate with ventricular remodeling and shed light on the degree of heart failure. (Takemura et al., 2009, Wess et al) [35] .

2.1a.3 Inflammatory and Systemic Markers:

The systemic inflammatory response associated with heart disease is represented by acute-phase proteins including serum amyloid A (SAA) and C-reactive protein (CRP), as well as cytokines like IL-6, TNF-α, and MCP-1. Despite their lack of specificity, these markers offer crucial prognostic data for progressive heart failure (Sasaki et al., 2019) [42] .

2.1b

Novel Molecular Biomarkers: MicroRNAs, metabolomic profiles, and proteomic patterns are examples of emerging indicators that offer early and mechanistic insights into cardiac pathology. Before clinical or echocardiographic alterations become noticeable, circulating miRNAs have demonstrated potential in identifying early myocardial stress. (Michel et al., 2022) [43] .

2.1c Mechanisms of Biomarker Release

Cardiovascular biomarkers are released through distinct physiological and pathological pathways:

• Troponins: Released primarily due to cardiomyocyte necrosis or apoptosis. Subclinical elevations may occur following extreme exercise, sepsis, or systemic hypoxia (Van Der Vekens et al., 2019) [36] . [13] .

• Molecular

Biomarkers: Circulating miRNAs, metabolomic fingerprints, and proteomic signatures arise from gene expression changes, cellular stress, and metabolic alterations during cardiac pathology, allowing earlier detection of disease processes than traditional protein markers (Filipovic et al.).

2.1d Diagnostic and Prognostic Relevance

Cardiovascular biomarkers have significant diagnostic and prognostic utility:

• Early detection: cTnI and miRNAs can identify subclinical myocardial injury before overt echocardiographic changes (Shah et al., 2025) [29] • Differential diagnosis: NT-proBNP differentiates cardiac from pulmonary causes of dyspnea in dogs and cats (Sleeper et al., 2001 & Noszczyk, 2011) [31,15] . • Disease severity and prognosis: Elevated troponins and acute-phase proteins correlate with mortality and morbidity in chronic heart failure (Xiao et al., 2021) [38] . • Therapeutic monitoring: Serial measurements of NT-proBNP and cTnI help monitor treatment efficacy and disease progression (Van Der Vekens et al., 2019) [36] .

2.1e Species-Specific Clinical Applications

• Dogs and Cats: NT-proBNP and cTnI are the most widely validated biomarkers. NT-proBNP is useful for differentiating cardiac vs respiratory dyspnea and monitoring CHF, while troponins detect myocardial injury (Sharkey& Rush, 2009, Langhorn & Willesen, 2016) [30,12] [36] . • Food-producing animals (cattle, sheep, goats, pigs):

Troponins and CK-MB detect myocardial damage from infectious, traumatic, or nutritional etiologies. Reference intervals are limited, and validation studies remain sparse (Rebez& Ninan, 2024) [24] .

2.1f Methodological and Biological Constraints

Despite their potential, cardiovascular biomarkers face several limitations: [42] . • Reference intervals: Many biomarkers lack speciesspecific reference ranges, limiting their clinical utility, especially in large animals and exotic species (Sasaki et al., 2019) [42] .

2.1g Prospective Innovations

Emerging approaches are focusing on:

• Multi-marker panels: Combining troponins, natriuretic peptides, miRNAs, and metabolomic signatures enhances sensitivity and specificity. (Michel et al., 2022) [43] [7,39,43] . [36] .

Results

Categories of Cardiovascular Biomarkers

Veterinary cardiovascular biomarkers may be grouped into four main classes: [12,36] . In horses, troponins are used to detect myocardial stress, subclinical myocarditis, and performancelimiting injury, while in livestock, elevated troponins correlate with traumatic or infectious cardiac lesions (Rebez & Ninan, 2024) [24] .

Markers of Cardiac Stretch

B-type natriuretic peptide (BNP) and its precursor, N-terminal pro-BNP (NT-proBNP), are secreted by ventricular myocardium in response to volume or pressure overload. These peptides regulate natriuresis, vascular tone, and neurohormonal activity, reflecting cardiac stress. NT-proBNP has been validated in dogs and cats for differentiating cardiac from pulmonary causes of dyspnea, assessing severity of valvular disease, and monitoring therapeutic response (Sleeper et al., 2001; Wess et al) [35] . In equine medicine, natriuretic peptide concentrations correlate with valvular disease and myocardial remodeling, although age, exercise, and training status can influence baseline values (Van Der Vekens et al., 2019) [36] .

Inflammatory and Systemic Biomarkers

Inflammation plays a significant role in the pathophysiology of cardiac diseases in small animals, particularly in dogs with congestive heart failure (CHF) resulting from conditions such as myxomatous mitral valve disease (MMVD) and dilated cardiomyopathy (DCM). Cardiovascular dysfunction is not solely hemodynamic; it also involves complex inflammatory and systemic responses that can be detected through specific biomarkers in serum or plasma (Ljungvall, et al., 2010) [13] .

C-Reactive Protein (CRP)

C-reactive protein (CRP) is a major acute-phase protein synthesized by the liver in response to pro-inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). CRP rapidly increases during systemic inflammation and is widely used as a marker of inflammatory activity in dogs. In canine cardiovascular patients, higher CRP concentrations are observed in advanced stages of CHF compared with both asymptomatic patients and healthy controls, indicating its utility as a marker of disease severity and systemic inflammation. CRP correlates positively with echocardiographic indicators of cardiac dysfunction, such as left ventricular ejection fraction and mitral valve inflow velocities, and with neutrophil counts and total white blood cell counts, which typically rise alongside CRP in systemic inflammatory states (Cerón, et al., 2005) [3] .

Serum Amyloid A (SAA)

Serum amyloid A (SAA) is another acute phase protein that is widely recognised as a highly sensitive marker of systemic inflammation in dogs. SAA concentrations increase dramatically within 24 hours of inflammatory stimulation and decrease rapidly upon resolution, making it valuable for detecting ongoing systemic inflammatory responses. SAA has been shown to outperform CRP in diagnostic performance for systemic inflammation because of its wider concentration range in affected patients.

Although much research on SAA has focused on systemic inflammatory diseases such as sepsis, noninfectious inflammatory conditions, and trauma, its sensitivity makes it a promising tool for identifying inflammatory components in cardiac disease when interpreted alongside cardiac-specific biomarkers (Christensen, et al., 2014) [4] .

White Blood Cell Count and Differentialfree

Systemic inflammation in CHF is often accompanied by elevations in white blood cell (WBC) counts and specifically neutrophil counts (NEUT). Studies have shown that dogs with decompensated heart failure exhibit significantly higher total WBC and neutrophil counts than healthy dogs or those with milder disease stages. These hematologic changes reflect systemic inflammatory activation and correlate with other markers such as CRP (Cunningham, et al., 2012) [5] .

Cytokines and Chemokines

Inflammatory cytokines, such as monocyte chemoattractant protein-1 (MCP-1) and chemokines like keratinocyte-derived chemokine (KC-like), are elevated in dogs with advanced heart failure. These molecules contribute to inflammatory signaling and attract immune cells to sites of tissue injury. Their serum levels correlate with traditional cardiac measurements such as left atrial size and left ventricular dimensions, suggesting a mechanistic link between inflammation and cardiac remodeling. (Aronson, 2008) [1] .

Inflammation-Oxidative Stress Interplay

Inflammatory markers often co-exist with oxidative stress indicators in heart failure patients, reflecting a bidirectional relationship between these biological processes. Increased CRP, WBC, and cytokines accompany reduced antioxidant capacity and elevated oxidative stress in dogs with CHF, suggesting that inflammatory and oxidative pathways act in concert to exacerbate cardiac dysfunction (Pereira, et al., 2016).

Clinical Relevance and Limitations

Inflammatory biomarkers such as CRP, SAA, WBC counts, and specific cytokines provide valuable supplementary information for assessing systemic involvement in cardiac disease. They help distinguish advanced CHF from compensated disease and may offer prognostic insight. However, they are nonspecific, as elevations can also result from infection, trauma, neoplasia, or other non-cardiac inflammatory conditions. Thus, interpreting these markers requires a holistic clinical context and correlation with cardiac imaging and functional tests (Ljungvall, et al., 2010) [13] .

Emerging Molecular Biomarkers

Molecular biomarkers represent the next frontier in small animal cardiology, offering sensitive and specific indicators of cardiac disease beyond traditional protein markers such as troponins and natriuretic peptides. These cutting-edge biomarkers include circulating microRNAs (miRNAs), proteomic signatures, and metabolomic profiles, which have demonstrated significant potential for early detection, disease staging, and therapeutic monitoring in dogs and cats (Perera et al., 2022) [19] .

3.2.1MicroRNAs: A New Class of Circulating Biomarkers

MicroRNAs (miRNAs) are short, non-coding RNA molecules that regulate gene expression post-transcriptionally and are increasingly recognized for their roles in cardiovascular diseases. Recent veterinary research emphasizes the diagnostic and prognostic value of miRNAs in small animal heart disease. Circulating miRNAs exhibit disease-specific expression patterns in conditions such as myxomatous mitral valve disease (MMVD), pulmonary stenosis, and cardiac hypertrophy, distinguishing affected animals from healthy controls with high sensitivity and specificity (Gidlöf et al., 2013) [11] . For example, in a pilot study of dogs with cardiac hypertrophy, differential expression of miRNAs such as cfa-miR-130b, cfa-miR-375, and cfa-let-7b was observed in animals with myxomatous mitral valve degeneration and pulmonic stenosis, suggesting potential utility as novel biomarkers and therapeutic targets.

Comprehensive reviews of veterinary miRNA research highlight their contribution to multiple cardiovascular pathways including myocardial growth, fibrosis, and remodelling, further supporting their candidacy as molecular biomarkers (Reis-Ferreira, et al., 2022) [6] .

Proteomic Biomarkers: Revealing Complex Pathophysiology

Proteomic analysis enables the identification of proteins whose expression changes with disease state. In chronic heart failure due to degenerative mitral valve disease, proteomic studies have revealed numerous up-and down-regulated proteins involved in immune response, hemostasis, oxidative stress, and energy metabolism. These proteomic shifts reflect underlying pathophysiological processes and may serve as biomarkers for staging disease, identifying therapeutic targets, and monitoring treatment response. The complexity of these protein networks underscores the need for multi-marker panels rather than reliance on single molecular indicators (Zhang, et al., 2017) [

Metabolomic

Beyond miRNAs and Proteins: Expanding the Molecular Biomarker Landscape

In addition to miRNAs and proteomics, recent feline studies have identified RNA markers such as WNT5A, IL-18, and IGFBP-2 that differ by disease stage in hypertrophic cardiomyopathy, suggesting that RNA-based biomarker panels may outperform traditional proteins for specific cardiomyopathies.

Collectively, these molecular signatures offer a more nuanced understanding of disease processes at the transcriptional, translational, and metabolic levels, paving the way for precision veterinary cardiology (Li et al., 2024) [14] .

Clinical and Translational Implications

While established biomarkers like troponins and natriuretic peptides remain valuable, molecular biomarkers promise:

• Earlier detection of cardiac disease before clinical signs emerge • Disease subtype differentiation (e.g., concentric vs eccentric hypertrophy) • Dynamic monitoring of therapy responses • Identification of novel therapeutic targets However, large-scale validation and standardization are still needed before widespread clinical implementation. The integration of molecular biomarkers with traditional diagnostics and imaging will likely provide the strongest predictive models for patient care.

Biomarkers in Equine Cardiology

Cardiovascular biomarkers are increasingly recognized as valuable tools in the diagnosis, monitoring, and prognostication of heart disease in horses. Unlike traditional diagnostic methods that rely largely on imaging and physical examination, biochemical markers can provide early, objective evidence of myocardial injury or physiological stress (Schwarzwald, et al., 2013) [33] .

Troponins as Primary Cardiac Injury Markers

Cardiac troponin I (cTnI) is the most studied and clinically useful biomarker in equine cardiology. Troponins are regulatory proteins in cardiomyocytes that are released into circulation when the heart muscle sustains injury. Elevated cTnI concentrations have been consistently observed in horses with confirmed myocardial disease, distinguishing them from healthy controls and those with structural abnormalities without direct myocardial damage. Several studies have established reference ranges for cTnI in healthy horses (generally ≤0.03 ng/mL) and shown that values above these ranges are associated with pathologic conditions such as myocarditis and ventricular arrhythmias. Horses with ventricular arrhythmias and documented myocardial toxicity can exhibit markedly elevated troponin levels, while some horses with non-severe arrhythmias show modest elevations (Rishniw, et al., 2019 & Oyama, & Sisson, 2004) [26,17] .

Exercise-Related and Non-Cardiac Influences

Acute exercise triggers a transient increase in cardiac biomarkers, including cTnI, as part of normal physiological adaptation. For example, show jumping and other intense exercise sessions induce significant, but typically temporary, elevations in troponin and other markers (e.g., creatine kinase), which return to baseline within hours post-exercise. This highlights the importance of timing when collecting blood samples for accurate clinical interpretation. Additionally, horses experiencing severe systemic illnesses such as colic with endotoxemia also show elevated cTnI levels indicative of myocardial injury secondary to systemic inflammation and stress. Horses with severe colic had significantly higher troponin concentrations than healthy controls, and higher levels were associated with poorer clinical outcomes (Fox et al., 2008 & Fox et al., 2011) [8,9] .

Other Equine Biomarkers under Investigation

Beyond troponins, other biomarkers are being evaluated in equine medicine. Inflammatory markers such as serum amyloid A (SAA) and C-reactive protein (CRP) have been studied in response to vaccination and systemic challenges, sometimes showing correlations with myocardial stress indicators. Although promising in humans and some animal species, microRNA panels developed for other species have demonstrated limited discriminatory power for equine cardiac disease, emphasizing the need for equine-specific molecular assays (Schwarzwald, et al., 2013) [33] .

Challenges and Practical Considerations

Most commercially available cardiac assays were originally designed for humans and require careful validation before application in horses. Differences in protein structure and immunoassay reactivity have led to variability in reference intervals and the need for species-specific calibration and validation protocols. Currently, cTnI remains the most sensitive and specific biomarker for detecting myocardial injury in horses, while additional markers (e.g., inflammatory proteins and advanced molecular profiles) are under investigation to enhance diagnostic precision (Rishniw, et al., 2019) [26] . Biomarkers in equine practice are particularly helpful for:

• Investigating unexplained poor performance • Detecting subclinical myocardial disease • Monitoring recovery after infectious illness • Assessing cardiac risk in sport horses

Biomarkers in Small Animal Cardiology 3.5.1 Biomarkers in Small Animal Cardiology

Cardiovascular biomarkers have become integral tools in diagnosing, monitoring, and prognosticating heart disease in small animals, especially dogs and cats. These biomarkers are measurable substances released into circulation in response to cardiac injury or stress and provide valuable insights beyond traditional diagnostic methods such as auscultation and imaging (echocardiography, radiography) (Langhorn & Willesen, 2016, Rebez & Ninan, 2024) [12,24] .

Primary Cardiac Biomarkers 3.5.2.1 Cardiac Troponin I (cTnI)

Cardiac troponin I is a highly specific marker of myocardial injury. Under normal conditions, little to no cTnI circulates in healthy dogs and cats, but concentrations rise significantly when cardiomyocytes are damaged (e.g., myocarditis, cardiomyopathy, ischemic injury). Troponin increases correlate with the extent of myocardial damage, making it a sensitive indicator of disease progression and severity. However, cTnI is not specific to disease etiology; elevations can occur with systemic illnesses (e.g., sepsis, renal disease) that secondarily impact the heart (Langhorn & Willesen, 2016) [12] .

N-Terminal pro-B-Type Natriuretic Peptide (NT-proBNP):

NT-proBNP is released by ventricular myocytes in response to increased wall stretch and pressure overload. It is widely used to differentiate cardiac from non-cardiac causes of respiratory distress in dogs and cats and to evaluate preclinical cardiomyopathy. Elevated NT-proBNP reflects volume overload states such as congestive heart failure and can be useful in monitoring treatment efficacy (Oyama, et al., 2008 & O'Shaughnessy et al., 2022) [41,16] .

Clinical Utility in Small Animal Practice 3.5.3.1 Diagnosis and Differentiation

Cardiac biomarkers improve diagnostic confidence when combined with clinical signs and imaging. NT-proBNP concentrations assist in distinguishing cardiac from respiratory causes of dyspnea, a frequent challenge in small animal practice. Meanwhile, increased cTnI levels are strong evidence of myocardial injury, even in cases without clear imaging abnormalities (Oyama, et al., 2008) [41] .

Prognosis and Monitoring

Studies support the prognostic value of these biomarkers. High NT-proBNP levels often correlate with more advanced disease and poorer outcomes, whereas dynamic changes in cTnI can reflect ongoing myocardial damage or therapeutic response. Both markers can be used serially to monitor disease progression and treatment effects (Oyama, et al., 2008 & Boswood et al., 2008) [41,2] .

Biological and Analytical Considerations

Cardiac biomarkers are influenced by age, breed, renal function, exercise, and comorbid conditions. For example, biologic variation studies indicate that individual baseline values may differ significantly, suggesting that serial measurements in the same patient may be more informative than population reference intervals (Li et al., 2024) [14] .

Emerging Biomarkers

Research in feline hypertrophic cardiomyopathy (HCM) has identified potential novel biomarkers such as WNT5A, IL-18, and IGFBP-2 RNA, suggesting a future where multiparameter molecular profiles may refine diagnosis and risk stratification beyond traditional proteins (Li et al., 2024) [14] .

Limitations and Interpretation

While valuable, cardiac biomarker testing should not replace imaging or clinical assessment. Interpretation of results requires context; for instance, elevated NT-proBNP may be seen in non-cardiac diseases affecting cardiac filling pressures, and cTnI can be influenced by systemic illnesses. Therefore, clinical decisions should integrate biomarker data with physical examination, echocardiography, and other laboratory tests (Oyama, et al., 2008) [41] .

Conventional Tests versus Cardiac Biomarkers

Traditional laboratory enzymes such as creatine kinase, lactate dehydrogenase, and aspartate aminotransferase lack specificity for heart tissue and may increase due to skeletal muscle or liver damage. In contrast, modern cardiac biomarkers offer greater organ specificity and diagnostic relevance. Nevertheless, they should complement rather than replace imaging and clinical assessment.

Discussion

The incorporation of cardiovascular biomarkers into veterinary practice mirrors developments in human cardiology. Troponins and natriuretic peptides have enabled earlier detection of myocardial injury and cardiac dysfunction. However, interpretation remains challenging due to interspecies variation, age-related changes, renal clearance effects, and exercise-induced fluctuations. Analytical differences between assays and limited standardization further complicate clinical use. These limitations highlight the importance of integrating biomarker data with physical examination and diagnostic imaging. Future biomarker research is expected to focus on molecular technologies that reveal disease-specific signatures. Multimarker panels combining protein and RNA-based indicators may enhance diagnostic accuracy. Portable testing devices will increase field applicability, particularly in equine and rural practice. Artificial intelligence tools may assist clinicians in interpreting complex biomarker datasets.

Conclusion

Cardiovascular biomarkers have become important tools in veterinary diagnostics. Cardiac troponins and natriuretic peptides are currently the most reliable and widely applied markers across animal species. Their combined use with imaging and clinical evaluation improves diagnostic confidence and disease monitoring. Advances in molecular biomarker discovery promise to further refine veterinary cardiology by supporting early detection and individualized therapeutic strategies.

References

1. Aronson PJ. A review of the role of neutrophils in psoriasis and related disorders. Dermatol Online J. 2008;14(7).
2. Boswood A, Dukes-McEwan J, Loureiro J, James RA, Martin M, Stafford-Johnson M. Plasma NT-proBNP concentration in dogs with heart disease. J Vet Intern Med. 2008;22(6):1372-1378.
3. Cerón JJ, Eckersall PD, Martínez-Subiela S. Acute phase proteins in dogs and cats: current knowledge and future perspectives. Vet Clin Pathol. 2005;34(2):85-99.
4. Christensen MB, Langhorn R, Goddard A, Andreasen EB, Moldal E, Tvarijonaviciute A, Kjelgaard-Hansen M. Comparison of serum amyloid A and C-reactive protein as diagnostic markers of systemic inflammation in dogs. Can Vet J. 2014;55(2):161.
5. Cunningham SM, Rush JE, Freeman LM. Systemic inflammation and endothelial dysfunction in dogs with congestive heart failure. J Vet Intern Med. 2012;26(3):547-557.
6. De Lima GV, Ferreira FS. N-terminal-pro brain natriuretic peptides in dogs and cats: a technical and clinical review. Vet World. 2017;10(9):1072-1082.
7. Dunn WB, Broadhurst D, Beger R. Metabolomics in systems medicine. Nat Rev Mol Cell Biol. 2011;12(5):345-358.
8. Fox PR, Oyama MA, Rush JE, Rozanski EA, Lesser M. Clinical utility of serum NT-proBNP for identifying canine cardiac disease and assessing severity. J Am Vet Med Assoc. 2008;232(10):1496-1503.
9. Fox PR, et al. Utility of NT-proBNP in feline cardiomyopathy. J Vet Intern Med. 2011;25(6):13211329.
10. Gavazza A, Fruganti A, Turinelli V. Cardiovascular biomarkers: current status and future directions. J Vet Cardiol. 2018;20(3):157-174.
11. Gidlöf O, Sharma S, Venge P. Circulating microRNAs in cardiovascular disease. Cardiovasc Res. 2013;98(3):341352.
12. Langhorn R, Willesen JL. Cardiac troponins in veterinary medicine: a review. J Vet Intern Med. 2016;30(1):14-31.
13. Ljungvall I, Höglund K, Tidholm A, Olsen LH, Borgarelli M, Venge P, Häggström J. Cardiac troponin I is associated with severity of myxomatous mitral valve disease, age, and C-reactive protein in dogs. J Vet Intern Med. 2010;24(1):153-159.
14. Li X, et al. RNA biomarkers in feline hypertrophic cardiomyopathy. Res Vet Sci. 2024;163:45-54.
15. Noszczyk-Nowak A. NT-proBNP and troponin I as predictors of mortality in dogs with heart failure. Pol J Vet Sci. 2011;14(4):551-556.
16. O'Shaughnessy S, Crawford I, Singleton D, Hughes D, Hezzell M. Clinical findings associated with N-terminal pro-B-type natriuretic peptide measurement in dogs and cats. Vet Rec. 2022;191(2):e945.
17. Oyama MA, Sisson DD. Cardiac troponin-I concentration in dogs with cardiac disease. J Vet Intern Med. 2004;18(6):831-839.
18. Pereira L, et al. Oxidative stress and inflammatory markers in dogs with congestive heart failure. Res Vet Sci. 2016;106:13-19.
19. Perera TRW, Skerrett-Byrne DA, Gibb Z, Nixon B, Swegen A. The future of biomarkers in veterinary medicine: emerging approaches and associated challenges. Front Vet Sci. 2021;8:123. doi:10.3389/fvets.2021.00123
20. Perera TR, Skerrett-Byrne DA, Gibb Z, Nixon B, Swegen A. The future of biomarkers in veterinary medicine: emerging approaches and associated challenges. Animals. 2022;12(17):2194.
21. Pierce KV. Diagnosis of cardiovascular disease in animals. In: MSD Veterinary Manual. 2025.
22. Polizopoulou ZS. Diagnostic significance of cardiac biomarkers in veterinary medicine. J Hellenic Vet Med Soc. 2017;68(4):357-370.
23. Prošek R, Sisson DD, Oyama MA, Solter PF. Distinguishing cardiac and noncardiac dyspnea in dogs using plasma natriuretic peptides and cTnI. J Vet Intern Med. 2007;21(2):238-242.
24. Rebez EB, Ninan J. Biomarkers in the cardiovascular system of animals: a review. Indian J Anim Health. 2024;63(1):22-28.
25. Reis-Ferreira A, Neto-Mendes J, Seabra A, et al. Emerging roles of microRNAs in veterinary cardiology. Vet Sci. 2022;9(10):533.
26. Rishniw M, et al. Biologic variation of NT-proBNP and cardiac troponin I in dogs. Vet Clin Pathol. 2019;48(1):66-74.
27. Scansen BA, Drees R. Joint virtual issue on recent advances in veterinary cardiac imaging. J Vet Intern Med. 2020;34(2):546.
28. Schober KE, Cornand C, Kirbach B. Cardiac biomarkers in small animal practice. WSAVA Proceedings. 2011:5664.
29. Shah V, Panchal V, Shah A, Vyas B, Bhowmik S, Panchal I, Jain P. Exosomal miRNAs as biomarkers in predicting chemotherapy-induced cardiotoxicity in patients with cancer. Med Int. 2025;5(6):69.
30. Sharkey LC, Rush JE. Evaluation of plasma NT-proBNP and cTnI in dogs with stable chronic kidney disease. J Vet Intern Med. 2009;23(3):654-662.
31. Sleeper MM, Sanders SP, Laster L. Troponin-I as a biomarker of myocardial injury in horses. Equine Vet J. 2001;33(1):34-38.
32. Smith KF, Quinn RL, Rahilly LJ. Biomarkers for differentiation of causes of respiratory distress in dogs and cats: part 1-cardiac diseases and pulmonary hypertension. J Vet Emerg Crit Care. 2015;25(3):311329.
33. Schwarzwald CC, et al. Cardiac troponin in horses with myocardial injury. Equine Vet J. 2013;45(1):55-61.
34. Truppel JH, et al. Metabolomic profiling in dogs with dilated cardiomyopathy. Metabolomics. 2019;15:74.
35. Takemura N, Toda N, Miyagawa Y, Asano K, Tejima K, Kanno N, Hirose H. Evaluation of plasma N-terminal pro-brain natriuretic peptide concentrations in dogs with mitral valve insufficiency. J Vet Med Sci. 2009;71(7):925-929.
36. Van der Vekens N, Decloedt A, De Clercq D, Verheyen T, Van Loon G. The use of cardiac biomarkers in veterinary medicine: the equine perspective. Equine Vet J. 2019;51(4):494-503.
37. Wilkins MR, Sánchez JC, Gooley AA. Multi-omics approaches in disease biomarker discovery. Nat Rev Genet. 2010;11(5):367-372.
38. Xiao H, Wang X, Li S, Liu Y, Cui Y, Deng X. Advances in biomarkers for detecting early cancer treatment-related cardiac dysfunction. Front Cardiovasc Med. 2021;8:753313.
39. Zhao Y, Fong S, Peng Y. Proteomics and cardiovascular disease: new insights and clinical applications. J Proteome Res. 2015;14(6):2345-2356.
40. Zhang C, et al. Proteomic profiling reveals immune and metabolic pathways in canine heart failure. Proteomics Clin Appl. 2017;11(9-10):1600107.
41. Oyama MA, et al. NT-proBNP in dogs and cats. J Vet Intern Med. 2008;22(3):578-583.
42. Sasaki R, Kanda T, Yokosuka O, Kato N, Matsuoka S, Moriyama M. Exosomes and hepatocellular carcinoma: from bench to bedside. International journal of molecular sciences. 2019 Mar 20;20(6):1406.
43. Michel P, Küppers M, Bagatin AC, Carry B, Charnoz S, De Leon J, Fitzsimmons A, Gordo P, Green SF, Hérique A, Juzi M. The ESA Hera mission: detailed characterization of the DART impact outcome and of the binary asteroid (65803) Didymos. The planetary science journal. 2022 Jul 15;3(7):160.