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Background  Evaluation of myocardial function is clinically challenging in dogs with degenerative mitral valve disease ( DMVD ). Although myocardial dysfunction is caused by pathologic degeneration, histopathologic progression is poorly understood.    Objectives  To characterize myocardial and pulmonary pathologic changes according to severity in dogs with naturally occurring  DMVD , and to investigate whether or not pathologic degeneration is reflected by traditional clinical indices.    Animals  One hundred and seventeen dogs with naturally occurring  DMVD .    Methods  Prospective observational study. Biopsied left atrium ( LA ), left ventricle ( LV ), and lung were evaluated histologically, and an attempt was made to correlate pathologic findings with clinical indices.    Results  Severe myocardial changes were observed in all International Small Animal Cardiac Health Council classes. In the lung, heart failure cell levels were significantly increased in class  III  patients ( P  <   .0001). In a paired comparison, the  LA  showed significantly more severe degeneration than the  LV , including myocardial fatty replacement, immune cell infiltration, and interstitial fibrosis ( P  <   .0001). In contrast, myocardial cells were more hypertrophied in the  LV  than in the  LA  ( P  <   .0001). Left ventricular end‐diastolic dimension ( LVED d) was associated with fatty replacement ( P =  .033,  R  2  = 0.584) and myocardial vacuolization ( P =  .003,  R  2  = 0.588) in the  LA .    Conclusions and Clinical Importance  In  DMVD , although severe pathologic changes may be evident even in early stages, there may be pathologic discrepancy between the  LA  and the  LV . Myocardial degeneration may be reflected by clinical indices such as  LVED d and  EF .

Pathologic Manifestations on Surgical Biopsy and Their Correlation with Clinical Indices in Dogs with Degenerative Mitral Valve Disease