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Background  Development and progression of myxomatous mitral valve disease ( MMVD ) in dogs are difficult to predict. Identification at a young age of dogs at high risk of adverse outcome in the future is desirable.    Hypothesis/Objectives  To study the predictive value of selected clinical and echocardiographic characteristics associated with  MMVD  obtained at a young age for prediction of long‐term cardiac and all‐cause mortality in Cavalier King Charles Spaniels ( CKCS ).    Animals  1125 privately owned  CKCS .    Methods  A retrospective study including  CKCS  examined at the age of 1–3 years. Long‐term outcome was assessed by telephone interview with owners. The value of variables for predicting mortality was investigated by Cox proportional hazard and Kaplan‐Meier analyses.    Results  Presence of moderate to severe mitral regurgitation ( MR ) (hazard ratio ( HR ) = 3.03, 95% confidence interval (95%  CI ) = 1.48–6.23,  P  = 0.0025) even intermittent moderate to severe  MR  ( HR  = 2.23, 95%  CI  = 1.48–6.23,  P  = 0.039) on color flow Doppler echocardiography was significantly associated with increased hazard of cardiac death. An interaction between  MR  and sex was significant for all‐cause mortality ( P  = 0.035), showing that males with moderate to severe  MR  had a higher all‐cause mortality compared to males with no  MR  ( HR  = 2.38, 95%  CI  = 1.27–4.49,  P  = 0.0071), whereas no difference was found between female  MR  groups. The risk of cardiac ( HR  = 1.37, 95%  CI  = 1.14–1.63,  P  < 0.001) and all‐cause ( HR  = 1.13, 95%  CI  = 1.02–1.24,  P  = 0.016) mortality increased with increasing left ventricular end‐systolic internal dimension normalized for body weight ( LVIDS N  ).    Conclusions and clinical importance  Moderate to severe  MR , even if intermittent, and increased  LVIDS N   in dogs <3 years of age were associated with cardiac death later in life in  CKCS .

Mitral Regurgitation Severity and Left Ventricular Systolic Dimension Predict Survival in Young Cavalier King Charles Spaniels