BACKGROUND: Revisiting the association between heart disease and renal infarction (RI) in cats is relevant to determine whether those with RI should undergo echocardiographic screening. OBJECTIVE: Compare the relative frequency of echocardiographically detectable heart disease and other comorbidities in cats with and without ultrasonographic evidence of RI. ANIMALS: A total of 826 cats that underwent concurrent abdominal ultrasonography and transthoracic echocardiography and were assigned a cardiac diagnosis. METHODS: Two-center cross-sectional study with a study population recruitment period from January 1, 2011 to June 15, 2021. Demographic, clinical, clinicopathologic, and ultrasonographic data were recorded. Available echocardiographic images were reviewed to assign a standardized cardiac diagnosis. Occult heart disease was defined as structural heart disease without clinical signs of congestive heart failure. Risk factors for RI were evaluated by univariable or multivariable logistic regression. RESULTS: The relative frequency of structural heart disease in cats with and without RI was 63% (114/181) and 46% (297/645), respectively (adjusted odds ratio [OR] 95% confidence interval [CI], 1.6
1.2-2.3). Older age (p = 0.03), higher maximum end-diastolic left ventricular wall thickness (p = 0.02), higher systolic blood pressure (p = 0.02), auscultable cardiac abnormalities other than murmur (p = 0.04), and diagnosis of acute kidney injury (p = 0.002), chronic kidney disease (p = 0.005), and occult heart disease (OR [95% CI], 2.4 [1.7-3.4]
p ≤ 0.002) were associated with increased risk of RI. Strength and statistical significance of associations varied by site. CONCLUSIONS AND CLINICAL IMPORTANCE: Occult heart disease is more frequent in cats with RI, and echocardiographic screening of these cats should be considered.