The LISTEN Study
Prospective Multicenter Evaluation of Murmur Localization and Stage-Dependent Grading in Various Canine Cardiac Diseases
The LISTEN STUDY: The world largest digital canine auscultation study
Study objective
The LISTEN Study was a prospective, multicentre observational study conducted across 50 internationally distributed centres. Examinations were performed by experienced veterinarians with advanced training in cardiology, including board-certified specialists (ACVIM or ECVIM) as well as clinicians holding nationally recognised cardiology qualifications.
Dogs undergoing clinical cardiac evaluation were prospectively enrolled. Digital cardiac auscultation recordings and echocardiographic examinations were obtained during the same clinical visit.
The study aimed to:
- investigate the distribution of PMI recording sites and audibility of heart murmurs from various canine cardiac diseases by echocardiographic diagnosis
- investigate the association of MMVD stage with heart murmur intensity
Patient characteristics and sound samples used
Results
The LISTEN Study demonstrated a strong association between increasing heart murmur intensity and more advanced MMVD stages.
In the study population, over one‑third (38.3%) of dogs with MMVD and a moderate murmur were found to be in stages B2 or C/D.
MMVD murmur grade to disease stage
Results from the LISTEN Study are used within the report generated by the Eko Vet+™ App to provide a probable disease output and an estimate of MMVD stage* likelihood where applicable, based on algorithmic analysis of auscultation patterns, to support further clinical assessment.
The Eko Vet+ App output does not provide a diagnosis and does not replace echocardiographic assessment. Results should be interpreted by professional veterinary judgement and are not a substitute for veterinary advice.
*These outputs are based on the algorithmic analysis of canine heart sound characteristics, including murmur intensity and punctum of maximal intensity (PMI) localization. In the prospective multicentre observational LISTEN study (50 centres; n=6,996), these auscultation characteristics were evaluated against echocardiographic diagnoses as the clinical reference standard and shown to be associated with cardiac diseases and MMVD stages.1 These findings form a key part of the scientific basis of the CANINEBEAT® AI algorithm embedded in the Eko Vet+™ App. Disease stage classifications are based on ACVIM guidelines.2 Definitive diagnosis and staging require confirmation by diagnostic imaging.
References: 1. The LISTEN Study. 2026. Publication in submission. 2. Keene BW, Atkins CE, Bonagura JD, et al. ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. J Vet Intern Med. 2019;33:1127–1140.
