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"Echocardiography generally is indicated in larger breed dogs because the murmur of MR is more likely to be related to other causes (eg, dilated cardiomyopathy)." In other words, the 2009 Consensus Statement recommended relying upon the size and shape of the heart on x-rays to determine whether it has enlarged, and especially compare two sets of those x-rays - one taken before enlargement and the other taken after enlargement is suspected