Echocardiographic Changes in Dogs with Stage B2 Myxomatous Mitral Valve Disease Treated with Pimobendan Monotherapy

Overview

Journal Vet Sci

Publisher MDPI

Specialty Veterinary Medicine

Date 2024 Dec 27

PMID 39728934

Authors

Andrew Crosland

Pablo Manuel Cortes-Sanchez

Siddharth Sudunagunta

Jonathan Bouvard

Elizabeth Bode

Geoff Culshaw

Joanna Dukes-McEwan

Affiliations

Soon will be listed here.

Abstract

The present study aimed to evaluate the effects of chronic pimobendan monotherapy on cardiac size in dogs with stage B2 myxomatous mitral valve disease (MMVD). Data from 31 dogs diagnosed with MMVD and cardiomegaly (LA/Ao ≥ 1.6 and LVIDdn ≥ 1.7) were included. The intervention group were dogs treated with pimobendan (n = 24). Dogs not receiving any cardiac medication were controls (n = 7). Echocardiographic changes in left atrial and left ventricular dimensions were compared over time. There was significant group × time interaction for LVIDdN ( = 0.011) between diagnosis and initial follow-up (median 3-6 months). There was a significant reduction in LVIDdN over time in the pimobendan group ( = 0.038) but not in the control group ( = 0.216). There was no significant group × time interaction for LA/Ao, and there was no effect of group ( = 0.561), but LA/Ao in both groups decreased over time ( = 0.01). Restraint is advised when prescribing pimobendan based on the detection of a heart murmur where echocardiographic staging is an option. Some stage B2 dogs that received pimobendan no longer met the echocardiographic classification criteria for stage B2 MMVD and could have been misclassified as stage B1 and had their medication inappropriately withdrawn. We suggest these dogs are referred to as reverse remodelled stage B2.

References

Cornell C, Kittleson M, Della Torre P, Haggstrom J, Lombard C, Pedersen H . Allometric scaling of M-mode cardiac measurements in normal adult dogs. J Vet Intern Med. 2004; 18(3):311-21. DOI: 10.1892/0891-6640(2004)18<311:asomcm>2.0.co;2. View

Boyle K, Leech E . A review of the pharmacology and clinical uses of pimobendan. J Vet Emerg Crit Care (San Antonio). 2012; 22(4):398-408. DOI: 10.1111/j.1476-4431.2012.00768.x. View

Lord P, Hansson K, Kvart C, Haggstrom J . Rate of change of heart size before congestive heart failure in dogs with mitral regurgitation. J Small Anim Pract. 2010; 51(4):210-8. DOI: 10.1111/j.1748-5827.2010.00910.x. View

Baron Toaldo M, Romito G, Guglielmini C, Diana A, Pelle N, Contiero B . Prognostic value of echocardiographic indices of left atrial morphology and function in dogs with myxomatous mitral valve disease. J Vet Intern Med. 2018; 32(3):914-921. PMC: 5980607. DOI: 10.1111/jvim.15093. View

Strohm L, Visser L, Chapel E, Drost W, Bonagura J . Two-dimensional, long-axis echocardiographic ratios for assessment of left atrial and ventricular size in dogs. J Vet Cardiol. 2018; 20(5):330-342. DOI: 10.1016/j.jvc.2018.07.008. View

Boswood A, Haggstrom J, Gordon S, Wess G, Stepien R, Oyama M . Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly: The EPIC Study-A Randomized Clinical Trial. J Vet Intern Med. 2016; 30(6):1765-1779. PMC: 5115200. DOI: 10.1111/jvim.14586. View

Kanno N, Kuse H, Kawasaki M, Hara A, Kano R, Sasaki Y . Effects of pimobendan for mitral valve regurgitation in dogs. J Vet Med Sci. 2007; 69(4):373-7. DOI: 10.1292/jvms.69.373. View

Wesselowski S, Borgarelli M, Bello N, Abbott J . Discrepancies in identification of left atrial enlargement using left atrial volume versus left atrial-to-aortic root ratio in dogs. J Vet Intern Med. 2014; 28(5):1527-33. PMC: 4895582. DOI: 10.1111/jvim.12410. View

Chetboul V, Tidholm A, Nicolle A, Carlos Sampedrano C, Gouni V, Pouchelon J . Effects of animal position and number of repeated measurements on selected two-dimensional and M-mode echocardiographic variables in healthy dogs. J Am Vet Med Assoc. 2005; 227(5):743-7. DOI: 10.2460/javma.2005.227.743. View

10.

Visser L, Ciccozzi M, Sintov D, Sharpe A . Echocardiographic quantitation of left heart size and function in 122 healthy dogs: A prospective study proposing reference intervals and assessing repeatability. J Vet Intern Med. 2019; 33(5):1909-1920. PMC: 6766555. DOI: 10.1111/jvim.15562. View

11.

Bode E, Mederska E, Hodgkiss-Geere H, Radford A, Singleton D . Analysis of canine cardiovascular therapeutic agent prescriptions using electronic health records in primary care veterinary practices in the United Kingdom. J Vet Cardiol. 2021; 39:35-45. DOI: 10.1016/j.jvc.2021.11.003. View

12.

Lord P, Hansson K, Carnabuci C, Kvart C, Haggstrom J . Radiographic heart size and its rate of increase as tests for onset of congestive heart failure in Cavalier King Charles Spaniels with mitral valve regurgitation. J Vet Intern Med. 2011; 25(6):1312-9. DOI: 10.1111/j.1939-1676.2011.00792.x. View

13.

Dukes-McEwan J, French A, Corcoran B . Doppler echocardiography in the dog: measurement variability and reproducibility. Vet Radiol Ultrasound. 2002; 43(2):144-52. DOI: 10.1111/j.1740-8261.2002.tb01662.x. View

14.

Hansson K, Haggstrom J, Kvart C, Lord P . Left atrial to aortic root indices using two-dimensional and M-mode echocardiography in cavalier King Charles spaniels with and without left atrial enlargement. Vet Radiol Ultrasound. 2002; 43(6):568-75. DOI: 10.1111/j.1740-8261.2002.tb01051.x. View

15.

DETWEILER D, Patterson D . The prevalence and types of cardiovascular disease in dogs. Ann N Y Acad Sci. 1965; 127(1):481-516. DOI: 10.1111/j.1749-6632.1965.tb49421.x. View

16.

Chetboul V, Lefebvre H, Carlos Sampedrano C, Gouni V, Saponaro V, Serres F . Comparative adverse cardiac effects of pimobendan and benazepril monotherapy in dogs with mild degenerative mitral valve disease: a prospective, controlled, blinded, and randomized study. J Vet Intern Med. 2007; 21(4):742-53. DOI: 10.1892/0891-6640(2007)21[742:caceop]2.0.co;2. View

17.

Summerfield N, Boswood A, OGrady M, Gordon S, Dukes-McEwan J, Oyama M . Efficacy of pimobendan in the prevention of congestive heart failure or sudden death in Doberman Pinschers with preclinical dilated cardiomyopathy (the PROTECT Study). J Vet Intern Med. 2012; 26(6):1337-49. PMC: 3546380. DOI: 10.1111/j.1939-1676.2012.01026.x. View

18.

Bonagura J . M-mode echocardiography. Basic principles. Vet Clin North Am Small Anim Pract. 1983; 13(2):299-319. DOI: 10.1016/s0195-5616(83)50031-4. View

19.

Borgarelli M, Crosara S, Lamb K, Savarino P, La Rosa G, Tarducci A . Survival characteristics and prognostic variables of dogs with preclinical chronic degenerative mitral valve disease attributable to myxomatous degeneration. J Vet Intern Med. 2012; 26(1):69-75. DOI: 10.1111/j.1939-1676.2011.00860.x. View

20.

Tissier R, Chetboul V, Moraillon R, Nicolle A, Carlos C, Enriquez B . Increased mitral valve regurgitation and myocardial hypertrophy in two dogs with long-term pimobendan therapy. Cardiovasc Toxicol. 2005; 5(1):43-51. DOI: 10.1385/ct:5:1:043. View