Results of the veterinary enalapril trial to prove reduction in onset of heart failure in dogs chronically treated with enalapril alone for compensated, naturally occurring mitral valve insufficiency

Atkins, Clarke E.; Keene, Bruce W.; Brown, W. A.; Coats, Julie R.; Crawford, Mary Ann; DeFrancesco, Teresa C.; Edwards, NM; Fox, Phillip R.; Lehmkuhl, Linda B.; Luethy, Michael W.; Meurs, Kathryn M.; Petrie, Jean-Paul; Pipers, F. S.; Rosenthal, Steven; Sidley, Jennifer A.; Straus, Justin

doi:10.2460/javma.231.7.1061

Cited by 110 publications

(153 citation statements)

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“…Several studies have reported efficacy of ACEI drugs in the management of dogs with heart disease associated with MMVD. Two clinical trials designed to determine whether treatment with enalapril would prevent or delay onset of CHF in small breed dogs with MMVD reported limited12 benefit or lack of clinical effect 13. Benazepril used alone or as an add‐on to standard treatment in MMVD or DCM dogs with CHF extended life span compared to dogs that did not receive benazepril 34.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical trial data are limited in dogs, and the majority of studies have focused on treatment to manage chronic myxomatous valvular disease (MMVD). Trials using enalapril and conducted largely in populations of dogs with advanced heart disease but not heart failure have reported limited benefit or no benefit in these populations 12, 13. Digitalis traditionally has been used to manage supraventricular tachyarrhythmias14 and dilated cardiomyopathy in dogs,14, 15, 16 but evidence for clinical efficacy is sparse.…”

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confidence: 99%

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Long‐term Outcome of Irish Wolfhound Dogs with Preclinical Cardiomyopathy, Atrial Fibrillation, or Both Treated with Pimobendan, Benazepril Hydrochloride, or Methyldigoxin Monotherapy

Vollmar¹,

Fox

2016

Veterinary Internal Medicne

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BackgroundDilated cardiomyopathy (DCM) is a common cause of morbidity and mortality in the Irish Wolfhound (IW). However, the benefit of medical treatment in IW dogs with preclinical DCM, atrial fibrillation (AF), or both has not been demonstrated.ObjectivesCompare the time to develop congestive heart failure (CHF) or sudden death in IW dogs with preclinical DCM, AF, or both receiving monotherapy with pimobendan, methyldigoxin, or benazepril hydrochloride.AnimalsSeventy‐five client‐owned IW dogs.MethodsIrish Wolfhound dogs were prospectively randomized to receive pimobendan (Vetmedin®)1, benazepril HCl (Fortekor®)2, or methyldigoxin (Lanitop®)3 monotherapy in a 1:1:1 ratio in a blinded clinical trial. The prospectively defined composite primary endpoint was onset of CHF or sudden death. To assure stringent evaluation of treatment effect, data from dogs complying with the study protocol were analyzed.ResultsSixty‐six IW fulfilling the study protocol included 39 males, 27 females; median (interquartile range) age, 4.0 years (3.0–5.0 years) and weight, 70.0 kg (63.0–75.0 kg). Primary endpoint was reached in 5 of 23 (21.7%) IW receiving pimobendan, 11 of 22 (50.0%) receiving benazepril HCl, and 9 of 21 (42.9%) receiving methyldigoxin. Median time to primary endpoint was significantly longer for pimobendan (1,991 days; 65.4 months) compared to methyldigoxin (1,263 days; 41.5 months; P = .031) or benazepril HCl‐(997 days; 32.8 months; P = .008) treated dogs.Conclusions and Clinical ImportanceIn IW dogs with preclinical DCM, AF or both, pimobendan monotherapy significantly prolonged time to onset of CHF or sudden death than did monotherapy with benazepril HCl or methyldigoxin.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Long‐term Outcome of Irish Wolfhound Dogs with Preclinical Cardiomyopathy, Atrial Fibrillation, or Both Treated with Pimobendan, Benazepril Hydrochloride, or Methyldigoxin Monotherapy

Vollmar¹,

Fox

2016

Veterinary Internal Medicne

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“…The above drugs may ameliorate clinical signs and improve both quality and quantity of life in symptomatic but not asymptomatic canine MVD [3,13,17]. Thus, precise evaluation and staging of dogs with MVD is mandatory before administering any therapeutic treatment.…”

Section: Discussionmentioning

confidence: 99%

Use of the Vertebral Heart Score in Coughing Dogs with Chronic Degenerative Mitral Valve Disease

Guglielmini

Diana

Pietra

et al. 2009

The Journal of Veterinary Medical Science

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ABSTRACT. The objective of the present study was to evaluate the usefulness of the vertebral heart score (VHS) in coughing dogs with chronic degenerative mitral valve disease (MVD). Survey thoracic radiographs of 90 dogs with a history of cough and clinical and echocardiographic evidence of MVD were evaluated by 2 independent observers. The observers were asked to first determine the origin of the cough as cardiac, non-cardiac or mixed and then to measure the VHS. Agreement regarding diagnosis of the origin of cough was obtained (kappa=0.64) in 69 dogs. Of these 69 dogs, 28 (41%), 32 (46%) and 9 (13%) had a cough of cardiac, non-cardiac and mixed origin, respectively. The dogs with a cough of non-cardiac origin had a significantly lower VHS (mean ± SD, 11 ± 0.9) compared with those of dogs with a cough of cardiac or mixed origin (12.8 ± 1 and 12.9 ± 0.9, respectively). Receiver operating characteristic curve analysis showed that a VHS ≤ 11.4 is fairly accurate for exclusion of a cough of cardiac origin in dogs with MVD. The results indicate that the VHS may be an additional tool for differentiating the origin of cough in dogs with MVD. KEY WORDS: canine and feline, cardiology, echocardiography, heart, radiology.J. Vet. Med. Sci. 71(1): 9-13, 2009The term "cardiac cough" is frequently used in the clinical setting as well as in veterinary textbooks to define the origin of cough in dogs affected by cardiac disorders. Chronic degenerative mitral valve disease (MVD) with associated mitral regurgitation (MR) is the most common canine cardiovascular disease [5] and coughing is the most common presenting complaint in dogs with MVD [10]. This symptom may be related to different pathophysiological mechanisms secondary to cardiac dilatation and dysfunction caused by MVD. Among the main consequences of MVD are dorsal elevation and compression of the trachea and/or dorsal elevation of the left main stem bronchus by the dilated left atrium, pulmonary congestion and pulmonary interstitial and/or alveolar transudate secondary to increased pulmonary capillary pressure [10]. The above mechanisms may be responsible for cough in dogs with MR [2]. Nevertheless, cough can be a consequence of different respiratory disorders that may concurrently affect dogs with MVD [1]. In particular, the same dogs (i.e., small or middle-sized, aged dogs) most commonly affected by MVD are predisposed to some respiratory disorders leading to cough (e.g., chronic bronchitis, lower airway collapse and interstitial lung disease) [12,21,24]. Thus, both respiratory and cardiac diseases may contribute to cough in some cases.The vertebral heart score (VHS) is a method for objectively evaluating the dimensions of the cardiac silhouette in thoracic radiograms and was first described by Buchanan and Bücheler in the dog [7]. Using this method, the cardiac long and short axis are measured on the lateral thoracic view and are then compared with the thoracic spine. The VHS is the vertebral scale sum of the long and short axes, each measured caudally from the crania...

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“…There is no consensus for this group of patients regarding whether or not a therapy might be beneficial. Two studies showed that long-term treatment with enalapril in asymptomatic dogs with MVD and MR did not or modestly delayed the onset of heart failure regardless of whether or not cardiomegaly was present at initiation of the study (27,28). Despite the lack of consensus, some use angiotensin-converting enzyme inhibitors (ACE-I) in this period of the disease, as it was shown in some studies in dogs and people to have some beneficial effect (28,29).…”

Section: Pharmacological Management Of Mmvdmentioning

confidence: 99%

Myxomatous Mitral Valve Disease in Dogs - an Update and Perspectives

Petrič

2015

Macedonian Veterinary Review

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Results of the veterinary enalapril trial to prove reduction in onset of heart failure in dogs chronically treated with enalapril alone for compensated, naturally occurring mitral valve insufficiency

Cited by 110 publications

References 44 publications

Long‐term Outcome of Irish Wolfhound Dogs with Preclinical Cardiomyopathy, Atrial Fibrillation, or Both Treated with Pimobendan, Benazepril Hydrochloride, or Methyldigoxin Monotherapy

Long‐term Outcome of Irish Wolfhound Dogs with Preclinical Cardiomyopathy, Atrial Fibrillation, or Both Treated with Pimobendan, Benazepril Hydrochloride, or Methyldigoxin Monotherapy

Use of the Vertebral Heart Score in Coughing Dogs with Chronic Degenerative Mitral Valve Disease

Myxomatous Mitral Valve Disease in Dogs - an Update and Perspectives

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