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Boswood, A.; Gordon, S. G.; Haggstrom, J.; Wess, G.; Stepien, R. L.; Oyama, M. A.; Keene, B. W.; Bonagura, J.; MacDonald, K. A.; Patteson, M.; Smith, S.; Fox, P. R.; Sanderson, K.; Woolley, R.; Szatmari, V.; Menaut, P.; Church, W. M.; O'Sullivan, M. L.; Jaudon, J. -P.; Kresken, J. -G.; Rush, J.; Barrett, K. A.; Rosenthal, S. L.; Saunders, A. B.; Ljungvall, I.; Deinert, M.; Bomassi, E.; Estrada, A. H.; Fernandez Del Palacio, M. J.; Moise, N. S.; Abbott, J. A.; Fujii, Y.; Spier, A.; Luethy, M. W.; Santilli, R. A.; Uechi, M.; Tidholm, A.; Schummer, C.; Watson, P. (2018): Longitudinal Analysis of Quality of Life, Clinical, Radiographic, Echocardiographic, and Laboratory Variables in Dogs with Preclinical Myxomatous Mitral Valve Disease Receiving Pimobendan or Placebo: The EPIC Study. In: Journal of Veterinary Internal Medicine, Vol. 32, No. 1: pp. 72-85
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Abstract

Background: Changes in clinical variables associated with the administration of pimobendan to dogs with preclinical myxomatous mitral valve disease (MMVD) and cardiomegaly have not been described. Objectives: To investigate the effect of pimobendan on clinical variables and the relationship between a change in heart size and the time to congestive heart failure (CHF) or cardiac-related death (CRD) in dogs with MMVD and cardiomegaly. To determine whether pimobendan-treated dogs differ from dogs receiving placebo at onset of CHF. Animals: Three hundred and fifty-four dogs with MMVD and cardiomegaly. Materials and Methods: Prospective, blinded study with dogs randomized (ratio 1:1) to pimobendan (0.4-0.6 mg/kg/d) or placebo. Clinical, laboratory, and heart-size variables in both groups were measured and compared at different time points (day 35 and onset of CHF) and over the study duration. Relationships between short-term changes in echocardiographic variables and time to CHF or CRD were explored. Results: At day 35, heart size had reduced in the pimobendan group: median change in (D) LVIDDN -0.06 (IQR: -0.15 to +0.02), P < 0.0001, and LA: Ao -0.08 (IQR: -0.23 to +0.03), P < 0.0001. Reduction in heart size was associated with increased time to CHF or CRD. Hazard ratio for a 0.1 increase in DLVIDDN was 1.26, P - 0.0003. Hazard ratio for a 0.1 increase in DLA: Ao was 1.14, P = 0.0002. At onset of CHF, groups were similar. Conclusions and Clinical Importance: Pimobendan treatment reduces heart size. Reduced heart size is associated with improved outcome. At the onset of CHF, dogs treated with pimobendan were indistinguishable from those receiving placebo.