Earlier treatment of preclinical MVD delays onset of heart failure in dogs, according to ground-breaking research
The findings of a global study have highlighted the need for a significant shift in how vets approach the diagnosis and management of mitral valve disease (MVD).
The EPIC study (Evaluation of Pimobendan In Cardiomegaly) found pimobendan extended the asymptomatic period by an average of 15 months, while dogs that received the drug also lived significantly longer than those receiving a placebo. The study was terminated early following an interim analysis as the evidence was considered conclusive and it was deemed unethical to continue to withhold treatment from the placebo group.
The study results, published in the Journal of Veterinary Internal Medicine, will be welcome news to thousands of vets and dog owners across the country as heart disease is one of the top 5 causes of death in UK dogs¹, with MVD accounting for around 75% of cases². The vast majority of older, small breed dogs with a characteristic heart murmur are likely to have preclinical MVD; many of which will also have cardiomegaly secondary to the disease and may benefit from early treatment.
Adrian Boswood, Professor of Veterinary Cardiology at the RVC, led the research and described it as a major breakthrough:
"Thanks to the EPIC study results, vets no longer have to adopt a 'watch and wait' approach to suspected preclinical cases of MVD. When a typical mitral valve murmur is detected, vets should now investigate further to look for cardiac enlargement. If demonstrated, this suggests the patient will probably benefit from treatment with pimobendan before the onset of clinical signs.
“It's great that as a trusted treatment, pimobendan has a wealth of safety data behind it in addition to that gleaned from the EPIC study, which can help support vets when prescribing it in this new way."
EPIC is the largest prospective veterinary cardiology study carried out to date, pushing best practice in evidence-based veterinary medicine to a new level, while the quality of the EPIC data rivals that of human clinical trials. The prospective study was double-blinded, placebo-controlled and randomised, taking seven years to complete and involved 360 dogs across 11 countries in four continents.
Professor Boswood added: "As far as evidence-based medicine goes, this is about as good as it gets. The size and design of the study places it in the top-tier. The study was designed and run by an independent team of investigators and sponsored by Boehringer Ingelheim. We, as lead investigators, had the right to publish the results regardless of the outcome. This makes EPIC very special indeed.”
In light of the findings, vets should now consider testing early for signs of preclinical MVD, and in dogs with cardiomegaly secondary to preclinical MVD, vets should consider the use of pimobendan to delay the onset of congestive heart failure and extend the asymptomatic period.
For more information about the study and results see EPIC Study - Evaluation of Pimobendan.
Dogs were recruited to the study if they had:
- Systolic heart murmur with maximal intensity over mitral valve area (>3/6 grade)
- Echocardiographic evidence of MVD
- Evidence of cardiomegaly (demonstrated radiographically and echocardiographically)
- D.G. O’Neill, D.B. Church, P.D. McGreevy, P.C. Thomson, D.C. Brodbelt (2013). Longevity and mortality of owned dogs in England, The Veterinary Journal Volume 198, Issue 3, December 2013, Pages 638–643
- Haggstrom J, Hoglund K, Borgarelli M. An update on treatment and prognostic indicators in canine myxomatous mitral valve disease. J Small Anim Pract 2009;50(Suppl 1):25–33.
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Notes to Editors
The Royal Veterinary College (RVC) is the UK's largest and longest established independent veterinary school and is a constituent College of the University of London. The RVC offers undergraduate, postgraduate and CPD programmes in veterinary medicine, veterinary nursing and biological sciences, being ranked in the top 10 universities nationally for biosciences degrees. It is currently the only veterinary school in the world to hold full accreditation from AVMA, EAEVE, RCVS and AVBC.
A research-led institution, in the most recent Research Excellence Framework (REF2014) the RVC maintained its position as the top HEFCE funded veterinary focused research institution.
The RVC also provides animal owners and the veterinary profession with access to expert veterinary care and advice through its teaching hospitals; the Beaumont Sainsbury Animal Hospital in central London, the Queen Mother Hospital for Animals (Europe's largest small animal referral centre), the Equine Referral Hospital, and the Farm Animal Clinical Centre located at the Hertfordshire campus.
RVC Press Release 4 October 2016
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