Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly: The EPIC Study-A Randomized Clinical Trial.

Autor: Boswood A; Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK., Häggström J; Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, SE., Gordon SG; Small Animal Clinical Science, Texas A&M University, College Station, TX., Wess G; Clinic of Small Animal Medicine, University of Munich, Munich, Germany., Stepien RL; Medical Sciences, University of Wisconsin Madison School of Veterinary Medicine, Madison, WI., Oyama MA; Clinical Studies-Philadelphia, MJR-VHUP-Cardiology, University of Pennsylvania, Philadelphia, PA., Keene BW; Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, NC., Bonagura J; Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH., MacDonald KA; Animal Care Center, Rohnert Park, CA., Patteson M; HeartVets @ Vale Referrals, The Animal Hospital, Dursley, Gloucestershire, UK., Smith S; Sarah Smith Cardiology, Derby, UK., Fox PR; Animal Medical Center, New York, NY., Sanderson K; Rocky Mountain Veterinary Cardiology, Boulder, CO., Woolley R; Cardio Respiratory Pet Referrals Victoria, Mordialloc, Vic, Australia., Szatmári V; Faculty of Veterinary Medicine, Clinical Sciences of Companion Animals, Utrecht University, Utrecht, Utrecht, Netherlands., Menaut P; Internal Medicine and Cardiology, Clinique Vétérinaire Aquivet, Eysines, France., Church WM; Desert Veterinary Medical Specialists, Phoenix, AZ., O'Sullivan ML; Deptartment of Clinical Studies, University of Guelph, Ontario Veterinary College, Guelph, ON, Canada., Jaudon JP; Clinique Veterinaire Des Etangs, Villars Les Dombes, France., Kresken JG; Clinic for Small Animals Kaiserberg, Duisburg, Germany., Rush J; Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA., Barrett KA; Cardiology, VCA West Los Angeles, Los Angeles, CA., Rosenthal SL; Cardiac Care for Pets, Towson, MD., Saunders AB; Small Animal Clinical Science, Texas A&M University, College Station, TX., Ljungvall I; Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, SE., Deinert M; Tierklinik am Sandpfad, Wiesloch, Germany., Bomassi E; Cardiology, Centre Hospitalier Vétérinaire des Cordeliers, Meaux, France., Estrada AH; Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL., Fernandez Del Palacio MJ; Medicina y Cirugía Animal, Universidad de Murcia, Murcia, Murcia, Spain., Moise NS; Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY., Abbott JA; Department of Small Animal Clinical Sciences, Virginia Tech, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA., Fujii Y; Azabu University, Chuo-ku, Sagamihara, Kanagawa, Japan., Spier A; Blue Pearl Veterinary Partners, Tampa, FL., Luethy MW; Chicago Veterinary Emergency and Specialty Center, Chicago, IL., Santilli RA; Cardiology, Clinica Veterinaria Malpensa, Viale Marconi, Varese, Italy., Uechi M; JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., Yokohama, Japan., Tidholm A; Djursjukhuset Albano, Danderyd, Sweden., Watson P; Boehringer Ingelheim, Animal Health, Ingelheim am Rhein, Germany.
Jazyk: angličtina
Zdroj: Journal of veterinary internal medicine [J Vet Intern Med] 2016 Nov; Vol. 30 (6), pp. 1765-1779. Date of Electronic Publication: 2016 Sep 28.
DOI: 10.1111/jvim.14586
Abstrakt: Background: Pimobendan is effective in treatment of dogs with congestive heart failure (CHF) secondary to myxomatous mitral valve disease (MMVD). Its effect on dogs before the onset of CHF is unknown.
Hypothesis/objectives: Administration of pimobendan (0.4-0.6 mg/kg/d in divided doses) to dogs with increased heart size secondary to preclinical MMVD, not receiving other cardiovascular medications, will delay the onset of signs of CHF, cardiac-related death, or euthanasia.
Animals: 360 client-owned dogs with MMVD with left atrial-to-aortic ratio ≥1.6, normalized left ventricular internal diameter in diastole ≥1.7, and vertebral heart sum >10.5.
Methods: Prospective, randomized, placebo-controlled, blinded, multicenter clinical trial. Primary outcome variable was time to a composite of the onset of CHF, cardiac-related death, or euthanasia.
Results: Median time to primary endpoint was 1228 days (95% CI: 856-NA) in the pimobendan group and 766 days (95% CI: 667-875) in the placebo group (P = .0038). Hazard ratio for the pimobendan group was 0.64 (95% CI: 0.47-0.87) compared with the placebo group. The benefit persisted after adjustment for other variables. Adverse events were not different between treatment groups. Dogs in the pimobendan group lived longer (median survival time was 1059 days (95% CI: 952-NA) in the pimobendan group and 902 days (95% CI: 747-1061) in the placebo group) (P = .012).
Conclusions and Clinical Importance: Administration of pimobendan to dogs with MMVD and echocardiographic and radiographic evidence of cardiomegaly results in prolongation of preclinical period and is safe and well tolerated. Prolongation of preclinical period by approximately 15 months represents substantial clinical benefit.
(Copyright © 2016 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)
Databáze: MEDLINE
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