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The Canadian Vetmedin Advisory Board* attended the first International
Canine Valvular Symposium and would like to share some information that
arose with other Canadian veterinarians. The purpose of the following
statement is to give veterinarians a timely view of this emerging data
realizing that not all of the information below has been fully assessed
by peer review. This information is meant as our best effort to keep our
colleagues informed of emerging information and not as "carved in
stone" standards of care.
Congestive heart failure in the dog due to DCM and atrioventricular valvular
insufficiency (endocardiosis) is a common clinical occurrence in veterinary
medicine. Therapy to date, has encompassed the use of furosemide and ACEI,
and/or digoxin as standard baseline therapy, and these remain a valuable
part of a veterinarian's therapeutic armamentarium; however, concurrent
disease or disease progression often necessitates additional or alternate
pharmacological intervention. Clinical goals of therapy are to improve
upon clinical symptomology, hence improving the patient's quality of life,
as well as extending survival. CHF is also an area of active research
and drug development. Emerging information is expanding our knowledge
of disease pathophysiology (including the finding that systolic dysfunction
occurs much earlier in the course of endocardiosis than once believed
and that ACEI may accentuate long-term pathological cardiac remodeling),
and this will likely lead to revisions in current treatment recommendations
as new concepts and drugs are subjected to the rigor of scientific investigation.
Information is emerging as to the benefits of pimobendan (a drug that
is both a positive inotrope and balanced peripheral vasodilator) in the
treatment of CHF due to DCM or endocardiosis in the canine. A peer-reviewed
study of pimobendan has clearly demonstrated its benefits in improving
quality and quantity of life when combined with traditional therapy of
a diuretic, an ACEI, and digoxin in Doberman Pinschers suffering from
DCM; while it is likely that similar results would be realized in other
species suffering from DCM, confirmatory studies are not available. For
canine endocardiosis, studies reported to date have demonstrated that,
when used on a background of diuretic therapy, pimobendan is as good as
or better than an ACEI for improving quality and quantity of life; however,
a limitation of these studies is that they have only been reported as
abstracts or part of conference proceedings and need to be subjected to
and confirmed via the peer-review process.
Nonetheless, recommendations for patient care need to be given based on
current information (including the available literature and individual
experience with drug use) to address the needs of those patients suffering
from CHF today. As such, the following are provided as recommended guidelines:
• Based upon complimentary modes of action, triple therapy of a
diuretic, an ACEI, and pimobendan is the recommended baseline therapy
for uncomplicated cases of CHF due to DCM or endocardiosis; however, the
superitority of this approach has not been demonstrated or refuted in
any veterinary studies
• The decision to use triple therapy may be influenced by cost concerns.
Based on the available information to date, if cost constraints limit
therapy to dual rather than triple therapy, a diuretic and pimobendan
would be a reasonable medical choice
• Mitigating circumstances/comorbid illness may alter these recommendations
and all animals should be treated as individuals with frequent follow-ups
to ascertain the need for therapeutic modifications
* Participants of the recent Canadian Vetmedin Advisory Board meeting
were:
• Marie-Claude Belanger, DVM, Diplomate ACVIM (internal medicine)
• Lisa Carioto, DVM, Diplomate ACVIM (internal medicine)
• Eric de Madron, DVM, Diplomate ACVIM (cardiology)
• Rocky DiFruscia, DVM, Diplomate ACVIM (internal medicine)
• Susan Finn-Bodner, DVM, MS, Diplomate ACVR (radiology)
• Susan Ford, DVM, Diplomate ACVIM (internal medicine)
• Hans Gelens, DVM, Diplomate ACVIM (internal medicine)
• Danny Joffe, DVM, Diplomate ABVP (companion animals)
• Doug Mason, DVM, Diplomate ACVIM (internal medicine)
• Alan Norris, DVM, Diplomate ACVIM (internal medicine)
• Mike O'Grady, DVM, MSc, Diplomate ACVIM (cardiology)
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