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Antonio Reid

Thus far, he has concentrated on treating cavalier King Charles spaniels in congestive heart failure. Ao in identification of mild LAE.

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The dogs were divided into three groups. The test group received the Fortekor Plus, while two control groups received separate doses of benazepril and pimobendan. The researchers found no significant differences between groups. They reported that the frequency of vomiting emesis was significantly lower in the Fortekor Plus group.

In this July entry , we reported that Fortekor Plus was approved in Europe for use on MVD-affected dogs in congestive heart failure. See also this January version of the same study as this July one. Sonya Gordon recommends pimobendan for Stage B dogs even without echocardiograms.

Gordon right , along with Drs. Saunders and Sonya R. Wesselowski, makes a variety of recommendations for treatment of MVD-affected dogs, some of which have not appeared in print elsewhere as yet.

Specifically regarding dogs in ACVIM Stage B2 of mitral valve disease MVD , they provide parameters for prescribing pimobendan even when no echocardiograms have been performed to determine if the dogs' hearts are enlarged.

Well, this is interesting. We can think of two possible reasons:. Whatever the reason they both focus on making more money for somebody , such corner-cutting certainly is of no net benefit to the MVD-affected dogs, particularly cavalier King Charles spaniels. Instead of warning veterinarians to not prescribe pimobendan to Stage B2 dogs without first performing any echocardiograms, Dr.

Gordon is ditching the mandatory echo parameters altogether and is recommending a new, dumbed-down, all-breed x-ray-only parameter for them to follow. Of course, that would include all dogs of several breeds. So, based upon Dr. Gordon is a member, first proposed this x-ray-only parameter for prescribing pimobendan to Stage B2 dogs.

See our December comments about this item. The CEG publication states that it, too, is sponsored by the manufacturer of Vetmedin, so commonality of conflict-of-interest reigns here. Plus, the current article has a strong whiff of a citation-stacking effort. Gordon is willing to forego measuring the two echo exam parameters, Dr.

Gordon ignores is that, for some breeds, especially the cavalier, a VHS value of While she describes using the species-wide We regard it as arbitrary, risky, and unsupported by any research. In fact, the published research contradicts her selection. In at least one study , a VHS value of At the very least, she should pay attention to the advice given in the article she cites in her footnote 15 , which expressly states:.

She and her cohorts violate the ethical tenet of veterinary medicine to treat the disease and not the arbitrary measurement. What is even more disturbing is that Dr. Gordon does not acknowledge the dirty little secret about GP vets: When that leads to prematurely prescribing pimobendan, severe heart damage can occur, based upon prior peer-reviewed studies. This is what we mean by using a patient-specific VHS value.

This usually is due to poor positioning of the dog during the x-rays, which is not uncommon. This poor result reflects the difficulty observers had identifying shape changes that can occur in radiographs of dogs with enlarged cardiac chambers.

Gordon ignored this advice is perplexing. Surely she is aware that the ACVIM Consensus Statement , of which she was one of the authors, specifically emphasized the importance of obtaining baseline x-rays. Here is what they she wrote back in Gordon and her cohorts may reply by saying that, in many instances, no baseline x-rays have been taken, and it is too late now.

Apart from the fact that they never mention the baseline option at all, our response to that situation is for the authors to recommend not relying solely upon a current x-ray, and to require that the dog undergo an echocardiographic examination.

To advise vets to waive echo exams for cavaliers, when there is no baseline x-ray for confirming if any enlargement has occurred, is, frankly, encouraging malpractice. Maybe a board certified cardiologist can tell from x-rays rads alone that the LA or LV is enlarged, but as we noted above, even they will disagree from time to time, and especially if the positioning of the dog even flexing the neck can cause misleading shadowing and quality of the films are less than perfect, or the dog was inhaling in one view and exhaling in another or sedated in one and not in the other.

This list could go on and on. The EPIC trial report emphasizes the importance that both the left atrium and left ventricle be enlarged by specified minimum dimensions, which is important information that the echocardiogram can provide and even an expertly produced x-ray can not. Boswood recognizes that the condition of the individual dog needs to be taken into account, instead of using an arbitrary, species-wide x-ray measurement which has been proven in previous peer-reviewed studies to erroneously indicate actual heart enlargement in several breeds of dogs, including the CKCS.

This is but one more example of why we repeatedly warn cavalier owners two essential things: It never hurts to ask the veterinarians treating your dog: The lab currently is experimenting with Doberman Pinschers affected with dilated cardiomyopathy.

His contact information is: ACE-inhibitor ramipril fails to extend survival times of MVD-affected dogs when combined with pimobendan and diuretic.

The dogs were divided into two groups: The results were troubling: Borgarelli reports successful replacement of mitral valve chords using the Harpoon TSD-5 device. In a May article , a team of Virginia-Maryland veterinary college surgeons, led by Dr. Gammie , report the successful implantation of synthetic expanded polytetra-fluoroethylene ePTFE replacement mitral valve chords in four of six healthy Beagles, using minimally-invasive surgical techniques in beating hearts without cardio-pulmonary bypass or cardiac arrest.

The body cavity was opened to reveal the beating heart. Then a "valved introducer" was inserted into the left ventricle, and the thin metal shaft of the Harpoon TSD-5 was inserted through the introducer, leading to the mitral valve. When the shaft was in proper position, the trigger of the Harpoon TSD-5 see image below was pressed, and its needle pierced the mitral valve leaflet, forming a bulky knot of the ePTFE chord through the leaflet.

The other end of the chord ultimately is extended and attached to the heart muscle through the intial insertion location. This video shows how the procedure is designed to operate. The study authors concluded:. EPIC Study authors plan to announce "longitudinal analysis" of the participating dogs' data. This is expected to be a review of the long term results of the treatment of the nearly dogs in the EPIC trial after they reached heart failure Stage C.

Virginia-Maryland veterinary college creates a database of MVD-affected dogs. Michele Borgarelli of the Virginia-Maryland Regional College of Veterinary Medicine is spearheading a longitudinal outcome database to serve as a reference library about dogs with mitral valve disease. The database will allow researchers to pose questions about which metrics predict outcomes and which interventions affect prognosis.

No such database currently exists for mitral valve disease, but according to Dr. Borgarelli, disease registries have proven effective in other veterinary and human diseases.

Patients with a new diagnosis at the Veterinary Teaching Hospital in Blacksburg are entered into the database. The cardiology clinicans also are partnering with cardiologists at Chesapeake Veterinary Cardiology Associates, a group of cardiac specialty practices in northern Virginia and Maryland, and the Swedish University of Agricultural Sciences in Uppsala, Sweden, to expand the database.

Borgarelli reported that, to date, the database contains clinical information from 2, dogs of breeds. This study is scheduled to terminate in October Borgarelli's ongoing mitral valve shape comparison study adds more data. In a May article , the international team of veterinary cardiologists G. See Figure 2, below.

Cardiologist Mark Rishniw says "Not so fast! First he warns that determining whether a dog's heart actually is enlarged is not so easy using x-rays alone. Philip Fox, below here. Rishniw points out that determining whether a small dog's heart is enlarged from an x-ray is not so easy, and that "many clinicians This alone is a scary factoid, considering that the EPIC Study's minimum x-ray parameter for determining enlargement in all dogs, regardless of breed, is a VHS value of He acknowledges that dog owners may "not be able to afford echocardiography, and clinicians will be faced with the decision based on radiographic evidence alone.

If for whatever reason you don't perform the echocardiogram, then don't prescribe the drug. Rishniw analyzes the EPIC Study's own statistics to observe the falsehood of the EPIC Study authors' simplistic notion that any and all MVD-affected dogs with enlarged hearts, regardless of the degree or rapidity of enlargement, would benefit from pimobendan.

Rishniw says, "Not so fast! Rishniw focuses on the economics of starting pimobendan too early. He writes that dogs which would likely never progress to congestive heart failure CHF ought "not be subjected to needless drug administration and needless expenses. Rishniw may be suggesting another possible downside of starting pimobendan before it is truly needed -- that the patients may develop a tolerance to the pimobendan, thereby decreasing its effectiveness.

Drug tolerance is a pharmacological concept describing the patient's reduced affinity to a drug after sustained exposure to that drug. This means that starting the drug earlier than necessary can result in having to increase the dosage later on to achieve the same beneficial effect. Even worse, at some point the drug may become totally ineffective.

In a January article , veterinary cardiologist Mikaela Mueller right impliedly concurs with Dr. Like the white-coated sanitation guys cleaning up behind the elephant parade, Drs. Rishniw and Mueller are critically analyzing the EPIC Study's own statistics, which the study's authors neglected to do themselves. The bottom line is that no cavalier owner should jump at the prospect of giving pimobendan to their dogs unless and until a very careful, thorough study -- "a more measured approach" -- is conducted for each patient, to determine the likelihood that the drug will do any good at the current stage of the dog's MVD.

The EPIC Study report needs to be retracted and re-written, so that no clinicians are misled by its lack of critical analysis of its own statistics. The authors had 18 months following the end of the study March to September in which to draft a thorough, objective review in accordance with the veterinary motto: But, unfortunately, they instead published a conclusion that could have been written by the drug manufacturer's press agent.

In a May article , Maryland board certified veterinary cardiologist Kristin A. Jacob gives a narrow interpretation of the EPIC Study report, confining pimobendan treatment to MVD-affected dogs with "advanced" or "significant" Stage B2 heart enlargement, as distinguished from "mildly enlarged".

Philip Fox right asserts that in determining when to start administering pimobendan to MVD-affected dogs under the EPIC Study, either x-rays or echocardiography may be used. There you have it. Our greatest fear about the terribly flawed EPIC Study report is that it would encourage veterinarians to skip echos entirely and diagnose heart enlargement solely based upon x-rays.

See our March blog article, "Will general practice vets cut corners to prematurely prescribe pimobendan to MVD-affected cavaliers? EPIC provides absolutely no breed-specific parameters, much less any case-by-case recommended parameters.

You see, the average heart-healthy cavalier, with no enlargement whatsoever, has a VHS value significantly above The only saving grace the EPIC Study lead authors must have had is that, hopefully , no veterinarian would rely solely upon an x-ray before prescribing the drug. Hopefully , all vets would also perform the M-mode echocardiography necessary to arrive at the other two parameters for determining if the dog's heart is sufficiently enlarged. Which is laughable, of course, because how many general practice vets have M-mode echocardiograph ultrasound devices at their clinics, much less know how to use them?

So now we even have a board certified veterinary cardiologist who participated in the EPIC Study, by the way -- his name is on it irresponsibly suggest that heart enlargement may be diagnosed by x-rays alone before starting pimobendan. And, he wrote this in an advice column directed to general practice veterinarians! The bottom line is that the thoughtlessly-worded EPIC Study report needs to be retracted and re-written, if cavaliers' lives are to be saved by pimobendan, instead of being destroyed by that drug.

If a cardiologist who actually participated in the EPIC Study does not understand how to follow it, how can we expect our general practice vets to do so? In a December report , a team of Columbian veterinary researchers Orlando A. The Columbian veterinarians found that "the allele T of the rs variant was over-represented in MMVD patients compared with healthy controls. Detroit hospital physicians find Neladenoson may reverse hind leg weakness in dogs in heart failure. Mitochondria are organelles in the muscle cells, which take in nutrients, break them down, and create energy rich molecules for the cell.

As heart failure progresses in MVD-affected dogs, the mitochondria reduce in size, resulting in reduced capacity to create energy. The researchers opine that treating dogs in heart failure with Neladenoson can potentially reduce or reverse exercise intolerance and skeletal muscle weakness. In a November abstract , the same researchers concluded that Neladenoson has beneficial effects on mitochondria function in dogs in heart failure.

They report improvement in mitochondria function after treatment with Neladenoson within one hour after initiation of therapy. Mayo Clinic researchers engineer a designer natriuretic peptide to mediate kidney impairment by furosemide. They noted that furosemide FURO alone lacks vasodilatory actions, impairs kidney function, and activates the renin-angiotensin-aldosterone system RAAS. They found NPA7 to decrease vascular resistance, reduce pulmonary capillary pressure, increase renal blood flow, increase urinary flow and sodium excretion.

B-type natriuretic peptide BNP is a natriuretic, diuretic, vasodilatory, and anti-remodeling hormone produced by myocardial cells in response to heart failure due to MVD and other causes of heart failure. BNP is activated during heart failure to counteract the effects of activation of the renin angiotensin aldosterone system RAAS in the heart, kidneys, and blood vessels. In a May article , US investigators M.

Oyama [right] , P. Stern discuss the feasibility, safety, and tolerance of injecting synthetic canine B-type natriuretic peptide syncBNP in four healthy dogs and two dogs with stage B1 mitral valve disease, including a cavalier.

The found that syncBNP was feasible, well tolerated at all doses, and safe, and that it significantly increased median plasma cGMP. Winter [right] , Ashley B. They noted that the use of a standard sensitivity cTnI assay was insufficiently sensitive to quantify and study changes in cTnI concentration in both healthy dogs and MVD-affected dogs in their study.

They argue that long-term serial measurements of cTnI changes helped predict the MVD end-points of onset of heart failure and death. They suggest that such periodic testing may provide more information for predicting survival time than a single measurement.

See this link to our review of that article. In a statement included in a DogWorld. The protocol has been proven effective in reducing the early onset of mitral valve disease in offspring. Kisko in effect ridiculed the protocol by declaring that 2. Brazilian researchers find a quality of life questionnaire can accurately predict approaching cardiac deaths of dogs.

The questions are mainly related to respiratory signs, difficulties with mobility such as walking and climbing stairs , physical activity, irritability, appetite, sleepiness, and frequency of urination and vomiting. They found that NT-proBNP levels and high quality life score were independently associated with impending death. They concluded that the score is easy to apply and does not require any technology, only a veterinarian and an observant owner.

Lung ultrasound exams can accurately diagnose early signs of pulmonary edema and may predict onset of congestive heart failure. Citi used lung ultrasound LUS to examine the conditions of dogs in different stages of mitral valve disease MVD , to distinguish lung patterns leading to congestive heart failure CHF. They report detecting "B-lines" also called ultrasound lung rockets representing interstitial edema.

The number and distribution of these B-lines correspond to the presence of extravascular fluid in the lungs and indicate the severity of pulmonary edema PE and stage of its progression. CoQ10 levels decreased with greater severity of CHF. CoQ10 concentrations were significantly higher in affected dogs receiving treatment, indicating a CoQ10 deficiency in affected dogs without treatment. Korean researchers find that serum homocysteine concentrations increase as MVD progresses in dogs. Homocysteine is an essential amino acid metabolite of methionine that is recycled into methionine or converted into cysteine by vitamin B.

They concluded that the measurement of serum homocysteine concentration may be useful in predicting the severity of MVD in dogs. Sildenafil is a selective phosphodiesterase-5 inhibitor that has been demonstrated to delay ventricular enlargement in humans and experimental animals.

Previously, sildenafil has been prescribed for MVD-affected dogs already in heart failure if pulmonary hypertension is also detected. Pulmonary arterial hypertension, as a complication of mitral valve disease, is higher diastolic or systolic pulmonary arterial pressure than normal pressure. This high pressure may lead to increased right ventricular pressure and right atrial chamber enlargement, leading to possible right side heart failure. In this new study, the authors state that sildenafil already has been demonstrated to delay left ventricular enlargement in humans and experimental animals.

In an October abstract , Japanese veterinary surgeon Masami Uechi right reported on the results of his team's cardiopulmonary CPB -- also known as open heart -- surgical mitral valve repair of over toy breed dogs. Chordae tendineae were replaced with expanded polytetrafluoroethylene, and a mitral annulus plasty was performed. For more information about CPB and mitral annulus plasty, click here. Postoperative complications include pancreatitis and thrombosis, which may be reduced by future advanced techniques.

Tricuspid valve replacement with cow or pig valves has significant complications. In a March article by a team of UK researchers P. Brockman , they reported on tricuspid valve replacements in nine dogs with severe valve regurgitation and signs of heart failure.

All of the dogs were suffering from tricuspid valve dysplasia, a congenital malformation more common in larger breeds than the cavalier King Charles spaniel. None of the nine dogs were cavaliers. The surgical procedures included cardiopulmonary bypasses.

Four of the dogs died due to complications during hospitalization. Of the five dogs discharged from the hospital, one died due to an unrelated injury seven days later. Of the four remaining dogs, they survived a median of days after receiving the cow bovine valve. The researchers acknowledge that some of the complications may have been due in part to their relative inexpericence when compared to the successes of the surgical group at Colorado State University.

In a March article , an international team of cardiologists G. Lahmers used real-time transthoracic three-dimensional echocardiography analysis RT3DE on dogs, including 13 cavalier King Charles spaniels affected in varying stages of mitral valve disease. They report that the study demonstrated that the MVs of MVD-affected dogs differed from those of healthy dogs in several morphological aspects.

In particular, the affected dogs had an increased sphericity and a decreased saddle shape of the MV annulus, as well as a decreased tenting height, area and volume. Austrian heart clinic offers mitral valve repair surgery on MVD-affected dogs in heart failure.

Peter Modler right has announced that he is performing surgical mitral valve repair on a routine basis to dogs with advanced degenerative mitral valve disease. Thus far, he has concentrated on treating cavalier King Charles spaniels in congestive heart failure. His open-heart surgical procedure includes installing a Gore-Tex annuloplasty ring around the valve, and also replacing diseased valve chords with Gore-Tex, while the dog is on cardiopulmonary bypass.

Modler's clinic is located in Sattledt, Austria. He advises that he is able to provide travel and accommodation assistance, as well. His exclusion criteria for surgery are: For more information about Dr. Serum proteins are found to be differentially expressed in cavaliers with MVD. In a February article on a study of twelve cavaliers, an Italian team reported finding eight serum proteins which were differentially expressed between groups of moderately M and severely S affected CKCSs with MVD and a control group of healthy cavaliers.

These proteins were found to be significantly related to the progression of the disease. In the M group versus healthy dogs complement factor H isoform 2, inhibitor of carbonic anhydrase, hemopexin, dystrobrevin beta isoform X7 and CD5 molecule-like resulted to be down-regulated, whereas fibronectin type-III domain-containing protein 3A isoform X4 was up-regulated. In the S dogs versus healthy group complement factor H isoform 2, calpain-3 isoform X2, dystrobrevin beta isoform X7, CD5 molecule-like and lhydroxyglutarate dehydrogenase resulted to be down-regulated.

Complement factor H isoform 2, calpain-3 isoform X2, dystrobrevin beta isoform X7, CD5 molecule-like and hydroxyglutarate dehydrogenase were found to be down-regulated in mild affected group versus healthy dogs. All of these proteins except complement factor H followed a decreasing trend according to the progression of the pathology. They concluded that the differential expression of serum proteins demonstrates the possibility these might be valuable for the detection and monitoring of the disease.

Japanese researchers find left atrium strain can predict heart failure in MVD-affected dogs. They found that there were no significant differences in parameters of LA strain between the Stages B1 and B2 groups. However, LA longitudinal strain during atrial contraction and during ventricular systole were significantly lower in Stages C and D than in Stages B1 and B2.

In a November article by a team of French cardiologists and specialists J. Chetboul , they reported on the use of a palatable complementary feed composed of high-energy ingredients glucose syrup, soybean oil and cod liver oil , hydrolyzed animal proteins, vitamins and oligo-elements, called Nutri-Plus Gel , in five case studies.

Case Report 4 was of a female year-old cavalier King Charles spaniel right in Stage C2 advanced heart failure of mitral valve disease, which had lost 1. She exhibited signs of fatigue, lack of appetite, and diarrhea. Her MVD treatment had been the standard six medicines for cavaliers in heart failure. Nutri-Plus Gel is available here. Borgarelli seeks cavaliers in heart failure for minimally invasive mitral valve repair.

Michele Borgarelli at Virginia Tech veterinary school is testing the feasibility of minimally invasive repair of the mitral valve using the Harpoon TSD-5 device developed by Harpoon Medical Inc.

The device is designed to anchor artificial cords on the flaps of the valve, to replace the vavle's natural chordae tendieae. The replacement cords are made of expanded polytetrafluoroethylene ePTFE. Borgarelli is seeking candidate dogs for a study to assess the efficacy and long-term effects of using the Harpoon Medical TSD-5 device. Dogs in Stage C, heart failure with significant enlargement, and weighing over 11 pounds.

Details of the study are available here. To apply, or for more information, contact Mindy Quigley, Clinical Trials Coordinator, telephone , email vettrials vt. Miller , they focused upon the inherent variability of the cardiac biomarker N-terminal pro-brain natriuretic peptide NTproBNP in all dogs -- both healthy and MVD-affected -- and how those random variations, called biologic variability, affects the accuracy of population-based reference ranges of NTproBNP readings.

This study highlights the fallibity of cardiac biomarker natriuretic peptide tests to predict the stage of MVD and the onset of heart failure in MVD-affected cavaliers. We have found that such blood tests have been used as a crutch for veterinarians who are insecure in their own judgment based upon traditional tools such as auscultation and signs such as breaths-per-minute.

This study suggests that a one-time test may not provide an accurate result, and that many repeats of that test are required over an extended period of time. Bonagura, Barret Bulmer, Whit M. Spier, and Rebecca L. Stepien, has proposed a short-cut version of the parameters recommended in the EPIC Study report, which is based solely upon the Vertebral Heart Score values determined from x-rays, skipping entirely any measurements taken from echocardiograms.

This is a stunning -- even jaw-dropping -- effort to water-down the recommendations of the EPIC Study report. In essence, by these admissions, the only professional course of action for the CEG to take would have been to not make any such x-ray-only recommendation at all.

One must wonder why the CEG is doing this. Could it be that it was pressured by the manufacturer of Vetmedin -- which fully funded the EPIC Study -- to go out on such an irresponsible limb?

Study shows healthy cavaliers' mitral valve structure differs markedly from other breeds. In a September abstract , an international panel of cardiologists G. Borgarelli used 3-D echocardiography to compare the mitral valves of 22 cavalier King Charles spaniels with 41 other dogs of 18 different breeds. They measured the dimensions of the mitral valve's annulus see diagram at right , tenting see diagram at left below , leaftet areas, and several other categories.

They found that cavaliers had significantly smaller annulus diameter, annulus height, tenting height, tenting area, normalized tenting volume, posterior leaflet length, normalized posterior leaflet area, and a greater annulus sphericity index. They concluded that the mitral valve of healthy CKCSs was more circular and had less tenting, compared to other breeds.

Andrew Hoffman right , is conducting a study of ten MVD-affected dogs in congestive heart failure determined by fluid in the lungs , which are being injected with mesenchymal stem cell MSC treatments to determine, first, if the therapy is safe for the dogs, and, second, will result in improved cardiac function, as determined by echocardiography, cardiac biomarkers, and quality of life.

Polish researchers find four cell markers signal left atrium enlargement in MVD-dogs. They compared them in dogs with end-stage dilated cardiomyopathy DCM and dogs with MVD and a control group of unaffected dogs.

Their research focused upon the enlargement of the left atrium in the diseased dogs. They reported that changes included: They concluded that, during heart failure, the pattern of desmin, vimentin, periostin and caspase-3 expression alters in the left atrium, regardless of the cause; that the changes are more pronounced in dogs with DCM than in dogs with MVD and similar left atrial enlargement.

See also this research team's January report , below. In a November press release , the UK Kennel Club announced that it has approved a health testing scheme for cavalier King Charles spaniels, with the intended result of "dramatically" improving the heart health of the CKCS.

The program will consist of veterinary cardiologists examining cavaliers to determine if each dog has a mitral valve murmur. An echocardiograph scan also will be performed and sent to Dr. Each dog will be issued a certificate from the University of Copenhagen, with both a murmur and mitral valve prolapse score. The Kennel Club will record the certificate results on the dog's registration record and made available publicly.

If the parents are not yet five years old, then he writes that the show dogs' grandparents meet that test standard. Thai cardiologists recommend "ECG monitoring should be performed in dogs chronically administered with pimobendan.

Types of cardiac arrhythmias included atrial fibrillation, sinus tachycardia, second degree AV block, ventricular premature beat, and junctional premature beat. Most of dogs with cardiac arrhythmias had atrial fibrillation. Tawian cardiologists find anemia increases with MVD progression and predicts mortality.

They stated that anemic dogs in heart failure had shorter median survival times 13 months than non-anemic dogs in heart failure 28 months , and that anemia was a predictor of mortality. In a September study by a team of Korean cardiology researchers Bum-Sul Choi, Hyeong-Sun Moon, Sang-Hyuk Seo, Changbaig Hyun [right] , they examined serum concentration levels of two kidney function biomarkers -- Cystatin-C or cystatin 3 Cys-C and symmetric dimethylarginine SDMA -- which appear to play roles in predicting new-onset or deteriorating kidney diseases.

Their goal was to evaluate these two renal disorder biomarkers in dogs with mitral valve disease MVD at varying degrees of heart failure. They found that serum Cys-C and SDMA concentrations were not correlated to age or body weight, but closely correlated to the severity of heart failure and echocardiographic markers of heart enlargement. The study found progressive elevation in renal markers in dogs with advancing MVD, suggesting that the reduction of glomerular filtration rate GFR might be worsened with the progression of cardiac dysfunction.

They concluded that their study demonstrated that the glomerular filtration rate GFR -- a common complication in advanced stages of heart failure -- was decreased in dogs with MVD in earlier stages of heart failure, based on results from serum Cys-C and SDMA tests, and therefore, earlier intervention for preventing renal injuries even in asymptomatic MVD dogs is necessary for the successful long-term management of heart failure in MVD-dogs.

The EPIC Study concludes that pimobendan can prolong pre-heart failure by 15 months in MVD-affected dogs with echo and x-ray evidence of heart enlargement. In a September article , an international team of veterinary cardiologists report that the administration of pimobendan to MVD-affected dogs with echocardiographic and radiographic evidence of heart enlargement results in prolonging the pre-heart failure period by approximately 15 months over non-treatment a placebo , which represents a substantial clinical benefit.

To be included in the study, a dog had to be 6 years of age or older, have a mitral valve murmur of at least Grade 3 of 6, have echocardiographic evidence of advanced MVD consisting of characteristic valvular lesions of the mitral valve, regurgitation through the mitral valve MR on the color Doppler echocardiogram, and have echocardiographic evidence of left atrial and left ventricular dilatation. All dogs entering the study met or exceeded three different heart size criteria.

The researchers warn that:. Therefore, to apply the results of this study to future treatment of MVD-affected dogs, an x-ray of the heart, showing a VHS over Of dogs in the study, Therefore, the results of this study obviously are of supreme importance to owners of cavaliers. Of those dogs treated with pimobendan, 59 The others had not reached CHF by the time the study ended.

The authors explained that:. This essentially means that once the MVD-affected dog develops a Grade 3 murmur and an x-ray showing enlargement, the owner should have a board certified veterinary cardiologist perform the echo exam. It previously has been customary when cardiologists determine heart enlargement using VHS values, to compare the current x-ray with previous ones, such as a baseline x-ray.

But if the manufacturer's goal is to sell more pills, then reducing the threshold VHS value to significantly below the average score of a healthy cavalier, will do just that -- sell more pills.

Let's face it, the CKCS breed will be its biggest customer. It also is disappointing that the study does not go into any details about 8. While the authors do acknowledge that "concerns had previously been raised about possible detrimental effects of the administration pimobendan to dogs with preclinical MMVD", they provide nothing to explain why pimobendan played a role in those sudden and unexpected Stage B2 deaths. To the contrary, they seem to be patting themselves on the back for even including any data on these premature cardiac deaths, stating: Instead, they minimize these 8.

Although a greater number of dogs in the pimobendan group experienced spontaneous cardiac death 12 versus 5 , the proportion of dogs in each group experiencing this event was not significantly different. Tucker Bryan, Trinity Presbyterian, , No. Michael Varosky-Jaclylm Bezovoska, St. Alana Boyce, Randolph, , No. Callie Ware, Briarwood Christian, , , No. Katelyn Bussey, Briarwood Christian, , No. James, , No. Spencer Skidmore, Altamont, , No.

William Robertson, Montgomery Academy, , No. Tanner Hearing, American Christian, Nicholas Ruddock, Houston Academy, , No. Wesley Sudarshan, Altamont, , Doubles finals No. Claire Prickett, Bayside Academy, , No. Claire Hillman, Donoho, , No. Virginia Hutto, Donoho, , No.

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