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M Patteson - One of the best experts on this subject based on the ideXlab platform.
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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
Journal of Veterinary Internal Medicine, 2018Co-Authors: A Boswood, Bruce W Keene, Sonya G Gordon, Jens Haggstrom, Gerhard Wess, Rebecca L Stepien, Mark A Oyama, John D Bonagura, Kristin A Macdonald, M PattesonAbstract: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 (Δ) LVIDDN -0.06 (IQR: -0.15 to +0.02), P 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.
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effect of Pimobendan in dogs with preclinical myxomatous mitral valve disease and cardiomegaly the epic study a randomized clinical trial
Journal of Veterinary Internal Medicine, 2016Co-Authors: A Boswood, Bruce W Keene, Sonya G Gordon, Jens Haggstrom, Gerhard Wess, Rebecca L Stepien, Mark A Oyama, John D Bonagura, Kristin A Macdonald, M PattesonAbstract: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.
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longitudinal analysis of quality of life clinical radiographic echocardiographic and laboratory variables in dogs with myxomatous mitral valve disease receiving Pimobendan or benazepril the quest study
Journal of Veterinary Internal Medicine, 2013Co-Authors: Jens Haggstrom, Michael R Ogrady, Olaf Jons, A Boswood, Sarah Smith, Simon Swift, M Borgarelli, B Gavaghan, Jangerd Kresken, M PattesonAbstract:BACKGROUND: Myxomatous mitral valve disease (MMVD) is an important cause of morbidity and mortality in dogs. OBJECTIVES: To compare, throughout the period of follow-up of dogs that had not yet reached the primary endpoint, the longitudinal effects of Pimobendan versus benazepril hydrochloride treatment on quality-of-life (QoL) variables, concomitant congestive heart failure (CHF) treatment, and other outcome variables in dogs suffering from CHF secondary to MMVD. ANIMALS: A total of 260 dogs in CHF because of MMVD. METHODS: A prospective single-blinded study with dogs randomized to receive Pimobendan (0.4-0.6 mg/kg/day) or benazepril hydrochloride (0.25-1.0 mg/kg/day). Differences in outcome variables and time to intensification of CHF treatment were compared. RESULTS: A total of 124 dogs were randomized to Pimobendan and 128 to benazepril. No difference was found between groups in QoL variables during the trial. Time from inclusion to 1st intensification of CHF treatment was longer in the Pimobendan group (Pimobendan 98 days, IQR 30-276 days versus benazepril 59 days, IQR 11-121 days; P = .0005). Postinclusion, dogs in the Pimobendan group had smaller heart size based on VHS score (P = .013) and left ventricular diastolic (P = .035) and systolic (P = .0044) dimensions, higher body temperature (P = .030), serum sodium (P = .0027), and total protein (P = .0003) concentrations, and packed cell volume (P = .030). Incidence of arrhythmias was similar in treatment groups. CONCLUSIONS AND CLINICAL IMPORTANCE: Pimobendan versus benazepril resulted in similar QoL during the study, but conferred increased time before intensification of CHF treatment. Pimobendan treatment resulted in smaller heart size, higher body temperature, and less retention of free water.
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efficacy of Pimobendan in the prevention of congestive heart failure or sudden death in doberman pinschers with preclinical dilated cardiomyopathy the protect study
Journal of Veterinary Internal Medicine, 2012Co-Authors: Nuala Summerfield, Michael R Ogrady, Anne French, A Boswood, Sonya G Gordon, Mark A Oyama, M Patteson, Sarah Smith, J Dukesmcewan, Geoff CulshawAbstract:Background The benefit of Pimobendan in delaying the progression of preclinical dilated cardiomyopathy (DCM) in Dobermans is not reported. Hypothesis That chronic oral administration of Pimobendan to Dobermans with preclinical DCM will delay the onset of CHF or sudden death and improve survival. Animals Seventy-six client-owned Dobermans recruited at 10 centers in the UK and North America. Methods The trial was a randomized, blinded, placebo-controlled, parallel group multicenter study. Dogs were allocated in a 1:1 ratio to receive Pimobendan (Vetmedin capsules) or visually identical placebo. The composite primary endpoint was prospectively defined as either onset of CHF or sudden death. Time to death from all causes was a secondary endpoint. Results The proportion of dogs reaching the primary endpoint was not significantly different between groups (P = .1). The median time to the primary endpoint (onset of CHF or sudden death) was significantly longer in the Pimobendan (718 days, IQR 441–1152 days) versus the placebo group (441 days, IQR 151–641 days) (log-rank P = 0.0088). The median survival time was significantly longer in the Pimobendan (623 days, IQR 491–1531 days) versus the placebo group (466 days, IQR 236–710 days) (log-rank P = .034). Conclusion and Clinical Importance The administration of Pimobendan to Dobermans with preclinical DCM prolongs the time to the onset of clinical signs and extends survival. Treatment of dogs in the preclinical phase of this common cardiovascular disorder with Pimobendan can lead to improved outcome.
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effect of Pimobendan or benazepril hydrochloride on survival times in dogs with congestive heart failure caused by naturally occurring myxomatous mitral valve disease the quest study
Journal of Veterinary Internal Medicine, 2008Co-Authors: Jens Haggstrom, Michael R Ogrady, Olaf Jons, A Boswood, Sarah Smith, Simon Swift, M Borgarelli, B Gavaghan, Jangerd Kresken, M PattesonAbstract:BACKGROUND: Myxomatous mitral valve disease (MMVD) continues to be an important cause of morbidity and mortality in geriatric dogs despite conventional therapy. HYPOTHESIS: Pimobendan in addition to conventional therapy will extend time to sudden cardiac death, euthanasia for cardiac reasons, or treatment failure when compared with conventional therapy plus benazepril in dogs with congestive heart failure (CHF) attributable to MMVD. ANIMALS: Two hundred and sixty client-owned dogs in CHF caused by MMVD were recruited from 28 centers in Europe, Canada, and Australia. METHODS: A prospective single-blinded study with dogs randomized to PO receive Pimobendan (0.4-0.6 mg/kg/d) or benazepril hydrochloride (0.25-1.0 mg/kg/d). The primary endpoint was a composite of cardiac death, euthanized for heart failure, or treatment failure. RESULTS: Eight dogs were excluded from analysis. One hundred and twenty-four dogs were randomized to Pimobendan and 128 to benazepril. One hundred and ninety dogs reached the primary endpoint; the median time was 188 days (267 days for Pimobendan, 140 days for benazepril hazard ratio = 0.688, 95% confidence limits [CL]=0.516-0.916, P= .0099). The benefit of Pimobendan persisted after adjusting for all baseline variables. A longer time to reach the endpoint was also associated with being a Cavalier King Charles Spaniel, requiring a lower furosemide dose, and having a higher creatinine concentration. Increases in several indicators of cardiac enlargement (left atrial to aortic root ratio, vertebral heart scale, and percentage increase in left ventricular internal diameter in systole) were associated with a shorter time to endpoint, as was a worse tolerance for exercise. CONCLUSIONS AND CLINICAL IMPORTANCE: Pimobendan plus conventional therapy prolongs time to sudden death, euthanasia for cardiac reasons, or treatment failure in dogs with CHF caused by MMVD compared with benazepril plus conventional therapy
Jens Haggstrom - One of the best experts on this subject based on the ideXlab platform.
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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
Journal of Veterinary Internal Medicine, 2018Co-Authors: A Boswood, Bruce W Keene, Sonya G Gordon, Jens Haggstrom, Gerhard Wess, Rebecca L Stepien, Mark A Oyama, John D Bonagura, Kristin A Macdonald, M PattesonAbstract: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 (Δ) LVIDDN -0.06 (IQR: -0.15 to +0.02), P 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.
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effect of Pimobendan in dogs with preclinical myxomatous mitral valve disease and cardiomegaly the epic study a randomized clinical trial
Journal of Veterinary Internal Medicine, 2016Co-Authors: A Boswood, Bruce W Keene, Sonya G Gordon, Jens Haggstrom, Gerhard Wess, Rebecca L Stepien, Mark A Oyama, John D Bonagura, Kristin A Macdonald, M PattesonAbstract: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.
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effects of Pimobendan on myocardial perfusion and pulmonary transit time in dogs with myxomatous mitral valve disease a pilot study
Australian Veterinary Journal, 2016Co-Authors: Sm Apple, Jens Haggstrom, G Menciotti, L Brazruivo, S Crosara, M BorgarelliAbstract:Objectives To describe pulmonary transit time (nPTT) and myocardial perfusion (nMP) normalised to heart rate in dogs with stable ACVIM stage C myxomatous mitral valve disease (MMVD) and to assess short-term effects of Pimobendan on these variables. We hypothesised that nPTT and nMP would increase in dogs with MMVD compared with normal dogs. Additionally, we hypothesised that treatment with Pimobendan would decrease nMP and nPTT in dogs with MMVD. Design Prospective, single-blind study involving 6 normal dogs and 12 dogs with MMVD. Methods Dogs with MMVD were treated with enalapril and furosemide for at least 1 month prior to examination. All dogs underwent standard and contrast echocardiographic examinations at the beginning of the study (T0). At this time, MMVD dogs were randomly assigned to receive either Pimobendan (0.4–0.6 mg/kg) or not. All dogs with MMVD were re-evaluated by standard and contrast echocardiography after 1 week (T1) and nPTT and nMP were measured. Results nPTT was significantly increased in dogs with MMVD (P = 0.0063), compared with normal dogs. It was significantly decreased at T1 in dogs receiving Pimobendan (P = 0.0250). The nMP was not significantly different in dogs with MMVD, compared with healthy dogs (P = 0.2552), and it was not significantly different at T1 in the treatment group (P = 0.8798). Conclusions Contrast echocardiography was a valid, complementary tool for echocardiographic analysis of dogs with MMVD. Pimobendan decreased nPTT in dogs affected by MMVD. Myocardial perfusion was not different in dogs with severe MMVD.
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longitudinal analysis of quality of life clinical radiographic echocardiographic and laboratory variables in dogs with myxomatous mitral valve disease receiving Pimobendan or benazepril the quest study
Journal of Veterinary Internal Medicine, 2013Co-Authors: Jens Haggstrom, Michael R Ogrady, Olaf Jons, A Boswood, Sarah Smith, Simon Swift, M Borgarelli, B Gavaghan, Jangerd Kresken, M PattesonAbstract:BACKGROUND: Myxomatous mitral valve disease (MMVD) is an important cause of morbidity and mortality in dogs. OBJECTIVES: To compare, throughout the period of follow-up of dogs that had not yet reached the primary endpoint, the longitudinal effects of Pimobendan versus benazepril hydrochloride treatment on quality-of-life (QoL) variables, concomitant congestive heart failure (CHF) treatment, and other outcome variables in dogs suffering from CHF secondary to MMVD. ANIMALS: A total of 260 dogs in CHF because of MMVD. METHODS: A prospective single-blinded study with dogs randomized to receive Pimobendan (0.4-0.6 mg/kg/day) or benazepril hydrochloride (0.25-1.0 mg/kg/day). Differences in outcome variables and time to intensification of CHF treatment were compared. RESULTS: A total of 124 dogs were randomized to Pimobendan and 128 to benazepril. No difference was found between groups in QoL variables during the trial. Time from inclusion to 1st intensification of CHF treatment was longer in the Pimobendan group (Pimobendan 98 days, IQR 30-276 days versus benazepril 59 days, IQR 11-121 days; P = .0005). Postinclusion, dogs in the Pimobendan group had smaller heart size based on VHS score (P = .013) and left ventricular diastolic (P = .035) and systolic (P = .0044) dimensions, higher body temperature (P = .030), serum sodium (P = .0027), and total protein (P = .0003) concentrations, and packed cell volume (P = .030). Incidence of arrhythmias was similar in treatment groups. CONCLUSIONS AND CLINICAL IMPORTANCE: Pimobendan versus benazepril resulted in similar QoL during the study, but conferred increased time before intensification of CHF treatment. Pimobendan treatment resulted in smaller heart size, higher body temperature, and less retention of free water.
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short term hemodynamic and neuroendocrine effects of Pimobendan and benazapril in dogs with myxomatous mitral valve disease and congestive heart failure
Journal of Veterinary Internal Medicine, 2013Co-Authors: Jens Haggstrom, Olaf Jons, P Lord, Katja Hoglund, I Ljungvall, C Kvart, Kerstin HanssonAbstract:Background Pimobendan and benazepril are frequently used with diuretics to treat dogs in congestive heart failure (CHF) caused by myxomatous mitral valve disease (MMVD). Aim To compare the short-term effects of Pimobendan versus benazepril on pump function, heart size, and neuroendocrine profile in dogs with CHF caused by MMVD. Animals Sixteen client-owned dogs. Material and methods Seven-day prospective single-blinded study of dogs stabilized on furosemide monotherapy, randomized to Pimobendan (0.4–0.6 mg/kg/day) or benazepril (0.25–1.0 mg/kg/day). Dogs had first-pass radionuclide angiocardiography, and heart size was measured by radiography and echocardiography. Circulating neuroendocrine hormones were measured. Results Baseline variables did not differ between treatment groups. Greater decreases in the Pimobendan than in the benazepril group were found for heart rate (P = .001), heart rate-normalized pulmonary transit time (P = .02), left atrial size (P = .03), and systolic and diastolic left ventricular diameters (P < .001 and P = .03, respectively) and volumes (P < .001 and P = .02, respectively), whereas ejection fraction increased more (P = .02) in the Pimobendan group. Of the neuroendocrine hormones, only N-terminal proatrial natriuretic peptide (NT-ProANP) differed (P = .04) between groups. Within groups, plasma aldosterone increased (P = .01), and NT-proANP (P = .01) and NT-proB-type (P = .02) natriuretic peptide decreased in the Pimobendan group, and NT-proANP (P = .02) and plasma vasopressin (P = .01) decreased in the benazepril group. Conclusions and Clinical Importance Pimobendan improves short-term cardiac function more than benazepril in dogs with CHF caused by MMVD. Pimobendan treatment enables the heart to work at smaller end-systolic and diastolic dimensions while maintaining adequate forward stroke volume. Some of the treatment responses found in neuroendocrine profile might have therapeutic relevance.
A Boswood - One of the best experts on this subject based on the ideXlab platform.
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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
Journal of Veterinary Internal Medicine, 2018Co-Authors: A Boswood, Bruce W Keene, Sonya G Gordon, Jens Haggstrom, Gerhard Wess, Rebecca L Stepien, Mark A Oyama, John D Bonagura, Kristin A Macdonald, M PattesonAbstract: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 (Δ) LVIDDN -0.06 (IQR: -0.15 to +0.02), P 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.
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effect of Pimobendan in dogs with preclinical myxomatous mitral valve disease and cardiomegaly the epic study a randomized clinical trial
Journal of Veterinary Internal Medicine, 2016Co-Authors: A Boswood, Bruce W Keene, Sonya G Gordon, Jens Haggstrom, Gerhard Wess, Rebecca L Stepien, Mark A Oyama, John D Bonagura, Kristin A Macdonald, M PattesonAbstract: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.
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longitudinal analysis of quality of life clinical radiographic echocardiographic and laboratory variables in dogs with myxomatous mitral valve disease receiving Pimobendan or benazepril the quest study
Journal of Veterinary Internal Medicine, 2013Co-Authors: Jens Haggstrom, Michael R Ogrady, Olaf Jons, A Boswood, Sarah Smith, Simon Swift, M Borgarelli, B Gavaghan, Jangerd Kresken, M PattesonAbstract:BACKGROUND: Myxomatous mitral valve disease (MMVD) is an important cause of morbidity and mortality in dogs. OBJECTIVES: To compare, throughout the period of follow-up of dogs that had not yet reached the primary endpoint, the longitudinal effects of Pimobendan versus benazepril hydrochloride treatment on quality-of-life (QoL) variables, concomitant congestive heart failure (CHF) treatment, and other outcome variables in dogs suffering from CHF secondary to MMVD. ANIMALS: A total of 260 dogs in CHF because of MMVD. METHODS: A prospective single-blinded study with dogs randomized to receive Pimobendan (0.4-0.6 mg/kg/day) or benazepril hydrochloride (0.25-1.0 mg/kg/day). Differences in outcome variables and time to intensification of CHF treatment were compared. RESULTS: A total of 124 dogs were randomized to Pimobendan and 128 to benazepril. No difference was found between groups in QoL variables during the trial. Time from inclusion to 1st intensification of CHF treatment was longer in the Pimobendan group (Pimobendan 98 days, IQR 30-276 days versus benazepril 59 days, IQR 11-121 days; P = .0005). Postinclusion, dogs in the Pimobendan group had smaller heart size based on VHS score (P = .013) and left ventricular diastolic (P = .035) and systolic (P = .0044) dimensions, higher body temperature (P = .030), serum sodium (P = .0027), and total protein (P = .0003) concentrations, and packed cell volume (P = .030). Incidence of arrhythmias was similar in treatment groups. CONCLUSIONS AND CLINICAL IMPORTANCE: Pimobendan versus benazepril resulted in similar QoL during the study, but conferred increased time before intensification of CHF treatment. Pimobendan treatment resulted in smaller heart size, higher body temperature, and less retention of free water.
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efficacy of Pimobendan in the prevention of congestive heart failure or sudden death in doberman pinschers with preclinical dilated cardiomyopathy the protect study
Journal of Veterinary Internal Medicine, 2012Co-Authors: Nuala Summerfield, Michael R Ogrady, Anne French, A Boswood, Sonya G Gordon, Mark A Oyama, M Patteson, Sarah Smith, J Dukesmcewan, Geoff CulshawAbstract:Background The benefit of Pimobendan in delaying the progression of preclinical dilated cardiomyopathy (DCM) in Dobermans is not reported. Hypothesis That chronic oral administration of Pimobendan to Dobermans with preclinical DCM will delay the onset of CHF or sudden death and improve survival. Animals Seventy-six client-owned Dobermans recruited at 10 centers in the UK and North America. Methods The trial was a randomized, blinded, placebo-controlled, parallel group multicenter study. Dogs were allocated in a 1:1 ratio to receive Pimobendan (Vetmedin capsules) or visually identical placebo. The composite primary endpoint was prospectively defined as either onset of CHF or sudden death. Time to death from all causes was a secondary endpoint. Results The proportion of dogs reaching the primary endpoint was not significantly different between groups (P = .1). The median time to the primary endpoint (onset of CHF or sudden death) was significantly longer in the Pimobendan (718 days, IQR 441–1152 days) versus the placebo group (441 days, IQR 151–641 days) (log-rank P = 0.0088). The median survival time was significantly longer in the Pimobendan (623 days, IQR 491–1531 days) versus the placebo group (466 days, IQR 236–710 days) (log-rank P = .034). Conclusion and Clinical Importance The administration of Pimobendan to Dobermans with preclinical DCM prolongs the time to the onset of clinical signs and extends survival. Treatment of dogs in the preclinical phase of this common cardiovascular disorder with Pimobendan can lead to improved outcome.
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current use of Pimobendan in canine patients with heart disease
Veterinary Clinics of North America-small Animal Practice, 2010Co-Authors: A BoswoodAbstract:Pimobendan is a drug with both inotropic and vasodilatory properties and is widely used for the treatment of heart failure in dogs. The best evidence regarding its efficacy is derived from several clinical studies of dogs with the two most common conditions that result in heart failure: dilated cardiomyopathy (DCM) and degenerative mitral valve disease (DMVD). The main studies addressing the effectiveness of Pimobendan in dogs with DCM and DVMD are discussed in this article.
Gerhard Wess - One of the best experts on this subject based on the ideXlab platform.
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effects of Pimobendan in cats with hypertrophic cardiomyopathy and recent congestive heart failure results of a prospective double blind randomized nonpivotal exploratory field study
Journal of Veterinary Internal Medicine, 2021Co-Authors: Karsten E Schober, John E Rush, Virginia Luis Fuentes, Gerhard Wess, Nuala Summerfield, T M Glaus, Kathy N Wright, Linda B Lehmkuhl, Margaret P Sayer, J LoureiroAbstract:Background: The benefits of Pimobendan in the treatment of congestive heart failure (CHF) in cats with hypertrophic cardiomyopathy (HCM) have not been evaluated prospectively. Hypothesis/objectives: To investigate the effects of Pimobendan in cats with HCM and recent CHF and to identify possible endpoints for a pivotal study. We hypothesized that Pimobendan would be well-tolerated and associated with improved outcome. Animals: Eighty-three cats with HCM and recently controlled CHF: 30 with and 53 without left ventricular outflow tract obstruction. Methods: Prospective randomized placebo-controlled double-blind multicenter nonpivotal field study. Cats received either Pimobendan (0.30 mg/kg q12h, n = 43), placebo (n = 39), or no medication (n = 1) together with furosemide (<10 mg/kg/d) with or without clopidogrel. The primary endpoint was a successful outcome (ie, completing the 180-day study period without a dose escalation of furosemide). Results: The proportion of cats in the full analysis set population with a successful outcome was not different between treatment groups (P = .75). For nonobstructive cats, the success rate was 32% in Pimobendan-treated cats versus 18.2% in the placebo group (odds ratio [OR], 2.12; 95% confidence interval [CI], 0.54-8.34). For obstructive cats, the success rate was 28.6% and 60% in the Pimobendan and placebo groups, respectively (OR, 0.27; 95% CI, 0.06-1.26). No difference was found between treatments for the secondary endpoints of time to furosemide dose escalation or death (P = .89). Results were similar in the per-protocol sets. Adverse events in both treatment groups were similar. Conclusions and clinical importance: In this study of cats with HCM and recent CHF, no benefit of Pimobendan on 180-day outcome was identified.
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efficacy of adding ramipril vasotop to the combination of furosemide lasix and Pimobendan vetmedin in dogs with mitral valve degeneration the valve trial
Journal of Veterinary Internal Medicine, 2020Co-Authors: Gerhard Wess, Jangerd Kresken, Ralph T Wendt, Juliane Gaugele, M Killich, Lisa Keller, Julia Simak, Peter Holler, Alexander Bauer, Helmut KuchenhofAbstract:Background Triple therapy (TT) consisting of furosemide, Pimobendan, and an angiotensin-converting enzyme inhibitor (ACEI) frequently is recommended for the treatment of congestive heart failure (CHF) attributable to myxomatous mitral valve disease (MMVD). However, the effect of adding an ACEI to the combination of Pimobendan and furosemide (dual therapy [DT]) so far has not been evaluated prospectively. Hypothesis Triple therapy will extend survival time compared to DT in dogs with CHF secondary to MMVD. Animals Client-owned dogs presented with the first episode of CHF caused by MMVD. Methods Prospective, single-blinded, randomized multicenter study. One-hundred and fifty-eight dogs were recruited and prospectively randomized to receive either DT (furosemide and Pimobendan) or TT (furosemide, Pimobendan, and ramipril). The primary endpoint was a composite of cardiac death, euthanasia for heart failure, or treatment failure. Results Seventy-seven dogs were randomized to receive DT and 79 to receive TT. Two dogs were excluded from analysis. The primary endpoint was reached by 136 dogs (87%; 66 dogs, DT; 70 dogs, TT). Median time to reach the primary endpoint for all dogs in the study was 214 days (95% confidence interval [CI], 168-259 days). Median time to reach the primary endpoint was not significantly different between the DT group (227 days; interquartile range [IQR], 103-636 days) compared with TT group (186 days; IQR, 72-453 days; P = .42). Conclusions and clinical importance Addition of the ACEI ramipril to Pimobendan and furosemide did not have any beneficial effect on survival time in dogs with CHF secondary to MMVD.
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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
Journal of Veterinary Internal Medicine, 2018Co-Authors: A Boswood, Bruce W Keene, Sonya G Gordon, Jens Haggstrom, Gerhard Wess, Rebecca L Stepien, Mark A Oyama, John D Bonagura, Kristin A Macdonald, M PattesonAbstract: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 (Δ) LVIDDN -0.06 (IQR: -0.15 to +0.02), P 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.
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effect of Pimobendan in dogs with preclinical myxomatous mitral valve disease and cardiomegaly the epic study a randomized clinical trial
Journal of Veterinary Internal Medicine, 2016Co-Authors: A Boswood, Bruce W Keene, Sonya G Gordon, Jens Haggstrom, Gerhard Wess, Rebecca L Stepien, Mark A Oyama, John D Bonagura, Kristin A Macdonald, M PattesonAbstract: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.
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longitudinal analysis of quality of life clinical radiographic echocardiographic and laboratory variables in dogs with myxomatous mitral valve disease receiving Pimobendan or benazepril the quest study
Journal of Veterinary Internal Medicine, 2013Co-Authors: Jens Haggstrom, Michael R Ogrady, Olaf Jons, A Boswood, Sarah Smith, Simon Swift, M Borgarelli, B Gavaghan, Jangerd Kresken, M PattesonAbstract:BACKGROUND: Myxomatous mitral valve disease (MMVD) is an important cause of morbidity and mortality in dogs. OBJECTIVES: To compare, throughout the period of follow-up of dogs that had not yet reached the primary endpoint, the longitudinal effects of Pimobendan versus benazepril hydrochloride treatment on quality-of-life (QoL) variables, concomitant congestive heart failure (CHF) treatment, and other outcome variables in dogs suffering from CHF secondary to MMVD. ANIMALS: A total of 260 dogs in CHF because of MMVD. METHODS: A prospective single-blinded study with dogs randomized to receive Pimobendan (0.4-0.6 mg/kg/day) or benazepril hydrochloride (0.25-1.0 mg/kg/day). Differences in outcome variables and time to intensification of CHF treatment were compared. RESULTS: A total of 124 dogs were randomized to Pimobendan and 128 to benazepril. No difference was found between groups in QoL variables during the trial. Time from inclusion to 1st intensification of CHF treatment was longer in the Pimobendan group (Pimobendan 98 days, IQR 30-276 days versus benazepril 59 days, IQR 11-121 days; P = .0005). Postinclusion, dogs in the Pimobendan group had smaller heart size based on VHS score (P = .013) and left ventricular diastolic (P = .035) and systolic (P = .0044) dimensions, higher body temperature (P = .030), serum sodium (P = .0027), and total protein (P = .0003) concentrations, and packed cell volume (P = .030). Incidence of arrhythmias was similar in treatment groups. CONCLUSIONS AND CLINICAL IMPORTANCE: Pimobendan versus benazepril resulted in similar QoL during the study, but conferred increased time before intensification of CHF treatment. Pimobendan treatment resulted in smaller heart size, higher body temperature, and less retention of free water.
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efficacy of Pimobendan in the prevention of congestive heart failure or sudden death in doberman pinschers with preclinical dilated cardiomyopathy the protect study
Journal of Veterinary Internal Medicine, 2012Co-Authors: Nuala Summerfield, Michael R Ogrady, Anne French, A Boswood, Sonya G Gordon, Mark A Oyama, M Patteson, Sarah Smith, J Dukesmcewan, Geoff CulshawAbstract:Background The benefit of Pimobendan in delaying the progression of preclinical dilated cardiomyopathy (DCM) in Dobermans is not reported. Hypothesis That chronic oral administration of Pimobendan to Dobermans with preclinical DCM will delay the onset of CHF or sudden death and improve survival. Animals Seventy-six client-owned Dobermans recruited at 10 centers in the UK and North America. Methods The trial was a randomized, blinded, placebo-controlled, parallel group multicenter study. Dogs were allocated in a 1:1 ratio to receive Pimobendan (Vetmedin capsules) or visually identical placebo. The composite primary endpoint was prospectively defined as either onset of CHF or sudden death. Time to death from all causes was a secondary endpoint. Results The proportion of dogs reaching the primary endpoint was not significantly different between groups (P = .1). The median time to the primary endpoint (onset of CHF or sudden death) was significantly longer in the Pimobendan (718 days, IQR 441–1152 days) versus the placebo group (441 days, IQR 151–641 days) (log-rank P = 0.0088). The median survival time was significantly longer in the Pimobendan (623 days, IQR 491–1531 days) versus the placebo group (466 days, IQR 236–710 days) (log-rank P = .034). Conclusion and Clinical Importance The administration of Pimobendan to Dobermans with preclinical DCM prolongs the time to the onset of clinical signs and extends survival. Treatment of dogs in the preclinical phase of this common cardiovascular disorder with Pimobendan can lead to improved outcome.
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effect of Pimobendan or benazepril hydrochloride on survival times in dogs with congestive heart failure caused by naturally occurring myxomatous mitral valve disease the quest study
Journal of Veterinary Internal Medicine, 2008Co-Authors: Jens Haggstrom, Michael R Ogrady, Olaf Jons, A Boswood, Sarah Smith, Simon Swift, M Borgarelli, B Gavaghan, Jangerd Kresken, M PattesonAbstract:BACKGROUND: Myxomatous mitral valve disease (MMVD) continues to be an important cause of morbidity and mortality in geriatric dogs despite conventional therapy. HYPOTHESIS: Pimobendan in addition to conventional therapy will extend time to sudden cardiac death, euthanasia for cardiac reasons, or treatment failure when compared with conventional therapy plus benazepril in dogs with congestive heart failure (CHF) attributable to MMVD. ANIMALS: Two hundred and sixty client-owned dogs in CHF caused by MMVD were recruited from 28 centers in Europe, Canada, and Australia. METHODS: A prospective single-blinded study with dogs randomized to PO receive Pimobendan (0.4-0.6 mg/kg/d) or benazepril hydrochloride (0.25-1.0 mg/kg/d). The primary endpoint was a composite of cardiac death, euthanized for heart failure, or treatment failure. RESULTS: Eight dogs were excluded from analysis. One hundred and twenty-four dogs were randomized to Pimobendan and 128 to benazepril. One hundred and ninety dogs reached the primary endpoint; the median time was 188 days (267 days for Pimobendan, 140 days for benazepril hazard ratio = 0.688, 95% confidence limits [CL]=0.516-0.916, P= .0099). The benefit of Pimobendan persisted after adjusting for all baseline variables. A longer time to reach the endpoint was also associated with being a Cavalier King Charles Spaniel, requiring a lower furosemide dose, and having a higher creatinine concentration. Increases in several indicators of cardiac enlargement (left atrial to aortic root ratio, vertebral heart scale, and percentage increase in left ventricular internal diameter in systole) were associated with a shorter time to endpoint, as was a worse tolerance for exercise. CONCLUSIONS AND CLINICAL IMPORTANCE: Pimobendan plus conventional therapy prolongs time to sudden death, euthanasia for cardiac reasons, or treatment failure in dogs with CHF caused by MMVD compared with benazepril plus conventional therapy
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effect of Pimobendan on case fatality rate in doberman pinschers with congestive heart failure caused by dilated cardiomyopathy
Journal of Veterinary Internal Medicine, 2008Co-Authors: Michael R Ogrady, Sandra L Minors, M L Osullivan, R. HorneAbstract:Background: Despite traditional therapy of a diuretic, angiotensin converting enzyme inhibitor, digoxin, or a combination of these drugs, survival of dogs with dilated cardiomyopathy (DCM) is low. Pimobendan, an inodilator, has both inotropic and balanced peripheral vasodilatory properties. Hypothesis: Pimobendan when added to conventional therapy will improve morbidity and reduce case fatality rate in Doberman Pinschers with congestive heart failure (CHF) caused by DCM. Animals: Sixteen Doberman Pinschers in CHF caused by DCM. Methods: A prospective randomized, double-blind, placebo-controlled study with treatment failure as the primary and quality of life (QoL) indices as secondary outcome variables. Therapy consisted of furosemide (per os [PO] as required) and benazepril hydrochloride (0.5 mg/kg PO q12h) and dogs were randomized in pairs and by sex to receive Pimobendan (0.25 mg/kg PO q12h) or placebo (1 tablet PO q12h). Results: Pimobendan-treated dogs had a significant improvement in time to treatment failure (Pimobendan median, 130.5 days; placebo median, 14 days; P= .002; risk ratio = 0.35, P= .003, lower 5% confidence limit = 0.13, upper 95% confidence limit = 0.71). Number and rate of dogs reaching treatment failure in the placebo group precluded the analysis of QoL. Conclusions and Clinical Importance: Pimobendan should be used as a first-line therapeutic in Doberman Pinschers for the treatment of CHF caused by DCM.