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CLINICAL INSIGHTS JULY/AUGUST 2018 77 severe enough to meet or exceed the EPIC criteria for initiating pimobendan ( FIGURE 2 ). 13 Is this dog a candidate for pimobendan therapy? Yes, initiating pimobendan therapy is recommended. This dog meets the EPIC criteria (VHS >10.5, LA/Ao-2D ≥1.6, LVIDdN ≥1.7). The echocardiogram confirms DMVD: thick mitral valve leaflets and an eccentric jet of mitral regurgitation. The VHS is 10.9, and the LA/ Ao-2D measured as depicted on FIGURE 2 is 2.1. The LVIDd is increased to 4.2 cm (reference range 2.8 to 4.0 cm),20 and the LVIDdN is 2.0 ( FIGURE 2 ). References 1. Boehringer Ingelheim Vetmedica, Inc. Vetmedin (pimobendan) chewable tablets. Accessed January 2017. 2. Hanzlicek AS, Gehring R, Kukanich B, et al. Pharmacokinetics of oral pimobendan in healthy cats. J Vet Cardiol 2012;14(4):489-496. 3. Yoshiyuki R, Nakata TM, Fukayama T, et al. Pimobendan improves right ventricular myocardial contraction and attenuates pulmonary arterial hypertension in rats with monocrotaline-induced pulmonary arterial hypertension. J Med Ultrason 2014;41(2):173-180. 4. Sotelo E, Fraiz N, Yanez M, et al. Pyridazines. Part 28: 5-alkylidene- 6-phenyl-3(2H)-pyridazinones, a new family of platelet aggregation inhibitors. Bioorg Med Chem Lett 2002;12(12):1575-1577. 5. Shipley EA, Hogan DF, Fiakui NN, et al. In vitro effect of pimobendan on platelet aggregation in dogs. Am J Vet Res 2013;74(3):403-407. 6. Matsumori A, Sasayama S. The role of inflammatory mediators in the failing heart: immunomodulation of cytokines in experimental models of heart failure. Heart Fail Rev 2001;6(2):129-136. 7. Atkins C, Bonagura J, Ettinger S, et al. Guidelines for the diagnosis and treatment of canine chronic valvular heart disease. J Vet Intern Med 2009;23(6):1142-1150. 8. Summerfield NJ, Boswood A, O'Grady MR, et al. Efficacy of pimobendan in the prevention of congestive heart failure or sudden death in Doberman pinschers with preclinical dilated cardiomyopathy (The PROTECT Study). J Vet Intern Med 2012;26(6):1337-1349. 9. Vollmar AC, Fox PR. Long-term outcome of Irish wolfhound dogs with preclinical cardiomyopathy, atrial fibrillation, or both treated with pimobendan, benazepril hydrochloride, or methyldigoxin monotherapy. J Vet Intern Med 2016;30(2):553-559. 10. Fuentes VL, Corcoran B, French A, et al. A double-blind, randomized, placebo-controlled study of pimobendan in dogs with dilated cardiomyopathy. J Vet Intern Med 2002;16(3):255-261. 11. O'Grady MR, Minors SL, O'Sullivan ML, Home R. Effect of pimobendan on case fatality rate in Doberman pinschers with congestive heart failure caused by dilated cardiomyopathy. J Vet Intern Med 2008;22(4):897-904. 12. Borgarelli M, Savarino P, Crosara S, et al. Survival characteristics and prognostic variables of dogs with mitral regurgitation attributable to my xomatous valve disease. J Vet Intern Med 2008;22(1):120-128. 13. Boswood A, Haggstrom J, Gordon SG, et al. Effect of pimobendan in dogs with preclinical my xomatous mitral valve disease and cardiomegaly: the EPIC study−a randomized clinical trial. J Vet Intern Med 2016;30(6):1765-1779. 14. Boswood A, Gordon SG, Haggstrom J, et al. Longitudinal analysis of quality of life , clinical, radiographic, echocardiographic, and laboratory variables in dogs with preclinical valve disease receiving pimobendan or placebo: the EPIC Study. J Vet Intern Med 2017; 32(1):72-85. 15. Cornell CC, Kittleson MD, Della Torre P, et al. Allometric scaling of M-mode cardiac measurements in normal adult dogs. J Vet Intern Med 2004;18(3):311–321. 16. Church WM, Bonagura JD, Gordon SG, et al. The EPIC trial: pimobendan in preclinical myxomatous mitral valve disease. cardiaceducationgroup. org/wp-content/uploads/2016/12/CEG_Recommendations_ EPIC_121316.pdf. Accessed March 2017. 17. Haggstrom J, Boswood A, O'Grady M, et al. 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. J Vet Intern Med 2008;22(5):1124-1135. 18. Kellihan HB, Stepien RL. Pulmonary hypertension in canine degenerative mitral valve disease. J Vet Cardiol 2012;14(1):149-164. 19. Reinker LN, Lee JA, Hovda LR, Rishniw M. Clinical signs of cardiovascular effects secondary to suspected pimobendan toxicosis in five dogs. J Am Anim Hosp Assoc 2012;48(4):250-255. 20. Boon JA. Veterinary Echocardiography. 2nd ed. West Sussex: Wiley- Blackwell; 2011:531-537. 21. O'Grady MR, O'Sullivan ML, Minors SL, Home R. Efficacy of benazepril hydrochloride to delay the progression of occult dilated cardiomyopathy in Doberman pinschers. J Vet Intern Med 2009;23(5):977–983. Ashley B. Saunders Ashley B. Saunders, DACVIM (Cardiology), is a professor of cardiology in the Department of Small Animal Clinical Sciences at Texas A&M University College of Veterinary Medicine and Biomedical Sciences. Her interests include interventional cardiology and advanced imaging, heart failure management, and educational technology. She is the recipient of multiple teaching awards and is a Montague Center for Teaching Excellence Scholar. Sonya G. Gordon Sonya G. Gordon, DVM, DVSc, DACVIM (Cardiology), is an associate professor of cardiology in the Department of Small Animal Clinical Sciences at Texas A&M University College of Veterinary Medicine and Biomedical Sciences where she is part of a busy progressive cardiology program. She is routinely an invited speaker at local, national and international veterinary meetings. Although she considers herself a clinician and teacher first her research interests include canine chronic valve disease, dilated cardiomyopathy, imaging, interventional procedures and clinical trials. She has published numerous manuscripts and book chapters and co-authored a practical small animal clinical cardiology book entitled The ABCDs of Small Animal Cardiology. Learn More In the absence of an equally effective drug licensed for use in cats, pimobendan has been used in patients of this species. To download information about off-label use of pimobendan in cats, please visit TODAYSVETERINARYPRACTICE.COM

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