Abstract
Background: Triple therapy (TT) consisting of furosemide, pimobendan, and anangiotensin-converting enzyme inhibitor (ACEI) frequently is recommended for thetreatment of congestive heart failure (CHF) attributable to myxomatous mitral valvedisease (MMVD). However, the effect of adding an ACEI to the combination ofpimobendan and furosemide (dual therapy [DT]) so far has not been evaluatedprospectively.
Hypothesis: Triple therapy will extend survival time compared to DT in dogs withCHF secondary to MMVD.
Animals: Client-owned dogs presented with the first episode of CHF causedby MMVD.
Methods: Prospective, single-blinded, randomized multicenter study. One-hundredand fifty-eight dogs were recruited and prospectively randomized to receive eitherDT (furosemide and pimobendan) or TT (furosemide, pimobendan, and ramipril). Theprimary endpoint was a composite of cardiac death, euthanasia for heart failure, ortreatment failure.
Results: Seventy-seven dogs were randomized to receive DT and 79 to receiveTT. Two dogs were excluded from analysis. The primary endpoint was reached by136 dogs (87%; 66 dogs, DT; 70 dogs, TT). Median time to reach the primary end-point 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 dif-ferent 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 pimobendanand furosemide did not have any beneficial effect on survival time in dogs with CHFsecondary to MMVD.
Wess, Gerhard