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 5 0.688, 95% confidence limits [CL] 5 0.516-0.916, P 5 .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.

Canine NT-proBNP appears to be a useful marker of the presence of cardiac disease, although concentrations must be interpreted in the light of the patient's renal function.

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Rapid changes in heart rate are caused by changes in parasympathetic tone. The NeuroScope is an electronic device designed to offer an objective real-time measure of instantaneous cardiac vagal tone by phase demodulation of a high-resolution time domain of R-R wave intervals. Data are displayed against an arbitrary but linear scale, the cardiac index of parasympathetic activity (CIPA). To validate this method, 10 conscious healthy dogs were each given six incremental doses of atropine (0.01 mg/kg) to a total dose of 0.06 mg/kg or equal volumes of saline. A dose-response curve was constructed. At the maximum dose of atropine, CIPA values fell to 1.3 ± 0.7% (SD) of baseline, whereas R-R intervals fell to 51.5 ± 11.5% of baseline, and standard deviation of the R-R wave interval fell to 10.6 ± 6.5% of baseline. These findings show that the NeuroScope can provide a specific real-time index of cardiac vagal tone in dogs without need for recourse to atropine.