Benazepril in dogs with asymptomatic mitral valve disease
Sally Edwards is a 5 year old springer spaniel cross who presented to you with a draining sinus in her left foot between digits 2 and 3. You suspect a grass seed or some other foreign body so advise that Sally is anaesthetised so you can explore the sinus. On clinical examination you detect a grade II heart murmur but no other abnormalities are detected. There is nothing in her history which suggests cardiac disease. You advise echocardiography prior to anaesthesia which reveals mitral valve disease with no chamber enlargement but significant mitral regurgitation. You go ahead with the surgery and successfully remove a large grass seed from the sinus in Sally’s left foot, there are no problems with the anaesthesia. When Mr and Mrs Edwards come to pick up Sally they ask if she needs any medication for her heart. Their last dog was euthanased due to a “heart problem” and they want to have Sally for as long as possible. You wonder if Sally would benefit from being on benazepril.
3-Part Question (PICO)
In [dogs with asymptomatic mitral valve disease] does [benazepril compared to no treatment] [improve the survival time of affected dogs]?
Search Strategy and Summary of Evidence
MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface
(canine.mp. OR canines.mp. OR canid.mp. OR canids.mp. OR canis.mp. OR canidae.mp OR dog.mp. OR dogs.mp. OR exp Dogs/ OR exp Canidae/)
(mitral valve.mp. OR mitral disease.mp. OR mitral insufficiency.mp. OR mitral regurgitation.mp. OR mitral incompetence.mp OR exp Mitral Valve Insufficiency/)
(benazepril.mp. OR ACE inhibitor.mp. OR ACE inhibitors.mp. OR Angiotensin converting enzyme inhibitor.mp. OR Angiotensin converting enzyme inhibitors.mp. OR ACEI.mp. OR ACEi.mp. OR ACE-I.mp. OR ACE-i.mp. OR exp Angiotensin-Converting Enzyme Inhibitors/)
CAB Abstracts 1910 to Present using the OVID interface
(canine.mp. OR canines.mp. OR canid.mp. OR canids.mp. OR canis.mp. OR canidae.mp OR dog.mp. OR dogs.mp. OR exp dogs/ OR exp Canis/ OR exp Canidae/)
(mitral valve.mp. OR mitral disease.mp. OR mitral insufficiency.mp. OR mitral regurgitation.mp. OR mitral incompetence.mp)
(benazepril.mp. OR ACE inhibitor.mp. OR ACE inhibitors.mp. OR angiotensin converting enzyme inhibitor.mp. OR angiotensin converting enzyme inhibitors.mp. OR ACEI.mp. OR ACEi.mp. OR ACE-I.mp. OR ACE-i.mp.)
- 62 papers found in MEDLINE search
- 61 papers excluded as they don't meet the PICO question
- 0 papers excluded as they are in a foreign language
- 0 papers excluded as they are review articles/in vitro research/conference proceedings
- 1 total relevant papers from MEDLINE
- 61 papers found in CAB search
- 59 papers excluded as they don't meet the PICO question
- 0 papers excluded as they are in a foreign language
- 1 papers excluded as they are review articles/in vitro research/conference proceedings
- 1 total relevant papers from CAB
Total relevant papers1 relevant papers from both MEDLINE and CAB Abstracts
Summary of Evidence
Pouchelon et al., 2008, France
Effect of benazepril on survival and cardiac events in dogs with asymptomatic mitral valve disease: A retrospective study of 141 cases
Dogs attending the Cardiology Unit of Alfort
- For all causes of death, dogs in the benazepril (BNZ) group and breeds other than Cavalier King Charles-King Charles (CKC-KC) breeds lived longer (no difference seen in CKC-KC treated and non-treated groups)
- For cardiac death, dogs of other breeds (not CKC-KC) in the BNZ group lived longer (no difference across whole cohort)
- For development of congestive heart failure (CHF), or generic ‘cardiac events’, there was no difference overall between treated and untreated dogs (and between treated and untreated CKC-KC groups). For other breeds group, time to ‘cardiac event’ was longer in BNZ group than untreated
- Confusion between what the authors were concentrating on—whole population analysis or subgroup analysis with different breeds
- No sample size calculation was done
- Not clear initially how long the population was followed for
- Time to onset of heart failure and time to onset of sudden death grouped as ‘cardiac event’
- Only a small number of dogs died from a cardiac cause, so the conclusions drawn from this are difficult to quantify
- CKCS breed overrepresented, so difficult to extrapolate results to other breeds
- Greater number of dogs with more severe and moderate mitral valve regurgitation in treated than in untreated group
- Not stated whether post-mortems were done to determine definitive cause of death
- Dogs with pulmonary arterial hypertension were included in the study
There are several questionable points in this study. There was a series of letters published in JVIM about this paper, which bring up some valid points about the weaknesses of the study.
The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print
Pouchelon J-L, Jamet N, Gouni V, Tissier R, Serres F, Carlos Sampedrano C, Castaignet M, Lefebvre HP, Chetboul V (2008) Effect of benazepril on survival and cardiac events in dogs with asymptomatic mitral valve disease: A retrospective study of 141 cases. Journal of Veterinary Internal Medicine 22:905-914.
About this BET
A BET is a simple method of searching for and appraising evidence around a very specific clinical situation.
BETs don’t tell you what to do, they tell you about the evidence on a certain topic.
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