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Pimobendan versus benazepril in dogs with mitral valve disease and congestive heart failure

Clinical Scenario

Barney is a 7 year old male neutered Cavalier King Charles Spaniel who presented to you with a cough and a heart murmur during morning surgery. He is in good body condition but has lost 1 kg in weight since you saw him last year. You have radiographed his thorax and he has cardiomegaly and pulmonary oedema. Echocardiography reveals marked mitral valve disease. His owner is very worried about Barney, has limited money but wants to know how long Barney will live and wants him to have the best treatment possible. You have pimobendan and benazepril on the shelf and wonder which drug will maximise Barney's survival time...

3-Part Question (PICO)

In [dogs with congestive heart failure secondary to mitral valve disease] does [pimobendan or benazepril] [improve the life expectancy of the affected dogs]?

Search Strategy and Summary of Evidence

Search Strategy

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/)

AND

(mitral valve disease.mp. OR mitral valve insufficiency.mp. OR mitral valve regurgitation.mp. OR mitral valve incompetence.mp. OR mitral disease.mp. OR mitral insufficiency.mp. OR mitral regurgitation.mp. OR mitral incompetence.mp OR heart failure.mp. OR heart insufficiency.mp. OR heart disease.mp. OR cardiac failure.mp. OR cardiac insufficiency.mp. OR cardiac disease.mp. OR exp Mitral Valve Insufficiency/ OR exp Heart Failure/)

AND

(pimobendan.mp. OR 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/)

AND

(mitral valve disease.mp. OR mitral valve insufficiency.mp. OR mitral valve regurgitation.mp. OR mitral valve incompetence.mp. OR mitral disease.mp. OR mitral insufficiency.mp. OR mitral regurgitation.mp. OR mitral incompetence.mp OR heart failure.mp. OR heart insufficiency.mp. OR heart disease.mp. OR cardiac failure.mp. OR cardiac insufficiency.mp. OR cardiac disease.mp. OR exp cardiac insufficiency/ OR exp heart diseases/)

AND

(pimobendan.mp. OR 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.)

Search Outcome

MEDLINE

  • 293 papers found in MEDLINE search
  • 289 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 3 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from MEDLINE

CAB Abstracts

  • 267 papers found in CAB search
  • 262 papers excluded as they don't meet the PICO question
  • 1 papers excluded as they are in a foreign language
  • 3 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from CAB

Total relevant papers

1 relevant papers from both MEDLINE and CAB Abstracts

Summary of Evidence

Haggstrom et al. (2008) Multicentre study

Title:

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.

Patient group:

Dogs with congestive heart failure

Study Type:

Randomised controlled trial

Outcomes:
  • Exercise tolerance
  • Demeanour
  • Appetite
  • Respiratory effort
  • Coughing
  • Nocturnal dyspnoea
  • Pulmonary oedema
  • Modified NYHA heart failure score
  • Heart rate and ECG
  • Echocardiography
  • Thoracic radiography
  • Time to withdrawal due to death or euthanasia owing to cardiac causes or treatment failure
  • Whether the animals were alive at the end of the study
  • Non-compliance
Key Results:
  • No difference between the two groups in terms of the number of dogs reaching the primary endpoint, the proportion dying for cardiac reasons and treatment failure endpoints
  • The median time to reach the primary end point was significantly greater in the pimobendan group than the benazepril group
  • Low number of reported potential adverse side effects in both groups
Study Weaknesses:
  • Power calculation was based on data from a previous study, and was not a bespoke calculation for the current study
  • Only included dogs between 5 and 20 kg in weight
  • Most dogs were Cavalier King Charles Spaniels and Dachshunds
  • Paper does not say if ethical approval was obtained, only that the study was conducted according to Good Clinical Practice
  • There was no interpretation of the findings of no difference between the two treatments in the discussion
  • The CKCS group appeared to behave differently to the other breeds – this was not really addressed
  • Only 75% of dogs reached the primary endpoint – what affect does this have on the study?
Attachment:
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Comments

Comparing this randomised controlled trial with others conducted in veterinary medicine, this is a fairly robust study. The study was funded by Boehringer Ingelheim who produce pimobendan

Bottom line

There appears to be some evidence suggesting that dogs on pimobendan live a median of 135 days longer than those on benazepril hydrochloride. However, for other outcomes there appears to be no difference between the treatments.

Disclaimer

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

References

Haggstrom J, Boswood A, O'Grady M, Jons O, Smith S, Swift S, Borgarelli M, Gavaghan B, Kresken JG, Patteson M, Ablad B, Bussadori CM, Glaus T, Kovacevic A, Rapp M, Santilli RA, Tidholm A, Eriksson A, Belanger MC, Deinert M, Little CJL, Kvart C, French A, Ronn-Landbo M, Wess G, Eggertsdottir AV, O’Sullivan ML, Schneider M, Lombard CW, Dukes-McEwan J, Willis R, Louvet A, DiFruscia R (2008) 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 22: 1124-1135.

About this BET

First author:
Marnie Brennan
Second author:
Jenny Stavisky
Institution:

CEVM, University of Nottingham

Search last performed:
2018-09-19 16:50:31
Original publication date:
2013-09-13 16:50:31
Last updated:
2018-09-19 16:50:31
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