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Background  Changes in clinical variables associated with the administration of pimobendan to dogs with preclinical myxomatous mitral valve disease ( MMVD ) and cardiomegaly have not been described.    Objectives  To investigate the effect of pimobendan on clinical variables and the relationship between a change in heart size and the time to congestive heart failure ( CHF ) or cardiac‐related death ( CRD ) in dogs with  MMVD  and cardiomegaly. To determine whether pimobendan‐treated dogs differ from dogs receiving placebo at onset of  CHF .    Animals  Three hundred and fifty‐four dogs with  MMVD  and cardiomegaly.    Materials and Methods  Prospective, blinded study with dogs randomized (ratio 1:1) to pimobendan (0.4–0.6 mg/kg/d) or placebo. Clinical, laboratory, and heart‐size variables in both groups were measured and compared at different time points (day 35 and onset of  CHF ) and over the study duration. Relationships between short‐term changes in echocardiographic variables and time to  CHF  or  CRD  were explored.    Results  At day 35, heart size had reduced in the pimobendan group: median change in (Δ)  LVIDDN  −0.06 ( IQR : −0.15 to +0.02),  P  < 0.0001, and  LA :Ao −0.08 ( IQR : −0.23 to +0.03),  P  < 0.0001. Reduction in heart size was associated with increased time to  CHF  or  CRD . Hazard ratio for a 0.1 increase in Δ LVIDDN  was 1.26,  P  = 0.0003. Hazard ratio for a 0.1 increase in Δ LA :Ao was 1.14,  P  = 0.0002. At onset of  CHF , groups were similar.    Conclusions and Clinical Importance  Pimobendan treatment reduces heart size. Reduced heart size is associated with improved outcome. At the onset of  CHF , dogs treated with pimobendan were indistinguishable from those receiving placebo.

journal of veterinary internal medicine

Longitudinal Analysis of Quality of Life, Clinical, Radiographic, Echocardiographic, and Laboratory Variables in Dogs with Preclinical Myxomatous Mitral Valve Disease Receiving Pimobendan or Placebo: The EPIC Study