Key result
Addition of ramipril to pimobendan and furosemide did not significantly delay cardiac death, euthanasia, or treatment failure in dogs with CHF compared to dual therapy (median 186 vs 227 days; P=.42).
Why the study?
The effect of adding an ACEI to furosemide and pimobendan for congestive heart failure attributable to myxomatous mitral valve disease had not been evaluated prospectively.
Does adding ramipril to furosemide and pimobendan improve survival in dogs with congestive heart failure secondary to myxomatous mitral valve disease?
RCT (n=158)
Single-blind
randomized
Yes
Does adding ramipril to furosemide and pimobendan improve survival in dogs with congestive heart failure secondary to myxomatous mitral valve disease?
The addition of the ACE inhibitor ramipril to furosemide and pimobendan did not improve survival time in dogs with heart failure secondary to mitral valve disease.
No survival benefit from adding ramipril in dogs with CHF; does not support its use and leaves open need for further veterinary trials.
BACKGROUND: Triple therapy (TT) consisting of furosemide, pimobendan, and an angiotensin-converting enzyme inhibitor (ACEI) frequently is recommended for the treatment of congestive heart failure (CHF) attributable to myxomatous mitral valve disease (MMVD). However, the effect of adding an ACEI to the combination of pimobendan and furosemide (dual therapy [DT]) so far has not been evaluated prospectively. HYPOTHESIS: Triple therapy will extend survival time compared to DT in dogs with CHF secondary to MMVD. ANIMALS: Client-owned dogs presented with the first episode of CHF caused by MMVD. METHODS: Prospective, single-blinded, randomized multicenter study. One-hundred and fifty-eight dogs were recruited and prospectively randomized to receive either DT (furosemide and pimobendan) or TT (furosemide, pimobendan, and ramipril). The primary endpoint was a composite of cardiac death, euthanasia for heart failure, or treatment failure. RESULTS: Seventy-seven dogs were randomized to receive DT and 79 to receive TT. Two dogs were excluded from analysis. The primary endpoint was reached by 136 dogs (87%; 66 dogs, DT; 70 dogs, TT). Median time to reach the primary endpoint 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 different 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 pimobendan and furosemide did not have any beneficial effect on survival time in dogs with CHF secondary to MMVD.
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Wess et al. (2020) conducted an RCT in congestive heart failure secondary to myxomatous mitral valve disease (n=158). Triple therapy (furosemide, pimobendan, and ramipril) vs. Dual therapy (furosemide and pimobendan) was evaluated on composite of cardiac death, euthanasia for heart failure, or treatment failure (p=.42). Addition of ramipril to pimobendan and furosemide did not significantly delay cardiac death, euthanasia, or treatment failure in dogs with CHF compared to dual therapy (median 186 vs 227 days; P=.42).
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