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2 MATERIALS AND METHODSĭogs were eligible for inclusion in this retrospective study if they had been evaluated by the Cardiology Service at the Cummings Veterinary Medical Center at Tufts University between January 2010 and February 2016, were diagnosed with DMVD, and had advanced heart failure. Therefore, the objective of our study was to describe the clinical findings and outcome of dogs with advanced heart failure secondary to DMVD. 2 In humans, Stage D heart failure has been described by some as “advanced progression and/or persistent severe signs and clinical signs of heart failure despite optimal medical, surgical, and device therapy.” 3 Frequent hospitalization, severe exercise intolerance, and poor quality of life are key features of the syndrome.Īdvanced heart failure in dogs represents a clinical challenge for veterinarians, not only with the precise definition, but optimal treatment since there are no studies or clinical trials that report clinical features and outcome for this population or are designed to evaluate treatment of dogs in this stage of disease. 1 In this 4-stage system, dogs with DMVD with end-stage disease and clinical signs of congestive heart failure that are refractory to standard therapy (ie, furosemide, an angiotensin converting enzyme inhibitor, and Pimobendan, ) were classified as Stage D heart failure.Įven in human medicine, a clear and precise definition of Stage D or advanced heart failure, has proven difficult. 1 Although other classification systems have been used to stratify the severity of disease, the 2009 ACVIM Consensus Statement on the diagnosis and treatment of DMVD provided a new system which has been incorporated into practice. angiotensin-converting-enzyme inhibitorĭegenerative mitral valve disease (DMVD) or chronic valvular disease is the most common canine acquired heart disease in dogs, and often leads to congestive heart failure.Higher furosemide dose and non-hospitalization were associated with longer survival. Conclusions and Clinical Importanceĭogs with advanced heart failure can have relatively long survival times.
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Dogs receiving a furosemide dose >6.70 mg/kg/day had significantly longer median survival times (402 days versus 129 days P = .017).
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Median survival time after diagnosis of advanced heart failure was 281 days (range, 3-885 days). After initial diagnosis of advanced heart failure, 38 (70%) dogs had additional medications adjustments (median = 2 ), with the final total medication number ranging from 2-10 (median = 5). ResultsĪt the diagnosis of advanced heart failure, doses of pimobendan (n = 30), furosemide (n = 28), ACEI (n = 13), and spironolactone (n = 4) were increased, with ≥1 new medications added in most dogs. Data were collected for the time of diagnosis of Stage C heart failure and time of diagnosis of advanced heart failure. Methodsįor study purposes, advanced heart failure was defined as recurrence of congestive heart failure signs despite receiving the initially prescribed dose of pimobendan, angiotensin-converting-enzyme inhibitor (ACEI), and furosemide >4 mg/kg/day. Animalsįifty-four dogs with advanced heart failure because of DMVD. To describe clinical findings and outcome of dogs with advanced heart failure caused by degenerative mitral valve disease (DMVD). Dogs with advanced heart failure are a clinical challenge for veterinarians but there are no studies reporting clinical features and outcome of this population.