The VALVE study: Vasotop in addition to Lasix and Vetmedin for the…

Présenté par Gerhard Wess, D.M.V., Dr habil., dipl. de l’ACVIM et dipl. de l’ECVIM-CA (cardiologie), dipl. de l’ECVIM-CA (médecine interne)

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Questions

1. With respect to chronic valvular heart disease in dogs, which of the following statements is true? *

It is the most common acquired heart disease in dogs

The ACVIM Consensus Guidelines recommend the treatment of all dogs in congestive heart failure due to valvular heart disease to be treated with digoxin as standard therapy

Chronic valvular heart disease most commonly affects large-breed dogs, such as the Doberman pinscher

The window of opportunity for treatment to be of benefit is limited to the rapid progression of the disease

2. Which of the following statements is false regarding the cumulative data on angiotensin converting enzyme inhibitors (ACEi) in the management of heart disease/failure in people and dogs? *

Cumulative data in people as to the benefits of ACEi therapy in heart disease is weak and limited to those with reduced contractility (dilated cardiomyopathy; DCM), myocardial infarcts, and hypertension

Data from veterinary studies demonstrate an ability of ACEi to slow down the progression of asymptomatic valvular heart disease

Pharmacokinetic data demonstrate that all ACEis are similar in their therapeutic activity

Data from veterinary studies on the benefits of ACEi therapy in canine heart failure have study design flaws that limit result interpretation and suggest more favourable outcomes for DCM

3. Which of the following statements is true regarding the QUEST publication on pimobendan use indogs for mitral valve disease? *

The results are not clinical relevant to mitral valve disease as the study enrolled only DCM dogs

The results indicate a statistically significant improved outcome (survival time) of 267 days in dogs treated with pimobendan & furosemide versus 140 days in dogs treated with benazepril and furosemide with heart failure due to valvular heart disease

The QUEST study had low recruitment and event rate, limiting result interpretation

The QUEST study results are only applicable to benazepril as an ACEi

4. Which of the following statements is false with respect to the VALVE study design? *

VALVE stands for Vasotop in Addition to Lasix and Vetmedin for the treatment of mitral valve Endocardiosis

It was a prospective, single blinded randomization clinical trial assessing double (furosemide + pimobendan) versus triple (furosemide + pimobenan + ramipril) treatment outcomes on survival in dogs with heart failure due to chronic valvular heart disease

Enrolment was restricted to Cavalier King Charles Spaniels

It used a patient number power calculation and robust statistics to ensure results would have significant clinical applicability

5. Which of the following statements is true with respect to the VALVE study results? *

The results showed no statistically significant benefit of triple therapy (furosemide + pimobendan + ramipril) over dual therapy (furosemide + pimobendan) in dogs with heart failure due to valvular heart disease

VALVE had a very high event rate (87%), which adds robustness to the statistical significance of the study conclusions

156 dogs representing over 29 different breeds were recruited in to the VALVE study, ensuring the results are relevant to any small-breed dog with heart failure due to acquired chronic valvular heart disease

All of the above