Review does not support ACE inhibitor use in dogs with preclinical MMVD

Use of angiotensin-converting enzyme inhibitors (ACEIs) for the management of preclinical myxomatous mitral valve disease (MMVD) in dogs made little or no difference to the risk of them developing congestive heart failure, new research has found.

The study – “Angiotensin-converting enzyme inhibitors in preclinical myxomatous mitral valve disease in dogs” – is the first comprehensive systematic review and meta-analysis of the efficacy and adverse events of using ACEIs for the condition, using the GRADE approach.

According to the study, administration of ACEIs to dogs with preclinical MMVD and cardiomegaly results in little or no difference in the risk of dogs developing congestive heart failure, and may result in little or no difference in cardiovascular-related and all-cause mortality.

High certainty

The study – published in the Journal of Small Animal Practice (JSAP), and from researchers in Argentina, Italy, Austria and Chile – was to evaluate the efficacy of, and adverse events from, the administration of ACEIs to treat preclinical MMVD in dogs, via a systematic review of published evidence conducted according to the Cochrane Handbook for Systematic Reviews of Interventions.

Certainty of evidence was assessed using the GRADE approach, with the main finding on preclinical MMVD and cardiomegaly backed by a high certainty of evidence. Certainty of evidence for the efficacy of ACEI administration in dogs without cardiomegaly was low.

MMVD is common in dogs of any breed, but is particularly seen in smaller breeds such as the cavalier King Charles spaniel and dachshund.

‘Fundamental tool’

Pablo Donati, corresponding author for the paper, said: “In recent times, multiple clinical trials have provided fundamental information to veterinary cardiology. In the era of evidence-based medicine, systematic reviews and meta-analyzes have emerged as a fundamental tool for clinical decision-making by gathering, appraising and summarizing the best available evidence.

“It is the hope of the authors that this systematic review and meta-analysis helps in the decision-making process for the treatment of preclinical myxomatous mitral disease with angiotensin-converting enzyme inhibitors in dogs.”


Nicola Di Girolamo, editor of JSAPsaid: “In line with other leading journals, the JSAP is prioritizing the publication of methodologically sound systematic reviews such as this one.

“However, our readers should be aware that the findings of systematic reviews should always be considered in light of their internal validity – that is, the quality of the included studies – and their external validity – that is, the generalisability of the included studied to the individual patient. ”


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