RE: When to start Pimobendan?

Anthony Dennison — Thu, 17 Sep 2020 11:33:57 GMT

Hi Dave,

Thanks for the information, really helpful. I was leaning towards waiting and re scanning but not had one so borderline for a while! I've rechecked my images, and I took a couple of measurements for LA:Ao - other value was 1.3

RE: When to start Pimobendan?

Dave Dickson — Thu, 17 Sep 2020 09:11:07 GMT

Hi Anthony

The cut-offs for treatment of preclinical mitral valve disease (ie stage B1 vs B2) are a combination of LVDD normalised to bodyweight (Cornell normalised) of >1.7, an LA:Ao of >1.6 and a radiographic VHS of >10.5.

So from your description, the dog has a borderline left ventricle but a normal LA. In fact, the LA sounds unusually small - an LA:Ao of 1:1 is pretty rare in a CKCS, in my experience. Can you post an image of the LA:Ao so I can see?

The E:A reversal is a good thing. If the E wave is smaller than the A wave, then this tells you there is no increase in left atrial pressure - if the LA pressure rises, then the E wave velocity will increase. So E:A reversal in an aged patient is normal, it's usually just part of the ageing process, and in mitral valve disease is a good sign as it tells you the LA pressure is (probably) normal, so the risk of CHF is very low.

Overall, sounds good for your dog. I'd recheck in 6-12 months. No pimo. You could look in 3 months but if the LA:Ao is really 1:1 then I think the chance of this dog going from B1 to B2 in 3 months is miniscule. Of course that is impossible to predict for sure but I would be happy to check 6-12 months later.

Dave