RE: Subaortic stenosis tx

Roger Wilkinson — Fri, 17 Jun 2022 07:27:09 GMT

Thanks Dave...that is exactly the kind of info I was looking for. When there's a gap between published data and what people do it's always difficult to work out what's really going on.... I need to start going to meetings again!

RE: Subaortic stenosis tx

Dave Dickson — Wed, 15 Jun 2022 11:57:53 GMT

Hi Roger

I read this when it came out and I agree, their conclusions do not match the evidence base. Possibly relating to inherent bias by the authors, possibly because they just don't have much evidence from which to draw any meaningful conclusions. I wouldn't have picked it for a Knowledge Summary! One of the authors is a believer in cutting balloons, which may have influenced the topic selection.

I do treat severe SAS with beta blockers but accept it is based on faith, not evidence.

My conclusions from this article are that we need proper controlled studies into SAS in dogs - basically a bigger, better version of the Eason paper. it was too small and too biased to draw any real conclusions. I think the improvement in clinical signs comes from Shen and Orton but I haven't read them in a while so I'm not 100% sure.

We need a prospective double blinded study in dogs with severe SAS on a proper dose of atenolol (2mg/kg BID) - Eason used 0.5mg/kg which is way too low IMO - to learn much more. Atenolol is cheap so there in no pharma incentive to study it. Plus you'd have a hard time convincing most cardiologists not to give severe SAS dogs treatment, so it makes it doubly hard to get the study done. Should we do it? Sure. Will it get done? Probably not, unless someone comes out with a new (expensive) beta blocker.

Such is life...

Dave