According to a review published in the May edition of the Journal of Small Animal Practiceadministration of ACEIs to dogs with preclinical MMVD and cardiomegaly results in little or no difference in the risk of developing congestive heart failure and may result in little or no difference in cardiovascular-related and all-cause mortality. 

For this study, researchers in Argentina, Italy, Austria and Chile, set out 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.

The main finding in relation to dogs with preclinical MMVD and cardiomegaly was backed by a high certainty of evidence. The certainty of evidence in relation to the efficacy of ACEI administration in dogs without cardiomegaly was low.

Dr 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-analyses 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 JSAP, added: “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, i.e. the quality of the included studies, and their external validity, i.e. the generalizability of the included studied to the individual patient.”


  1. Donati, P., Tarducci, A., Zanatta, R., Verdier, N., Belerenian, G., Cordero, I., Villalta, C., Franco, J. and Tarragona, L. (2022), Angiotensin-converting enzyme inhibitors in preclinical myxomatous mitral valve disease in dogs: systematic review and meta-analysis. J Small Anim Pract.

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