Effect of pimobendan on mitral annular dynamics and mitral regurgitation in dogs with myxomatous mitral valve disease as determined by cardiac computed tomography.

Abstract

BACKGROUND: Pimobendan might affect mitral annular dynamics (MAD) in dogs with myxomatous mitral valve disease (MMVD); in humans, alterations in MAD are known to increase the severity of mitral regurgitation (MR). HYPOTHESIS/OBJECTIVES: To investigate the short-term effect of pimobendan on MAD, severity of MR, and systemic arterial compliance in dogs with MMVD. ANIMALS: Twenty dogs with newly diagnosed ACVIM stage B2 MMVD. METHODS: Prospective, open-label, longitudinal study. All dogs underwent echocardiographic and cardiac computed tomographic (CCT) examinations before and 2 weeks after oral administration of pimobendan. Changes in MAD, leaflet-to-annulus index, left heart volumes, regurgitant volume/fraction, and aortic distensibility index were evaluated on CCT. RESULTS: All dogs completed the study without major adverse events. Pimobendan decreased normalized end-systolic mitral annular area (mean difference of 1.38&#xa0;cm2/m2; 95% CI, 0.79-1.97&#xa0;cm2/m2; P&#xa0;<&#xa0;.001), aortoparietal distance (mean difference of 1.03&#xa0;mm/kg1/3; 95% CI, 0.54-1.53&#xa0;mm/kg1/3; P&#xa0;<&#xa0;.001), and intercommissural distance (mean difference of 0.75&#xa0;mm/kg1/3; 95% CI, 0.44-1.06&#xa0;mm/kg1/3; P&#xa0;<&#xa0;.001). Mean leaflet-to-annulus index increased (mean difference of 0.06; 95% CI, 0.02-0.09; P&#xa0;=&#xa0;.002). Changes in left ventricular end-diastolic and end-systolic volumes, left atrial end-diastolic and end-systolic volumes, regurgitant volume (mean reduction of 0.31&#xa0;mL/kg; 95% CI, 0.13-0.5&#xa0;mL/kg), and regurgitant fraction (mean reduction of 9.8%; 95% CI, 5.2%-14.3%) were detected (all P&#xa0;<&#xa0;.05) with administration of pimobendan. There was no detectable difference in aortic distensibility index (P&#xa0;=&#xa0;.6). CONCLUSIONS AND CLINICAL IMPORTANCE: Short-term pimobendan administration decreases MR severity by augmenting systolic contraction of the mitral annulus. The study provides new insight into the mechanism of action of pimobendan in dogs with MMVD.