Abstract
Simple SummaryMyxomatous mitral valve disease (MMVD) is the most common acquired cardiovascular disease in dogs. The progression of the disease and the increasing severity of valvular regurgitation cause a volume overload of the left heart, leading to left atrial and ventricular remodeling and congestive heart failure (CHF). The treatment of chronic CHF secondary to MMVD in dogs has not always been the same over time. In the last fifty years, the drugs utilized have considerably changed, as well as the therapeutic protocols. Some drugs have also changed their intended use. An analysis of the literature concerning the therapy of chronic heart failure in dogs affected by this widespread degenerative disease is not available; a synthesis of the published literature on this topic and a description of its current state of art are needed. To the authors’ knowledge, a review of this topic has never been published in veterinary medicine; therefore, the aim of this study is to overview the treatments of chronic CHF secondary to MMVD in dogs from 1970 to 2020 using the general framework of narrative reviews.The treatment of chronic congestive heart failure (CHF), secondary to myxomatous mitral valve disease (MMVD) in dogs, has considerably changed in the last fifty years. An analysis of the literature concerning the therapy of chronic CHF in dogs affected by MMVD is not available, and it is needed. Narrative reviews (NRs) are aimed at identifying and summarizing what has been previously published, avoiding duplications, and seeking new study areas that have not yet been addressed. The most accessible open-access databases, PubMed, Embase, and Google Scholar, were chosen, and the searching time frame was set in five decades, from 1970 to 2020. The 384 selected studies were classified into categories depending on the aim of the study, the population target, the pathogenesis of MMVD (natural/induced), and the resulting CHF. Over the years, the types of studies have increased considerably in veterinary medicine. In particular, there have been 43 (24.29%) clinical trials, 41 (23.16%) randomized controlled trials, 10 (5.65%) cross-over trials, 40 (22.60%) reviews, 5 (2.82%) comparative studies, 17 (9.60%) case-control studies, 2 (1.13%) cohort studies, 2 (1.13%) experimental studies, 2 (1.13%) questionnaires, 6 (3.40%) case-reports, 7 (3.95%) retrospective studies, and 2 (1.13%) guidelines. The experimental studies on dogs with an induced form of the disease were less numerous (49–27.68%) than the studies on dogs affected by spontaneous MMVD (128–72.32%). The therapy of chronic CHF in dogs has considerably changed in the last fifty years: in the last century, some of the currently prescribed drugs did not exist yet, while others had different indications.
Highlights
Myxomatous mitral valve disease (MMVD) is the most common acquired cardiovascular disease in dogs [1]
To the authors’ knowledge, an Narrative reviews (NRs) on the therapeutic management of congestive heart failure (CHF) secondary to myxomatous mitral valve disease (MMVD) in dogs has not yet been published in veterinary medicine, and the aim of this study is to overview the treatments of this disease in dogs from 1970 to 2020 using the general framework of narrative reviews
The key concept “therapy of chronic congestive heart failure caused by mitral valve disease in dogs” was transformed into keywords through the thesaurus system used to index articles for PubMed (Medical Subject Heading—MSH)
Summary
Myxomatous mitral valve disease (MMVD) is the most common acquired cardiovascular disease in dogs [1]. Remodeling secondary to MMVD is associated with characteristic histopathologic features, such as the expansion of the extracellular matrix with glycosaminoglycans and proteoglycans, the alteration of the valvular interstitial cell, and the attenuation or loss of the collagen-laden fibrosa layer. These lead to malformation of the mitral apparatus, biomechanical dysfunction, and mitral incompetence. Mitral regurgitation is the most common manifestation of MMVD and, in advanced stages, associated volume overload promotes progressive valvular regurgitation, left atrial and left ventricular remodeling, atrial tears, chordal rupture, and CHF, as stated before [5]. The health and wellness of dogs have become primary endpoints; the research has been carried out on dogs as patients, and the therapy of CHF secondary to MMVD has been studied mainly on the spontaneous disease
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