Effect of prespecified therapy escalation on plasma NT-proBNP concentrations in dogs with stable congestive heart failure due to myxomatous mitral valve disease.

BackgroundHypothesisTreatment targeted to achieve reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP) improves outcomes in human congestive heart failure (CHF) patients. A pre-specified therapeutic algorithm that increased diuretic or pimobendan usage will reduce plasma NT-proBNP concentrations in dogs with CHF secondary to myxomatous mitral valve disease (MMVD). AnimalsMethodsTwenty-six dogs with clinically stable CHF secondary to MMVD. Prospective, controlled before-and-after study. Dogs were examined up to 3 times over 21 days. Treatment was prescribed based on NT-proBNP as follows: <1500 pmol/L at baseline, no treatment adjustment at any point during the study (group 1); 1500 pmol/L and creatinine 3.0 mg/dL at baseline or SC visits, treatment escalated according to the algorithm (group 2); 1500 pmol/L at baseline, no treatment adjustment (group 3). ResultsConclusions and Clinical ImportanceN-terminal pro-B-type natriuretic peptide decreased significantly in group 2 (mean change = -1736 pmol/L (95% CI, -804 to -2668), P<.001) but not in groups 1 or 3 (623 pmol/L [-631 to 1877 pmol/L], P=.14 and 685 pmol/L [-304 to 1068 pmol/L], P=.46, respectively). Serum BUN and creatinine did not change significantly between visit 0 and visit 2 in group 1 (median=23 mg/dL [range 13-32] versus 19 mg/dL [12-38], P=.72 and 1.15 mg/dL [0.70-1.40] versus 0.95 mg/dL [0.70-1.10], P=.10, respectively) or group 2 (28 mg/dL [18-87] versus 43.5 mg/dL [21-160], P=.092 and 1.10 mg/dL [0.90-2.50] versus 1.55 mg/dL [0.90-3.30], P=.062, respectively). Use of this treatment escalation algorithm allows effective targeting of treatment for CHF in dogs against an objective criterion.