Evidence-based medical therapy for mitral regurgitation in dogs.

Evidence supports ACE inhibitors, MRAs, and diuretics; emerging therapies need veterinary validation.

Myxomatous mitral valve disease represents the most prevalent acquired cardiac condition in dogs and a significant contributor to congestive heart failure mortality. This comprehensive review evaluates the evidence base for pharmacologic management of mitral regurgitation, synthesizing three decades of experimental and clinical research. Established therapeutic classes including ACE inhibitors, mineralocorticoid receptor antagonists, diuretics, and inodilators demonstrate varying levels of clinical support. The authors examine newer drug classes such as angiotensin receptor-neprilysin inhibitors and sodium-glucose cotransporter-2 inhibitors, which show promise but require further investigation. A critical analysis reveals substantial gaps between current veterinary evidence and clinical practice, with many recommendations extrapolated from human cardiology rather than derived from robust veterinary trials. The review emphasizes the need for improved study methodologies and additional research to optimize therapeutic decision-making. Understanding the strength of evidence for each intervention enables clinicians to make informed treatment selections while recognizing areas requiring further investigation to enhance patient outcomes.

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