Clinical findings and survival time in dogs with myxomatous mitral valve disease at the American College of Veterinary Internal Medicine stage D.

Dogs with ACVIM stage D MMVD have a median cardiac-related survival of approximately 155 days after diagnosis.

This retrospective study characterizes clinical findings and survival outcomes in 61 dogs with end-stage myxomatous mitral valve disease (MMVD) classified as ACVIM stage D, defined by furosemide requirements exceeding 8 mg/kg/day or torasemide equivalent. At study inclusion, left-sided congestive heart failure was present in 77.5% of dogs, pulmonary hypertension in 37.7%, and arrhythmias in 29.5%. The median progression time from ACVIM stage C to stage D was 245 days (IQR 144–376 days), and median cardiac-related survival after stage D diagnosis was 155 days (IQR 103–259 days). Comparison between dogs receiving furosemide versus torasemide revealed no significant differences in median survival time or serum sodium and chloride concentrations. However, torasemide-treated dogs demonstrated significantly higher serum creatinine (P=0.025) and lower serum potassium concentrations (P=0.005), raising considerations regarding renal function and electrolyte monitoring in this subgroup. The heterogeneous treatment protocols and retrospective design limit definitive therapeutic conclusions. Nevertheless, this study fills an important knowledge gap by providing benchmark data on the clinical trajectory, comorbidities, and survival expectations for dogs with refractory, end-stage MMVD. These findings can assist clinicians in establishing realistic prognoses and guiding client communication, while also highlighting the need for prospective studies to optimize diuretic management and monitoring protocols in this challenging patient population.

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