Mitral valve degeneration is common among small dogs as they age. It’s often asymptomatic and not always lethal, but it can lead to heart enlargement and heart failure. Medications can reduce the effects and delay the onset of heart failure.

A $141,000 grant from the Stanton Foundation will fund research at the Virginia-Maryland College of Veterinary Medicine to determine if primary care veterinarians using only a stethoscope and chest X-rays can be effective in identifying dogs that would benefit from medical treatment for myxomatous mitral valve disease before symptoms have occurred.

Spectrum of care

The research supports the Stanton Foundation’s focus on “spectrum of care,” a concept also embraced by the veterinary college, its Veterinary Teaching Hospital, and its Small Animal Community Practice veterinary clinic. Clinicians provide a variety of care options and work with the client to decide together which approach best meets the needs of the pet and its family. This approach provides affordable and readily available options for those who cannot afford or don’t have access to more expensive or specialized procedures for their dogs.

“The foundation’s mission in canine health is to ensure that dogs who belong to families of modest economic means enjoy the best possible health throughout their lives,” according to the Stanton Foundation website. “It supports clinical research on preventive care and alternatives to ‘gold standard’ veterinary medicine with wider experiential learning in veterinary training.”

In this case, research will determine the accuracy of less costly and readily available diagnostic testing for identifying dogs for mitral valve disease that would benefit from treatment without the use of an echocardiogram

“Clients have a variety of ability, both from an access standpoint - whether there's a specialist in their area - and a cost standpoint - what their budget can allow for – in pursuing gold standard veterinary care,” said Sunshine Lahmers, clinical associate professor of cardiology and principal investigator for the Stanton-supported research. “The spectrum of care concept from the Stanton Foundation is for all clients to feel like they can provide their pets quality care, even if they can't pursue the gold standard testing. We want to develop evidence-based approaches for a primary care practitioner to provide a client a variety of options when they hear a murmur in a patient’s heart.”

Jenny Marin examining a small white dog.
Jenny Marin. Photo by Margie Christianson for Virginia Tech.

Heart murmurs

Jenny Marin, clinical assistant professor in community practice, said cases of heart murmurs in dogs, often related to mitral valve disease, are very common.

“We see it all the time in general practice,” said Marin, who was a veterinarian in a North Carolina private clinic before joining the Veterinary Teaching Hospital. “The struggle I was having a lot before I came here, where I have cardiologists down the hall, was getting these dogs in to see a cardiologist at an early stage of their heart disease. We were having to make a lot of decisions just based on things we could do.

“The goal is to see if those techniques work well and have some evidence-based procedures to help general practitioners, like me, be able to make those decisions when we can’t send those dogs to a cardiologist.”

Kurt Zimmerman working on a computer.
Kurt Zimmerman. Photo by Madison Brown for Virginia Tech.

Two stages of research

The research funded by the Stanton Foundation at veterinary college will have two stages.

The first stage is a retrospective study, in which 150 radiographs of asymptomatic dogs with murmurs evaluated at the teaching hospital over the past decade will be reviewed. Kurt Zimmerman, professor of pathology and informatics, will use a computer model to create a decision tree designed to help clinicians predict the cases of asymptomatic mitral valve disease that would benefit from treatment.

The second stage will involve 30 dogs in a case recruitment pilot study to test the performance of the model, which will gauge how accurate primary care clinicians can be, without an echocardiogram, in identifying the dogs with a murmur that can have the onset of heart failure delayed with medical treatment.

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