EPIC Guidelines

Identifying Advanced Preclinical Mitral Disease

Dog Suspected to Have MMVD

Common breeds include Cavalier King Charles spaniels, dachshunds, miniature schnauzers, poodles, Yorkshire terriers

Left Apical Systolic Heart Murmur (Moderate to loud murmur — grade 3/6 +

Thoracic Radiographs

Vertebral Heart Score (VHS)

VHS < 10.5

VHS ≥ 10.5 < 11.5

VHS ≥ 11.5

No Treatment

Recheck in 12 months

Echo

Confirm Cardiomegaly

Echo

NO Echo

Measure LA:Ao Ratio

Left Atrial-to-Aortic Ratio

Measure LVIDD

Left ventricular internal diameter in diastole

LA:Ao < 1.6 and/or LVIDDN < 1.7

Left Normalised left ventricular internal diameter in diastole

LA:Ao ≥ 1.6 and LVIDDN3 ≥ 1.7

Normalised left ventricular internal diameter in diastole

Recheck in 6 months

DIAGNOSIS: STAGE B2 HEART DISEASE

References

EPIC Trial Site

Boswood A, Häggström J, Gordon SG, et al. Effect of pimobendan in dogs with preclinical myxomatous mitral valve disease and cardiomegaly: the EPIC Study—a randomized clinical trial. J Vet Intern Med. 2016;30:1765–1779.