Angiotensin‐converting enzyme inhibitors in preclinical myxomatous mitral valve disease in dogs: systematic review and meta‐analysis

Objectives To determine the efficacy and adverse events of the administration of angiotensin‐­converting enzyme inhibitors for the management of preclinical myxomatous mitral valve disease in dogs. Materials and Methods A comprehensive search using Pubmed/MEDLINE, LILACS and CAB abstracts databases was performed. Randomised clinical trials that assessed efficacy and adverse events of angiotensin‐converting enzyme inhibitors for the management of preclinical myxomatous mitral valve disease in dogs were included. Certainty of evidence was rated using GRADE methods. Results Four randomised clinical trials were included. While safe, angiotensin‐converting enzyme inhibitors administration to dogs with myxomatous mitral valve disease and cardiomegaly results in little to no difference in the risk of development congestive heart failure (high certainty of evidence; relative risk: 1.03; 95% confidence interval: 0.87 to 1.23) and may result in little to no difference in cardiovascular‐related (low certainty of evidence; relative risk: 1.01; 95% confidence interval: 0.54 to 1.89) and all‐cause mortality (low certainty of evidence; relative risk: 0.93; 95% confidence interval: 0.63 to 1.36). Administration of angiotensin‐converting enzyme inhibitors to dogs with myxomatous mitral valve disease without cardiomegaly may result in a reduced risk of congestive heart failure development. However, the range in which the actual effect for this outcome may be, the “margin of error,” indicates it might also increase the risk of congestive heart failure development (low certainty of evidence; relative risk: 0.86; 95% confidence interval: 0.54 to 1.35). Clinical Significance Administration of angiotensin‐converting enzyme inhibitors to dogs with ­preclinical myxomatous mitral valve disease and cardiomegaly results in little to no difference in the risk of the development of congestive heart failure and may result in little to no difference in ­cardiovascular‐related and all‐cause mortality. The certainty of evidence of the efficacy of angiotensin‐converting enzyme inhibitors administration to dogs without cardiomegaly was low.