The EPIC study sets out criteria for dogs with preclinical myxomatous mitral valve disease (MMVD) likely to benefit from treatment with pimobendan. These include echocardiographic assessment of left atrial (LA) and ventricular (LV) size; access to echocardiography by a cardiologist is not universally available. The aim of this study was to evaluate a focussed training programme for the accurate identification of dogs fulfilling the EPIC criteria by primary care veterinarians (PCVs).

Six PCVs with no previous echocardiographic experience underwent the training programme. Each PCV subsequently evaluated ≤10 dogs that they believed to have preclinical MMVD. The evaluation was repeated by one of three board-certified cardiologists, blinded to the PCV's findings. The median time between PCV and cardiologist evaluation was 0 days (range 0–8). Fifty-two dogs were evaluated by PCVs; one dog was withdrawn from the study due to radiographic evidence of CHF.

In one dog, the PCV's diagnosis of MMVD was incorrect (this dog had preclinical dilated cardiomyopathy [DCM]); preclinical MMVD was confirmed by the cardiologist in the remaining 50 dogs. Agreement between PCVs and cardiologists was fair to moderate for auscultatory findings (apex beat intensity (kappa=0.474; P<0.001), precordial thrill (κ=0.510; P<0.001), heart sound intensity (κ=0.338; P=0.012), murmur intensity (κ=0.411; P=0.002) and murmur grade (κ=0.550; P<0.001). No differences in heart rate (P=0.454), vertebral heart scale (P=0.147; coefficient of variation [CV]=2.1%), interventricular septal thickness in diastole (P=0.979; CV=11.4%), LV free wall thickness in diastole (P=0.342; CV=13.4%), LV internal dimension in systole (P=0.280; CV=7.7%) or LA to aortic ratio (P=0.935; CV=7.1%) were detected between PCVs and cardiologists. LV internal diameter in diastole (LVIDd; 3.31 cm [2.07–5.14] vs 3.45 cm [1.42–5.80]; P=0.024; CV=7.7%), LVIDd normalised for body weight (1.71 cm/kg^0.294 [1.29–2.21] vs 1.73 cm/kg^0.294 [1.32–2.73]; P=0.017; CV=5.7%), LA diameter (2.56 cm [1.22–3.61] vs 2.76 cm [1.68–4.55]; P<0.001; CV=12.2%) and aortic root diameter (1.72 cm [0.82–3.34] vs 1.73 cm (1.26–3.13); P=0.016; CV=10.5%) were significantly lower when assessed by PCVs vs cardiologists; all differences were clinically insignificant. Agreement between PCVs and cardiologists regarding whether dogs fulfilled the EPIC criteria was almost perfect (kappa=0.828; P<0.001); both agreed in 47 cases, disagreed in 4 and the diagnosis was incorrect in 1 (DCM). Plasma N-terminal pro-B-type natriuretic peptide concentrations, measured in surplus samples, were significantly higher in dogs which fulfilled the EPIC criteria vs those that did not (1748 pmol/L [449–3088] vs 571 pmol/L [250–2172]; P<0.001).

This study suggests that the focussed programme effectively trained PCVs to accurately assess EPIC criteria.

Disclosures

The research was supported by a grant funded by Boehringer Ingelheim GmbH. Dr Hezzell has previously received research support from IDEXX Laboratories, Inc.