{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T22:39:36Z","timestamp":1774132776768,"version":"3.50.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"vor","delay-in-days":2712,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2018,9,14]],"date-time":"2018-09-14T00:00:00Z","timestamp":1536883200000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"University of Pennsylvania Companion Animal Research Fund"},{"name":"University of Pennsylvania Companion Animal Research Fund"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Treatment targeted to achieve reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP) improves outcomes in human congestive heart failure (CHF) patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis<\/jats:title>\n                    <jats:p>A pre-specified therapeutic algorithm that increased diuretic or pimobendan usage will reduce plasma NT-proBNP concentrations in dogs with CHF secondary to myxomatous mitral valve disease (MMVD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Animals<\/jats:title>\n                    <jats:p>Twenty-six dogs with clinically stable CHF secondary to MMVD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective, controlled before-and-after study. Dogs were examined up to 3 times over 21 days. Treatment was prescribed based on NT-proBNP as follows: &amp;lt;1500 pmol\/L at baseline, no treatment adjustment at any point during the study (group 1); \u22651500 pmol\/L and creatinine \u22643.0 mg\/dL at baseline or SC visits, treatment escalated according to the algorithm (group 2); \u22651500 pmol\/L at baseline, no treatment adjustment (group 3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>N-terminal pro-B-type natriuretic peptide decreased significantly in group 2 (mean change = \u22121736 pmol\/L (95% CI, \u2212804 to \u22122668), P\u2009&amp;lt;\u2009.001) but not in groups 1 or 3 (623 pmol\/L [\u2013631 to 1877 pmol\/L], P\u2009=\u2009.14 and 685 pmol\/L [\u2013304 to 1068 pmol\/L], P\u2009=\u2009.46, respectively). Serum BUN and creatinine did not change significantly between visit 0 and visit 2 in group 1 (median\u2009=\u200923 mg\/dL [range 13-32] versus 19 mg\/dL [12-38], P\u2009=\u2009.72 and 1.15 mg\/dL [0.70-1.40] versus 0.95 mg\/dL [0.70-1.10], P\u2009=\u2009.10, respectively) or group 2 (28 mg\/dL [18-87] versus 43.5 mg\/dL [21-160], P\u2009=\u2009.092 and 1.10 mg\/dL [0.90-2.50] versus 1.55 mg\/dL [0.90-3.30], P\u2009=\u2009.062, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Clinical Importance<\/jats:title>\n                    <jats:p>Use of this treatment escalation algorithm allows effective targeting of treatment for CHF in dogs against an objective criterion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jvim.15228","type":"journal-article","created":{"date-parts":[[2018,9,16]],"date-time":"2018-09-16T03:49:18Z","timestamp":1537069758000},"page":"1509-1516","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Effect of prespecified therapy escalation on plasma NT-proBNP concentrations in dogs with stable congestive heart failure due to myxomatous mitral valve disease"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1890-6161","authenticated-orcid":false,"given":"Melanie J.","family":"Hezzell","sequence":"first","affiliation":[{"name":"School of Veterinary Medicine, University of Pennsylvania Department of Clinical Studies, , Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chlo\u00eb L.","family":"Block","sequence":"additional","affiliation":[{"name":"School of Veterinary Medicine, University of Pennsylvania Department of Clinical Studies, , Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle S.","family":"Laughlin","sequence":"additional","affiliation":[{"name":"School of Veterinary Medicine, University of Pennsylvania Department of Clinical Studies, , Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5218-9226","authenticated-orcid":false,"given":"Mark A.","family":"Oyama","sequence":"additional","affiliation":[{"name":"School of Veterinary Medicine, University of Pennsylvania Department of Clinical Studies, , Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,9,1]]},"reference":[{"key":"2026020922060813200_jvim15228-bib-0001","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1111\/j.1749-6632.1965.tb49421.x","article-title":"The prevalence and types of cardiovascular disease in dogs","volume":"127","author":"Detweiler","year":"1965","journal-title":"Ann N Y Acad Sci."},{"key":"2026020922060813200_jvim15228-bib-0002","first-page":"75","article-title":"Chronic valvular disease (endocardiosis) in dogs","volume":"21","author":"Buchanan","year":"1977","journal-title":"Adv Vet Sci Comp Med."},{"key":"2026020922060813200_jvim15228-bib-0003","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1111\/j.1939-1676.2007.0008.x","article-title":"Survival characteristics and prognostic variables of dogs with mitral regurgitation attributable to myxomatous valve disease","volume":"22","author":"Borgarelli","year":"2008","journal-title":"J Vet Intern Med."},{"key":"2026020922060813200_jvim15228-bib-0004","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1111\/j.1939-1676.2012.00894.x","article-title":"The combined prognostic potential of serum high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide concentrations in dogs with degenerative mitral valve disease","volume":"26","author":"Hezzell","year":"2012","journal-title":"J Vet Intern Med."},{"issue":"5","key":"2026020922060813200_jvim15228-bib-0005","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.2460\/javma.1998.213.11.1573","article-title":"Effects of enalapril maleate on survival of dogs with naturally acquired heart failure. 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