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Dogs with clinically significant pulmonary hypertension or systemic disease were excluded, as were dogs on any medication s known to alter the RAAS. All dogs received pimobendan throughout the study period.

Each patient was evaluated at three time points Day 0, Day 7, and Day Investigators, veterinary technicians, and owners were blinded to treatment. Serum renal enzyme and electrolyte concentrations and SAP were rechecked on Day 7. No statistical differences were seen in echocardiographic, CXR, SAP, or biochemical profiles measured at any time point between groups. No adverse events were noted by the owners for dogs in either group. Echocardiography was performed, and fasting plasma concentrations of TMAO, choline, and carnitine fractions were measured.

Prospective studies are warranted to determine if TMAO concentrations can be altered with dietary or gut microflora modification, and whether altering TMAO concentrations could impact disease progression.