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While the answer is not entirely clear at this point in time, careful case selection when deciding when and how to use pimobendan is advised and at present, it should be reserved for use when systolic myocardial failure is detected or suspected." Even in the 2016 EPIC Study, in which the investigators concluded that pimobendan was effective in treating MVD-affected dogs with both murmurs and left chamber enlargement, 8.4% of the dogs in the pimobendan group died "spontaneous cardiac death[s] or euthanasia" prior to reaching the stage of congestive heart failure

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Instead, the effects are often subtle and cumulative