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Furthermore, the in vitro blocking evidence primarily strengthens mechanistic specificity rather than strictly proving in vivo therapeutic necessity

He pointed out that in the VALVE Study trial, in which an ACE-inhibitor (ramipril) was added to the combination of furosemide and pimobendan, the median survival time was only 214 days, and in the QUEST Study (in which the Stage C dogs received either pimobendan or benazepril), the median survival time was only 267 days for pimobendan

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