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, the CEG recommends starting pimobendan in dogs with heart murmurs of grade 3/6 or louder only when the VHS exceeds 11.5 vertebral bodies or an incremental increase of greater than 0.5 vertebral bodies per 6 months is accurately documented." (Emphasis added.) If an echocardiogram is not available and only thoracic radiographs are performed CEG admits their advice is "not based on evidence" The CEG goes on to acknowledge that: "ACVIM guidelines recommend both imaging methods for optimal evaluation of a dog with suspected MMVD