The Effects of Sacubitril/Valsartan on Cardiac Oxygen Consumption and Efficiency of Cardiac Work in Heart Failure Patients

Heart Failure Clinical Trial

— TurkuPET  

Official title:

Controlled Trial on the Short-term Effects of Sacubitril/Valsartan Therapy on Cardiac Oxygen Consumption and Efficiency of Cardiac Work in Patients With NYHA II-III Heart Failure and Reduced Systolic Function Using 11C-acetate Positron Emission Tomography and Echocardiography

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03300427
• Other study ID #: CLCZ696BFI03
• Secondary ID: 2017-002113-64
• Status: Completed
• Phase: Phase 4
• Start date: July 5, 2018
• Est. completion date: March 23, 2022

Study information

• Verified date: March 2023
• Source: Novartis
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a phase IV, prospective, randomized, double-blind, double-dummy, parallel-group study. The study assessed the effects of 6 weeks of stable sacubitril/valsartan therapy, as compared with valsartan therapy, on the efficiency of cardiac work in patients with NYHA II-III heart failure (HF) and reduced systolic function using 11C-acetate positron emission tomography (PET) and echocardiography.

Description:

Subjects were randomized into valsartan or sacubitril/valsartan arms in a 1:1 ratio. Regardless of the treatment arm a subject is in, the study drug was up-titrated to the highest tolerated dose level during the scheduled study visits. The different strengths of the two study drugs were not identical in appearance so the possible dose modification(s) during the treatment period could not be performed in a blinded manner. Subjects started on valsartan 80 mg BID or sacubitril/valsartan 100 mg BID dose and there was only one scheduled up-titration visit after the randomization. Exception for this were the subjects that were on valsartan 160 mg BID dose during the run-in phase. These subjects were randomized directly to valsartan 160 mg BID or sacubitril/valsartan 100 mg BID. Subjects that were randomized to valsartan arm had similar visit after which they continued on the same dose. For subjects that were randomized from valsartan 160 mg BID to sacubitril/valsartan 100 mg BID the dose was up-titrated to 200 mg BID if clinically possible. The total duration for each patient was planned to be about 14 weeks but could be longer if required for scheduling purposes . The longest participation, from signing of ICF until end of study, was 26 weeks.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 55
• Est. completion date: March 23, 2022
• Est. primary completion date: March 23, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 40 Years to 80 Years

Eligibility

Inclusion criteria:

• 40-80 years of age
• Chronic HF with reduced EF (left ventricle EF 25-35%) and NYHA class II-III symptoms.
• Systolic BP 110-160 mm Hg
• Optimal standard HF therapy according to European Society of Cardiology (ESC) guidelines at a stable dose for at least 4 weeks before the screening visit.

Exclusion criteria:

• Estimated glomerular filtration rate (eGFR) < 45 ml/min
• Serum potassium > 5.2 mmol/l and creatinine >1.5 x ULN

Related Conditions & MeSH terms

• Heart Failure

Intervention

Drug:
• sacubitril/valsatran
sacubitril/valsatran 100 or 200 mg BID
• valsartan
Valsartan 80 or 160 mg BID
• placebo to valsartan
placebo to valsartan 80 or 160 BID
• placebo to sacubitril/valsartan
placebo to sacubitril/valsartan 100 or 200 mg BID

Locations

Country	Name	City	State
Finland	Novartis Investigative Site	Turku

Sponsors (1)

Lead Sponsor	Collaborator
Novartis Pharmaceuticals

Country where clinical trial is conducted

Finland, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Myocardial Energetic Efficiency	Positron emission tomography (PET) imaging and echocardiography were performed before randomization (after a minimum of 4 weeks on stable dose of 80 mg BID or 160 mg BID of valsartan) and repeated after 6 weeks on a stable dose of either 80 mg BID or 160 mg BID of valsartan or 100 mg BID or 200 mg BID of sacubitril/valsartan.; Cardiac efficiency was calculated based on the following formula: Myocardial efficiency = ((SBP x SV x HR)/LV mass)/Kmono Where; SBP : Systolic blood pressure during PET; SV : Stroke volume (Echocardiography); HR : Heart rate; Kmono: Mono-exponential clearance rate (11C-acetate PET- scan); LV mass: Left ventricular mass; Visit 3 was performed after the study treatment was on a stable dose for a minimum of 6 weeks. It could be performed before or after 8 weeks, based on when the last dose modification was performed.; No imputation of missing data was performed.	Baseline, Visit 3 (approximately Week 8)
Primary	Change From Baseline in Myocardial Energetic Efficiency	Positron emission tomography (PET) imaging and echocardiography were performed before randomization (after a minimum of 4 weeks on stable dose of 80 mg BID or 160 mg BID of valsartan) and repeated after 6 weeks on a stable dose of either 80 mg BID or 160 mg BID of valsartan or 100 mg BID or 200 mg BID of sacubitril/valsartan.; Cardiac efficiency was calculated based on the following formula: Myocardial efficiency = ((SBP x SV x HR)/LV mass)/Kmono Where; SBP : Systolic blood pressure during PET; SV : Stroke volume (Echocardiography); HR : Heart rate; Kmono: Mono-exponential clearance rate (11C-acetate PET- scan); LV mass: Left ventricular mass; Visit 3 was performed after the study treatment was on a stable dose for a minimum of 6 weeks. It could be performed before or after 8 weeks, based on when the last dose modification was performed.; No imputation of missing data was performed.	Baseline, Visit 3 (approximately Week 8)
Primary	Viable Myocardial Energetic Efficiency (Sensitivity Analysis)	In addition to the derivation of the primary endpoint, an alternative formula was used, where the viable myocardial energetic efficiency was derived as: Viable myocardial energetic efficiency = ((SBP x SV x HR)/LV mass) / vKmono Where vKmono is the viable myocardium clearance rate. This alternative parameter was included as a sensitivity analysis to exclude possible bias related to scar tissue in patients with ischemic myopathy.	Baseline, Visit 3 (approximately Week 8)
Primary	Change From Baseline in Viable Myocardial Energetic Efficiency (Sensitivity Analysis)	In addition to the derivation of the primary endpoint, an alternative formula was used, where the viable myocardial energetic efficiency was derived as: Viable myocardial energetic efficiency = ((SBP x SV x HR)/LV mass) / vKmono Where vKmono is the viable myocardium clearance rate. This alternative parameter was included as a sensitivity analysis to exclude possible bias related to scar tissue in patients with ischemic myopathy.	Baseline, Visit 3 (approximately Week 8)