Heart Failure Clinical Trial
Official title:
A Randomized Trial of Carvedilol After Renin-angiotensin System Inhibition in Chronic Chagas Cardiomyopathy
Chronic Chagas cardiomyopathy causes substantial morbidity and mortality in Latin America. Whether RAS inhibitors and beta-blockers are safe and beneficial has been challenged because of the lack of formal trials. Hence, the objective of this study was to determine the safety and efficacy of renin-angiotensin system (RAS) inhibitors and beta-blockers in chronic Chagas cardiomyopathy. This way, the investigators conducted a double-blind, placebo-controlled, and randomized trial in 42 patients with Trypanosoma cruzi infection and cardiomyopathy. All patients received enalapril (up-titrated to 20 mg BID) and spironolactone (25 mg QD). Subsequently, the patients were randomly assigned to receive placebo (n = 20) or carvedilol up-titrated to 25 mg BID (n = 19). The primary end points were change in left ventricular ejection fraction (LVEF) after RAS inhibition and that after the addition of carvedilol. The secondary end points were changes in other echocardiographic parameters, Framingham score, quality of life (36-item Short-Form Health Survey), New York Heart Association class, radiographic indices, brain natriuretic peptide levels, and chemokines as well as safety end points.
Status | Completed |
Enrollment | 42 |
Est. completion date | December 2006 |
Est. primary completion date | March 2004 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Criteria for inclusion were positivity for T cruzi as confirmed by 2 or more serological tests (indirect immunofluorescence, ELISA, and/or indirect hemagglutination) and having cardiomyopathy. - Cardiomyopathy was present when at least 3 of the following criteria were fulfilled: - LV enddiastolic diameter (LVDD) N55 mm - LVDD/body surface area > 2.7cm/m2 - LV ejection fraction (LVEF) < 55% - QRS interval > 120 ms - echocardiographic evidence of diffuse or segmental systolic wall motion abnormalities. Exclusion Criteria: - Exclusion criteria were being pregnant - Using any h-blocker - Having additional comorbidities (eg, hypertension, diabetes mellitus, thyroid dysfunction, chronic obstructive pulmonary disease, asthma, and renal or hepatic failure). |
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment
Country | Name | City | State |
---|---|---|---|
Brazil | Chagas Disease Outpatient Center of the Federal University of Minas Gerais | Belo Horizonte | Minas Gerais |
Lead Sponsor | Collaborator |
---|---|
Federal University of Minas Gerais |
Brazil,
Botoni FA, Poole-Wilson PA, Ribeiro AL, Okonko DO, Oliveira BM, Pinto AS, Teixeira MM, Teixeira AL Jr, Reis AM, Dantas JB, Ferreira CS, Tavares WC Jr, Rocha MO. A randomized trial of carvedilol after renin-angiotensin system inhibition in chronic Chagas c — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Changes in left ventricular ejection fraction | Baseline, 4 months and 8 months | Yes | |
Secondary | Changes in Framingham score | Baseline, 4 months and 8 months | No | |
Secondary | Changes in quality of life (36-item Short-Form Health Survey) | Baseline, 4 months and 8 months | No | |
Secondary | Changes in New York Heart Association functional class | Baseline, 4 months and 8 months | No | |
Secondary | Changes in cardiothoracic ratio | Baseline, 4 months and 8 months | No | |
Secondary | Changes in echocardiographic diastolic function indices | Baseline, 4 months and 8 months | No | |
Secondary | Changes in brain natriuretic peptide levels | Baseline, 4 months and 8 months | No | |
Secondary | Changes in chemokines | Baseline, 4 months and 8 months | No | |
Secondary | Changes in autoantibodies levels | Baseline, 4 months and 8 months | No |
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