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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04633460
Other study ID # 833870
Secondary ID
Status Completed
Phase Phase 2
First received
Last updated
Start date October 6, 2020
Est. completion date October 16, 2023

Study information

Verified date October 2023
Source University of Pennsylvania
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The purpose of this study is to test whether a ketone ester drink will improve exercise in people with heart failure (HF) compared to a placebo. In HF, patients are limited in their ability to do all the things they want to do, and exercise as much as they would like, due to becoming tired and short of breath early. There may be several reasons why these symptoms occur. There is some evidence that in addition to problems with the heart, patients with HF also have problems with their arteries and muscles that affect their ability to exercise. Ketones have been shown to improve exercise capacity in healthy volunteers, which may be related to effects on the heart function or on muscles. An infusion of ketones through an intravenous (IV) line has also been shown to significantly improve heart function, but whether a drink can produce similar improvements in HF patients is not known. This drink has been given status by Food and Drug Administration as "generally regarded as safe". The use of DeltaG in this study is experimental. DeltaG has not been approved by the Food and Drug Administration (FDA) for the use being evaluated in this study.


Recruitment information / eligibility

Status Completed
Enrollment 20
Est. completion date October 16, 2023
Est. primary completion date October 4, 2023
Accepts healthy volunteers No
Gender All
Age group 18 Years to 85 Years
Eligibility Inclusion criteria: 1. Left ventricular ejection fraction = 50% 2. Evidence for elevated filling pressures as follows (at least one of the following between a-d): a. Mitral early (E)/mitral septal tissue annular (e') velocity ratio > 8 in addition to one of the following: i. Large left atrium (LA>4.0 cm width or LA volume index >34 mL/m2) ii. Chronic loop diuretic use for control of symptoms iii. Elevated natriuretic peptides within the past year (NT-proBNP>125 pg/ml or BNP>35 pg/ml) b. Mitral E/e' ratio > 1441 at rest or with exercise c. Elevated invasively-determined filling pressures previously (resting left ventricular end-diastolic pressure >16 mm Hg or pulmonary capillary wedge pressure > 15 mmHg; or PCWP/LVEDP = 25 mmHg with exercise) d. Prior episode of acute heart failure requiring IV diuretics with evidence of volume overload on exam/radiology or elevated natriuretic peptides. Exclusion Criteria 1. Intentional ketogenic (high fat, low carbohydrate) diet in the last week or use of ketogenic medications (SGLT2 inhibitors) 2. Significant liver disease (liver function tests > 3x upper limit of normal, cirrhosis) or alcohol abuse disorder (>14 drinks/week). 3. Contraindications to stress testing, conditions that limit exercise, and other clinically-significant causes of exertional limitation (claudication with peripheral artery disease, atrial fibrillation and heart rate >110 at rest, systolic blood pressure>180 mmHg or diastolic blood pressure>110 mmHg, infiltrative/hypertrophic/inflammatory cardiomyopathy, clinically significant pericardial disease, joint or neuromuscular disease that precludes exercise, acute coronary syndrome within the last 2 months, estimated glomerular filtration rate<30 mL/min/1.73 m2, and hemoglobin < 9 mg/dL). 4. Clinically significant lung disease. This would be defined by severe obstructive lung disease (Gold stage 3), a requirement for supplemental oxygen, or chronic obstructive pulmonary disease with an exacerbation requiring steroids or antibiotics within the last 2 months. 5. >= Moderate aortic stenosis, >mild mitral stenosis, >= moderate aortic or mitral regurgitation on screening echocardiogram 6. Type 1 diabetes mellitus 7. Pregnant women. Due to unknown affects of nutritional ketosis in pregnant women, pregnancy will be an exclusion. Accordingly, women of childbearing age with a menstrual cycle within the past year will be asked to submit a urine specimen for pregnancy testing. 8. Angina due to epicardial coronary disease or known presence of clinically-significant, unrevascularized epicardial coronary disease, in the investigator's opinion. 9. Prior reduced LVEF to < 45%

Study Design


Related Conditions & MeSH terms


Intervention

Dietary Supplement:
Ketone ester
A nutraceutical ketone ester (KE), (R)-3-hydroxybutyl (R)-3-hydroxybutyrate which provides systemic ketosis
placebo drink
KE free placebo drink

Locations

Country Name City State
United States Penn Presbyterian Medical Center Philadelphia Pennsylvania

Sponsors (1)

Lead Sponsor Collaborator
University of Pennsylvania

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Other Heart rate variability at rest Assessed 20 minutes after the intervention.
Other Left ventricular global longitudinal strain (%) assessed by echocardiography strain analysis at rest. Assessed 30 minutes after the intervention.
Other Exercise-induced extravascular lung water (B-lines) assessed during lung ultrasound with exercise. Assessed 60 minutes after the intervention.
Other VO2 kinetics (Tau) during submaximal cardiopulmonary exercise testing Assessed 30 minutes after the intervention.
Other Tissue Doppler velocity measured during rest echocardiography. Assessed 30 minutes after the intervention.
Other E/e' ratio measured during stress echocardiography. Assessed 60 minutes after the intervention.
Primary Maximal exercise capacity (peak VO2) assessed by cardiopulmonary exercise testing Assessed 60 minutes after the intervention.
Primary Submaximal exercise capacity (exercise time at 75% of peak workload) assessed by cardiopulmonary exercise testing. Assessed 30 minutes after the intervention.
Secondary Percent change in systemic vascular resistance with exercise Assessed 60 minutes after the intervention.
Secondary Substrate utilization (reflected by the respiratory exchange ratio) assessed by cardiopulmonary exercise testing. Assessed 60 minutes after the intervention.
Secondary VO2 efficiency (total work performed over oxygen consumed) during submaximal cardiopulmonary exercise testing. Assessed 30 minutes after the intervention.
Secondary Presence of exercise-induced arrhythmias (significant atrial or ventricular arrhythmias) Assessed throughout the study visit date after the intervention is given.
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