Exogenous Ketones for Acutely Decompensated HEart Failure — KADHEF  

Hemodynamic Instability Clinical Trial

Official title: Exogenous Ketones for Acutely Decompensated Heart Failure

Status Recruiting

Clinical Trial Summary

This study will evaluate whether supplementation of exogenous ketones in patients with severe left ventricular dysfunction and acutely decompensated heart failure requiring inotropic therapy would improve the patient's hemodynamics and symptoms.

Clinical Trial Description

The study will include patients with acutely decompensated chronic heart failure requiring inotropic therapy for the syndrome of low cardiac output. While being on the inotropic therapy, the patients will be randomized to oral supplementation of exogenous ketones vs. placebo, which will be repeatedly administered over 9 hours. The patients will undergo continuous invasive hemodynamic monitoring by pulmonary artery catheter, repeated laboratory assessment, and repeated assessment of the severity of symptoms for 24 hours.

Exogenous ketones will be administered orally using monoester 3-OHB concentrate without added salts (25g 3-OHB in 65ml H.V.M.N Ketone Ester, H.V.M.N, USA or equivalent). The drink will be administered over 10 mins every 3 hours, 3 times in a row (hour 0, 3, 6).

All patients with K<3.7 mmol/l will receive a continuous infusion of 7.5% potassium until reach target K levels of 4.0-4.9 mmol /l. Glycemia will be controlled as needed by insulin and dextrose to maintain glucose concentration of 4 - 12 mmol/l

All patients will receive standard treatment of acute heart failure, including intravenous diuretics and inotropic therapy. The recommended inotropic therapy will include milrinone 0.5 ug/kg/min, levosimendan 0.1 ug/kg/min up to 25mg without initial bolus, or dobutamine 0.5 ug/kg/min in patients without chronic therapy with beta-blockers.

The severity of symptoms will be self-reported by the patient using 1-10 visual analog scale.

Workflow:

• Hemodynamic assessment, assessment of ketones concentration: 1-3h before randomization, 0-9h hourly, 16-24h (next morning)

• Biochemical assessment (renal function, liver enzymes, BNP, hs-TnT) 0h, 9h, 16-24h

• Assessment of symptoms and Scv02: 0h, 1h, 3h, 9h, 16-24h

Statistical methods:

Each study arm will include 12 patients. The study size was estimated to have power of (1 - beta) of 0.8 and alpha of 5% for between-group comparison of changes in cardiac index and stroke volume index by ANOVA and for comparison of the changes in cardiac index and stroke volume index by paired t-tests. ;

Related Conditions & MeSH terms

• Acute Heart Failure
• Cardiac Output, Low
• Heart Failure
• Hemodynamic Instability
• Ketosis
• Low Cardiac Output Syndrome

• NCT number: NCT04698005
• Study type: Interventional
• Source: Institute for Clinical and Experimental Medicine
• Contact: Marek Sramko, MD, PhD
• Phone: +420776246127
• Email: marek.sramko@ikem.cz
• Status: Recruiting
• Phase: Phase 3
• Start date: December 2, 2020
• Completion date: December 31, 2021