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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT02589977
Other study ID # 141686
Secondary ID
Status Completed
Phase Phase 4
First received
Last updated
Start date November 2015
Est. completion date January 21, 2020

Study information

Verified date February 2021
Source Vanderbilt University Medical Center
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Unlike heart failure with reduced ejection fraction (HFrEF) where several medicines and devices have been demonstrated to reduce mortality, no such therapies have been identified in HFpEF. This may be in part due to incomplete understanding of the underlying mechanisms of HFpEF. Recently, impaired myocardial blood flow, reduced myocardial energy utilization, and increased myocardial fibrosis have been postulated to play important pathophysiologic roles in HFpEF. The investigators and others have demonstrated that HFrEF may be associated with altered myocardial energy utilization and "energy starvation." However, there are limited data regarding "energy starvation" in HFpEF and the relationships between myocardial blood flow, energy utilization, and fibrosis in HFpEF are largely unknown. Therefore, the purposes of this study are to use non-invasive cardiac imaging techniques to describe cardiac structure, function, blood flow, energetics, and fibrosis, and the relationships between these in order to better understand underlying mechanisms in HFpEF.


Description:

The investigators hypothesize that HFpEF is associated with reductions in myocardial blood flow and energy utilization and increased myocardial fibrosis as compared to age and gender matched hypertensive and healthy controls. The investigators will test their hypotheses by comparing measurements of myocardial blood flow, energy utilization, and fibrosis between three subject groups (HFpEF vs hypertension vs healthy). Myocardial blood flow will be quantitated from nitrogen (N)13-Ammonia positron emission tomography (PET) and gadolinium enhanced cardiac magnetic resonance (CMR) imaging, both at rest and stress following coronary vasodilation with regadenoson. Myocardial energy utilization will be quantified with 11C-acetate PET imaging and myocardial fibrosis will be assessed with gadolinium enhanced CMR and alterations in myocardial T1. Echocardiography will be utilized to quantify cardiac diastolic function. It is anticipated that the results of this proposed study will provide a foundation that will inform future studies aimed at identifying novel preventive or therapeutic agents in HFpEF.


Recruitment information / eligibility

Status Completed
Enrollment 55
Est. completion date January 21, 2020
Est. primary completion date January 21, 2020
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group 50 Years to 75 Years
Eligibility ALL Inclusion Criteria: - estimated glomerular filtration rate (eGFR) > 60 ml/min - preserved left ventricular ejection fraction (>= 50%) on echocardiography Exclusion Criteria: - coronary artery disease - diabetes mellitus - contraindications to cardiac magnetic resonance imaging (CMR) - weight >350 lbs - inability to lie flat for imaging - anemia - contraindications to regadenoson or aminophylline HEALTHY Inclusion criteria: - normal cardiac structure and function on echocardiography - BP < 140/90 Exclusion criteria: - known cardiovascular disease, cardiac risk factors or use of cardiac medications HYPERTENSIVE Inclusion criteria: - history of BP >140/90 - 1 or more antihypertensive medications - LV ejection fraction (LVEF) at least 50% - current BP < 160/90 Exclusion criteria: - known cardiovascular disease or risk factors aside from hypertension or use of cardiac medications HFpEF Inclusion criteria: - physician-confirmed diagnosis of HF - symptomatic HF - LVEF at least 50% - elevated LV filling pressure by catheterization, echocardiographic criteria or B-type-natriuretic peptide > 100 - current BP < 160/90 Exclusion criteria: - prior history of LVEF below 50% - acute decompensated HF - moderate or greater valvular disease - significant cardiac arrhythmias - pericardial disease - congenital heart disease - primary pulmonary hypertension

Study Design


Intervention

Drug:
regadenoson
evaluation of myocardial blood flow, interstitial fibrosis and oxidative metabolism in HFpEF, compared to hypertensive and normal participants

Locations

Country Name City State
United States Vanderbilt University Medical Center Nashville Tennessee

Sponsors (2)

Lead Sponsor Collaborator
Marvin W. Kronenberg, M.D. Astellas Pharma US, Inc.

Country where clinical trial is conducted

United States, 

References & Publications (2)

Bell SP, Adkisson DW, Ooi H, Sawyer DB, Lawson MA, Kronenberg MW. Impairment of subendocardial perfusion reserve and oxidative metabolism in nonischemic dilated cardiomyopathy. J Card Fail. 2013 Dec;19(12):802-10. doi: 10.1016/j.cardfail.2013.10.010. Epub — View Citation

Gupta DK, Shah AM, Castagno D, Takeuchi M, Loehr LR, Fox ER, Butler KR, Mosley TH, Kitzman DW, Solomon SD. Heart failure with preserved ejection fraction in African Americans: The ARIC (Atherosclerosis Risk In Communities) study. JACC Heart Fail. 2013 Apr — View Citation

Outcome

Type Measure Description Time frame Safety issue
Primary Coronary Flow Reserve Rest and regadenoson stress coronary flow reserve by ammonia PET. Coronary flow calculated at rest and again at stress with coronary flow reserve calculated as the ratio of stress to rest coronary flow. Baseline study visit
Secondary Myocardial Perfusion Reserve by CMR in Each Study Group. Myocardial perfusion reserve by CMR. Baseline study visit.
Secondary Extracellular Volume (ECV) by CMR in Each Study Group Extracellular volume (ECV) by CMR. Baseline study visit
Secondary Oxidative Metabolism (Kmono/Rate Pressure Product) by PET in Each Study Group. Oxidative metabolism (Kmono/rate pressure product) by PET. Baseline study visit
Secondary E/e' by Echo in Each Study Group. E/e' by echo. E is the transmitral peak velocity in early diastole. e' is the early diastolic tissue Doppler velocity average between the septal and lateral mitral annulus. E/e' is the ratio of these two values. Baseline study visit
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