Effect of Early Use of Levosimendan Versus Placebo on Top of a Conventional Strategy of Inotrope Use on a Combined Morbidity-mortality Endpoint in Patients With Cardiogenic Shock (LevoHeartShock)
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Phase 3
Contacts and Locations
Study Contact
Study Contact
- Name: Bruno LEVY, Pr
- Phone Number: +33 3 83 15 40 84
- Email: b.levy@chru-nancy.fr
Study Locations
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-
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Bordeaux, France
- Recruiting
- CHU Bordeaux
-
Contact:
- Alexandre OUTARRA, MD-PhD
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Principal Investigator:
- Alexandre OUTARRA, Md-PhD
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Creteil, France
- Not yet recruiting
- HENRI MONDOR -réanimation
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Contact:
- Armand MEKONTSO DESSAP, MD-Phd
- Phone Number: +33 1 49 81 21 11
- Email: armand.dessap@aphp.fr
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Principal Investigator:
- Armand MEKONTSO DESSAP, MD-PhD
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Dijon, France
- Recruiting
- CHU Dijon
-
Contact:
- Pierre Grégoire GUINOT, MD-PhD
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Principal Investigator:
- Pierre Grégoire GUINOT, MD-PhD
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La Tronche, France, 38700
- Recruiting
- CHU Grenoble -USIC
-
Contact:
- Nicolas PILIERO, MD
-
Principal Investigator:
- Nicolas PILIERO, MD
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Marseille, France, 13385
- Recruiting
- AP-HM CHU La Timone
-
Contact:
- Florent ARREGLE, MD
-
Principal Investigator:
- Florent ARREGLE, MD
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Montpellier, France, 34295
- Recruiting
- CHU Montpellier -hôpital Arnaud de Villeneuve
-
Contact:
- Philippe GAUDARD, MD-PhD
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Principal Investigator:
- Philippe GAUDARD, MD-PhD
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Paris, France, 75013
- Recruiting
- APHP, La Pitié Salpêtrière (medical intensive care unit)
-
Contact:
- Alain Combes, MD
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Principal Investigator:
- Alain Combes, MD
-
Rouen, France
- Recruiting
- CHU Rouen
-
Contact:
- Emmanuel BESNIER, MD-PhD
-
Principal Investigator:
- Emmanuel BESNIER, MD-PhD
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Strasbourg, France
- Not yet recruiting
- HU Strasbourg USIC
-
Contact:
- Olivier MOREL, MD PhD
- Phone Number: +33 3 88 11 67 68
- Email: olivier.morel@chru-strasbourg.fr
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Principal Investigator:
- Olivier MOREL, MD-pHD
-
Vandoeuvre les Nancy, France
- Recruiting
- Chru Nancy
-
Contact:
- Bruno Lévy, Prof
-
Principal Investigator:
- Bruno LEVY, Prof
-
-
Bas-Rhin
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Strasbourg, Bas-Rhin, France, 67091
- Recruiting
- CHRU Strasbourg -Nouvel Hôpital Civil
-
Contact:
- Ferhat MEZIANI, MD-PhD
-
Principal Investigator:
- Ferhat MEZIANI, MD-PhD
-
-
Bouches du Rhône
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Marseille, Bouches du Rhône, France, 13015
- Recruiting
- AP-HM, Nord Hospital, Marseille
-
Contact:
- Laurent Bonello, MD
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Principal Investigator:
- Laurent Bonello, MD
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Calvados
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Caen, Calvados, France, 14000
- Not yet recruiting
- CHU caen
-
Contact:
- Katrien Blanchart, MD
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Principal Investigator:
- Katrien Blanchart, MD
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-
Côte d'Or
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Dijon, Côte d'Or, France, 21000
- Recruiting
- CHU Dijon
-
Contact:
- Jean-Pierre Quenot, MD-PhD
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Principal Investigator:
- Jean-Pierre Quenot, MD-PhD
-
-
Doubs
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Besançon, Doubs, France, 25000
- Recruiting
- CHU Besançon Jean Minjoz Hospital
-
Contact:
- Hadrien WINISZEWSKI, MD
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Principal Investigator:
- Hadrien WINISZEWSKI, MD
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Gard
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Nîmes, Gard, France, 30029
- Recruiting
- CHU Nîmes, Carémeau Hospital
-
Contact:
- Benoît Lattuca, MD
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Principal Investigator:
- Benoît Lattuca, MD
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Gironde
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Bordeaux, Gironde, France, 33600
- Recruiting
- CHU Bordeaux - Hôpital Haut-Lévêque
-
Contact:
- Edouard Gerbaud, MD
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Principal Investigator:
- Edouard Gerbaud, MD
-
-
Haute-Garonne
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Toulouse, Haute-Garonne, France, 31059
- Recruiting
- CHU de Toulouse
-
Contact:
- Clément DELMAS, MD
-
Principal Investigator:
- Clément Delmas, MD
-
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Haute-Vienne
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Limoges, Haute-Vienne, France, 87000
- Recruiting
- CHU Limoges, Dupuytren Hospital
-
Contact:
- Philippe Vignon, MD
-
Principal Investigator:
- Philippe Vignon, MD
-
-
Hérault
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Montpellier, Hérault, France, 34090
- Recruiting
- CHU Montpellier, Arnaud de Villeneuve Hospital
-
Contact:
- François Roubille, MD
-
Principal Investigator:
- François Roubille, MD
-
-
Ille et Vilaine
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Rennes, Ille et Vilaine, France, 35000
- Recruiting
- CHU Rennes, Pontchaillou Hospital
-
Contact:
- Abdelkader BAKHTI, MD
-
Principal Investigator:
- Abdelkader BAKHTI, MD
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-
Isère
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La Tronche, Isère, France, 38043
- Recruiting
- CHU Grenoble, Michallon Hospital
-
Contact:
- Joanna Bougnaud, MD
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Principal Investigator:
- Joanna Bougnaud, MD
-
-
Loire-Atlantique
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Nantes, Loire-Atlantique, France, 44000
- Recruiting
- CHU Nantes
-
Contact:
- Julien Plessis, MD
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Principal Investigator:
- Julien Plessis, MD
-
-
Moselle
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Ars-Laquenexy, Moselle, France, 57245
- Recruiting
- CHR Metz-Thionville, Mercy Hospital
-
Contact:
- Guillaume Louis, MD
-
Principal Investigator:
- Guillaume LOUIS, MD
-
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Nord
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Lille, Nord, France, 59000
- Recruiting
- CHRU Lille, Cœur Poumon Institute
-
Contact:
- Gilles LEMESLE, MD-PhD
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Principal Investigator:
- Gilles LEMESLE, MD-PhD
-
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Rhône
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Bron, Rhône, France, 69500
- Recruiting
- Hospices Civils de Lyon - Louis Pradel Hospital
-
Contact:
- Bertrand SCHEPPLER, MD
- Phone Number: +33 4 72 11 80 88
- Email: bertrand.scheppler01@chu-lyon.fr
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Principal Investigator:
- Bertrand SCHEPPLER, MD
-
-
Val de Marne
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Créteil, Val de Marne, France, 94010
- Recruiting
- APHP, Henri Mondor Hospital
-
Contact:
- Raphaëlle HUGUET, MD
- Phone Number: +33 1 49 81 21 11
- Email: raphaelle.huguet@aphp.fr
-
Principal Investigator:
- Raphaelle HUGUET, MD
-
-
Vaucluse
-
Avignon, Vaucluse, France, 84000
- Not yet recruiting
- CH Henri Duffaut, Avignon
-
Contact:
- Stéphane Andrieu, MD
-
Principal Investigator:
- Stéphane Andrieu, MD
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Adult patient ≥ 18 years with cardiogenic shock defined by:
- Adequate intravascular volume
- Norepinephrine to maintain MAP at least at 65 mmHg for at least 3 hours and less than 24h. At inclusion the dose must be <1 microgram/kg/min under norepinephrine base or <2 microgram/kg/min under norepinephrine tartrate, OR/AND Dobutamine since at least 3h and less than 24h at inclusion.
- Tissue hypoperfusion: at least 1 sign within 24h prior to inclusion (lactate ≥ 2 mmol/l; mottling, capillary refeel time > 3 seconds, oliguria <500ml/24h or ≤ 20 ml/h during the last 2 hours, ScVO2 ≤ 60% or veno-arterial PCO2 gap ≥ 5 mmHg);
Exclusion Criteria:
- Myocardial sideration after cardiac arrest of non-cardiac etiology
- Immediate or anticipated (within 6 hours) indication of Extra Corporel Life Support
- Use of VA-ECMO or IMPELLA or LVAD;
- Chronic renal failure requiring hemodialysis
- Cardiotoxic poisoning
- Septic cardiomyopathy
- Previous levosimendan administration within 15 days
- Cardiac arrest with non-shockable rhythm;
- No flow time higher > 3 minutes;
- Cardiac arrest with unknown no flow duration;
- Total duration of cardiac arrest (no flow plus low flow) > 45 minutes;
- Cerebral deficit with fixed dilated pupils
- Patient moribund on the day of enrollment
- Irreversible neurological pathology
- Known hypersensitivity to levosimendan or placebo, or one of its excipients
- Pregnant woman, birthing or breastfeeding mother
- Minor (not emancipated)
- Person deprived of liberty for judicial or administrative decision;
- Adult subject to a legal protection measure (such as guardianship, conservatorship)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Levosimendan
Experimental group: patients with cardiogenic shock treated with levosimendan in addition to the conventional strategy.
|
Levosimendan will be diluted with Glucose G5%.
The reconstitution of levosimendan will be performed, as close as possible to the start of the infusion.
A continuous infusion of levosimendan will be administered over 24 h without bolus, started at a rate of 0.1 μg per kilogram of body weight per minute and, in both the persistence of hypoperfusion signs and in the absence of rate-limiting side effects, will be increased after 2 to 4 hours to a maximum of 0.2 μg per kilogram per minute for a further 20 to 22 hours.
|
|
Placebo Comparator: Placebo
Control group: Patients with cardiogenic shock treated with placebo (Cernevit/Soluvit) in addition to the conventional strategy.
|
Placebo will be diluted with Glucose G5%.
The reconstitution of Placebo will be performed, as close as possible to the start of the infusion.
A continuous infusion of Placebo will be administered over 24 h without bolus, started at a rate of 0.1 μg per kilogram of body weight per minute and, in both the persistence of hypoperfusion signs and in the absence of rate-limiting side effects, will be increased after 2 to 4 hours to a maximum of 0.2 μg per kilogram per minute for a further 20 to 22 hours.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Proportion of All-cause mortality
Time Frame: Day 30 following randomization
|
Composite endpoint (i.e.
All-cause Mortality and/or Extra Corporel Life Support implantation and/or dialysis)
|
Day 30 following randomization
|
|
Proportion of Extra Corporel Life Support implantation
Time Frame: Day 30 following randomization
|
Composite endpoint (i.e.
All-cause Mortality and/or Extra Corporel Life Support implantation and/or dialysis)
|
Day 30 following randomization
|
|
Proportion of Dialysis
Time Frame: Day 30 following randomization
|
Composite endpoint (i.e.
All-cause Mortality and/or Extra Corporel Life Support implantation and/or dialysis)
|
Day 30 following randomization
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Duration of intensive care unit stay
Time Frame: Up to Intensive Care Unit discharge (assessed up to 1 month)
|
Up to Intensive Care Unit discharge (assessed up to 1 month)
|
|
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Duration of hospitalization
Time Frame: Up to hospitalization discharge (assessed up to 1 month)
|
Up to hospitalization discharge (assessed up to 1 month)
|
|
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Time to death
Time Frame: Day 90
|
Prioritized composite endpoint with the following priority order: 1/ time to death, 2/ escalation to permanent left ventricular assist device or cardiac transplantation, 3/ dialysis, 4/ ECLS requirement, 5/ number of cardiovascular events (stroke, recurrent myocardial infarction, urgent coronary revascularization, re-hospitalization for heart failure).
|
Day 90
|
|
Time to escalation to permanent left ventricular assist device or cardiac transplantation
Time Frame: Day 90
|
Prioritized composite endpoint with the following priority order: 1/ time to death, 2/ escalation to permanent left ventricular assist device or cardiac transplantation, 3/ dialysis, 4/ ECLS requirement, 5/ number of cardiovascular events (stroke, recurrent myocardial infarction, urgent coronary revascularization, re-hospitalization for heart failure).
|
Day 90
|
|
Time to dialysis
Time Frame: Day 90
|
Prioritized composite endpoint with the following priority order: 1/ time to death, 2/ escalation to permanent left ventricular assist device or cardiac transplantation, 3/ dialysis, 4/ ECLS requirement, 5/ number of cardiovascular events (stroke, recurrent myocardial infarction, urgent coronary revascularization, re-hospitalization for heart failure).
|
Day 90
|
|
Time to ECLS requirement
Time Frame: Day 90
|
Prioritized composite endpoint with the following priority order: 1/ time to death, 2/ escalation to permanent left ventricular assist device or cardiac transplantation, 3/ dialysis, 4/ ECLS requirement, 5/ number of cardiovascular events (stroke, recurrent myocardial infarction, urgent coronary revascularization, re-hospitalization for heart failure).
|
Day 90
|
|
number of cardiovascular events
Time Frame: Day 90
|
Prioritized composite endpoint with the following priority order: 1/ time to death, 2/ escalation to permanent left ventricular assist device or cardiac transplantation, 3/ dialysis, 4/ ECLS requirement, 5/ number of cardiovascular events (stroke, recurrent myocardial infarction, urgent coronary revascularization, re-hospitalization for heart failure).
|
Day 90
|
|
Proportion of death.
Time Frame: Day 90
|
Day 90
|
|
|
Proportion of Extra Corporel Life Support implantation
Time Frame: Day 90
|
Day 90
|
|
|
Proportion of dialysis
Time Frame: Day 90
|
Day 90
|
|
|
Proportion of cardiac transplantation
Time Frame: Day 90
|
Day 90
|
|
|
Proportion of escalation to permanent Left Ventricular Assist Device
Time Frame: Day 90
|
Day 90
|
|
|
Proportion of stroke
Time Frame: Day 90
|
Day 90
|
|
|
Proportion of recurrent myocardial infarction
Time Frame: Day 90
|
Day 90
|
|
|
Proportion of urgent coronary revascularization
Time Frame: Day 90
|
Day 90
|
|
|
Proportion of re-hospitalization for heart failure
Time Frame: Day 90
|
Day 90
|
|
|
Proportion of All-cause mortality
Time Frame: Day 90
|
Composite endpoint of all-cause mortality and/or ECLS requirement and/or dialysis on day 90.
|
Day 90
|
|
Proportion of Extra Corporel Life Support implantation
Time Frame: Day 90
|
Composite endpoint of all-cause mortality and/or ECLS requirement and/or dialysis on day 90.
|
Day 90
|
|
Proportion of Dialysis
Time Frame: Day 90
|
Composite endpoint of all-cause mortality and/or ECLS requirement and/or dialysis on day 90.
|
Day 90
|
|
Number of dobutamine free days
Time Frame: From randomization to day 30
|
From randomization to day 30
|
|
|
Number of vasopressors free days
Time Frame: From randomization to day 30
|
From randomization to day 30
|
|
|
Number of ventilatory free days
Time Frame: From randomization to day 30
|
From randomization to day 30
|
|
|
Number of renal replacement free days
Time Frame: From randomization to day 90
|
From randomization to day 90
|
|
|
Lactate clearance
Time Frame: from randomization to day 7
|
from randomization to day 7
|
|
|
Proportion of All-cause mortality
Time Frame: days 7, 60, and 180 days and 12 months
|
Composite endpoint of all-cause mortality and/or ECLS requirement and/or dialysis
|
days 7, 60, and 180 days and 12 months
|
|
Proportion of Extra Corporel Life Support implantation
Time Frame: days 7, 60, and 180 days and 12 months
|
Composite endpoint of all-cause mortality and/or ECLS requirement and/or dialysis
|
days 7, 60, and 180 days and 12 months
|
|
Proportion of dialysis
Time Frame: days 7, 60, and 180 days and 12 months
|
Composite endpoint of all-cause mortality and/or ECLS requirement and/or dialysis
|
days 7, 60, and 180 days and 12 months
|
|
Number of renal replacement free days
Time Frame: D 30, 60, 180 and at 12 months
|
D 30, 60, 180 and at 12 months
|
|
|
Proportion of death
Time Frame: days 180 and at 12 months
|
days 180 and at 12 months
|
|
|
Proportion of Extra Corporel Life Support implantation
Time Frame: days 180 and at 12 months
|
days 180 and at 12 months
|
|
|
Proportion of dialysis
Time Frame: days 180 and at 12 months
|
days 180 and at 12 months
|
|
|
proportion of cardiac transplantation
Time Frame: days 180 and at 12 months
|
days 180 and at 12 months
|
|
|
proportion of escalation to permanent left ventricular assist device
Time Frame: days 180 and at 12 months
|
days 180 and at 12 months
|
|
|
Proportion of stroke
Time Frame: days 180 and at 12 months
|
days 180 and at 12 months
|
|
|
Proportion of recurrent myocardial infarction
Time Frame: days 180 and at 12 months
|
days 180 and at 12 months
|
|
|
Proportion urgent coronary revascularization
Time Frame: days 180 and at 12 months
|
days 180 and at 12 months
|
|
|
proportion of re-hospitalization for heart failure
Time Frame: days 180 and at 12 months
|
days 180 and at 12 months
|
|
|
Occurrence of arrhythmias requiring therapy
Time Frame: from randomization to intensive care unit discharge.
|
Occurrence of arrhythmias requiring therapy with anti-arrhythmic drugs or electric cardioversion (including atrial fibrillation, ventricular tachycardia, ventricular fibrillation, torsade de pointe)
|
from randomization to intensive care unit discharge.
|
|
the changes in biomarkers
Time Frame: from randomization to intensive care unit discharge.
|
From a dedicated biological collection on which we will measure existing and future biological parameters, we will evaluate the effect of Levosimendan on the changes in biomarkers between randomization and ICU/CCU discharge
|
from randomization to intensive care unit discharge.
|
|
All-cause mortality and/or ECLS and/or dialysis
Time Frame: Day 30
|
From a dedicated biological collection on which we will measure existing and future biological parameters, we will evaluate the ability of clinical and biological measure to predict levosimendan effect for the primary endpoint.
|
Day 30
|
|
All-cause mortality and/or ECLS and/or dialysis
Time Frame: At intensive care unit discharge
|
From a dedicated biological collection on which we will measure existing and future biological parameters, we will evaluate the ability of biological measure to predict subsequent outcome
|
At intensive care unit discharge
|
Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Study Chair: Clément DELMAS, Dr, CHU Toulouse
- Study Chair: Nicolas GIRERD, Pr, Chru Nancy
- Study Chair: Patrick ROSSIGNOL, Pr, Chru Nancy
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Vascular Diseases
- Cardiovascular Diseases
- Pathologic Processes
- Heart Diseases
- Infarction
- Necrosis
- Myocardial Ischemia
- Myocardial Infarction
- Ischemia
- Shock, Cardiogenic
- Shock
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Protective Agents
- Cardiotonic Agents
- Vasodilator Agents
- Phosphodiesterase Inhibitors
- Phosphodiesterase 3 Inhibitors
- Simendan
Other Study ID Numbers
Other Study ID Numbers
- 2024-513811-29-00 (Ctis)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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