- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00587470
Angiotensin-II Blockade in Mitral Regurgitation
October 14, 2010 updated by: Mayo Clinic
Mitral regurgitation (MR) is common in the elderly and its prevalence is increasing with the aging of the population.
Organic MR, due to primary valvular lesions, initiates a cascade of complications determined by its degree.
MR of severe degree is associated with excess mortality and high cardiac morbidity (heart failure, atrial fibrillation).
It also causes left ventricular remodeling which induces left ventricular dysfunction, which in turn leads to poor clinical outcome.
Surgery can eliminate MR, but carries immediate and long-term risks, especially in the elderly.
Therefore, chronically decreasing the degree of MR is a major goal of medical therapy but such an effect is yet unproved because of conflicting results of small and mostly non-randomized series.
Our recent preliminary studies suggest that a sustained decrease of degree of MR and improvement of left ventricular remodeling can be achieved with powerful reduction of afterload, obtained in particular with angiotensin-II receptor blockade.
Therefore, the present proposal seeks to address gaps of knowledge regarding vasoactive treatment of MR through the verification of the following hypothesis: Hypothesis: Vasoactive therapy using angiotensin-II receptor blocker (Candesartan Cilexetil) weighed against placebo produces a sustained reduction of the consequences of organic MR.
The specific aims are that the treatment a) decreases the degree of MR (decreases the regurgitant volume, primary end-point) and b) improves left ventricular remodeling (decreases the end-diastolic volume index, secondary end-point), as compared to placebo.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
Patients with MR organic (intrinsic valve disease), isolated (no other valve disease), moderate or more severe (regurgitant volume *30 mL/beat).
A Clinical trial, randomized, placebo controlled, double-blind, without cross-over, of 1 year oral treatment with potent angiotensin-II receptor blockade using 32 mg Candesartan daily.
The trial is preceded in all patients by an acute open-label study to determine tolerance and immediate response.
The methods used to measure the end-points will be: a) Doppler-Echocardiography for quantitation of the degree of MR (measurement of regurgitant volume) using a combination of three simultaneous methods (quantitative Doppler, quantitative two-dimensional echocardiography, proximal flow convergence) and b) of left ventricular remodeling (end-diastolic volume index measured by echocardiography and by electron beam computed tomography).
This single center study seeks to enroll a total of 90 patients.
The analysis will be based on intention to treat and compare the regurgitant volume and left ventricular end-diastolic volume index measured after one year of treatment with the active drug or placebo.
The results of the trial should provide strong evidence regarding medical treatment of patients with organic MR.
Study Type
Interventional
Enrollment (Actual)
60
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Minnesota
-
Rochester, Minnesota, United States, 55905'
- Mayo Clinic
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
Patients:
- 18 years old or older, with
- Mitral regurgitation on the basis of Color flow imaging
- Due to organic disease of the mitral valve on the basis of two-dimensional echocardiography
- Isolated (no valve disease other than functional tricuspid regurgitation on the basis of Doppler-Echocardiography)
- Pure (no mitral stenosis by Doppler echocardiography)
- Quantifiable by Doppler-Echocardiographic methods
- Of more than mild degree, defined as regurgitant volume * 30 mL/beat
- Occurring on native valves
- With Two-dimensional echocardiographic imaging allowing assessment of LV remodeling, and
- Asymptomatic (or mildly symptomatic but not considered as candidates for immediate surgery by their attending physician).
Exclusion Criteria:
- Associated aortic valve disease (more than trace aortic regurgitation by color flow imaging or mean gradient *25 mmHg)
- Associated mitral stenosis (mean gradient* 5 mmHg, valve area < 1.5 cm2)
- Associated congenital or pericardial diseases on the basis of Doppler echocardiography
- Intolerance to either AII blockers or Angiotensin converting enzyme inhibitors
- Intolerance to iodine contrast material
- Intolerance to intravenous echographic contrast agents
- Renal failure with creatinine * 2 mg/dl
- Blood pressure below 100 mmHg
- Known renal artery stenosis
- Ongoing therapy with hydralazine, calcium-entry blocking drugs or angiotensin converting enzyme inhibitors
- Known severe comorbidity such as liver disease, malignancy
- Pregnancy (A negative pregnancy test and effective contraceptive methods are required prior to enrollment of females of childbearing potential (not post-menopausal or surgically sterilized)), and
- Patients considered as requiring mitral valve surgery by their attending physician or with previous valve repair or replacement.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: QUADRUPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
PLACEBO_COMPARATOR: 2
Placebo
|
Placebo
|
EXPERIMENTAL: 1
Atacand treatment.
|
Maximum vasodilation.
Other Names:
maximum vasodilation
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Tolerance of the medication.
Time Frame: one year
|
one year
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Decrease of severity of mitral regurgitation.
Time Frame: 1 year
|
1 year
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Maurice E. Sarano, M.D., Mayo Clinic Foundation
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
August 1, 1998
Primary Completion (ACTUAL)
August 1, 2001
Study Completion (ACTUAL)
August 1, 2001
Study Registration Dates
First Submitted
December 21, 2007
First Submitted That Met QC Criteria
January 4, 2008
First Posted (ESTIMATE)
January 7, 2008
Study Record Updates
Last Update Posted (ESTIMATE)
October 15, 2010
Last Update Submitted That Met QC Criteria
October 14, 2010
Last Verified
October 1, 2010
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1129-98
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.
Clinical Trials on Mitral Regurgitation
-
Abbott Medical DevicesCompletedFunctional Mitral Regurgitation | Degenerrative Mitral RegurgitationRussian Federation
-
Ancora Heart, Inc.CompletedMitral Regurgitation | Mitral Valve Regurgitation | Functional Mitral RegurgitationAustria, Lithuania, Germany
-
Heinrich-Heine University, DuesseldorfCompletedMitral Regurgitation | Functional Mitral Regurgitation | Degenerative Mitral Valve RegurgitationGermany
-
Mitre Medical Corp.BSWRI Cardiac Imaging Core Lab (CICL)Not yet recruitingIschemic Mitral Regurgitation | Functional Mitral RegurgitationUnited States
-
Abbott Medical DevicesCompletedMitral Valve Regurgitation | Mitral Valve Incompetence | Mitral Insufficiency | Functional Mitral Regurgitation | Mitral Stenosis With InsufficiencyJapan
-
Hospital Clinic of BarcelonaAbbottUnknownMITRAL REGURGITATIONSpain
-
Edwards LifesciencesRecruitingMitral Regurgitation | Mitral Insufficiency | Functional Mitral Regurgitation | Degenerative Mitral Valve DiseaseUnited States, Canada, Switzerland, Germany
-
Boston Scientific CorporationActive, not recruitingCardiovascular Diseases | Mitral Regurgitation Functional | Mitral Valve DiseaseUnited States, Australia
-
Abbott Medical DevicesActive, not recruitingHeart Failure | Mitral Regurgitation | Mitral Valve Regurgitation | Treatment of Functional Mitral Regurgitation in Symptomatic Heart Failure SubjectsUnited States, Canada
-
Mardil MedicalRecruitingFunctional Mitral RegurgitationCanada, Hungary, France, Germany, Netherlands, Panama, Poland
Clinical Trials on Placebo
-
SamA Pharmaceutical Co., LtdUnknownAcute Bronchitis | Acute Upper Respiratory Tract InfectionKorea, Republic of
-
National Institute on Drug Abuse (NIDA)CompletedCannabis UseUnited States
-
AstraZenecaParexel; Spandauer Damm 130; 14050; Berlin, GermanyCompletedMale Subjects With Type II Diabetes (T2DM)Germany
-
Heptares Therapeutics LimitedCompletedPharmacokinetics | Safety IssuesUnited Kingdom
-
GlaxoSmithKlineCompletedPulmonary Disease, Chronic ObstructiveUnited Kingdom, Netherlands
-
ItalfarmacoCompletedBecker Muscular DystrophyNetherlands, Italy
-
Shijiazhuang Yiling Pharmaceutical Co. LtdXuanwu Hospital, BeijingCompleted
-
GlaxoSmithKlineCompletedInfections, BacterialUnited States
-
West Penn Allegheny Health SystemCompletedAsthma | Allergic RhinitisUnited States