- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02099903
Renal Denervation in Patients With Heart Failure Secondary to Chagas Disease
Transcatheter Renal Denervation in Patients With Systolic Heart Failure Due to Chagas' Disease - a Safety and Efficacy Study.
Study Overview
Status
Intervention / Treatment
Detailed Description
The activation of the sympathetic nervous system is one of the main mechanisms involved in heart failure pathophysiology, as well as activation of the renin-angiotensin-aldosterone system. These compensatory mechanisms are initially beneficial, in order to restore adequate cardiac output. Their long-term activation, nevertheless, leads to several deleterious effects on cardiovascular system, such as direct myocite lesion, cardiac hypertrophy, myocardial ischemia, oxidative stress, cardiac arrhythmias and myocite apoptosis, among others.
It has been widely demonstrated that modulation of sympathetic nervous system is an important therapeutic target for the treatment of systolic heart failure. Beta-blocker and ACE inhibitors therapies are the main stem of heart failure treatment and have demonstrated reduction in morbidity and mortality of this condition. Despite optimized medical treatment, heart failure carries a poor prognosis.
Surgical sympathectomy has been used decades ago for the treatment of malignant hypertension and showed marked reduction in arterial pressure. However, these procedures were very aggressive and lead to long hospitalization and recovery periods, as well as several limiting adverse effects. Recently, transcatheter renal denervation has evolved as a promising and less invasive technique, which allows destruction of renal nerves located on the adventitia of the renal arteries. The ablation procedure is performed by delivery of radiofrequency energy from the tip of a catheter positioned into the renal arteries, through standard femoral artery catheterization, a less morbid and safer approach.
Renal denervation has been tested mainly in patients with resistant hypertension, among other indications, with promising results. The pathophysiological basis for this treatment in hypertension, as well as heart failure, stands on the participation of renal afferent and efferent nerves on the maintenance of elevated systemic vascular resistance. Activation of efferent nerves leads to excretion o renin, aldosterone, angiotensin II, elevated norepinephrine levels and consequent retention of salt and water and reduction of renal blood flow. This mechanism and also afferent renal nerves activation contributes to the elevation of sympathetic tonus on the central nervous system.
In animal models of heart failure, renal denervation demonstrated improvement on renal and cardiac function. Initial clinical studies suggest that this intervention is safe and potentially effective on the treatment of heart failure in humans. Chagas heart disease is a prevalent cause of heart failure in Brazil and shares several pathophysiological aspects described for other causes of heart failure. Our aim is to evaluate the safety and effectiveness of renal denervation in systolic heart failure due to Chagas Heart disease.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
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Sao Paulo, Brazil, 05403-000
- Recruiting
- Heart Institute - InCor. University of Sao Paulo Medical School
-
Contact:
- Patricia Pereira
- Phone Number: +55 11 2661-5368
- Email: patricia.pereira@incor.usp.br
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Principal Investigator:
- Pedro Lemos, MD PhD
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients ≥ 18 to ≤ 70 years of age with chronic systolic heart failure, Chagas disease etiology.
- Two positive serology results for Chagas by two distinct methods.
- NYHA (New York Heart Association) class II or III.
- Patients treated with maximum tolerated doses of standard pharmacotherapy for heart failure.
- LVEF (Left Ventricular Ejection Fraction) ≤ 40% (Simpson Method).
Exclusion Criteria:
- Patients with NYHA class I or IV.
- Sustained ventricular tachycardia (>30 sec) or with hemodynamic compromise.
- Presence of permanent pacemaker or implantable defibrillator.
- Systolic blood pressure < 90 mmHg.
- Heart beat < 60 bpm at rest.
- Advanced renal insufficiency (estimated glomerular filtration rate (GFR) < 30 ml/min/1.73 square meters).
- Patients with planned cardiac surgery or percutaneous revascularization.
- Other reasons which would preclude the patient from participating in the study (comorbidities, life expectancy less than 1 year).
- Unsuitable anatomy of renal arteries, renal stenosis or previous treatment with balloon or stent.
- Refusal of the patient.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Medical therapy for heart failure
Standard optimized medical therapy for heart failure.
|
|
Experimental: Renal denervation + medical therapy.
Transcatheter Renal Denervation with irrigated radiofrequency catheter + standard medical therapy.
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Renal sympathetic denervation with an irrigated radiofrequency catheter.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Composite: death, myocardial infarction, cerebrovascular event, need of intervention on renal arteries and renal function impairment (decrease in estimated GFR > 30% from baseline).
Time Frame: 30 days.
|
30 days.
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Left Ventricular Ejection Fraction (LVEF) by echocardiography.
Time Frame: 9 months.
|
9 months.
|
New York Heart Association (NYHA) functional class.
Time Frame: 9 months.
|
9 months.
|
6-minute walk test
Time Frame: 9 months.
|
9 months.
|
Peak Oxygen consumption (VO2) by ergoespirometry.
Time Frame: 9 months.
|
9 months.
|
Other Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Change in serum B-type natriuretic peptide (BNP).
Time Frame: 9 months.
|
9 months.
|
Quality of life assessed by Minnesota and EuroQOL five dimensions (EQ-5D)questionnaires.
Time Frame: 9 months.
|
9 months.
|
Peripheral sympathetic activity measured by microneurography.
Time Frame: 9 months.
|
9 months.
|
Collaborators and Investigators
Sponsor
Collaborators
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 18400613.1.0000.0068
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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