- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02684786
A Study of Stellate Ganglion Block and / or Reserpine in Group 2 Pulmonary Hypertension
A Phase I Study of Stellate Ganglion Block and / or Reserpine in Group 2 Pulmonary Hypertension
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background. Pulmonary hypertension Group 2 (PH 2) associated with left-sided heart disease is relatively common, is associated with a poor prognosis, and unfortunately there are no proven medical treatments beyond attempts at correcting the left sided heart disease. Many PH 2 patients have evidence of vasoconstriction and increased sympathetic nervous system activity. Use of agents or procedures which produce a reversible chemical sympathectomy have not been systematically tested in PH 2.
Methods. Two groups will be eligible for participation: Group 1 (n=10): Patients with PH 2 previously documented by echocardiography (echo), 6 minute walk test, biomarkers, and right heart catheterization (RHC) will receive reserpine, 0.05 mg per day for two weeks, then, 0.1 mg per day for an additional two weeks. After one month, patients will be reassessed for New York Heart Association (NYHA) class and drug side effects, echocardiography, 6 minute walk assessment, and brain natriuretic peptide (BNP). Group 2 patients (n=10) will have clinically suspected PH 2 and be scheduled to undergo clinically indicated RHC. If during RHC PH 2 is confirmed, after assessment of nitric oxide responsiveness, their baseline hemodynamics will be re-established over 10 minutes, and a left stellate ganglion block with lidocaine will be performed, and immediate hemodynamic responsiveness assessed. Four hours post-procedure, a side effect questionnaire will be obtained. Group 2 patients who complete RHC will then begin reserpine treatment in the same manner as Group I patients.
Hypothesis and Impact. PH 2 is the most common type of pulmonary hypertension. The current diagnostic and therapeutic strategy aims to treat the left sided heart disease in attempt to normalize pulmonary artery pressure. The place of selective pulmonary vasodilators is undefined. The investigator's approach addresses inhibition of adverse pulmonary vasoconstriction mediated by the sympathetic nervous system in PH 2.
Study Type
Phase
- Phase 1
Contacts and Locations
Study Locations
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Florida
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Jacksonville, Florida, United States, 32224
- Mayo Clinic Florida
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion criteria:
- Prior right heart catheterization, with mean pulmonary artery pressure > 25 mm Hg, pulmonary capillary wedge pressure > 15 mm Hg, and diastolic pressure gradient (pulmonary artery diastolic pressure - mean pulmonary capillary wedge pressure) ≥ 7 mm Hg OR clinically suspected group 2 pulmonary hypertension from non-invasive testing with planned right heart catheterization (RHC).
- On stable diuretic therapy
- Able to attend end-study visit 4 weeks after study entry
Exclusion criteria:
- Anticipated surgery to correct heart lesion responsible for pulmonary hypertension
- Need for heparinization for right heart catheterization (not standard practice, but sometimes utilized)
- History of depression, or treatment with tricyclic anti-depressant, serotonin uptake inhibitor, monamine oxidase inhibitor
- Severe renal or hepatic impairment, creatinine clearance < 30 ml/minute or renal replacement therapy or post-kidney transplant, abnormal liver function with elevated enzymes> 1.5 times the upper limit of normal or prior liver transplant.
- Systolic blood pressure <100 mm Hg
- Heart rate < 60 beats per minute
- Inability to independently complete telephone follow-up at two weeks, and clinic end-study visit at 4 weeks.
- Pulmonary edema
- Infiltrative cardiomyopathy - amyloidosis
- Symptomatic orthostatic hypotension
- Women of childbearing age who have not had surgical sterilization and are not using oral contraceptives, or who's spouse has not had surgical sterilization will be excluded due to the length of the trial and the possibility that they could become pregnant after entry.
- Uncontrolled heartburn
- Prior surgery to the left neck, for example, carotid endarterectomy, or other surgery which would increase the risk of stellate ganglion block
- Known sensitivity, allergy, or contraindication to lidocaine, any local anesthetic, or reserpine
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Prior right heart catheterization
Patients with qualifying hemodynamics from prior right heart catheterization will receive open label reserpine, 0.05 mg by mouth daily for two weeks, then 0.10 mg by mouth daily for two weeks, and then have repeat non-invasive assessments of status.
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Patients with qualifying hemodynamics from prior right heart catheterization will receive open label reserpine, 0.05 mg by mouth daily for two weeks, then 0.10 mg by mouth daily for two weeks, and then have repeat non-invasive assessments of status
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Experimental: Scheduled for right heart catheterization
Patients with suspected group 2 pulmonary hypertension by clinical and non-invasive assessments and are scheduled to undergo clinically indicated right heart catheterization will have pulmonary artery pressures measured.
If qualifying severity of group 2 pulmonary hypertension is present, after clinically indicated assessment of inhaled nitric oxide, their baseline hemodynamics will be allowed to re-equilibrate over 10 minutes, and then ultrasound guided left stellate ganglion block with lidocaine will be performed, and hemodynamics reassessed 10 minutes afterward
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Patients with suspected group 2 pulmonary hypertension by clinical and non-invasive assessments and are scheduled to undergo clinically indicated right heart catheterization will have pulmonary artery pressures measured.
If qualifying severity of group 2 pulmonary hypertension is present, after clinically indicated assessment of inhaled nitric oxide, their baseline hemodynamics will be allowed to re-equilibrate over 10 minutes, and then ultrasound guided left stellate ganglion block with lidocaine will be performed, and hemodynamics reassessed 10 minutes afterward
Patients with suspected group 2 pulmonary hypertension by clinical and non-invasive assessments and are scheduled to undergo clinically indicated right heart catheterization will have pulmonary artery pressures measured.
If qualifying severity of group 2 pulmonary hypertension is present, after clinically indicated assessment of inhaled nitric oxide, their baseline hemodynamics will be allowed to re-equilibrate over 10 minutes, and then ultrasound guided left stellate ganglion block with lidocaine will be performed, and hemodynamics reassessed 10 minutes afterward
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
Time Frame: one month
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Adverse events of interest are for stellate ganglion block: pulmonary edema, bradycardia requiring treatment, hypotension requiring treatment, arrhythmia, pneumothorax, hoarseness, dysphagia, globus, left upper extremity weakness. For reserpine, heart failure hospitalization, syncope, all cause hospitalization, bradycardia requiring treatment, hypotension requiring treatment, new arrhythmia, edema requiring an increase in diuretics, depression, lethargy, nasal stuffiness, dizziness, orthostatic hypotension, falls, nightmares, sexual dysfunction, anxiety, dyspepsia. Adverse events classed as serious:
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one month
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of participants with successful stellate ganglion block
Time Frame: One hour
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Stellate block: frequency of the occurrence of ptosis and conjunctival flushing.
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One hour
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Effect of stellate ganglion block on heart rate
Time Frame: One hour
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Heart rate before and after stellate ganglion block
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One hour
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Change in 6 minute walk distance from one month of reserpine therapy
Time Frame: One month
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Six minute walk distance, meters, baseline compared to one month
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One month
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Change in brain natriuretic peptide (BNP) from one month of reserpine therapy
Time Frame: One month
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BNP, pg/ml, baseline compared to one month
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One month
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Change in Doppler derived mean pulmonary artery pressure from one month of reserpine therapy
Time Frame: One month
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Mean pulmonary artery pressure estimate, mm Hg
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One month
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Change in blood pressure from one month of reserpine therapy
Time Frame: One month
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Blood pressure, mm Hg, baseline versus one month
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One month
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Change in Minnesota Living with heart failure questionnaire from one month of reserpine therapy
Time Frame: One month
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Minnesota Living with heart failure questionnaire aggregate score, baseline versus one month
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One month
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Hemodynamic effect of stellate ganglion block
Time Frame: One hour
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Blood pressure, mm Hg, before and after stellate ganglion block
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One hour
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Hemodynamic effect of stellate ganglion block
Time Frame: One hour
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Pulmonary artery pressure, mm Hg, before and after stellate ganglion block
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One hour
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Hemodynamic effect of stellate ganglion block
Time Frame: One hour
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Pulmonary capillary wedge pressure, mm Hg, before and after stellate ganglion block
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One hour
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Hemodynamic effect of stellate ganglion block
Time Frame: One hour
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right atrial pressure, mm Hg, before and after stellate ganglion block
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One hour
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Hemodynamic effect of stellate ganglion block
Time Frame: One hour
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Cardiac output, liters per minute, before and after stellate ganglion block
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One hour
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Change in heart rate from one month of reserpine therapy
Time Frame: One month
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Heart rate, baseline versus one month
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One month
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Joseph Blackshear, MD, Mayo Clinic
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Respiratory Tract Diseases
- Lung Diseases
- Hypertension
- Pulmonary Arterial Hypertension
- Hypertension, Pulmonary
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Anti-Arrhythmia Agents
- Antihypertensive Agents
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Sensory System Agents
- Anesthetics
- Antipsychotic Agents
- Tranquilizing Agents
- Psychotropic Drugs
- Neurotransmitter Uptake Inhibitors
- Membrane Transport Modulators
- Anesthetics, Local
- Voltage-Gated Sodium Channel Blockers
- Sodium Channel Blockers
- Adrenergic Uptake Inhibitors
- Lidocaine
- Reserpine
Other Study ID Numbers
- 16-000928
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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