- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02767024
Intravenous Vasodilator vs. Inotropic Therapy in Patients With Heart Failure (PRIORITY-ADHF)
October 29, 2018 updated by: Mario Garcia, Montefiore Medical Center
Intravenous Vasodilator vs. Inotropic Therapy in Patients With Heart Failure Reduced Ejection Fraction and Acute Decompensation With Low Cardiac Output: A Single Center, Randomized, Non-Blinded, and Parallel Study (PRIORITY-ADHF Study)
Single center, prospective, randomized, non-blinded research study comparing intravenous vasodilator infusion vs. inotropic infusion in patients admitted to the hospital or in the emergency room at Montefiore Medical Center presenting with the diagnosis of acute decompensated systolic heart failure with low cardiac output but no hypotensive.
Study Overview
Status
Withdrawn
Conditions
Intervention / Treatment
Detailed Description
The objective of the study is determine if the administration of diuretics with intravenous sodium nitroprusside (vasodilator therapy) in comparison to intravenous dobutamine (inotropic therapy) will lead to a reduction in the primary and secondary endpoints in patients with acute decompensated systolic heart failure with low cardiac output and no hypotensive.
Study Type
Interventional
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
-
-
New York
-
Bronx, New York, United States, 10461
- Montefiore Medical Center
-
-
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
16 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- History of heart failure reduced ejection fraction (HFrEF), New York Heart Association (NYHA) class IV and known left ventricular ejection fraction (LVEF ) ≤ 40% within the last 6 months by any of the following imaging techniques: echocardiogram, radio-nuclear stress test, ventriculogram or cardiac magnetic resonance imaging (CMR) performed within 6 months.
Hospitalized or presented to the emergency department for acute decompensated heart failure (ADHF) with the anticipated requirement if intravenous (IV) therapy (including IV diuretics). ADHF is defined as including all of the following measured at any time between the presentation (including the emergency department) and the end of the screening:
- Persistent dyspnea or orthopnea or edema at screening and at the time or randomization, despite standard background therapy for heart failure.
- Pulmonary congestion on chest radiograph.
- N-terminal pro b-type natriuretic peptide (NT-proBNP) ≥ 2000 pg/ml; for patients ≥ 75 years old or with current atrial fibrillation, NT-proBNP ≥ 3000 pg/ml.
- Clinical suspicious of low cardiac output state; consider by the presence of any of the following signs or symptoms of hypoperfusion: narrow pulse pressure, cold extremities, mental obtundation, declining renal function, and/or low serum sodium.
- Systolic blood pressure (SBP) measured ≥ 90 but < 120 mmHg at the start and the end of the screening, without use of an intravenous vasopressor therapy.
- Hemodynamic criteria: CI ≤ 2.2 L·min-1·m-2 based on CO calculated by Fick formula and PCWP ≥ 20 mmHg measured by right heart catheterization at the time of the enrollment and confirmed by Swan-Ganz measurement upon arrival to the Cardiac Care Unit (CCU).
- Able to be randomized within the first 24 hours from the presentation to the hospital, including the emergency department.
Exclusion Criteria:
- Clinical evidence of acute coronary syndrome (ACS) currently or within 30 days prior to enrollment. (Note that the diagnosis of ACS is a clinical diagnosis and that the sole presence of elevated troponin concentrations is not sufficient for a diagnosis of ACS).
- Significant, uncorrected left ventricular outflow track obstruction, such us obstructive cardiomyopathy or severe aortic stenosis (i.e. aortic valve area < 1.0 cm2 or mean gradient > 40 mmHg on prior or current echocardiogram).
- Severe mitral stenosis.
- Severe aortic insufficiency or severe mitral regurgitation for which surgical or percutaneous intervention is indicated.
- Documented, prior to or at the time of the randomization, restrictive amyloid myocardiopathy or acute myocarditis or hypertrophic obstructive, restrictive or constrictive cardiomyopathy (does not include restrictive mitral filling patterns seen on Doppler echocardiographic assessments of diastolic function).
- Complex congenital heart disease.
- Significant arrhythmias, which include any of the following: sustained ventricular tachycardia; atrial fibrillation or atrial flutter with sustained heart rate > 130 beats per minute.
- Bradycardia with sustained ventricular rate < 45 beats per minute.
- Temperature > 38.5°C (oral or equivalent) or sepsis or active infection requiring IV anti-microbial treatment.
- History of malignancy (other than localized basal cell carcinoma of the skin), treated or untreated or any terminal illness (other than heart failure) with a current life expectancy less than a year.
- Major surgery or major neurologic event including cerebrovascular events, within 30 days prior to enrollment.
- Need for mechanical circulatory support (MCS), including intra-aortic balloon pump, Extracorporeal Membrane Oxygenation (ECMO) or any ventricular assist device.
- Need for mechanical ventilatory support (endotracheal intubation or mechanical ventilation).
- Patient with chronic heart failure and inotropic-depended.
- Current (within 2 hours prior to screening) treatment with any IV vasoactive therapies, including vasodilators, inotropic agents and vasopressors.
- Patients with severe renal impairment defined as pre-randomization estimated Glomerular Filtration Rate (eGFR) < 25 ml/min/1.73m2 calculated using the simplified Modification of Diet in Renal Disease (sMDRD) equalization and/or those receiving current or planned dialysis or ultrafiltration.
- Patients with acute kidney injury defined as an increase in serum creatinine 3 times of baseline, or reduction in urine output to <0.3 mL/kg per hour for ≥12 hours, or anuria for ≥12 hours, or patients undergoing renal replacement therapy.
- Patients with Child C cirrhosis or history of cirrhosis with evidence of portal hypertension such as varices.
- Patients with acute liver failure and serum transaminase: aspartate transaminase (AST) and/or alanine transaminase (ALT) > 3 times above the upper limit of normal.
- Any major solid organ transplant recipient or planned/anticipated organ transplant within 1 year.
- Patients with hematocrit < 25%, or a history of blood transfusion within 14 days prior to screening, or active life-threatening gastrointestinal bleeding.
- Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive human chorionic gonadotropin (hCG) laboratory test. .
- History of hypersensitive to dobutamine or sodium nitroprusside.
- Inability to follow instructions or comply with follow-up procedures.
- Any other medical condition (s) that the investigator deems unsuitable for the study, including drug or alcohol use or psychiatric, behavioral or cognitive disorder.
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: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Sodium Nitroprusside
Dose titration will start at 25 μg/min and increased by 25 μg every 5 minutes to maximal dose of 400 μg/min while maintaining SBP ≥ 90 mmHg.
Every 5 minutes, the Pulmonary Capillary Wedge Pressure (PCWP), SBP will be measured.
If PCWP > 16 mmHg while maintaining SBP ≥ 90 mmHg, the investigator will proceed to titrate dose with the goal to achieve the target of PCWP ≤ 16 mmHg and Cardiac Index (CI) > 2.2 L·min-1·m-2, or maximal infusion dose has been reached, whichever comes earliest.
Continuous intravenous furosemide infusion dose will be maintained by protocol.
|
Sodium nitroprusside is a medication used to lower blood pressure.
Other Names:
Furosemide is a prescription drug used to treat hypertension (high blood pressure) and edema.
Learn about side effects, warnings, dosage, and more.
Other Names:
|
Active Comparator: Dobutamine
Dose titration will start at 2.5 μg/kg/min and increased to doses of 5, 7.5 and 10 μg/kg/min (maximal dose).
Every 30 minutes, the investigator will collect Pulmonary Artery (PA) blood samples for PA sat measurement to calculate Cardiac Output (CO) and CI by Fick.
If CI ≤ 2.2 L·min-1·m-2, the investigator will proceed to titrate dose until CI > 2.2 L·min-1·m-2 or maximal infusion dose has been reached, whichever comes earliest.
Continuous intravenous furosemide infusion dose will be maintained by protocol.
|
Furosemide is a prescription drug used to treat hypertension (high blood pressure) and edema.
Learn about side effects, warnings, dosage, and more.
Other Names:
Dobutamine is a direct-acting inotropic agent whose primary activity results from stimulation of the ß receptors of the heart while producing comparatively mild chronotropic, hypertensive, arrhythmogenic, and vasodilative effects.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Arrhythmia incidence
Time Frame: within 72 hours after the initiation of the drug
|
defined by the presence of ventricular arrhythmia (either ventricular tachycardia or ventricular fibrillation) or supraventricular arrhythmias (either recurrent or new onset of atrial fibrillation, atrial flutter or supraventricular tachycardia) with sustained heart rate ≥ 130 beats per minute
|
within 72 hours after the initiation of the drug
|
Serum troponin T release
Time Frame: within 72 hours after the initiation of the drug
|
defined as measured serum cardiac troponin T (cTnT) with a value > 0.10 ng/ml
|
within 72 hours after the initiation of the drug
|
Hypotension incidence
Time Frame: within 72 hours after the initiation of the drug
|
defined as ≥ 2 consecutive blood pressure measurement with SBP < 90 mmHg
|
within 72 hours after the initiation of the drug
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
≥2 point improvement in the 5 point Likert dyspnea scale
Time Frame: within 72 hours after the initiation of the drug involved in the study
|
within 72 hours after the initiation of the drug involved in the study
|
|
≥ 30% improvement in the 100 point global patient assessment scale
Time Frame: within 72 hours after the initiation of the drug involved in the study
|
within 72 hours after the initiation of the drug involved in the study
|
|
Reduction in the Cardiac Care Unit length of stay
Time Frame: Up to 30 days
|
Length of stay (in hours) will be defined as the index discharge date and time minus the initiation of study drug date and time.
|
Up to 30 days
|
Reduction in the hospitalization length of stay
Time Frame: Up to 30 days
|
Length of stay (in hours) will be defined as the index discharge date and time minus the initiation of study drug date and time.
|
Up to 30 days
|
Assessment of difference in restrictive filling pattern by echocardiogram
Time Frame: from initiation of the of the drug involved in the study up to 72 hours.
|
from initiation of the of the drug involved in the study up to 72 hours.
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- WRITING COMMITTEE MEMBERS, Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013 Oct 15;128(16):e240-327. doi: 10.1161/CIR.0b013e31829e8776. Epub 2013 Jun 5. No abstract available.
- Heart Failure Society of America, Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, Katz SD, Klapholz M, Moser DK, Rogers JG, Starling RC, Stevenson WG, Tang WH, Teerlink JR, Walsh MN. HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2010 Jun;16(6):e1-194. doi: 10.1016/j.cardfail.2010.04.004.
- Gheorghiade M, Zannad F, Sopko G, Klein L, Pina IL, Konstam MA, Massie BM, Roland E, Targum S, Collins SP, Filippatos G, Tavazzi L; International Working Group on Acute Heart Failure Syndromes. Acute heart failure syndromes: current state and framework for future research. Circulation. 2005 Dec 20;112(25):3958-68. doi: 10.1161/CIRCULATIONAHA.105.590091. No abstract available.
- Abraham WT, Adams KF, Fonarow GC, Costanzo MR, Berkowitz RL, LeJemtel TH, Cheng ML, Wynne J; ADHERE Scientific Advisory Committee and Investigators; ADHERE Study Group. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol. 2005 Jul 5;46(1):57-64. doi: 10.1016/j.jacc.2005.03.051.
- Cuffe MS, Califf RM, Adams KF Jr, Benza R, Bourge R, Colucci WS, Massie BM, O'Connor CM, Pina I, Quigg R, Silver MA, Gheorghiade M; Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) Investigators. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA. 2002 Mar 27;287(12):1541-7. doi: 10.1001/jama.287.12.1541.
- Elkayam U, Tasissa G, Binanay C, Stevenson LW, Gheorghiade M, Warnica JW, Young JB, Rayburn BK, Rogers JG, DeMarco T, Leier CV. Use and impact of inotropes and vasodilator therapy in hospitalized patients with severe heart failure. Am Heart J. 2007 Jan;153(1):98-104. doi: 10.1016/j.ahj.2006.09.005.
- Mebazaa A, Nieminen MS, Packer M, Cohen-Solal A, Kleber FX, Pocock SJ, Thakkar R, Padley RJ, Poder P, Kivikko M; SURVIVE Investigators. Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE Randomized Trial. JAMA. 2007 May 2;297(17):1883-91. doi: 10.1001/jama.297.17.1883.
- Grant S, Aitchison T, Henderson E, Christie J, Zare S, McMurray J, Dargie H. A comparison of the reproducibility and the sensitivity to change of visual analogue scales, Borg scales, and Likert scales in normal subjects during submaximal exercise. Chest. 1999 Nov;116(5):1208-17. doi: 10.1378/chest.116.5.1208.
- Gage J, Rutman H, Lucido D, LeJemtel TH. Additive effects of dobutamine and amrinone on myocardial contractility and ventricular performance in patients with severe heart failure. Circulation. 1986 Aug;74(2):367-73. doi: 10.1161/01.cir.74.2.367.
- Mager G, Klocke RK, Kux A, Hopp HW, Hilger HH. Phosphodiesterase III inhibition or adrenoreceptor stimulation: milrinone as an alternative to dobutamine in the treatment of severe heart failure. Am Heart J. 1991 Jun;121(6 Pt 2):1974-83. doi: 10.1016/0002-8703(91)90834-5.
- Allen LA, Metra M, Milo-Cotter O, Filippatos G, Reisin LH, Bensimhon DR, Gronda EG, Colombo P, Felker GM, Cas LD, Kremastinos DT, O'Connor CM, Cotter G, Davison BA, Dittrich HC, Velazquez EJ. Improvements in signs and symptoms during hospitalization for acute heart failure follow different patterns and depend on the measurement scales used: an international, prospective registry to evaluate the evolution of measures of disease severity in acute heart failure (MEASURE-AHF). J Card Fail. 2008 Nov;14(9):777-84. doi: 10.1016/j.cardfail.2008.07.188. Epub 2008 Aug 15.
- Binanay C, Califf RM, Hasselblad V, O'Connor CM, Shah MR, Sopko G, Stevenson LW, Francis GS, Leier CV, Miller LW; ESCAPE Investigators and ESCAPE Study Coordinators. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA. 2005 Oct 5;294(13):1625-33. doi: 10.1001/jama.294.13.1625.
- Mullens W, Abrahams Z, Francis GS, Skouri HN, Starling RC, Young JB, Taylor DO, Tang WH. Sodium nitroprusside for advanced low-output heart failure. J Am Coll Cardiol. 2008 Jul 15;52(3):200-7. doi: 10.1016/j.jacc.2008.02.083.
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 (Actual)
May 1, 2018
Primary Completion (Actual)
May 1, 2018
Study Completion (Actual)
June 1, 2018
Study Registration Dates
First Submitted
May 4, 2016
First Submitted That Met QC Criteria
May 6, 2016
First Posted (Estimate)
May 10, 2016
Study Record Updates
Last Update Posted (Actual)
October 31, 2018
Last Update Submitted That Met QC Criteria
October 29, 2018
Last Verified
October 1, 2018
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Heart Diseases
- Cardiovascular Diseases
- Heart Failure
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Antihypertensive Agents
- Vasodilator Agents
- Autonomic Agents
- Peripheral Nervous System Agents
- Protective Agents
- Adrenergic Agonists
- Natriuretic Agents
- Cardiotonic Agents
- Membrane Transport Modulators
- Diuretics
- Adrenergic beta-Agonists
- Sympathomimetics
- Adrenergic beta-1 Receptor Agonists
- Sodium Potassium Chloride Symporter Inhibitors
- Nitric Oxide Donors
- Furosemide
- Dobutamine
- Nitroprusside
Other Study ID Numbers
- 2014-3586
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
Yes
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 Acute Heart Failure
-
Idorsia Pharmaceuticals Ltd.CompletedAcute Heart Failure | Acute Decompensation of Chronic Heart Failure | New Onset of Heart FailureUnited States, United Kingdom, Israel, Switzerland, Austria, Denmark, France, Germany, Greece, Poland
-
Idorsia Pharmaceuticals Ltd.CompletedAcute Heart Failure | Acute Decompensation of Chronic Heart Failure | New Onset of Heart FailureUnited States, Hungary, Australia, Czechia, Germany, Italy, Norway, United Kingdom
-
Abiomed Inc.RecruitingHeart Diseases | Acute Decompensated Heart Failure | Congestive Heart Failure | Acute Heart FailureUnited States
-
Shanghai Chest HospitalUnknownAcute Renal Failure | Acute Heart FailureChina
-
Magenta Medical Ltd.TerminatedCongestive Heart Failure | Heart Failure, Congestive | Acute Heart FailureCroatia, Belgium, Serbia
-
University Medical Center GroningenCompletedHeart Failure; With Decompensation | Heart Failure,Congestive | Heart Failure AcuteNetherlands
-
Jordan Cardio Vascular Research GroupRecruitingHeart Failure | Chronic Heart Failure | Acute Heart FailureJordan
-
Azienda Ospedaliera Città della Salute e della...Caretek S.r.l. Turin, Italy; Santer Reply S.p.A. Milan, ItalyUnknownHeart Failure; With Decompensation | Heart Failure,Congestive | Heart Failure AcuteItaly
-
University Hospital, Clermont-FerrandHospices Civils de Lyon; University Hospital, Grenoble; Hôpital de la Croix-Rousse and other collaboratorsRecruitingHeart Failure | Chronic Heart Failure | Acute Heart FailureFrance
-
Clinica Alemana de SantiagoNot yet recruitingDecompensated Heart Failure | Heart Failure Acute
Clinical Trials on Sodium nitroprusside
-
The Emmes Company, LLCDuke University; Stanford UniversityCompleted
-
Niguarda HospitalCompleted
-
University of EdinburghNHS LothianCompletedHeart Disease | VasodilationUnited Kingdom
-
University Hospital, AngersAlfediam; UNIVALOIREUnknown
-
Kavaklıdere Umut HospitalAnkara UniversityUnknownThyroid Hormones | NitroprussideTurkey
-
Vicore Pharma ABCTC Clinical Trial Consultants ABCompleted
-
Massachusetts General HospitalStanley Medical Research InstituteCompletedSchizophreniaUnited States
-
King's College LondonCompletedSchizophreniaUnited Kingdom
-
Mount Sinai Hospital, CanadaUnknownHypoxia | Respiratory Failure | Acute Respiratory Distress Syndrome | Acute Lung Injury | Sodium NitroprussideCanada
-
University of Sao PauloCompleted