- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03445754
Effect of Transcutaneous Vagal Stimulation (TVS) on Endothelial Function in PAD (TVS-PAD)
December 20, 2021 updated by: University of Oklahoma
Effect of Transcutaneous Vagal Stimulation (TVS) on Endothelial Function and Arterial Stiffness in Peripheral Artery Disease
Peripheral arterial disease (PAD) constitutes a major public health burden.
The incidence of PAD increases with age and is associated with other comorbid cardiovascular disorders.
Atherosclerosis which underlies PAD is associated with increased arterial stiffness and an enhanced inflammatory state as evidenced by increased levels of pro-inflammatory cytokines and markers.
One the earliest signs of cardiovascular disease is endothelial dysfunction which is characterized by a decreased vasodilatory capacity of the vascular endothelium and this lesion predates the development of clinical atherosclerosis.
Endothelial dysfunction has been shown to be widely prevalent in PAD.
It is postulated that endothelial dysfunction is due to enhanced sympathetic drive, diminished parasympathetic drive, chronic inflammatory state all of which leads to reduced nitric oxide synthase activity in the vascular endothelium with subsequent loss of vasodilatory capacity.
Studies have shown endothelial dysfunction to be reversible with pharmaco-therapeutic interventions, though these interventions are associated with their own adverse effects.
Stimulation of Vagal nerve increases the parasympathetic activity while suppressing sympathetic drive, decreases inflammation and enhancing nitric oxide synthase activity.
Recent experimental and clinical data suggest that low-level tragus nerve stimulation (by stimulating the auricular branch of the vagus nerve located at the tragus of the external ear) may produce the same desired neuromodulator effect compared to vagus nerve stimulation.
It is however unknown if Transcutaneous Vagal Stimulation (TVS) would lead to improved endothelial function as measured by flow mediated dilatation (FMD) and laser speckle contrast imaging(LSCI), a non-invasive method of measuring endothelial function or decrease in arterial stiffness as measured by Pulse Wave Analysis (PWA), in patients with PAD.
The objective of this study is to determine the impact of TVS on endothelial dysfunction as measured by FMD & LSCI and arterial stiffness.
Study population will include patients with established diagnosis of PAD.
After performing baseline FMD, LSCI and PWA patients will be randomized to TVS and sham stimulation with cross over.
The patient randomized to TVS stimulation will obtain stimulation for 1 hour followed by measurement of FMD,LSCI and PWA.
There will be a washout period of at least 24 hours with patient crossing over to the other arms thus serving as their self-control.
Study Overview
Status
Completed
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
11
Phase
- Not Applicable
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
-
-
Oklahoma
-
Oklahoma City, Oklahoma, United States, 73117
- University of Oklahoma Health Sciences 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
18 years to 85 years (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- peripheral arterial disease (PAD) - patients with an ankle-brachial index of <0.9
- symptoms of intermittent claudication, rest pain, or minor tissue loss (Rutherford category I-V)
Exclusion Criteria:
- patients with acute limb ischemia
- Patients with overt congestive heart failure / recent acute myocardial infarction (< 3 months)
- Premenopausal women and post-menopausal women on hormone supplements.
- chronic inflammatory disease (systemic lupus erythematosus, rheumatoid arthritis, and Crohn's disease), or receiving therapy with steroids, cyclosporine, methotrexate or immunocompromised patients.
- unilateral or bilateral vagotomy
- Patients with bilateral upper extremity amputation
- pregnant patients
- prisoners
- end-stage renal disease.
- End-stage liver disease.
- patients with BMI>34
- Patients with upper extremity arterial disease
- history of recurrent vasovagal syncope, Sick sinus syndrome, 2nd- or 3rd-degree atrioventricular block (AV) block, prolonged first degree AV block.
- Refusal to sign a consent form.
- Significant hypotension from autonomic dysfunction
- Patients with pacemakers who have significant interaction with TVNS during testing
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
- Masking: TRIPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Interventional Arm
Active TVS will be performed by use of a Tragus stimulator device with electrodes attached to the tragus of the ear.
Stimulator will be applied continuously for 1 hour.
|
Active TVS will be performed by use of a Tragus stimulator device with electrodes attached to the tragus of the ear.
Stimulator will be applied continuously for 1 hour
|
SHAM_COMPARATOR: Control
Sham TVS will be performed by use of a Tragus stimulator device with electrodes attached to the ear lobule.
Stimulator will be applied continuously for 1 hour.
|
Device will be applied but not to the Tragus of the ear but will be attached to the ear lobule.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Flow mediated vasodilatation
Time Frame: Change from baseline to post stimulation(within 10 minutes of stimulation) with TVS/Sham stimulation
|
Flow mediated vasodilatation will be tested.
A change in the maximal diameter of the brachial artery(in mm) will be assessed immediately(within 10 minutes) after TVNS/sham stimulation.
|
Change from baseline to post stimulation(within 10 minutes of stimulation) with TVS/Sham stimulation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Endothelial function in microcirculation
Time Frame: Change from baseline to post stimulation(within 20-30 minutes of stimulation) with TVS/Sham stimulation
|
LSCI based calculation of perfusion unit before and after TVS/Sham stimulation
|
Change from baseline to post stimulation(within 20-30 minutes of stimulation) with TVS/Sham stimulation
|
Pulse wave analysis
Time Frame: Change from baseline to post stimulation(within 15-20 minutes) with TVS/Sham stimulation.
|
Arterial elasticity.
Augmentation pressure (AP) will be calculated which is expressed as a percentage of the aortic pulse pressure (PP) which is the difference of systolic and diastolic BP(mm Hg).
|
Change from baseline to post stimulation(within 15-20 minutes) with TVS/Sham stimulation.
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
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)
December 11, 2017
Primary Completion (ACTUAL)
May 30, 2020
Study Completion (ACTUAL)
May 30, 2020
Study Registration Dates
First Submitted
October 12, 2017
First Submitted That Met QC Criteria
February 19, 2018
First Posted (ACTUAL)
February 26, 2018
Study Record Updates
Last Update Posted (ACTUAL)
December 21, 2021
Last Update Submitted That Met QC Criteria
December 20, 2021
Last Verified
December 1, 2021
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 8473
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
UNDECIDED
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
Yes
product manufactured in and exported from the U.S.
No
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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