- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04345796
Pharmacological Reduction of Right Ventricular Enlargement (PROVE)
July 19, 2023 updated by: Duk-Hyun Kang, Asan Medical Center
Multicenter, Randomized, 2 x 2 Factorial, Phase 3 Study to Assess the Efficacy of Carvedilol and Empagliflozin on Improvement of Right Ventricular Remodeling in Patients With Severe Functional Tricuspid Regurgitation
Functional tricuspid regurgitation (TR) has been regarded as a secondary phenomenon of heart failure (HF), mitral valve (MV) disease or atrial fibrillation.
Regardless of left ventricular (LV) function or pulmonary artery pressure, presence of moderate or greater functional TR is associated with poor prognosis.
When a patient develops functional TR, it causes RV dilation and tricuspid annular enlargement, which also lead to deterioration of TR.
A vicious cycle of significant TR, RV volume overload, tricuspid annular dilation and consequent aggravation of TR is accepted as a main determinant of the poor clinical outcome of patients with TR.
Therefore, therapies that induce reverse remodeling of the RV and consequently reduce TR, may improve clinical outcomes.
However, there have been no proven medical therapies for TR.
The investigators hypothesize that carvedilol or empagliflozin is effective on improving RV remodeling in patients with functional severe TR and try to examine this hypothesis in a multicenter, 2x2 factorial, and randomized comparison study using cardiac MRI.
Study Overview
Status
Recruiting
Intervention / Treatment
Detailed Description
Functional tricuspid regurgitation (TR) has been regarded as a secondary phenomenon of heart failure (HF), mitral valve (MV) disease or atrial fibrillation.
The prevalence of functional TR was reported to be 25-64% in patients with either ischemic or non-ischemic cardiomyopathy.
Regardless of left ventricular (LV) function or pulmonary artery pressure, presence of moderate or greater functional TR is associated with poor prognosis.
When a patient develops functional TR, it causes RV dilation and tricuspid annular enlargement, which also lead to deterioration of TR.
A vicious cycle of significant TR, RV volume overload, tricuspid annular dilation and consequent aggravation of TR is accepted as a main determinant of the poor clinical outcome of patients with TR.
Because the quantitative assessment of RV size and function using echocardiography is often limited due to the complex geometry of RV, cardiac magnetic resonance imaging (MRI) has emerged as a gold standard for evaluating RV volume and function with excellent accuracy and reproducibility.
The investigators previously reported that RV end-systolic volume index (ESVI) and RV end-diastolic volume index (EDVI) measured by MRI were significantly larger in severe TR patients, and also found that preoperative RV ESVI and RV ejection fraction (EF) on MRI were independent predictors of cardiac death and postoperative adverse events in patients who underwent TV surgery for severe functional TR.
Therefore, therapies that induce reverse remodeling of the RV and consequently reduce TR, may improve clinical outcomes.
However, there have been no proven medical therapies for TR.
The morbidity and mortality of patients with functional TR remain high and novel therapeutic agents are needed to improve the prognosis of patients with functional TR.
The investigators hypothesize that carvedilol or empagliflozin is effective on improving RV remodeling in patients with functional severe TR and try to examine this hypothesis in a multicenter, 2x2 factorial, and randomized comparison study using cardiac MRI.
Study Type
Interventional
Enrollment (Estimated)
180
Phase
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: DUK HYUN KANG, MD
- Phone Number: 82-2-3010-3166
- Email: dhkang@amc.seoul.kr
Study Locations
-
-
-
Seoul, Korea, Republic of
- Not yet recruiting
- Seoul National University Hospital
-
Contact:
- Yong-Jin Kim, MD, PhD
- Email: kimdamas@snu.ac.kr
-
Principal Investigator:
- Yong-Jin Kim, MD,PhD
-
Seoul, Korea, Republic of, 138-736
- Recruiting
- Asan Medical Center
-
Contact:
- Duk Hyun Kang, MD, PhD
- Phone Number: 82-2-3010-3166
- Email: dhkang@amc.seoul.kr
-
Contact:
- Seung-Ah Lee, MD
-
Principal Investigator:
- Duk Hyun Kang, MD, PhD
-
Seoul, Korea, Republic of
- Not yet recruiting
- Samsung Medical Center
-
Contact:
- Seung Woo Park, MD, PhD
- Email: parksmc@gmail.com
-
Principal Investigator:
- Seung Woo Park, MD, PhD
-
-
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
20 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Patients must agree to the study protocol and provide written informed consent
- Outpatients ≥ 20 years of age, male or female
Patients with severe functional tricuspid regurgitation
- TR whose vena contracta ≥0.7cm or central jet area > 10 square cm and which lasted > 6 months under medical treatment
- LV ejection fraction ≥ 40%
- Dyspnea of NYHA functional class II or III
Exclusion Criteria:
- History of hypersensitivity or allergy to the study drugs, drugs of similar chemical classes, as well as known or suspected contraindications to the study drug
- Current use or prior use of a SGLT-2 inhibitor or combined SGLT-1 and 2 inhibitor
- Significant left-sided valve disease
- Left ventricular ejection fraction <40%
- Marked bradycardia (<50 beats/min) or 2nd or 3rd degree AVB, sinus node dysfunction
- Severe pulmonary hypertension: TR Vmax >4m/s at screening (including Cor pulmonale)
- Medical history of hospitalization within 6 weeks
- Current acute decompensated heart failure or dyspnea of NYHA functional class IV
- Symptomatic hypotension and/or a SBP < 90 mmHg at screening Estimated GFR < 30 mL/min/1.73 square m
- History of ketoacidosis, Type 1 diabetes
- Evidence of hepatic disease as determined by any one of the following: AST or ALT values exceeding 2 x upper limit of normal (ULN) at screening visit (Visit 0), history of hepatic encephalopathy, history of esophageal varices, or history of portocaval shunt.
- Acute coronary syndrome, stroke, severe peripheral artery disease or major CV surgery or PCI within 3 months
- History of severe pulmonary disease (asthma, COPD with bronchial hypersensitivity)
- Secondary hypertension such as pheochromocyotoma
- Acute pulmonary thromboembolism
- Variant angina, vocal cord edema, severe allergic rhinitis
- Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using a barrier method plus a hormonal method
- Pregnant or nursing (lactating) women
Contraindication for MRI
- Presence of pacemaker or ICD, implanted metallic objects, claustrophobia
- Severe beat-to-beat variation
- Galactose intolerance, Lapp lactose deficiency, glucose-galactose malabsorption
- Any clinically significant abnormality identified at the screening visit, physical examination, laboratory tests, or electrocardiogram which, in the judgment of the investigator, would preclude safe completion of the study
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: Factorial Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: carvedilol+empagliflozin
Patients will receive carvedilol SR 16mg and empagliflozin 10mg qd.
|
Group A
Other Names:
|
Active Comparator: carvedilol alone
Patients will receive carvedilol SR 16mg alone.
|
Group B
Other Names:
|
Active Comparator: empagliflozin alone
Patients will receive empagliflozin 10mg and matching placebo of carvedilol.
|
Group C
Other Names:
|
Placebo Comparator: placebo
Patients will receive matching placebo of carvedilol.
|
Group D
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change of RV end-systolic volume index
Time Frame: from baseline to 12 months follow-up
|
Change of RV end-systolic volume index by cardiac MRI
|
from baseline to 12 months follow-up
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change of RV end-diastolic volume index
Time Frame: from baseline to 12 months follow-up
|
Change of RV end-diastolic volume index by cardiac MRI
|
from baseline to 12 months follow-up
|
Change of RV ejection fraction
Time Frame: from baseline to 12 months follow-up
|
Change of RV ejection fraction by cardiac MRI
|
from baseline to 12 months follow-up
|
Change of vena contract width of TR
Time Frame: from baseline to 12 months follow-up
|
Change of vena contract width of TR by echocardiography
|
from baseline to 12 months follow-up
|
Occurrences of death from cardiovascular causes or hospitalization for heart failure
Time Frame: the entire follow-up period (continuing until 12 months after the last patient was enrolled)
|
Clinical outcome
|
the entire follow-up period (continuing until 12 months after the last patient was enrolled)
|
Occurrences of death from any causes
Time Frame: the entire follow-up period (continuing until 12 months after the last patient was enrolled)
|
Clinical outcome
|
the entire follow-up period (continuing until 12 months after the last patient was enrolled)
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: DUK HYUN KANG, Asan Medical Center
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)
February 15, 2021
Primary Completion (Estimated)
December 1, 2024
Study Completion (Estimated)
December 1, 2024
Study Registration Dates
First Submitted
April 12, 2020
First Submitted That Met QC Criteria
April 12, 2020
First Posted (Actual)
April 14, 2020
Study Record Updates
Last Update Posted (Actual)
July 21, 2023
Last Update Submitted That Met QC Criteria
July 19, 2023
Last Verified
July 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Heart Diseases
- Cardiovascular Diseases
- Heart Valve Diseases
- Tricuspid Valve Insufficiency
- Hypoglycemic Agents
- Physiological Effects of Drugs
- Adrenergic beta-Antagonists
- Adrenergic Antagonists
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Antihypertensive Agents
- Vasodilator Agents
- Protective Agents
- Membrane Transport Modulators
- Calcium-Regulating Hormones and Agents
- Calcium Channel Blockers
- Sodium-Glucose Transporter 2 Inhibitors
- Antioxidants
- Adrenergic alpha-1 Receptor Antagonists
- Adrenergic alpha-Antagonists
- Empagliflozin
- Carvedilol
Other Study ID Numbers
- 2020-0127
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
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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