- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04886713
Adipose Tissue Inflammation in HFpEF (SLIM-HFpEF)
Adipose Tissue Inflammation in the Development, Maintenance and Functional Impairments in Heart Failure With Preserved Ejection Fraction
Study Overview
Status
Detailed Description
Heart Failure with preserved Ejection Fraction (HFpEF) is a growing public health concern with an increasing incidence, high morbidity and mortality and no proven therapy to date. Better characterization of individual pathophysiological implications is mandatory to develop effective therapeutic strategies or preventive programs. Obesity is an important risk factor for the development of HFpEF and also modulates its course possibly by its association with systemic inflammation. However, the role of adipose tissue (AT) inflammation in the development, maintenance and functional impairments in HFpEF has been under-investigated. Dysfunctional AT leads to a shift from a protective adipokine profile to an imbalanced production of pro-inflammatory, pro-oxidant and pro-fibrotic adipokines. Besides depot specific paracrine effects, the overall secretory activity or endocrine effect of AT can be evaluated in peripheral plasma.
The investigators hypothesize that adipose inflammation distinguishes obese HFpEF patients from obese patients without heart failure and that adipose tissue inflammation is a key driver the maintenance and development of HFpEF and determines functional capacity.
In addition the investigators hypothesize that the degree of myocardial inflammatory alterations is more closely related to epicardial tissue alterations than subcutaneous or visceral AT tissue inflammation or peripheral adipokine profiles.
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Contact
- Name: Karl-Patrik Kresoja, MD
- Phone Number: +49 341 865 252596
- Email: karl-patrik.kresoja@medizin.uni-leipzig.de
Study Locations
-
-
Saxony
-
Leipzig, Saxony, Germany, 04289
- Recruiting
- Heart Centre at University Leipzig
-
Contact:
- Philipp Lurz, MD, PhD
- Email: philipp.lurz@medizin.uni-leipzig.de
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Stable patients with indication for coronary bypass crafting will be prospectively identified at the Heart Center Leipzig (either during the admission process for patients referred to surgery or at the time of coronary angiography when the indication for operative revascularization is established). Patients will be grouped according to the presence of HFpEF and obesity in order to generate 3 distinct patient groups, defined as:
- Obesity HFpEF
- Obesity Non-HF
- Non-Obesity Non-HF
Description
Inclusion Criteria:
- HFpEF: Left ventricular ejection fraction ≥ 50%, NT-pro-BNP ≥ 125ng/l, evidence of structural heart diseases (diastolic dysfunction, left ventricular-hypertrophy or left atrial-dilatation), BMI ≥ 30kg/m²
- Non-HF patients: No history of heart failure, Left ventricular ejection fraction > 50% and NT-pro-BNP <125ng/l
Exclusion Criteria:
- Previous cardiac surgery / coronary intervention / myocardial infraction
- Acute coronary syndrome (Serum levels of troponin T >50 pg/ml)
- Left ventricular ejection fraction < 50%
- Indication for concomitant valvular surgery
- Planned beating heart coronary bypass surgery
- Hemodynamic instability
- Contraindication for magnetic resonance imaging
- Pregnancy
- Age < 18 years
- No informed consent possible
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Obese HFpEF
Left ventricular-EF ≥ 50%, N-terminal-pro-brain natriuretic peptide (NT-proBNP) ≥ 125ng/l, evidence of structural heart diseases (diastolic dysfunction, Left ventricular-hypertrophy or Left atrial-dilatation) BMI ≥30 kg/m²
|
After median sternotomy tissue samples will be collected from the epicardial space, the abdominal wall and the myocardium.
Magnetic resonance imaging will be performed at 1.5 Tesla ('Intera', Philips Medical Systems, Best, The Netherlands). All subjects will be examined in the supine position with initial anatomy scans to cover the thorax to the first sacral vertebrae. The magnetic resonance imaging protocol is summarized in Figure 4. The following imaging parameters will be acquired:
After completion of a regular cardiac rehabilitation program patients are scheduled to undergo their discharge examination at 3 to 4 weeks after the operation in order to be functionally characterized.
Cardiopulmonary exercise testing will be performed, if possible by patients condition, on a mechanically braked bicycle ergometer and respiratory gas exchange analysis via a mouthpiece or facemask.
|
Obese controls
No history of heart failure, Left ventricular-EF > 50% and NT-pro-BNP <125ng/l, BMI ≥ 30kg/m²
|
After median sternotomy tissue samples will be collected from the epicardial space, the abdominal wall and the myocardium.
Magnetic resonance imaging will be performed at 1.5 Tesla ('Intera', Philips Medical Systems, Best, The Netherlands). All subjects will be examined in the supine position with initial anatomy scans to cover the thorax to the first sacral vertebrae. The magnetic resonance imaging protocol is summarized in Figure 4. The following imaging parameters will be acquired:
After completion of a regular cardiac rehabilitation program patients are scheduled to undergo their discharge examination at 3 to 4 weeks after the operation in order to be functionally characterized.
Cardiopulmonary exercise testing will be performed, if possible by patients condition, on a mechanically braked bicycle ergometer and respiratory gas exchange analysis via a mouthpiece or facemask.
|
Lean control
No history of heart failure, Left ventricular-EF > 50% and NT-pro-BNP <125ng/l, BMI < 30kg/m²
|
After median sternotomy tissue samples will be collected from the epicardial space, the abdominal wall and the myocardium.
Magnetic resonance imaging will be performed at 1.5 Tesla ('Intera', Philips Medical Systems, Best, The Netherlands). All subjects will be examined in the supine position with initial anatomy scans to cover the thorax to the first sacral vertebrae. The magnetic resonance imaging protocol is summarized in Figure 4. The following imaging parameters will be acquired:
After completion of a regular cardiac rehabilitation program patients are scheduled to undergo their discharge examination at 3 to 4 weeks after the operation in order to be functionally characterized.
Cardiopulmonary exercise testing will be performed, if possible by patients condition, on a mechanically braked bicycle ergometer and respiratory gas exchange analysis via a mouthpiece or facemask.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Adipose tissue inflammation
Time Frame: Tissue collection during surgery.
|
Adipose tissue inflammation and distribution as well as association with adipokines
|
Tissue collection during surgery.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Evaluation of serum adipokine levels
Time Frame: At baseline, before surgery.
|
Circulating adipokine levels will be measured at a central lab.
|
At baseline, before surgery.
|
Cardiac MRI - Myocardial function
Time Frame: At baseline, before surgery.
|
Myocardial function and extent of myocardial fibrosis.
|
At baseline, before surgery.
|
Cardiac MRI - Epicardial fat
Time Frame: At baseline, before surgery.
|
Extent of epicardial fat.
|
At baseline, before surgery.
|
Echocardiography
Time Frame: At baseline, before surgery and at follow-up approximately three months after surgery.
|
Measurement of standard echocardiographic parameters of left- and right- ventricular systolic and diastolic function.
|
At baseline, before surgery and at follow-up approximately three months after surgery.
|
Functional capacity on spiroergometry
Time Frame: At follow-up approximately three months after surgery.
|
Follow-up investigation by spiroergometry to assess post-surgical functional capacity.
Measures included Peak Oxygen consumption (VO2 max) and oxygen consumption at anaerobic threshold (AT VO2)
|
At follow-up approximately three months after surgery.
|
Stress echocardiography
Time Frame: At follow-up approximately three months after surgery.
|
Assessment of echocardiographic parameters of left- and right- ventricular systolic and diastolic function during semi-supine bicycle exercise.
These measures include the change of E/E' during exercise for the left ventricle and the change of tricuspid annular plane systolic excursion (TAPSE) during exercise for the right ventricle.
|
At follow-up approximately three months after surgery.
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
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
Other Study ID Numbers
- SLIM-HFpEF V1.0
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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