The Effect of Angiotensin Receptor-Neprilysin Inhibition on Cardiac Fibrosis in Patients With HFpEF (ARNICFH)

October 21, 2021 updated by: Dongying Zhang, Chongqing Medical University

The Effect of Angiotensin Receptor-Neprilysin Inhibition on Cardiac Fibrosis in Patients With HFpEF: A Randomized Controlled Trial

The effectively therapeutic approaches for Heart failure with preserved ejection fraction (HFpEF) remain limited. The PARAGON-HF trial found that Angiotensin Receptor-Neprilysin Inhibition (ARNI) has potential benefits for the management of HFpEF. Nevertheless, the role of ARNI in cardiac fibrosis in HFpEF are still unclear. We will conduct a prospective randomized controlled trial to evaluate the effect of ARNI on cardiac fibrosis in patients with HFpEF by cardiac magnetic resonance (CMR).

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Heart failure with preserved ejection fraction (HFpEF) comprises approximately 50% of all heart failure. The effectively therapeutic approaches for HFpEF remain limited. The PARAGON-HF trial found that Angiotensin Receptor-Neprilysin Inhibition (ARNI) has potential benefits for the management of HFpEF. Nevertheless, the role of ARNI in cardiac fibrosis in HFpEF are still unclear. We will conduct a prospective randomized controlled trial to evaluate the effect of ARNI on cardiac fibrosis in patients with HFpEF by cardiac magnetic resonance (CMR). We will randomly assign 60 patients with HFpEF (NYHA II-IV) class, ejection fraction ≥ 50% and elevated level of natriuretic peptides to receive sacubitril-valsartan (target 100mg bid) or placebo (100mg bid). The primary endpoint is change in extracellular volume [ECV] measured by CMR. The secondary endpoints were 6-minute walking distance(6-WMD), KCCQ, hospitalizations for heart failure, myocardial infarction and death.

Study Type

Interventional

Enrollment (Anticipated)

60

Phase

  • Phase 2

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

  • China
      • Chongqing, China, 400042
        • The First Affiliated Hospital of Chongqing Medical University

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

45 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Signed and dated written informed consent
  • Age ≥ 45 years at time of screening
  • Preserved systolic left ventricular function, defined by left ventricular ejection fraction (LVEF) ≥ 50%
  • NYHA classes II-IV
  • H2FPEF score ≥ 6 or HFA-PEFF score ≥ 5

Exclusion Criteria:

  • Patients with a known history of angioedema
  • History of hypersensitivity to ARNI
  • Any prior echocardiographic measurement of LVEF <45%
  • Significant congenital heart disease
  • Rheumatic valvular heart disease
  • Acute coronary syndrome, cardiac surgery, other major cardiovascular surgery
  • Probable alternative diagnoses could account for the patient's HF symptoms
  • Systolic blood pressure(BP) >180 mm Hg or diastolic BP >120 mm Hg at visit
  • Diastolic BP <90 mm Hg at visit 1, or symptomatic hypotension
  • Patients with a cardiac pacemaker therapy device
  • eGFR <30 ml/min/1.73 m2
  • Serum potassium >5.2 mmol/l at visit 1
  • Pregnant or nursing women

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: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: HFpEF with ARNI treatment
Sacubitril/valsartan (ARNI, 100mg bid)
Drug: Angiotensin Receptor-Neprilysin Inhibition
Sacubitril/valsartan [100 mg] bid). Continuous treatment was maintained for at least three months.
Other Names:
  • Sacubitril/valsartan
Placebo Comparator: Control group
placebo (100mg bid)
Drug: Placebo
Placebo [100 mg] bid). Continuous treatment was maintained for at least three months.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Extracellular volume [ECV]
Time Frame: Before ARNI or placebo treatment and after 3 months of continuous ANRI or palcebo treatment
Extracellular volume [ECV] assessment by CMR
Before ARNI or placebo treatment and after 3 months of continuous ANRI or palcebo treatment

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
myocardial infarction, hospitalization for heart failure and death
Time Frame: After 3 months of continuous ANRI or palcebo treatment
myocardial infarction, hospitalization for heart failure and all-cause death
After 3 months of continuous ANRI or palcebo treatment

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Chongqing Medical University

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

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 (Anticipated)

November 1, 2021

Primary Completion (Anticipated)

February 1, 2022

Study Completion (Anticipated)

April 1, 2022

Study Registration Dates

First Submitted

October 21, 2021

First Submitted That Met QC Criteria

October 21, 2021

First Posted (Actual)

October 22, 2021

Study Record Updates

Last Update Posted (Actual)

October 22, 2021

Last Update Submitted That Met QC Criteria

October 21, 2021

Last Verified

October 1, 2021

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2021-10-21

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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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