RELIEVE METAB Study

Interatrial Shunt Device (IASD) Treatment in Symptomatic Heart Failure With Reduced Left Ventricular Ejection Fraction (HFrEF) Alleviates Elevated Myocardial Left Ventricular Pressures, Improves Myocardial Mitochondrial Function and Promotes Regional and Global Myocardial Recovery

This prospective, single-center post-market-follow-up study aims to fill knowledge gaps by combining advanced cardiac MRI/MRS with systemic mitochondrial assays and exercise testing to characterize the energetic and functional impact of IASD therapy in HFrEF patients.

Study Overview

• Status: Not yet recruiting
• Conditions: Heart Failure With Reduced Ejection Fraction (HFrEF)
• Intervention / Treatment: Other: cardiac MRI; Other: Functional Testing

Detailed Description

All patients receive standard of care percutaneous implantation of the interatrial Ventura shunt according to the instructions for use. Cardiac function, volumes, pressures, and energy efficiency will be determined by state-of-the-art clinical multiparametric cMRI and spectroscopy (MRS) at baseline, 3-months, and 12-months follow-up. Systemic mitochondrial respiratory function will be determined by established Oroboros and Seahorse protocols.

Post-procedural assessments include:

• Cardiac Imaging: Multiparametric cardiac MRI (cMRI) and Phosphorus-31 Magnetic Resonance Spectroscopy (³¹P-MRS) at rest and during cycle ergometry to evaluate ventricular volumes, pressures, and myocardial energy efficiency.
• Functional Testing: Cardiopulmonary exercise testing (CPET) to quantify functional capacity via VO2 max and standardized symptom assessment in the heart failure unit.
• Laboratory & Biomarkers: Blood sampling for systemic mitochondrial respiratory function (PBMC respirometry via Oroboros® and Seahorse® protocols) and serum metabolomic testing.
• Clinical Follow-up: NYHA classification, quality of life assessment using the Kansas City Cardiomyopathy Questionnaire (KCCQ), and standard-of-care echocardiography.

• Study Type: Interventional
• Enrollment (Estimated): 15
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Lisa Dannenberg, MD; Phone Number: +49 2118105187; Email: LisaKristina.Dannenberg@med.uni-duesseldorf.de
• Study Contact Backup: Name: Amin Polzin, MD; Phone Number: +49 2118105187; Email: ctu@med.uni-duesseldorf.de

Study Locations

• Germany
  • North Rhine-Westphalia
    • Düsseldorf, North Rhine-Westphalia, Germany, 40225
      • University Hospital Duesseldorf
      • Principal Investigator: Amin Polzin, MD
      • Sub-Investigator: Mareike Cramer, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Ischemic or non-ischemic cardiomyopathy with LVEF ≤ 40%
2. Patient is eligible and scheduled to receive the Ventura IASD as per the current IFU.
3. Symptoms: NYHA Class III
4. Stability: Chronic heart failure for ≥ 6 months on stable, and at least 3 months on guideline-directed medical therapy (GDMT)
5. Biomarkers: NTproBNP ≥ 1,200 pg/ml
6. Age 18 years or older
7. Subject has signed informed consent form and is willing and able to attend all follow-up visits and is physically capable of performing all tests.

Exclusion Criteria:

1. Hemodynamics: Resting SBP < 90 or > 160 mmHg
2. Severe PH (PASP >70 mmHg, PVR > 4 Wood Units)

3. Anatomy/Structure:

   • intracardiac thrombus
   • Severe RV dysfunction (TAPSE <12 mm or RVFAC ≤25%)
   • LVEDD > 8 cm
   • Significant ASD or PFO

4. Valvular Disease:

   • Severe, untreated mitral stenosis or aortic stenosis or regurgitation
   • Mitral repair device <3 months prior to enrollment

5. Recent Events:

   • ACS, PCI, Cardiac Surgery (< 3 months prior to enrollment)
   • CAD requiring revascularization
   • Stroke, TIA, PE, Thrombosis (< 6 months prior to enrollment)
6. Issues undergoing MRI: e.g non-compatible implant, claustrophobia, or physically not suitable for MRI
7. Participation in the active treatment or follow-up phase of another clinical study of an investigational drug or device that has not reached its primary endpoint
8. Any medical or psychiatric condition such as dementia, alcoholism or substance abuse which may preclude informed consent or interfere with any of the study procedures, including follow-up visits
9. Any non-cardiac condition with life expectancy <1 years (e.g., cirrhosis, cancer not in remission, etc.)
10. Subject belongs to a vulnerable population

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Other: IASD therapy in HFrEF; All patients receive standard of care percutaneous implantation of the interatrial Ventura shunt according to the instructions for use.

Other: cardiac MRI; Cardiac Imaging: Multiparametric cardiac MRI (cMRI) and Phosphorus-31 Magnetic Resonance Spectroscopy (³¹P-MRS) at rest and during cycle ergometry to evaluate ventricular volumes, pressures, and myocardial energy efficiency; Other: Functional Testing; Cardiopulmonary exercise testing (CPET) to quantify functional capacity via VO2 max and standardized symptom assessment in the heart failure unit.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reverse LV remodeling	The primary endpoint is to achieve reverse remodeling detected by gold standard cMRI, comparing left-ventricular end-diastolic volume (LVEDV).	Baseline to 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Myocardial Energy metabolism	Improvement in myocardial energy metabolism at rest and during exercise, measured as an increase in the myocardial PCr/ATP ratio after Ventura IASD implantation determined by 31P-MRS	Baseline to 12 months

Collaborators and Investigators

• Sponsor: Heinrich-Heine University, Duesseldorf
• Investigators: Study Director: Malte Kelm, MD, Division of Cardiology, Pulmonary Disease and Vascular Medicine at University Hospital Duesseldorf

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): July 1, 2027

Study Registration Dates

• First Submitted: April 22, 2026
• First Submitted That Met QC Criteria: April 22, 2026
• First Posted (Actual): April 29, 2026

Study Record Updates

• Last Update Posted (Actual): April 29, 2026
• Last Update Submitted That Met QC Criteria: April 22, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: MRI; MRS; CMR; Myocardial Energetics; Interatrial Shunt Device (IASD); Ventura Shunt; Mitchondrial Function
• Other Study ID Numbers: RELIEVE METAB

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No