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Initiering og titrering af retningslinje rettet medicinsk terapi i hjertesvigt kardiogent chok med Empella 5.5 til hjerteinddrivelse (integreret) (INTeGRATE)

10. november 2026 opdateret af: Abiomed Inc.

Initiering og titrering af retningslinje rettet medicinsk terapi i hjertesvigt kardiogent chok med impona 5.5 til hjerteinddrivelse: integrere

The study will evaluate the impact of a combined device-drug strategy with Impella 5.5 with best practices and optimized GDMT on heart recovery outcomes in patients with decompensated heart failure and cardiogenic shock.

Studieoversigt

Status

Rekruttering

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

This is a prospective, single arm, multi-center, post-market, on-label study. For patients presenting with cardiogenic shock in the setting of cardiomyopathy, including peripartum cardiomyopathy, or myocarditis (also known as decompensated heart failure complicated with cardiogenic shock, commonly referred to as heart failure-related cardiogenic shock, HF-CS, including both acute-on-chronic and de novo presentations) as a result of isolated left ventricular failure that is not responsive to optimal medical management and conventional treatment measures (including volume loading and use of pressors and inotropes, with or without IABP), an intentional device-supported strategy with Impella 5.5™ for optimization of guideline-directed medical therapy (GDMT) combined with best practices improves outcomes over standard of care.

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

250

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

  • Navn: Roberta Chapman, MD, FACC, FACP, FHFSA
  • Telefonnummer: +1 978-882-8421
  • E-mail: rchapm11@its.jnj.com

Undersøgelse Kontakt Backup

Studiesteder

    • California
      • Sacramento, California, Forenede Stater, 95816
        • Ikke rekrutterer endnu
        • Sutter Medical Center Sacramento
        • Ledende efterforsker:
          • Michael Gibson, MD
        • Kontakt:
      • San Francisco, California, Forenede Stater, 94110
        • Ikke rekrutterer endnu
        • California Pacific Medical Center
        • Kontakt:
        • Ledende efterforsker:
          • Jared Herr, MD
        • Ledende efterforsker:
          • Michael Pham, M.D., FACC, MPH
    • Florida
      • Naples, Florida, Forenede Stater, 34102
        • Ikke rekrutterer endnu
        • NCH Rooney Heart Institute
        • Kontakt:
        • Ledende efterforsker:
          • Viviana Navas, MD
      • Tampa, Florida, Forenede Stater, 33606
        • Rekruttering
        • Tampa General Hospital
        • Kontakt:
        • Ledende efterforsker:
          • Debbie Rinde-Hoffman, MD, FACC, FACP, FHFSA
    • Indiana
      • Indianapolis, Indiana, Forenede Stater, 46260
        • Ikke rekrutterer endnu
        • Ascension St. Vincent
        • Kontakt:
        • Ledende efterforsker:
          • Sunit-Preet Chaudhry, MD, FACC
    • Minnesota
      • Minneapolis, Minnesota, Forenede Stater, 555407
        • Rekruttering
        • Abbott Northwestern
        • Kontakt:
        • Ledende efterforsker:
          • Kasia Hryniewicz, MD
    • Missouri
      • St Louis, Missouri, Forenede Stater, 63110
        • Ikke rekrutterer endnu
        • Barnes Jewish
        • Kontakt:
        • Ledende efterforsker:
          • Justin Vader, MD, MPHS
    • New Jersey
      • Hackensack, New Jersey, Forenede Stater, 07601
        • Ikke rekrutterer endnu
        • Hackensack University Medical Center
        • Ledende efterforsker:
          • Kanika Mody, MD
        • Kontakt:
      • New Brunswick, New Jersey, Forenede Stater, 08901
        • Rekruttering
        • Rutgers-Robert Wood Johnson Medical School
        • Kontakt:
        • Ledende efterforsker:
          • Maya Guglin, MD, PhD
    • New York
      • New York, New York, Forenede Stater, 10032
        • Ikke rekrutterer endnu
        • New York Presbyterian - Columbia
        • Ledende efterforsker:
          • Adil Yunis, MD
        • Kontakt:
      • Valhalla, New York, Forenede Stater, 10595
        • Ikke rekrutterer endnu
        • Westchester Medical Center
        • Ledende efterforsker:
          • Alan Gass, MD
        • Kontakt:
    • North Carolina
      • Charlotte, North Carolina, Forenede Stater, 28204
        • Ikke rekrutterer endnu
        • Atrium Health- Sanger Heart and Vascular Institute
        • Kontakt:
        • Ledende efterforsker:
          • Priyesh Patel, M.D.
      • Durham, North Carolina, Forenede Stater, 27710
        • Ikke rekrutterer endnu
        • Duke University
        • Kontakt:
        • Ledende efterforsker:
          • Adam DeVore, MD, MHS, FHFSA, FAHA, FACC
      • Winston-Salem, North Carolina, Forenede Stater, 27157
        • Ikke rekrutterer endnu
        • Wake Forest Baptist Medical Center
        • Kontakt:
        • Ledende efterforsker:
          • Olivia Gilbert, MD
    • Oklahoma
      • Tulsa, Oklahoma, Forenede Stater, 74136
        • Ikke rekrutterer endnu
        • Saint Francis Hospital - Tulsa
        • Ledende efterforsker:
          • Jaime Hernandez-Montfort, MD
        • Kontakt:
    • Oregon
      • Portland, Oregon, Forenede Stater, 97225
        • Ikke rekrutterer endnu
        • Providence St. Vincent Medical Center
        • Kontakt:
        • Ledende efterforsker:
          • Vidang Nguyen, MD
    • Pennsylvania
      • Philadelphia, Pennsylvania, Forenede Stater, 19104
        • Ikke rekrutterer endnu
        • University of Pennsylvania Health System
        • Kontakt:
        • Ledende efterforsker:
          • Joyce Wald, DO, FACC
      • Pittsburgh, Pennsylvania, Forenede Stater, 15212
        • Ikke rekrutterer endnu
        • Allegheny General Hospital
        • Ledende efterforsker:
          • Matthew Lander, MD
        • Kontakt:
      • Pittsburgh, Pennsylvania, Forenede Stater, 15213
        • Ikke rekrutterer endnu
        • UPMC Presbyterian
        • Kontakt:
        • Ledende efterforsker:
          • Sideris Facaros, MD
    • Tennessee
      • Nashville, Tennessee, Forenede Stater, 32703
        • Ikke rekrutterer endnu
        • Centennial Medical Center
        • Kontakt:
        • Ledende efterforsker:
          • Thomas McRae, MD, FACC
        • Ledende efterforsker:
          • Zachary J II'Giovine, MD, FACC
    • Texas
      • Dallas, Texas, Forenede Stater, 75243
        • Rekruttering
        • Medical City Heart Hospital Dallas
        • Kontakt:
        • Ledende efterforsker:
          • Song Li, MD
    • Utah
      • Salt Lake City, Utah, Forenede Stater, 84132
        • Ikke rekrutterer endnu
        • University of Utah
        • Ledende efterforsker:
          • Stavros Drakos, MD
        • Kontakt:
        • Ledende efterforsker:
          • Thomas Hanff, MD
    • Virginia
      • Falls Church, Virginia, Forenede Stater, 22042
        • Ikke rekrutterer endnu
        • Inova Fairfax Hospital
        • Ledende efterforsker:
          • Shashank Sinha, MD
        • Kontakt:

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 80 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  1. Age ≥ 18 and < 80 years

  2. Subject or subject's legally authorized representative (LAR) has signed the Informed Consent Form

  3. LVEF ≤ 40%

  4. Subject is presenting with decompensated heart failure and meets at least two (2) of the following cardiogenic shock criteria:

    1. Hypotension (sustained episode of systolic blood pressure ≤ 90 mmHg for at least 30 minutes or need for inotropic/vasoactive agents to maintain such blood pressure)
    2. Hypoperfusion (physical sign(s) of organ hypoperfusion or serum lactate >2 mmol/L)
    3. Cardiac index (CI) < 2.2 L/min/m2 determined to be secondary to cardiac dysfunction, in the absence of hypovolemia
    4. Required support with an intra-aortic balloon pump (IABP) or Impella CP™
  5. Subject has inadequate heart failure GDMT based on the most recent outpatient prescription prior to index admission, defined as:

    1. On 2 or less of the 4-Pillar HF Drug Classes (BB, MRA, SGLT2i, and RASi)
    2. If on BB and RASi, at least one of the two medications is < 50% of the maximal target dose

Exclusion Criteria:

  1. Underlying unmodifiable conditions that limit initiation of GDMT prior to enrollment, including but not limited to:

    1. Drug allergies or hypersensitivities* to HF GDMT medications, unless alternative can be identified

      *Drug allergy/hypersensitivity is an immune-mediated reaction to a medication. Adverse reactions must be a result of immune or inflammatory cell stimulations by the mеԁiсаtion.

    2. Known bilateral renal artery stenosis

    3. Type 1 diabetes

    4. 2o or 3o AV block, unless pacemaker is in place

    5. Angioedema, hereditary or idiopathic

    6. Pregnancy, known or confirmed by a pregnancy test if of childbearing potential

  2. ST-segment elevation or acute coronary syndrome (ACS) prior to enrollment

  3. Septic shock, shock from non-cardiac origins, or mixed shock

  4. SCAI Stage E cardiogenic shock per study definition (Appendix C) prior to enrollment

  5. In cardiac arrest prior to enrollment

  6. Prolonged use (or use with complication) of Intra-aortic balloon pump (IABP) or Impella CP™ prior to enrollment, meeting at least one of the following:

    1. IABP use >24 hours if placed at the enrolling site or >48 hours if transferred on IABP
    2. Impella CP™ use >24 hours if placed at the enrolling site or >48 hours if transferred on Impella CP™
    3. Experienced complication(s) from IABP including clinically significant vascular injury, limb ischemia, end organ damage, or bleeding requiring transfusion(s) per Investigator's discretion
    4. Experienced complication(s) from Impella CP™ including clinically significant hemolysis, vascular injury, limb ischemia, end organ damage, or bleeding requiring transfusion(s) per Investigator's discretion
  7. On mechanical circulatory support other than IABP or Impella CP™ (i.e. ECMO, etc) or on mechanical ventilation for non-procedural reasons prior to enrollment

  8. Revascularization or cardiac surgery within 30-days prior to enrollment

  9. Infiltrative/restrictive cardiomyopathy (sarcoidosis and amyloidosis), hypertrophic cardiomyopathy, constrictive pericarditis, pericardiac tamponade, or myocarditis requiring high-dose immunosuppression

  10. Complex adult congenital heart disease

  11. Primary severe valvular disease

  12. Predominant RV dysfunction per Investigator's discretion

  13. History of heart transplant or listed for heart transplant or planned for heart transplantation prior to enrollment

  14. Planned to be implanted with a permanent VAD within 180-days of the index hospitalization date

  15. Continuous outpatient inotropic support prior to the index hospitalization date

  16. Planned to pursue palliative care or hospice, or life expectancy of less than 1 year due to non-cardiac illness at the time of index hospitalization date

  17. Currently on dialysis, or has pre-existing end-stage chronic kidney disease (stage 4 and above), or has nephropathy of hereditary, infectious, or autoimmune origin

  18. Pre-existing functional liver disease including liver cirrhosis, alcoholic hepatitis, metabolic dysfunction associated steatohepatitis (MASH), or genetic liver disease

  19. Pre-existing pulmonary disease with oxygen dependency

  20. History of stroke or intracranial hemorrhage ≤ 90 days prior to the index hospitalization date, or a history of cerebrovascular disease with significant (> 80%) uncorrected carotid stenosis, or any permanent neurological deficit with modified Rankin Scale (mRS) >2

  21. Any contraindication that precludes placing an Impella 5.5™, including but not limited to:

    1. Aortic valve stenosis/calcification with orifice area ≤ 0.6cm2 or aortic insufficiency of any grade greater than mild on pre-procedure echocardiography
    2. Presence of mechanical aortic valve or heart constrictive device
    3. Mural thrombus in the left ventricle
    4. Severe arterial disease precluding placement of Impella
    5. Presence of atrial or ventricular septal defect
    6. Left ventricular rupture
    7. Cardiac tamponade
    8. Combined cardiorespiratory failure
  22. Infection of the planned procedural access site or systemic active infection including sepsis and bacteremia

  23. Intolerance to anticoagulant or antiplatelet therapies, or will refuse blood transfusions

  24. Subject has other medical, social or psychological problems that, in the opinion of the Investigator, compromises the subject's ability to give written informed consent and/or to comply with study procedures

  25. Participation in the active treatment or follow-up phase of another clinical study of an investigational drug or device

  26. Subject belongs to a vulnerable population, such as prisoners, pregnant women, handicapped, mentally disabled persons, or economically or educationally disadvantaged persons per 21CFR56.111(a)(3) and 111(b)

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: N/A
  • Interventionel model: Enkelt gruppeopgave
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Andet: Single arm study

This is a single arm study.

The intervention is Impella 5.5 with SmartAssist® support combined with protocolized guideline directed medical therapy (GDMT) and HF-CS best practices.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Tidsramme
Sammensat af dødsfald uanset årsag, hospitalsindlæggelse for hjertesvigt og hjerteerstatning (hjertetransplantation eller implantation af varig LVAD)
Tidsramme: Tidsramme: 180 dage efter tilmelding
Tidsramme: 180 dage efter tilmelding

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Samlet sammensætning af død af alle årsager og hjerteerstatning
Tidsramme: 90 dage, 180 dage, 1 år efter tilmelding
90 dage, 180 dage, 1 år efter tilmelding
Sammensætning af dødsfald af alle årsager, HF-hospitalisering og hjerterstatning
Tidsramme: 90 dage, 1 år efter indskrivning
90 dage, 1 år efter indskrivning
Dødelighed uanset årsag
Tidsramme: Indlæggelsesudskrivelse (inden for 24 timer), 90 dage, 180 dage, 1 år efter tilmelding
Indlæggelsesudskrivelse (inden for 24 timer), 90 dage, 180 dage, 1 år efter tilmelding
Kardiovaskulær dødelighed
Tidsramme: Udlæggelse fra hospital (inden for 24 timer), 90 dage, 180 dage, 1 år efter indskrivning
Udlæggelse fra hospital (inden for 24 timer), 90 dage, 180 dage, 1 år efter indskrivning
Sammensat af død uanset årsag og forværring af hjertesvigt
Tidsramme: 90 dage, 180 dage, 1 år efter tilmelding
90 dage, 180 dage, 1 år efter tilmelding
Ikke-HF kardiovaskulær indlæggelse
Tidsramme: 90 dage, 180 dage, 1 år efter tilmelding
90 dage, 180 dage, 1 år efter tilmelding
Alle hjerte-kar-indlæggelser
Tidsramme: 90 dage, 180 dage, 1 år efter tilmelding
90 dage, 180 dage, 1 år efter tilmelding
Sammensat af død uanset årsag og alle kardiovaskulære indlæggelser
Tidsramme: 90 dage, 180 dage, 1 år efter tilmelding
90 dage, 180 dage, 1 år efter tilmelding
Ændring i LVEF fra baseline
Tidsramme: 180 dage efter udskrivelse
180 dage efter udskrivelse
Ændring i LVEDD fra baseline
Tidsramme: 180 dage efter udskrivelse
180 dage efter udskrivelse
Ændring i NYHA HF Klasse fra baseline
Tidsramme: 180 dage efter udskrivelse
180 dage efter udskrivelse
Worsening heart failure
Tidsramme: 90-days, 180-days, 1-year post-enrollment

HF hospitalization or urgent HF visit

90-days, 180-days, 1-year post-enrollment
Rate of major device-related adverse events
Tidsramme: Hospital Discharge (within 24 hours), 30-days post-enrollment

The composite rate of any of the following device-related serious adverse events:

  1. Major vascular access site complication
  2. Major hemolysis
  3. Bleeding, defined as MCS-ARC Type 3 or higher
  4. Structural complication requiring repair
  5. Stroke
Hospital Discharge (within 24 hours), 30-days post-enrollment
Subjects achieving indicated GDMT treatment
Tidsramme: Hospital Discharge(within 24 hours), 90-days, 180-days post-enrollment

Achieving any dose of all four classes

Hospital Discharge(within 24 hours), 90-days, 180-days post-enrollment
% of Subjects achieving optimized GDMT treatment
Tidsramme: 90-days and 180-days post-enrollment

Achieving at least 50% of the target dose of all four classes

90-days and 180-days post-enrollment
Modified Heart Failure Collaboratory (mHFC) score
Tidsramme: Hospital Discharge(within 24 hours), 90-days, 180-days post-enrollment

Defined by HFC in 2022. Improvement from baseline

Hospital Discharge(within 24 hours), 90-days, 180-days post-enrollment
Rate of GDMT-Related Serious Adverse Events
Tidsramme: Hospital Discharge (within 24 hours), 90-days, and 180-days post-enrollment

The composite rate of any of the following GDMT-related serious adverse events:

  1. Recurrence or worsening shock; symptomatic hypotension requiring admission
  2. Bradycardia requiring treatment
  3. Hyperkalemia requiring intervention
  4. Ketoacidosis requiring treatment
  5. Need for new renal replacement therapy (RRT)
Hospital Discharge (within 24 hours), 90-days, and 180-days post-enrollment
Quality of life assessed by EQ-5D
Tidsramme: 180-days and 1-year post-discharge

improvement from baseline

180-days and 1-year post-discharge
6-Minute Walk Test Distance
Tidsramme: 180-days and 1-year post-discharge

improvement from baseline

180-days and 1-year post-discharge
Change in HF biomarker
Tidsramme: Hospital Discharge (within 24 hours), 30-days, and 90-days post-discharge

NT-proBNP from baseline

Hospital Discharge (within 24 hours), 30-days, and 90-days post-discharge

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Samarbejdspartnere

Efterforskere

  • Ledende efterforsker: Adam DeVore, MD, MHS, Duke University
  • Ledende efterforsker: Gavin Hickey, MD, University of Pittsburgh
  • Ledende efterforsker: Manreet Kanwar, MD, University of Chicago

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

2. oktober 2026

Primær færdiggørelse (Anslået)

1. december 2028

Studieafslutning (Anslået)

1. juni 2029

Datoer for studieregistrering

Først indsendt

21. april 2025

Først indsendt, der opfyldte QC-kriterier

2. maj 2025

Først opslået (Faktiske)

11. maj 2025

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

12. november 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

10. november 2026

Sidst verificeret

1. november 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • INTeGRATE

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

INGEN

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Ingen

Studerer et amerikansk FDA-reguleret enhedsprodukt

Ja

produkt fremstillet i og eksporteret fra U.S.A.

Ingen

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