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Effects of Hormonal Anabolic Deficiency and Neurovascular Alterations on Mortality in Male Patients With Heart Failure (TestoHF)

29 de abril de 2021 actualizado por: Maria Janieire de Nazaré Nunes Alves, University of Sao Paulo General Hospital

Hormonal Anabolic Deficiency Associated With Neurovascular Alterations Predict Poor Prognosis in Male Patients With Heart Failure

Heart failure (HF) has been associated with chronic deleterious effects on skeletal muscle, endocrine system, vasculature and sympathetic nervous system. These alterations have a significant impact on quality of life, leading to a reduction in functional capacity and limited symptoms, which involve dyspnea and fatigue. The investigators tested the hypothesis that hormonal anabolic deficiency associated with neurovascular alterations may worsen the prognosis of patients with heart failure.

Descripción general del estudio

Estado

Terminado

Condiciones

Intervención / Tratamiento

Descripción detallada

One hundred and fifty six patients have been enrolled so far. Methods were as described below:

  • Muscle sympathetic nerve activity (MSNA) was directly recorded from the peroneal nerve using the microneurography technique ;
  • All patients underwent symptom-limited cardiopulmonary exercise test performed on a cycle ergometer, using a ramp protocol with workload increments of 5 or 10 Watts per minute;
  • Body composition measurements were performed using dual-energy X-ray absorptiometry (DXA);
  • Muscle strength was assessed by handgrip dynamometer using the mean value of three attempts;
  • Blood samples were drawn in the morning after 12h overnight fasting. The laboratory tests included B-type natriuretic peptide (BNP; pg/mL) plasma level, serum sodium (mEq/L), serum potassium (mEq/L), creatinine (mg/dL), haemoglobin level (g/dL), high-sensitivity C-reactive protein (CRP; mg/L), lipid profile (triglyceride, total cholesterol, high-density lipoprotein, and low-density lipoprotein; mg/dL), and fasting glucose (mg/dL). Blood sample to assess hormone plasma levels were also drawn at the same time: total testosterone (TT), free testosterone (FT), sex hormone binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicle-stimulating hormone (FSH), thyroid stimulating hormone (TSH) and insulin-like growth factor 1 (IGF1).

Tipo de estudio

De observación

Inscripción (Actual)

169

Contactos y Ubicaciones

Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.

Ubicaciones de estudio

  • Brasil
    • SP
      • Sao Paulo, SP, Brasil, 05403-900
        • Instituto do Coração do Hospital da Clínicas da Universidade de Sao Paulo

Criterios de participación

Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.

Criterio de elegibilidad

Edades elegibles para estudiar

18 años a 65 años (Adulto, Adulto Mayor)

Acepta Voluntarios Saludables

No

Géneros elegibles para el estudio

Masculino

Método de muestreo

Muestra de probabilidad

Población de estudio

Patients with heart failure recruited at Clinical Unit of Myocardiopathy at General Hospital of the University of São Paulo Medical School (UNCAR/HC-FMUSP).

Descripción

Inclusion Criteria:

  • age between 18 and 65 years old;
  • at least1 year of diagnosed HF;
  • left ventricular ejection fraction (LVEF) lower than 40% measured by echocardiography;
  • non-ischaemic and ischaemic aetiologies;
  • compensated HF with optimal medication for at least 3 months prior the study;
  • New York Heart Association (NYHA) class of I to IV.

Exclusion Criteria:

  • patients with autonomic diabetic neuropathy;
  • patients with chronic renal failure with haemodialysis;
  • heart transplantation;
  • presence of pacemaker;
  • patients with muscular dystrophy (i.e. Duchenne muscular dystrophy);
  • patients submitted to any hormonal treatment;
  • history of cancer;
  • ongoing infection;
  • myocardial infarction with percutaneous coronary intervention or revascularization 6 months prior to the study entry.

Plan de estudios

Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.

¿Cómo está diseñado el estudio?

Detalles de diseño

  • Modelos observacionales: Grupo
  • Perspectivas temporales: Futuro

Cohortes e Intervenciones

Grupo / Cohorte
Intervención / Tratamiento
Low testosterone

Patients with HF and testosterone deficiency.

  • Cardiopulmonary exercise test
  • Muscle Sympathetic Nerve Activity
  • Dual-energy X-ray absorptiometry
  • Venous occlusion plethysmography
  • Blood sample collection
  • Dynamometers for Handgrip Strength
Prueba de diagnóstico: Cardiopulmonary exercise test
Oxygen consumption (VO2) and carbon dioxide output (VCO2) were measured by means of gas exchange on a breath-by-breath basis. The patients were initially monitored for 2 minutes at rest when seated on the ergometer, after that they were instructed to pedal at a pace of 60-70 rpm and the completion of the test occurred when, in spite of verbal encouragement, the patient reached maximal volitional fatigue.
Prueba de diagnóstico: Muscle Sympathetic Nerve Activity
Multiunit post-ganglionic muscle sympathetic nerve recordings were made using a tungsten microelectrode placed in the peroneal nerve near the fibular head. Nerve signals were amplified by a factor of 50,000 to 100,000 and band-pass filtered (700 to 2000 Hz). For recording and analysis, nerve activity was rectified and integrated (time constant 0.1 seconds) to obtain a mean voltage display of sympathetic nerve activity.
Prueba de diagnóstico: Dual-energy X-ray absorptiometry
Dual-energy X-ray absorptiometry (DXA) scan was used to measure total lean mass, body fat and bone mineral content.
Prueba de diagnóstico: Venous occlusion plethysmography
Venous occlusion plethysmography was used to assess non-invasively blood flow.
Prueba de diagnóstico: Blood sample collection
Blood samples were drawn in the morning after 12h overnight fasting.
Prueba de diagnóstico: Dynamometers for Handgrip Strength
Muscle strength was assessed by handgrip dynamometer using the mean value of three attempts.
Normal testosterone

Patients with HF and normal plasma levels of testosterone.

  • Cardiopulmonary exercise test
  • Muscle Sympathetic Nerve Activity
  • Dual-energy X-ray absorptiometry
  • Venous occlusion plethysmography
  • Blood sample collection
  • Dynamometers for Handgrip Strength
Prueba de diagnóstico: Cardiopulmonary exercise test
Oxygen consumption (VO2) and carbon dioxide output (VCO2) were measured by means of gas exchange on a breath-by-breath basis. The patients were initially monitored for 2 minutes at rest when seated on the ergometer, after that they were instructed to pedal at a pace of 60-70 rpm and the completion of the test occurred when, in spite of verbal encouragement, the patient reached maximal volitional fatigue.
Prueba de diagnóstico: Muscle Sympathetic Nerve Activity
Multiunit post-ganglionic muscle sympathetic nerve recordings were made using a tungsten microelectrode placed in the peroneal nerve near the fibular head. Nerve signals were amplified by a factor of 50,000 to 100,000 and band-pass filtered (700 to 2000 Hz). For recording and analysis, nerve activity was rectified and integrated (time constant 0.1 seconds) to obtain a mean voltage display of sympathetic nerve activity.
Prueba de diagnóstico: Dual-energy X-ray absorptiometry
Dual-energy X-ray absorptiometry (DXA) scan was used to measure total lean mass, body fat and bone mineral content.
Prueba de diagnóstico: Venous occlusion plethysmography
Venous occlusion plethysmography was used to assess non-invasively blood flow.
Prueba de diagnóstico: Blood sample collection
Blood samples were drawn in the morning after 12h overnight fasting.
Prueba de diagnóstico: Dynamometers for Handgrip Strength
Muscle strength was assessed by handgrip dynamometer using the mean value of three attempts.

¿Qué mide el estudio?

Medidas de resultado primarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Impact of testosterone deficiency on mortality
Periodo de tiempo: 2 years
Blood sample was collected in the morning (between 8:00-10:00 a.m.) after 12 hours fasting.
2 years
Impact of muscle sympathetic nerve activity on mortality
Periodo de tiempo: 2 years
Microneurography was used to assess the sympathetic nervous system.
2 years
Impact of neurovascular alterations on mortality
Periodo de tiempo: 2 years
Venous occlusion pletysmography was used to evaluate vasodilation.
2 years

Medidas de resultado secundarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Impact of testosterone deficiency on body composition
Periodo de tiempo: 2 years
Body composition measurements were performed using dual-energy X-ray absorptiometry.
2 years
Impact of testosterone deficiency on functional capacity
Periodo de tiempo: 2 years
All patients underwent symptom-limited cardiopulmonary exercise test to measure functional capacity.
2 years
Impact of testosterone deficiency on strength
Periodo de tiempo: 2 years
Muscle strength was assessed by handgrip dynamometer using the mean value of three attempts.
2 years

Colaboradores e Investigadores

Aquí es donde encontrará personas y organizaciones involucradas en este estudio.

Patrocinador

University of Sao Paulo General Hospital

Colaboradores

Fundação de Amparo à Pesquisa do Estado de São Paulo

Investigadores

  • Investigador principal: Maria Janieire de Nazaré Nunes Alves, PhD, InCor Heart Institute

Fechas de registro del estudio

Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados ​​por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.

Fechas importantes del estudio

Inicio del estudio (Actual)

30 de junio de 2016

Finalización primaria (Actual)

23 de marzo de 2020

Finalización del estudio (Actual)

30 de diciembre de 2020

Fechas de registro del estudio

Enviado por primera vez

1 de marzo de 2018

Primero enviado que cumplió con los criterios de control de calidad

9 de marzo de 2018

Publicado por primera vez (Actual)

13 de marzo de 2018

Actualizaciones de registros de estudio

Última actualización publicada (Actual)

3 de mayo de 2021

Última actualización enviada que cumplió con los criterios de control de calidad

29 de abril de 2021

Última verificación

1 de abril de 2021

Más información

Términos relacionados con este estudio

Palabras clave

Términos MeSH relevantes adicionales

Otros números de identificación del estudio

  • AnabolicHormonesPrognosis

Plan de datos de participantes individuales (IPD)

¿Planea compartir datos de participantes individuales (IPD)?

No

Información sobre medicamentos y dispositivos, documentos del estudio

Estudia un producto farmacéutico regulado por la FDA de EE. UU.

No

Estudia un producto de dispositivo regulado por la FDA de EE. UU.

No

Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .

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