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Evaluating the Effectiveness of Sildenafil at Improving Health Outcomes and Exercise Ability in People With Diastolic Heart Failure (The RELAX Study) (RELAX)

14 luglio 2014 aggiornato da: Duke University

Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart Failure (RELAX)

Diastolic heart failure (DHF), which affects older individuals and women at a disproportionate rate, is a condition that can lead to shortness of breath and fluid build-up in the lungs. This study will evaluate the effectiveness of the medication sildenafil at improving exercise ability and health outcomes in people with DHF.

Panoramica dello studio

Stato

Completato

Condizioni

Intervento / Trattamento

Descrizione dettagliata

DHF is a condition in which one of the chambers of the heart, the left ventricle, loses its ability to relax completely because the muscle has become too stiff. When this occurs, the heart is unable to properly fill with blood, which can lead to decreased blood circulation. People with DHF may experience shortness of breath and pulmonary congestion, which is an abnormal build-up of fluid in the lungs. Current treatment for DHF includes guidelines/recommendations to lower blood pressure, stop smoking, and lose weight, but there are no medications available to specifically treat DHF. Sildenafil, commonly known as Revatio or Viagra, is a medication that increases the supply of blood to the lungs and reduces the workload of the heart. Preliminary studies have shown that sildenafil may be beneficial at improving heart and lung function in people with DHF, but more research is needed to confirm these findings. The purpose of this study is to determine if sildenafil can improve exercise ability and health outcomes in people with DHF.

This 24-week study will enroll people with DHF. Participants will be randomly assigned to receive either sildenafil or placebo three times a day for 24 weeks. Participants will attend study visits at baseline and Weeks 1, 4, 12, 13, and 24. At most study visits, the following procedures will occur: physical exam, medical history review, questionnaires, blood collection, 6-minute walk test to measure endurance, and an exercise test. At baseline and Week 24, participants will also undergo an electrocardiogram, which will measure the electrical activity of the heart, and a cardiac magnetic resonance imaging (MRI) procedure and an echocardiogram, which will both obtain pictures of the heart. At Weeks 3, 8, 16, and 20, study researchers will call participants to collect health information.

Tipo di studio

Interventistico

Iscrizione (Effettivo)

216

Fase

  • Fase 3

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Luoghi di studio

    • Quebec
      • Montreal, Quebec, Canada, H1T - 1C8
        • Montreal Heart Institute
    • Arizona
      • Phoenix, Arizona, Stati Uniti, 85054
        • Mayo Clinic Arizona
    • Georgia
      • Atlanta, Georgia, Stati Uniti, 30310
        • Morehouse School of Medicine
    • Massachusetts
      • Boston, Massachusetts, Stati Uniti, 02115
        • Brigham and Women's Hospital
    • Minnesota
      • Minneapolis, Minnesota, Stati Uniti, 55415
        • Minnesota Heart Failure Network
      • Rochester, Minnesota, Stati Uniti, 55905
        • Mayo Clinic
    • North Carolina
      • Durham, North Carolina, Stati Uniti, 27705
        • Duke University Medical Center
    • Texas
      • Houston, Texas, Stati Uniti, 77030
        • Baylor College of Medicine
    • Utah
      • Murray, Utah, Stati Uniti, 84107
        • University of Utah Health Sciences Center
    • Vermont
      • Burlington, Vermont, Stati Uniti, 05401
        • University of Vermont - Fletcher Allen Health Care

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

18 anni e precedenti (Adulto, Adulto più anziano)

Accetta volontari sani

No

Sessi ammissibili allo studio

Tutto

Descrizione

Inclusion Criteria:

  • Previous clinical diagnosis of heart failure with current New York Heart Association (NYHA) Class II-IV symptoms
  • Has experienced at least one of the following in the 12 months before study entry:

    • Hospitalization for decompensated heart failure
    • Acute treatment with intravenous loop diuretic or hemofiltration
    • Mean pulmonary capillary wedge pressure greater than 15 mm Hg or left ventricular end diastolic pressure (LVEDP) greater than 18 mm Hg at catheterization for dyspnea
    • Long term treatment with a loop diuretic and chronic diastolic dysfunction on echocardiography, as determined by left atrial enlargement
  • Left ventricular ejection fraction greater than or equal to 50%, as determined by a clinical echocardiogram or ventriculogram in the 12 months before study entry
  • Receiving stable medical therapy in the 30 days before study entry, as determined by no addition or removal of angiotensin converting enzyme inhibitor (ACE), angiotensin receptor blocker (ARB), beta-blockers, or calcium channel blockers (CCB) and no change in dosage of ACE, ARBs, beta-blockers, or CCBs of more than 100%

Exclusion Criteria:

  • Has a neuromuscular, orthopedic, or other non-cardiac condition that prevents individual from exercise testing on a bicycle ergometer or from walking in a hallway
  • Non-cardiac condition that limits life expectancy to less than 1 year at the time of study entry, based on the judgment of the physician
  • Current or anticipated future need for nitrate therapy
  • Valve disease (i.e., greater than mild aortic or mitral stenosis; greater than moderate aortic or mitral regurgitation)
  • Hypertrophic cardiomyopathy
  • Infiltrative or inflammatory myocardial disease (e.g., amyloid, sarcoid)
  • Pericardial disease
  • Primary pulmonary arteriopathy
  • Has experienced a heart attack or unstable angina, or has undergone percutaneous transluminal coronary angiography (PTCA) or coronary artery bypass grafting (CABG) in the 60 days before study entry, or requires either PTCA or CABG at the time of study entry
  • Other clinically important causes of dyspnea, such as morbid obesity or significant lung disease, as defined by clinical judgment or use of steroids or oxygen for lung disease
  • Systolic blood pressure less than 110 mm Hg or greater than 180 mm Hg
  • Diastolic blood pressure less than 40 mm Hg or greater than 100 mm Hg
  • Resting heart rate (HR) greater than 100 bpm
  • History of reduced ejection fraction (less than 50%)
  • Implanted metallic device that will interfere with MRI examination (in people without atrial fibrillation)
  • Severe kidney dysfunction (estimated glomerular filtration rate [GFR] less than 20 ml/min/1.73m2 by modified modification of diet in renal disease [MDRD] equation)
  • Pregnant or not using an effective form of contraception
  • Hemoglobin level of less than 10 g/dL
  • Taking alpha antagonists or cytochrome P450 3A4 inhibitors (e.g., ketoconazole, itraconazole, erythromycin, saquinavir, cimetidine, or serum protease inhibitors for HIV)
  • Retinitis pigmentosa, previous diagnosis of nonischemic optic neuropathy, untreated proliferative retinopathy, or unexplained visual disturbance
  • Sickle cell anemia, multiple myeloma, leukemia, or penile deformities that increase the risk for priapism (e.g., angulation, cavernosal fibrosis, Peyronie's disease)
  • Severe liver disease (aspartate aminotransferase [AST] level greater than three times the normal limit, alkaline phosphatase or bilirubin greater than two times the normal limit)
  • In being consistent with American College of Cardiology (ACC)/American Heart Association (AHA) guidelines, people with dyspnea and risk factors for coronary artery disease should have had a stress test and those people with a clinically indicated stress test demonstrating significant ischemia in the 1 year before study entry will be excluded.
  • Listed for heart transplantation

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento
  • Assegnazione: Randomizzato
  • Modello interventistico: Assegnazione parallela
  • Mascheramento: Triplicare

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Comparatore placebo: Placebo
Placebo 20 mg three tid for 12 weeks followed by 60 mg tid for 12 weeks
Altri nomi:
  • Pillola di zucchero per imitare il Sildenafil
Sperimentale: Sildenafil
Sildenafil 20 mg three tid for 12 weeks followed by 60 mg tid for 12 weeks
Altri nomi:
  • Sildenafil attivo

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Lasso di tempo
Exercise Capacity, as Determined by Peak Oxygen Uptake
Lasso di tempo: Change from Baseline to Week 24
Change from Baseline to Week 24

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Exercise Capacity, as Determined by Peak Oxygen Uptake
Lasso di tempo: Change from Baseline to Week 12
Change from Baseline to Week 12
Exercise Capacity as Determined by Walk Distance
Lasso di tempo: Change from Baseline to Week 12
6 Minute Walk Distance
Change from Baseline to Week 12
Composite Score Reflective of Clinical Status
Lasso di tempo: Measured at Week 24

Participants ranked sequentially with ranking stratified in one of three tiers based on:

  1. Death (lowest tier) The person with the shortest time from randomization to death is given the lowest rank within the tier.
  2. Hospitalizations due to cardiovascular or renal causes (middle tier) For patients alive, the ranking within this tier is based on time to hospitalization from randomization date. The person with the first cardiovascular or renal cause hospitalization will be given the lowest rank within the tier.
  3. Change in Minnesota Living with Heart Failure Questionnaire (MLWHFQ) from baseline (highest tier)

The use of three tiers within the ranking reflects the greater adverse impact of death or cardiovascular hospitalization on clinical status without an arbitrary assignment as to the relative value of these events in relation to changes in quality of life. Rank order: 1-189 (higher values are better)

Measured at Week 24
Exercise Capacity as Determined by Walk Distance
Lasso di tempo: Change from Baseline to Week 24
6 minute walk distance
Change from Baseline to Week 24
Cardiopulmonary Exercise Test (CPET) Duration
Lasso di tempo: Change from Baseline to Week 12
To interpret the CPET Exercise Duration change endpoints, an increase in exercise duration between Baseline and Week 12/Week 24 is considered to be an improvement
Change from Baseline to Week 12
Cardiopulmonary Exercise Test (CPET) Duration
Lasso di tempo: Change from Baseline to Week 24
To interpret the CPET Exercise Duration change endpoints, an increase in exercise duration between Baseline and Week 12/Week 24 is considered to be an improvement
Change from Baseline to Week 24
Ventilatory Anaerobic Threshold
Lasso di tempo: Change from Baseline to Week 12
To interpret the Ventilatory Anaerobic Threshold (VAT) change endpoints, an increase in VAT between Baseline and Week 12/Week 24 is considered to be an improvement
Change from Baseline to Week 12
Ventilatory Anaerobic Threshold
Lasso di tempo: Change from Baseline to Week 24
To interpret the Ventilatory Anaerobic Threshold (VAT) change endpoints, an increase in VAT between Baseline and Week 12/Week 24 is considered to be an improvement
Change from Baseline to Week 24
Minnesota Living With Heart Failure Questionnaire (MLWHFQ)
Lasso di tempo: Change from Baseline to Week 12

The MLWHFQ is a self-administered, disease-specific measure of health related quality of life (QOL) that assesses patients perceptions of the influence of heart failure on physical, socioeconomic and psychological aspects of life. Patients respond to 21 items using a six-point response scale (0-5). The total summary score can range from 0-105 with a lower score reflecting better heart failure related QOL. Two sub-scale scores reflect physical (8 items) and emotional (5 items) impairment.

Total score: 0 - 105 Physical subscore: 0 - 40 Emotional subscore: 0 - 25

Change from Baseline to Week 12
Minnesota Living With Heart Failure Questionnaire
Lasso di tempo: Change from Baseline to Week 24
The MLWHFQ is a self-administered, disease-specific measure of health related quality of life (QOL) that assesses patients perceptions of the influence of heart failure on physical, socioeconomic and psychological aspects of life. Patients respond to 21 items using a six-point response scale (0-5). The total summary score can range from 0-105 with a lower score reflecting better heart failure related QOL. Two sub-scale scores reflect physical (8 items) and emotional (5 items) impairment.
Change from Baseline to Week 24

Altre misure di risultato

Misura del risultato
Misura Descrizione
Lasso di tempo
MRI Left Ventricular Mass
Lasso di tempo: Change from Baseline to Week 24
A decrease in LV Mass is considered an improvement
Change from Baseline to Week 24
MRI Left Ventricular Mass Index
Lasso di tempo: Change from Baseline to Week 24
A decrease in Left Ventricular Mass Index is considered an improvement
Change from Baseline to Week 24
MRI Left Ventricular End Diastolic Volume
Lasso di tempo: Change from Baseline to Week 24
An increase in Left Ventricular End Diastolic Volume is considered an improvement
Change from Baseline to Week 24
MRI Left Ventricular End Diastolic Volume Index
Lasso di tempo: Change from Baseline to Week 24
An increase in Left Ventricular End Diastolic Volume Index is considered an improvement
Change from Baseline to Week 24
MRI Left Ventricular End Systolic Volume Index
Lasso di tempo: Change from Baseline to Week 24
An increase in Left Ventricular End Systolic Volume Index is considered an improvement
Change from Baseline to Week 24
MRI Left Ventricular Ejection Fraction (LVEF)
Lasso di tempo: Change from Baseline to Week 24
An increase in LVEF is considered an improvement
Change from Baseline to Week 24
Echocardiogram Left Ventricular Mass
Lasso di tempo: Change from Baseline to Week 24
A decrease in Left Ventricular Mass is considered an improvement
Change from Baseline to Week 24
Medial Diastolic Elastance
Lasso di tempo: Change from Baseline to Week 24
A decrease in Medial Diastolic Elastance is considered an improvement
Change from Baseline to Week 24
Lateral Diastolic Elastance
Lasso di tempo: Change from Baseline to Week 24
A decrease in Lateral Diastolic Elastance is considered an improvement
Change from Baseline to Week 24
Medial Left Ventricular Relaxation
Lasso di tempo: Change from Baseline to Week 24
An increase in Left Ventricular relaxation is considered to be an improvement
Change from Baseline to Week 24
Lateral Left Ventricular Relaxation
Lasso di tempo: Change from Baseline to Week 24
An increase in Left Ventricular relaxation is considered to be an improvement
Change from Baseline to Week 24
Medial Filling Pressure
Lasso di tempo: Change from Baseline to Week 24
A decrease in medial filling pressure is considered an improvement
Change from Baseline to Week 24
Lateral Filling Pressure
Lasso di tempo: Change from Baseline to Week 24
A decrease in lateral filling pressure is considered an improvement
Change from Baseline to Week 24
ECHO Effective Arterial Elastance
Lasso di tempo: Change from Baseline to Week 24
A decrease in Effective Arterial Elastance is considered an improvement
Change from Baseline to Week 24
ECHO Systemic Vascular Resistance
Lasso di tempo: Change from Baseline to Week 24
A decrease in Systemic Vascular Resistance is considered an improvement
Change from Baseline to Week 24
MRI Effective Arterial Elastance
Lasso di tempo: Change from Baseline to Week 24
A decrease in Effective Arterial Elastance is considered an improvement
Change from Baseline to Week 24
MRI Systemic Vascular Resistance
Lasso di tempo: Change from Baseline to Week 24
A decrease in Systemic Vascular Resistance is considered an improvement
Change from Baseline to Week 24
MRI Aortic Thickness
Lasso di tempo: Change from Baseline to Week 24
A decrease in Aortic Thickness is considered an improvement
Change from Baseline to Week 24
MRI Aortic Distensibility
Lasso di tempo: Change from Baseline to Week 24
An increase in Aortic Distensibility is considered to be an improvement
Change from Baseline to Week 24
ECHO Pulmonary Artery Systolic Pressure
Lasso di tempo: Change from Baseline to Week 24
A decrease in Pulmonary Artery Systolic Pressure is considered to be an improvement
Change from Baseline to Week 24
Best Available Creatinine
Lasso di tempo: Change from Baseline to Week 24
Best available=local lab results only when core lab results not available
Change from Baseline to Week 24
Best Available Glomerular Filtration Rate (GFR)
Lasso di tempo: Change from Baseline to Week 24
Best available=local lab results when core lab results not available
Change from Baseline to Week 24
Cystatin C
Lasso di tempo: Change from Baseline to Week 24
Change from Baseline to Week 24
Uric Acid
Lasso di tempo: Change from Baseline to Week 24
Change from Baseline to Week 24
N-terminal Pro B-type Natriuretic Peptide (NT Pro-BNP)
Lasso di tempo: Change from Baseline to Week 24
Change from Baseline to Week 24
Aldosterone
Lasso di tempo: Change from Baseline to Week 24
Change from Baseline to Week 24
High Sensitivity Troponin I
Lasso di tempo: Change from Baseline to Week 24
Change from Baseline to Week 24
Procollagen III N-terminal Peptide
Lasso di tempo: Change from Baseline to Week 24
Change from Baseline to Week 24
Endothelin-1
Lasso di tempo: Change from Baseline to Week 24
Change from Baseline to Week 24
High Sensitivity C-Reactive Protein
Lasso di tempo: Change from Baseline to Week 24
Change from Baseline to Week 24
Collagen Type I (CITP)
Lasso di tempo: Change from Baseline to Week 24
Change from Baseline to Week 24
Cyclic Guanosine Monophosphate (cGMP)
Lasso di tempo: Change from Baseline to Week 24
Change from Baseline to Week 24
Galectin 3
Lasso di tempo: Change from Baseline to Week 24
Change from Baseline to Week 24
Furosemide-Equivalent Dose
Lasso di tempo: Change from Baseline to Week 24
Change from Baseline to Week 24

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Pubblicazioni e link utili

La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.

Pubblicazioni generali

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio

1 settembre 2008

Completamento primario (Effettivo)

1 settembre 2012

Completamento dello studio (Effettivo)

1 settembre 2012

Date di iscrizione allo studio

Primo inviato

30 settembre 2008

Primo inviato che soddisfa i criteri di controllo qualità

30 settembre 2008

Primo Inserito (Stima)

1 ottobre 2008

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Stima)

23 luglio 2014

Ultimo aggiornamento inviato che soddisfa i criteri QC

14 luglio 2014

Ultimo verificato

1 luglio 2013

Maggiori informazioni

Termini relativi a questo studio

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .

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