Evaluating the Effectiveness of Sildenafil at Improving Health Outcomes and Exercise Ability in People With Diastolic Heart Failure (The RELAX Study) (RELAX)
Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart Failure (RELAX)
調査の概要
詳細な説明
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.
研究の種類
入学 (実際)
段階
- フェーズ 3
連絡先と場所
研究場所
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Arizona
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Phoenix、Arizona、アメリカ、85054
- Mayo Clinic Arizona
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Georgia
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Atlanta、Georgia、アメリカ、30310
- Morehouse School of Medicine
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Massachusetts
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Boston、Massachusetts、アメリカ、02115
- Brigham and Women's Hospital
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Minnesota
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Minneapolis、Minnesota、アメリカ、55415
- Minnesota Heart Failure Network
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Rochester、Minnesota、アメリカ、55905
- Mayo Clinic
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North Carolina
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Durham、North Carolina、アメリカ、27705
- Duke University Medical Center
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Texas
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Houston、Texas、アメリカ、77030
- Baylor College of Medicine
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Utah
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Murray、Utah、アメリカ、84107
- University of Utah Health Sciences Center
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Vermont
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Burlington、Vermont、アメリカ、05401
- University of Vermont - Fletcher Allen Health Care
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Quebec
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Montreal、Quebec、カナダ、H1T - 1C8
- Montreal Heart Institute
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
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
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:トリプル
武器と介入
参加者グループ / アーム |
介入・治療 |
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プラセボコンパレーター:Placebo
Placebo 20 mg three tid for 12 weeks followed by 60 mg tid for 12 weeks
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他の名前:
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実験的:Sildenafil
Sildenafil 20 mg three tid for 12 weeks followed by 60 mg tid for 12 weeks
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他の名前:
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
時間枠 |
---|---|
Exercise Capacity, as Determined by Peak Oxygen Uptake
時間枠:Change from Baseline to Week 24
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Change from Baseline to Week 24
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Exercise Capacity, as Determined by Peak Oxygen Uptake
時間枠:Change from Baseline to Week 12
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Change from Baseline to Week 12
|
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Exercise Capacity as Determined by Walk Distance
時間枠:Change from Baseline to Week 12
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6 Minute Walk Distance
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Change from Baseline to Week 12
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Composite Score Reflective of Clinical Status
時間枠:Measured at Week 24
|
Participants ranked sequentially with ranking stratified in one of three tiers based on:
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
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Exercise Capacity as Determined by Walk Distance
時間枠:Change from Baseline to Week 24
|
6 minute walk distance
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Change from Baseline to Week 24
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Cardiopulmonary Exercise Test (CPET) Duration
時間枠: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
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Change from Baseline to Week 12
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Cardiopulmonary Exercise Test (CPET) Duration
時間枠: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
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Ventilatory Anaerobic Threshold
時間枠: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
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Change from Baseline to Week 12
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Ventilatory Anaerobic Threshold
時間枠: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
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Change from Baseline to Week 24
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Minnesota Living With Heart Failure Questionnaire (MLWHFQ)
時間枠: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
時間枠: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
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その他の成果指標
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
MRI Left Ventricular Mass
時間枠:Change from Baseline to Week 24
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A decrease in LV Mass is considered an improvement
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Change from Baseline to Week 24
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MRI Left Ventricular Mass Index
時間枠:Change from Baseline to Week 24
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A decrease in Left Ventricular Mass Index is considered an improvement
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Change from Baseline to Week 24
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MRI Left Ventricular End Diastolic Volume
時間枠:Change from Baseline to Week 24
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An increase in Left Ventricular End Diastolic Volume is considered an improvement
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Change from Baseline to Week 24
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MRI Left Ventricular End Diastolic Volume Index
時間枠:Change from Baseline to Week 24
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An increase in Left Ventricular End Diastolic Volume Index is considered an improvement
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Change from Baseline to Week 24
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MRI Left Ventricular End Systolic Volume Index
時間枠:Change from Baseline to Week 24
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An increase in Left Ventricular End Systolic Volume Index is considered an improvement
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Change from Baseline to Week 24
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MRI Left Ventricular Ejection Fraction (LVEF)
時間枠:Change from Baseline to Week 24
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An increase in LVEF is considered an improvement
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Change from Baseline to Week 24
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Echocardiogram Left Ventricular Mass
時間枠:Change from Baseline to Week 24
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A decrease in Left Ventricular Mass is considered an improvement
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Change from Baseline to Week 24
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Medial Diastolic Elastance
時間枠:Change from Baseline to Week 24
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A decrease in Medial Diastolic Elastance is considered an improvement
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Change from Baseline to Week 24
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Lateral Diastolic Elastance
時間枠:Change from Baseline to Week 24
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A decrease in Lateral Diastolic Elastance is considered an improvement
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Change from Baseline to Week 24
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Medial Left Ventricular Relaxation
時間枠:Change from Baseline to Week 24
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An increase in Left Ventricular relaxation is considered to be an improvement
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Change from Baseline to Week 24
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Lateral Left Ventricular Relaxation
時間枠:Change from Baseline to Week 24
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An increase in Left Ventricular relaxation is considered to be an improvement
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Change from Baseline to Week 24
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Medial Filling Pressure
時間枠:Change from Baseline to Week 24
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A decrease in medial filling pressure is considered an improvement
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Change from Baseline to Week 24
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Lateral Filling Pressure
時間枠:Change from Baseline to Week 24
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A decrease in lateral filling pressure is considered an improvement
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Change from Baseline to Week 24
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ECHO Effective Arterial Elastance
時間枠:Change from Baseline to Week 24
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A decrease in Effective Arterial Elastance is considered an improvement
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Change from Baseline to Week 24
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ECHO Systemic Vascular Resistance
時間枠:Change from Baseline to Week 24
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A decrease in Systemic Vascular Resistance is considered an improvement
|
Change from Baseline to Week 24
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MRI Effective Arterial Elastance
時間枠:Change from Baseline to Week 24
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A decrease in Effective Arterial Elastance is considered an improvement
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Change from Baseline to Week 24
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MRI Systemic Vascular Resistance
時間枠: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
時間枠:Change from Baseline to Week 24
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A decrease in Aortic Thickness is considered an improvement
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Change from Baseline to Week 24
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MRI Aortic Distensibility
時間枠:Change from Baseline to Week 24
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An increase in Aortic Distensibility is considered to be an improvement
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Change from Baseline to Week 24
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ECHO Pulmonary Artery Systolic Pressure
時間枠:Change from Baseline to Week 24
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A decrease in Pulmonary Artery Systolic Pressure is considered to be an improvement
|
Change from Baseline to Week 24
|
Best Available Creatinine
時間枠:Change from Baseline to Week 24
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Best available=local lab results only when core lab results not available
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Change from Baseline to Week 24
|
Best Available Glomerular Filtration Rate (GFR)
時間枠:Change from Baseline to Week 24
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Best available=local lab results when core lab results not available
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Change from Baseline to Week 24
|
Cystatin C
時間枠:Change from Baseline to Week 24
|
Change from Baseline to Week 24
|
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Uric Acid
時間枠:Change from Baseline to Week 24
|
Change from Baseline to Week 24
|
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N-terminal Pro B-type Natriuretic Peptide (NT Pro-BNP)
時間枠:Change from Baseline to Week 24
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Change from Baseline to Week 24
|
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Aldosterone
時間枠:Change from Baseline to Week 24
|
Change from Baseline to Week 24
|
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High Sensitivity Troponin I
時間枠:Change from Baseline to Week 24
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Change from Baseline to Week 24
|
|
Procollagen III N-terminal Peptide
時間枠:Change from Baseline to Week 24
|
Change from Baseline to Week 24
|
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Endothelin-1
時間枠:Change from Baseline to Week 24
|
Change from Baseline to Week 24
|
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High Sensitivity C-Reactive Protein
時間枠:Change from Baseline to Week 24
|
Change from Baseline to Week 24
|
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Collagen Type I (CITP)
時間枠:Change from Baseline to Week 24
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Change from Baseline to Week 24
|
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Cyclic Guanosine Monophosphate (cGMP)
時間枠:Change from Baseline to Week 24
|
Change from Baseline to Week 24
|
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Galectin 3
時間枠:Change from Baseline to Week 24
|
Change from Baseline to Week 24
|
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Furosemide-Equivalent Dose
時間枠:Change from Baseline to Week 24
|
Change from Baseline to Week 24
|
協力者と研究者
出版物と役立つリンク
一般刊行物
- Reddy YNV, Rikhi A, Obokata M, Shah SJ, Lewis GD, AbouEzzedine OF, Dunlay S, McNulty S, Chakraborty H, Stevenson LW, Redfield MM, Borlaug BA. Quality of life in heart failure with preserved ejection fraction: importance of obesity, functional capacity, and physical inactivity. Eur J Heart Fail. 2020 Jun;22(6):1009-1018. doi: 10.1002/ejhf.1788. Epub 2020 Mar 9.
- Redfield MM, Chen HH, Borlaug BA, Semigran MJ, Lee KL, Lewis G, LeWinter MM, Rouleau JL, Bull DA, Mann DL, Deswal A, Stevenson LW, Givertz MM, Ofili EO, O'Connor CM, Felker GM, Goldsmith SR, Bart BA, McNulty SE, Ibarra JC, Lin G, Oh JK, Patel MR, Kim RJ, Tracy RP, Velazquez EJ, Anstrom KJ, Hernandez AF, Mascette AM, Braunwald E; RELAX Trial. Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure with preserved ejection fraction: a randomized clinical trial. JAMA. 2013 Mar 27;309(12):1268-77. doi: 10.1001/jama.2013.2024.
- Bevan GH, Rana M, Al-Furaih N, Dalton J, Zidar DA, Al-Kindi SG. Anisocytosis is associated with myocardial fibrosis and exercise capacity in heart failure with preserved ejection fraction. Heart Lung. 2022 Jul-Aug;54:68-73. doi: 10.1016/j.hrtlng.2022.03.013. Epub 2022 Mar 28.
- Fudim M, Kelly JP, Jones AD, AbouEzzeddine OF, Ambrosy AP, Greene SJ, Reddy YNV, Anstrom KJ, Alhanti B, Lewis GD, Hernandez AF, Felker GM. Are existing and emerging biomarkers associated with cardiorespiratory fitness in patients with chronic heart failure? Am Heart J. 2020 Feb;220:97-107. doi: 10.1016/j.ahj.2019.11.006. Epub 2019 Nov 16.
- Reddy YNV, Lewis GD, Shah SJ, Obokata M, Abou-Ezzedine OF, Fudim M, Sun JL, Chakraborty H, McNulty S, LeWinter MM, Mann DL, Stevenson LW, Redfield MM, Borlaug BA. Characterization of the Obese Phenotype of Heart Failure With Preserved Ejection Fraction: A RELAX Trial Ancillary Study. Mayo Clin Proc. 2019 Jul;94(7):1199-1209. doi: 10.1016/j.mayocp.2018.11.037.
- AbouEzzeddine OF, McKie PM, Dunlay SM, Stevens SR, Felker GM, Borlaug BA, Chen HH, Tracy RP, Braunwald E, Redfield MM. Suppression of Tumorigenicity 2 in Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc. 2017 Feb 18;6(2):e004382. doi: 10.1161/JAHA.116.004382. Erratum In: J Am Heart Assoc. 2017 Sep 20;6(9):
- DeVore AD, McNulty S, Alenezi F, Ersboll M, Vader JM, Oh JK, Lin G, Redfield MM, Lewis G, Semigran MJ, Anstrom KJ, Hernandez AF, Velazquez EJ. Impaired left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: insights from the RELAX trial. Eur J Heart Fail. 2017 Jul;19(7):893-900. doi: 10.1002/ejhf.754. Epub 2017 Feb 14.
- Hussain I, Mohammed SF, Forfia PR, Lewis GD, Borlaug BA, Gallup DS, Redfield MM. Impaired Right Ventricular-Pulmonary Arterial Coupling and Effect of Sildenafil in Heart Failure With Preserved Ejection Fraction: An Ancillary Analysis From the Phosphodiesterase-5 Inhibition to Improve Clinical Status And Exercise Capacity in Diastolic Heart Failure (RELAX) Trial. Circ Heart Fail. 2016 Apr;9(4):e002729. doi: 10.1161/CIRCHEARTFAILURE.115.002729.
- Lindman BR, Davila-Roman VG, Mann DL, McNulty S, Semigran MJ, Lewis GD, de las Fuentes L, Joseph SM, Vader J, Hernandez AF, Redfield MM. Cardiovascular phenotype in HFpEF patients with or without diabetes: a RELAX trial ancillary study. J Am Coll Cardiol. 2014 Aug 12;64(6):541-9. doi: 10.1016/j.jacc.2014.05.030.
- Mohammed SF, Borlaug BA, McNulty S, Lewis GD, Lin G, Zakeri R, Semigran MJ, LeWinter M, Hernandez AF, Braunwald E, Redfield MM. Resting ventricular-vascular function and exercise capacity in heart failure with preserved ejection fraction: a RELAX trial ancillary study. Circ Heart Fail. 2014 Jul;7(4):580-9. doi: 10.1161/CIRCHEARTFAILURE.114.001192. Epub 2014 May 15.
- Zakeri R, Borlaug BA, McNulty SE, Mohammed SF, Lewis GD, Semigran MJ, Deswal A, LeWinter M, Hernandez AF, Braunwald E, Redfield MM. Impact of atrial fibrillation on exercise capacity in heart failure with preserved ejection fraction: a RELAX trial ancillary study. Circ Heart Fail. 2014 Jan;7(1):123-30. doi: 10.1161/CIRCHEARTFAILURE.113.000568. Epub 2013 Oct 25.
- Redfield MM, Borlaug BA, Lewis GD, Mohammed SF, Semigran MJ, Lewinter MM, Deswal A, Hernandez AF, Lee KL, Braunwald E; Heart Failure Clinical Research Network. PhosphdiesteRasE-5 Inhibition to Improve CLinical Status and EXercise Capacity in Diastolic Heart Failure (RELAX) trial: rationale and design. Circ Heart Fail. 2012 Sep 1;5(5):653-9. doi: 10.1161/CIRCHEARTFAILURE.112.969071.
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
- Pro00018007
- U01HL084904 (米国 NIH グラント/契約)
- 521
- U01HL084904-01 (米国 NIH グラント/契約)
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
心不全の臨床試験
-
Novartis Pharmaceuticals完了EC-MPS による治療に関心があり、コア研究の 12 か月の治療期間を無事に完了した患者 (de novo Heart Recipients)
プラセボの臨床試験
-
Palacky University完了
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Universidade Federal do ParaConselho Nacional de Desenvolvimento Científico e Tecnológico完了
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Advice Pharma Group srl積極的、募集していない肥満 | 栄養障害 | 体重 | 減量 | 食生活 | 太りすぎと肥満 | 健康行動 | ダイエット、健康 | ダイエット習慣 | ライフスタイル | 栄養、健康 | 行動障害イタリア
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University Hospital, Strasbourg, France積極的、募集していない