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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 lipca 2014 zaktualizowane przez: 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.

Przegląd badań

Status

Zakończony

Interwencja / Leczenie

Szczegółowy opis

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.

Typ studiów

Interwencyjne

Zapisy (Rzeczywisty)

216

Faza

  • Faza 3

Kontakty i lokalizacje

Ta sekcja zawiera dane kontaktowe osób prowadzących badanie oraz informacje o tym, gdzie badanie jest przeprowadzane.

Lokalizacje studiów

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

Kryteria uczestnictwa

Badacze szukają osób, które pasują do określonego opisu, zwanego kryteriami kwalifikacyjnymi. Niektóre przykłady tych kryteriów to ogólny stan zdrowia danej osoby lub wcześniejsze leczenie.

Kryteria kwalifikacji

Wiek uprawniający do nauki

18 lat i starsze (Dorosły, Starszy dorosły)

Akceptuje zdrowych ochotników

Nie

Płeć kwalifikująca się do nauki

Wszystko

Opis

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

Plan studiów

Ta sekcja zawiera szczegółowe informacje na temat planu badania, w tym sposób zaprojektowania badania i jego pomiary.

Jak projektuje się badanie?

Szczegóły projektu

  • Główny cel: Leczenie
  • Przydział: Randomizowane
  • Model interwencyjny: Przydział równoległy
  • Maskowanie: Potroić

Broń i interwencje

Grupa uczestników / Arm
Interwencja / Leczenie
Komparator placebo: Placebo
Placebo 20 mg three tid for 12 weeks followed by 60 mg tid for 12 weeks
Inne nazwy:
  • Pigułka cukrowa imitująca Sildenafil
Eksperymentalny: Sildenafil
Sildenafil 20 mg three tid for 12 weeks followed by 60 mg tid for 12 weeks
Inne nazwy:
  • Aktywny sildenafil

Co mierzy badanie?

Podstawowe miary wyniku

Miara wyniku
Ramy czasowe
Exercise Capacity, as Determined by Peak Oxygen Uptake
Ramy czasowe: Change from Baseline to Week 24
Change from Baseline to Week 24

Miary wyników drugorzędnych

Miara wyniku
Opis środka
Ramy czasowe
Exercise Capacity, as Determined by Peak Oxygen Uptake
Ramy czasowe: Change from Baseline to Week 12
Change from Baseline to Week 12
Exercise Capacity as Determined by Walk Distance
Ramy czasowe: Change from Baseline to Week 12
6 Minute Walk Distance
Change from Baseline to Week 12
Composite Score Reflective of Clinical Status
Ramy czasowe: 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
Ramy czasowe: Change from Baseline to Week 24
6 minute walk distance
Change from Baseline to Week 24
Cardiopulmonary Exercise Test (CPET) Duration
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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)
Ramy czasowe: 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
Ramy czasowe: 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

Inne miary wyników

Miara wyniku
Opis środka
Ramy czasowe
MRI Left Ventricular Mass
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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)
Ramy czasowe: Change from Baseline to Week 24
An increase in LVEF is considered an improvement
Change from Baseline to Week 24
Echocardiogram Left Ventricular Mass
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: Change from Baseline to Week 24
A decrease in Aortic Thickness is considered an improvement
Change from Baseline to Week 24
MRI Aortic Distensibility
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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)
Ramy czasowe: 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
Ramy czasowe: Change from Baseline to Week 24
Change from Baseline to Week 24
Uric Acid
Ramy czasowe: Change from Baseline to Week 24
Change from Baseline to Week 24
N-terminal Pro B-type Natriuretic Peptide (NT Pro-BNP)
Ramy czasowe: Change from Baseline to Week 24
Change from Baseline to Week 24
Aldosterone
Ramy czasowe: Change from Baseline to Week 24
Change from Baseline to Week 24
High Sensitivity Troponin I
Ramy czasowe: Change from Baseline to Week 24
Change from Baseline to Week 24
Procollagen III N-terminal Peptide
Ramy czasowe: Change from Baseline to Week 24
Change from Baseline to Week 24
Endothelin-1
Ramy czasowe: Change from Baseline to Week 24
Change from Baseline to Week 24
High Sensitivity C-Reactive Protein
Ramy czasowe: Change from Baseline to Week 24
Change from Baseline to Week 24
Collagen Type I (CITP)
Ramy czasowe: Change from Baseline to Week 24
Change from Baseline to Week 24
Cyclic Guanosine Monophosphate (cGMP)
Ramy czasowe: Change from Baseline to Week 24
Change from Baseline to Week 24
Galectin 3
Ramy czasowe: Change from Baseline to Week 24
Change from Baseline to Week 24
Furosemide-Equivalent Dose
Ramy czasowe: Change from Baseline to Week 24
Change from Baseline to Week 24

Współpracownicy i badacze

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Publikacje i pomocne linki

Osoba odpowiedzialna za wprowadzenie informacji o badaniu dobrowolnie udostępnia te publikacje. Mogą one dotyczyć wszystkiego, co jest związane z badaniem.

Publikacje ogólne

Daty zapisu na studia

Daty te śledzą postęp w przesyłaniu rekordów badań i podsumowań wyników do ClinicalTrials.gov. Zapisy badań i zgłoszone wyniki są przeglądane przez National Library of Medicine (NLM), aby upewnić się, że spełniają określone standardy kontroli jakości, zanim zostaną opublikowane na publicznej stronie internetowej.

Główne daty studiów

Rozpoczęcie studiów

1 września 2008

Zakończenie podstawowe (Rzeczywisty)

1 września 2012

Ukończenie studiów (Rzeczywisty)

1 września 2012

Daty rejestracji na studia

Pierwszy przesłany

30 września 2008

Pierwszy przesłany, który spełnia kryteria kontroli jakości

30 września 2008

Pierwszy wysłany (Oszacować)

1 października 2008

Aktualizacje rekordów badań

Ostatnia wysłana aktualizacja (Oszacować)

23 lipca 2014

Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości

14 lipca 2014

Ostatnia weryfikacja

1 lipca 2013

Więcej informacji

Te informacje zostały pobrane bezpośrednio ze strony internetowej clinicaltrials.gov bez żadnych zmian. Jeśli chcesz zmienić, usunąć lub zaktualizować dane swojego badania, skontaktuj się z register@clinicaltrials.gov. Gdy tylko zmiana zostanie wprowadzona na stronie clinicaltrials.gov, zostanie ona automatycznie zaktualizowana również na naszej stronie internetowej .

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