Anemia in Heart Failure With a Preserved Ejection Fraction (HFPEF)

• ClinicalTrials.gov Identifier: NCT00286182
• Recruitment Status: Completed
• First Posted: February 3, 2006
• Results First Posted: June 10, 2016
• Last Update Posted: March 10, 2017
• Sponsor: Mathew S. Maurer
• Collaborator: National Institute on Aging (NIA)
• Information provided by (Responsible Party): Mathew S. Maurer, Columbia University

Study Description

Brief Summary:

The purpose of this study is to determine if treating anemia with subcutaneous erythropoetin in patients with heart failure and a preserved ejection fraction (HFPEF) will be associated with reverse ventricular remodeling, significant improvements in exercise capacity, and improved health status, as compared with placebo.

Condition or disease	Intervention/treatment	Phase
Anemia	Drug: Erythropoietin alpha; Drug: Placebo	Phase 2

Detailed Description:

Heart failure frequently occurs in patients with a preserved ejection fraction (HFPEF) and affected subjects are predominantly elderly women with several co-morbid conditions. Despite the diversity of underlying clinical pathologies and co-morbid conditions present in these patients, a common pathophysiologic explanation is generally applied to explain their clinical symptoms. Our preliminary data show that a significant subgroup with HFPEF has increases in ventricular volumes and expanded plasma volumes, consistent with a volume overloaded state. In the setting of a preserved EF with end diastolic volume increased, stroke volume must increase, indicating a high output state. Anemia may be an important, modifiable contributor to the observed high output and volume overload as well as exercise intolerance in elderly HFPEF patients, abnormal ventricular remodeling and impaired overall health status and quality of life. This protocol evaluates the impact of treating anemia in subjects with HFPEF. The specific aims of the current study are to provide a comprehensive and mechanistically based assessment of how correcting anemia in subjects with HFPEF can impact on functional capacity, ventricular structure and function and overall health status. We propose to perform a randomized, prospective, double blind study in 80 subjects with HFPEF to test the hypothesis that the administration of subcutaneous erythropoietin will be associated with reverse ventricular remodeling, significant improvements in exercise capacity and improved health status.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 56 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Double (Participant, Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: Efficacy of Treating Anemia in Heart Failure With a Preserved Ejection Fraction (HFPEF) on Ventricular Function, Exercise Capacity and Health Status
• Study Start Date: July 2007
• Actual Primary Completion Date: November 2012
• Actual Study Completion Date: November 2012

Arms and Interventions

Arm	Intervention/treatment
Experimental: Erythropoietin alpha; Subcutaneous erythropoietin will be administered once weekly to achieve a target hemoglobin of 13 g/dL. Subjects will be dosed with the study drug for 24 weeks. The administration of study drug will be performed according to a pre-specified treatment algorithm that adjust erythropoietin dosages based on the rate of rise of the hemoglobin.	Drug: Erythropoietin alpha; Erythropoietin alpha is administered weekly by subcutaneous injection using a pre-specified dosing algorithm. The dosing algorithm is designed to make adjustments based on the rate of rise (ROR) of the hemoglobin over a one week period, as well as the absolute hemoglobin value. Subjects initially received active treatment with 7,500 units of erythropoietin given weekly by subcutaneously injection. Subjects are carefully monitored (e.g. every week) to avoid rapid increases in hemoglobin/hematocrit and/or increasing blood pressure control. Dose adjustments are made if the hemoglobin rises too rapidly (greater than 0.3 g/dL) in any given weekly interval.; Other Name: Erythropoietin alpha (Epogen)
Placebo Comparator: Placebo; Placebo consists of saline injections.	Drug: Placebo; Placebo

Outcome Measures

Primary Outcome Measures :

1. Change in Left Ventricular End-diastolic Volume [ Time Frame: Baseline and 6 month ]
   This outcome measure is collected using a three dimensional echocardiography.

Eligibility Criteria

• Ages Eligible for Study: 55 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Heart failure and a preserved ejection fraction (HFPEF) - EF >=40%
2. Anemia - defined as hemoglobin < 12 g/dL
3. Age >= 55 years
4. Patients must be able to understand and sign the informed consent document after the nature of the study has been fully explained, prior to beginning any study procedures.

Exclusion Criteria:

1. Presence of uncontrolled hypertension (Systolic blood pressure > 160 mm Hg and/or diastolic blood pressure > 90 mm Hg)
2. Resting heart rate > 120 bpm
3. Baseline 6-minute walk test > 450 meters
4. Valvular heart disease (e.g. more than mild regurgitant or stenotic mitral, aortic, tricuspid, or pulmonic valve disease).
5. Infiltrative cardiac disease such as hemochromatosis and amyloidosis
6. Hypertrophic cardiomyopathy
7. Chronic pulmonary disease (FEV 1 < 60% predicted)
8. Renal failure (GFR < 15 ml/min)
9. Hemoglobin < 8 g/dL
10. BMI > 40
11. Exercise limited by angina, claudication, orthopedic, or neurological diseases.
12. Severe liver dysfunction that is defined by an international normalized ratio > 2.0, not caused by an anticoagulant.
13. Current or recent treatment (within past 6 months) with erythropoietin
14. Erythropoietin level > 100 mU/ml
15. Recent cardiac surgery (< 3 months)
16. Known iron deficiency anemia from chronic GI blood loss, uterine bleeding, or other chronic bleeding
17. Planned surgery during the course of the study
18. Significant alcohol use or illicit drug use.
19. Patients with a known hypercoagulable state.
20. Active hematologic disease (e.g. sickle cell anemia, thalassemia, chronic myelogenous leukemia) or malignancy
21. Patients with current seizure disorder or activity
22. Patients who are known to be pregnant
23. History of deep venous thrombosis (DVT) or pulmonary embolus (PE) within 12 months before study entry. Prior superficial thrombophlebitis is not an exclusion criterion.
24. History of cerebrovascular accident (CVA) within 6 months
25. History of transient ischemic attack (TIA) within 6 months
26. History of acute coronary syndrome (ACS), or other arterial thrombosis within 6 months before study entry. ACS includes unstable angina, Q wave myocardial infarction (QwMI), and non-Q wave myocardial infarction (NQMI).
27. Allergy or sensitivity to human serum albumin
28. Known hypersensitivity to mammalian cell-derived products

Contacts and Locations

Locations

United States, New York

Clinical Cardiovascular Research Laboratory for the Elderly

New York, New York, United States, 10034

Sponsors and Collaborators

Mathew S. Maurer

National Institute on Aging (NIA)

Investigators

• Principal Investigator: Mathew S Maurer, MD; Columbia University

More Information

Publications:

Maurer MS, King DL, El-Khoury Rumbarger L, Packer M, Burkhoff D. Left heart failure with a normal ejection fraction: identification of different pathophysiologic mechanisms. J Card Fail. 2005 Apr;11(3):177-87.

Brucks S, Little WC, Chao T, Rideman RL, Upadhya B, Wesley-Farrington D, Sane DC. Relation of anemia to diastolic heart failure and the effect on outcome. Am J Cardiol. 2004 Apr 15;93(8):1055-7.

Silverberg DS, Wexler D, Blum M, Tchebiner J, Sheps D, Keren G, Schwartz D, Baruch R, Yachnin T, Shaked M, Zubkov A, Steinbruch S, Iaina A. The correction of anemia in severe resistant heart failure with erythropoietin and intravenous iron prevents the progression of both the heart and the renal failure and markedly reduces hospitalization. Clin Nephrol. 2002 Jul;58 Suppl 1:S37-45.

Silverberg DS, Wexler D, Sheps D, Blum M, Keren G, Baruch R, Schwartz D, Yachnin T, Steinbruch S, Shapira I, Laniado S, Iaina A. The effect of correction of mild anemia in severe, resistant congestive heart failure using subcutaneous erythropoietin and intravenous iron: a randomized controlled study. J Am Coll Cardiol. 2001 Jun 1;37(7):1775-80.

Mancini DM, Katz SD, Lang CC, LaManca J, Hudaihed A, Androne AS. Effect of erythropoietin on exercise capacity in patients with moderate to severe chronic heart failure. Circulation. 2003 Jan 21;107(2):294-9.

Klapholz M, Maurer M, Lowe AM, Messineo F, Meisner JS, Mitchell J, Kalman J, Phillips RA, Steingart R, Brown EJ Jr, Berkowitz R, Moskowitz R, Soni A, Mancini D, Bijou R, Sehhat K, Varshneya N, Kukin M, Katz SD, Sleeper LA, Le Jemtel TH; New York Heart Failure Consortium. Hospitalization for heart failure in the presence of a normal left ventricular ejection fraction: results of the New York Heart Failure Registry. J Am Coll Cardiol. 2004 Apr 21;43(8):1432-8.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Green P, Babu BA, Teruya S, Helmke S, Prince M, Maurer MS. Impact of epoetin alfa on left ventricular structure, function, and pressure volume relations as assessed by cardiac magnetic resonance: the heart failure preserved ejection fraction (HFPEF) anemia trial. Congest Heart Fail. 2013 Jul-Aug;19(4):172-9. doi: 10.1111/chf.12027. Epub 2013 Mar 20.

Maurer MS, Teruya S, Chakraborty B, Helmke S, Mancini D. Treating anemia in older adults with heart failure with a preserved ejection fraction with epoetin alfa: single-blind randomized clinical trial of safety and efficacy. Circ Heart Fail. 2013 Mar;6(2):254-63. doi: 10.1161/CIRCHEARTFAILURE.112.969717. Epub 2012 Dec 20.

Altincatal A, Macarthur RB, Teruya S, Helmke S, Maurer MS. A dosing algorithm for erythropoietin alpha in older adults with heart failure and a preserved ejection fraction. Cardiovasc Ther. 2013 Apr;31(2):92-9. doi: 10.1111/j.1755-5922.2011.00295.x. Epub 2011 Aug 26.

• Responsible Party: Mathew S. Maurer, Associate Professor of Clinical Medicine, Columbia University
• ClinicalTrials.gov Identifier: NCT00286182
• Other Study ID Numbers: AAAB3037; R01AG027518-01 ( U.S. NIH Grant/Contract )
• First Posted: February 3, 2006
• Results First Posted: June 10, 2016
• Last Update Posted: March 10, 2017
• Last Verified: January 2017

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Undecided

Keywords provided by Mathew S. Maurer, Columbia University:

Heart Failure; Elderly; Diastolic Dysfunction; Anemia; Ventricular End Diastolic Volume; Aged

Additional relevant MeSH terms:

Heart Failure; Anemia; Heart Diseases; Cardiovascular Diseases; Hematologic Diseases; Epoetin Alfa; Hematinics