Myocardial Perfusion, Oxidative Metabolism, and Fibrosis in HFpEF (HFpEF-PRoF)
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| ClinicalTrials.gov Identifier: NCT02589977 |
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Recruitment Status :
Completed
First Posted : October 28, 2015
Results First Posted : February 2, 2021
Last Update Posted : February 2, 2021
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Unlike heart failure with reduced ejection fraction (HFrEF) where several medicines and devices have been demonstrated to reduce mortality, no such therapies have been identified in HFpEF. This may be in part due to incomplete understanding of the underlying mechanisms of HFpEF.
Recently, impaired myocardial blood flow, reduced myocardial energy utilization, and increased myocardial fibrosis have been postulated to play important pathophysiologic roles in HFpEF. The investigators and others have demonstrated that HFrEF may be associated with altered myocardial energy utilization and "energy starvation." However, there are limited data regarding "energy starvation" in HFpEF and the relationships between myocardial blood flow, energy utilization, and fibrosis in HFpEF are largely unknown. Therefore, the purposes of this study are to use non-invasive cardiac imaging techniques to describe cardiac structure, function, blood flow, energetics, and fibrosis, and the relationships between these in order to better understand underlying mechanisms in HFpEF.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Heart Failure, Diastolic Diastolic Heart Failure Hypertension | Drug: regadenoson | Phase 4 |
The investigators hypothesize that HFpEF is associated with reductions in myocardial blood flow and energy utilization and increased myocardial fibrosis as compared to age and gender matched hypertensive and healthy controls. The investigators will test their hypotheses by comparing measurements of myocardial blood flow, energy utilization, and fibrosis between three subject groups (HFpEF vs hypertension vs healthy). Myocardial blood flow will be quantitated from nitrogen (N)13-Ammonia positron emission tomography (PET) and gadolinium enhanced cardiac magnetic resonance (CMR) imaging, both at rest and stress following coronary vasodilation with regadenoson. Myocardial energy utilization will be quantified with 11C-acetate PET imaging and myocardial fibrosis will be assessed with gadolinium enhanced CMR and alterations in myocardial T1. Echocardiography will be utilized to quantify cardiac diastolic function.
It is anticipated that the results of this proposed study will provide a foundation that will inform future studies aimed at identifying novel preventive or therapeutic agents in HFpEF.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 55 participants |
| Allocation: | Non-Randomized |
| Intervention Model: | Factorial Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Diagnostic |
| Official Title: | Myocardial Perfusion, Oxidative Metabolism, and Fibrosis in HFpEF |
| Study Start Date : | November 2015 |
| Actual Primary Completion Date : | January 21, 2020 |
| Actual Study Completion Date : | January 21, 2020 |
| Arm | Intervention/treatment |
|---|---|
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normal participants
No cardiovascular abnormalities or diabetes. Estimated glomerular filtration rate (eGFR) >60. Studies: Echocardiography for left ventricular function and LV diastolic performance; cardiac magnetic resonance (CMR) imaging using gadolinium for LV fibrosis and regadenoson for myocardial blood flow (MBF); positron-emission tomography (PET) using regadenoson for MBF and 11C-acetate for oxidative metabolism. |
Drug: regadenoson
evaluation of myocardial blood flow, interstitial fibrosis and oxidative metabolism in HFpEF, compared to hypertensive and normal participants
Other Names:
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hypertensive participants
No history of coronary artery disease or diabetes. Estimated glomerular filtration rate (eGFR) >60. Studies: Echocardiography for left ventricular function and LV diastolic performance; cardiac magnetic resonance (CMR) imaging using gadolinium for LV fibrosis and regadenoson for myocardial blood flow (MBF); positron-emission tomography (PET) using regadenoson for MBF and 11C-acetate for oxidative metabolism. |
Drug: regadenoson
evaluation of myocardial blood flow, interstitial fibrosis and oxidative metabolism in HFpEF, compared to hypertensive and normal participants
Other Names:
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HFpEF patients
No history of coronary artery disease or diabetes. Estimated glomerular filtration rate (eGFR) >60. Studies: Echocardiography for left ventricular function and LV diastolic performance; cardiac magnetic resonance (CMR) imaging using gadolinium for LV fibrosis and regadenoson for myocardial blood flow (MBF); positron-emission tomography (PET) using regadenoson for MBF and 11C-acetate for oxidative metabolism. |
Drug: regadenoson
evaluation of myocardial blood flow, interstitial fibrosis and oxidative metabolism in HFpEF, compared to hypertensive and normal participants
Other Names:
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- Coronary Flow Reserve [ Time Frame: Baseline study visit ]Rest and regadenoson stress coronary flow reserve by ammonia PET. Coronary flow calculated at rest and again at stress with coronary flow reserve calculated as the ratio of stress to rest coronary flow.
- Myocardial Perfusion Reserve by CMR in Each Study Group. [ Time Frame: Baseline study visit. ]Myocardial perfusion reserve by CMR.
- Extracellular Volume (ECV) by CMR in Each Study Group [ Time Frame: Baseline study visit ]Extracellular volume (ECV) by CMR.
- Oxidative Metabolism (Kmono/Rate Pressure Product) by PET in Each Study Group. [ Time Frame: Baseline study visit ]Oxidative metabolism (Kmono/rate pressure product) by PET.
- E/e' by Echo in Each Study Group. [ Time Frame: Baseline study visit ]E/e' by echo. E is the transmitral peak velocity in early diastole. e' is the early diastolic tissue Doppler velocity average between the septal and lateral mitral annulus. E/e' is the ratio of these two values.
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| Ages Eligible for Study: | 50 Years to 75 Years (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | Yes |
ALL
Inclusion Criteria:
- estimated glomerular filtration rate (eGFR) > 60 ml/min
- preserved left ventricular ejection fraction (>= 50%) on echocardiography
Exclusion Criteria:
- coronary artery disease
- diabetes mellitus
- contraindications to cardiac magnetic resonance imaging (CMR)
- weight >350 lbs
- inability to lie flat for imaging
- anemia
- contraindications to regadenoson or aminophylline
HEALTHY
Inclusion criteria:
- normal cardiac structure and function on echocardiography
- BP < 140/90
Exclusion criteria:
- known cardiovascular disease, cardiac risk factors or use of cardiac medications
HYPERTENSIVE
Inclusion criteria:
- history of BP >140/90
- 1 or more antihypertensive medications
- LV ejection fraction (LVEF) at least 50%
- current BP < 160/90
Exclusion criteria:
- known cardiovascular disease or risk factors aside from hypertension or use of cardiac medications
HFpEF
Inclusion criteria:
- physician-confirmed diagnosis of HF
- symptomatic HF
- LVEF at least 50%
- elevated LV filling pressure by catheterization, echocardiographic criteria or B-type-natriuretic peptide > 100
- current BP < 160/90
Exclusion criteria:
- prior history of LVEF below 50%
- acute decompensated HF
- moderate or greater valvular disease
- significant cardiac arrhythmias
- pericardial disease
- congenital heart disease
- primary pulmonary hypertension
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02589977
| United States, Tennessee | |
| Vanderbilt University Medical Center | |
| Nashville, Tennessee, United States, 37232 | |
| Principal Investigator: | Marvin W Kronenberg, MD | Vanderbilt University |
Documents provided by Marvin W. Kronenberg, M.D., Vanderbilt University Medical Center:
| Responsible Party: | Marvin W. Kronenberg, M.D., Professor of Medicine and Radiology, Vanderbilt University Medical Center |
| ClinicalTrials.gov Identifier: | NCT02589977 |
| Other Study ID Numbers: |
141686 |
| First Posted: | October 28, 2015 Key Record Dates |
| Results First Posted: | February 2, 2021 |
| Last Update Posted: | February 2, 2021 |
| Last Verified: | February 2021 |
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magnetic resonance imaging positron-emission tomography echocardiography myocardial blood flow energy metabolism |
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Heart Failure Heart Failure, Diastolic Cardiovascular Diseases Heart Diseases Regadenoson Adenosine A2 Receptor Agonists |
Purinergic P1 Receptor Agonists Purinergic Agonists Purinergic Agents Neurotransmitter Agents Molecular Mechanisms of Pharmacological Action Physiological Effects of Drugs |