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Assessment of CCM in HF With Higher Ejection Fraction (AIM HIGHer)

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ClinicalTrials.gov Identifier: NCT05064709
Recruitment Status : Recruiting
First Posted : October 1, 2021
Last Update Posted : January 26, 2023
Sponsor:
Information provided by (Responsible Party):
Impulse Dynamics

Brief Summary:
The AIM HIGHer Clinical Trial will evaluate the safety and efficacy of Cardiac Contractility Modulation (CCM) therapy in patients with heart failure with LVEF ≥40% and ≤60%.

Condition or disease Intervention/treatment Phase
Heart Failure Heart Failure With Preserved Ejection Fraction Heart Failure With Mid Range Ejection Fraction Heart Failure With Moderately Reduced Ejection Fraction Diastolic Heart Failure Device: Cardiac Contractility Modulation Therapy via OPTIMIZER™ Smart Mini System Device: OPTIMIZER™ Smart Mini System Not Applicable

Detailed Description:

The AIM HIGHer Clinical Trial is a prospective, multi-center, randomized, quadruple-blind, sham-controlled, two-part embedded trial of the safety and efficacy of CCM therapy delivered via the OPTIMIZER Smart Mini System in subjects with heart failure and an LVEF ≥40% and ≤60%. Subjects will be enrolled at approximately 150 sites in the US and 75 sites OUS.

All subjects will undergo screening and baseline testing; all eligible subjects will be implanted with the Optimizer System. Subjects will be randomized in a 2:1 ratio to either CCM ON (CCM group) or to CCM OFF (Sham group). The trial will be blinded to the treatment assignment of the device for 18-months. Subjects in the Sham group will have CCM turned ON after completion of the 18-month study visit. Subjects enrolled during Part I (450 subjects) of the trial will continue follow-up through the end of Part II (up to an additional 1,050) and contribute data to both parts of the trial. Each part of the trial is distinguished by a separate scientific purpose. The specific purpose of each part is:

Part I - Establish safety and effectiveness based on functional capacity and health status.

Part II - Establish safety and effectiveness based on clinical outcome data.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 1500 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Multicenter, multi-national, randomized, quadruple-blind, sham controlled, 2-part, embedded IDE clinical trial
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description: In addition to the subject, the entire site research team, the implanting physician, the Clinical Events Committee (CEC), and the clinical study monitors will all be blinded to the treatment assignment. Site research staff and Impulse Dynamics monitoring personnel will not have viewing rights to the randomization assignment.
Primary Purpose: Treatment
Official Title: Assessment of Implantable CCM in the Heart Failure Group With Higher Ejection Fraction
Actual Study Start Date : February 3, 2022
Estimated Primary Completion Date : February 1, 2025
Estimated Study Completion Date : February 1, 2026

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Heart Failure

Arm Intervention/treatment
Experimental: CCM Group (CCM ON)
CCM therapy will be turned on in 2/3 of the subjects for the entire duration of the study.
Device: Cardiac Contractility Modulation Therapy via OPTIMIZER™ Smart Mini System
The OPTIMIZER™ Smart Mini System will be implanted and CCM will be programmed ON for the first 18 months (blinded phase). CCM therapy will be programmed to deliver 7 one-hour phases of CCM therapy that are distributed equally over every 24-hour period. CCM will remain on following completion of the 18-month visit.
Other Name: CCM Group (CCM ON)

Sham Comparator: Sham Group (CCM OFF)
CCM therapy will be turned off in 1/3 of the subjects for the first 18 months of the study. After 18 months, CCM therapy will be turned on for the rest of the study duration.
Device: OPTIMIZER™ Smart Mini System
The OPTIMIZER™ Smart Mini System will be implanted and CCM will be programmed OFF for the first 18 months (blinded phase). CCM will be turned on following completion of the 18-month visit.
Other Name: Sham Group (CCM OFF)




Primary Outcome Measures :
  1. Part 1 Efficacy Endpoint - Change in 6-minute walk distance (6MWD) from baseline to 6 months. [ Time Frame: 6 months ]
    Demonstrate that CCM therapy improves functional capacity in subjects with symptomatic heart failure with LVEF ≥40% and ≤60%. Compare the changes in functional capacity, as measured by the 6-minute walk distance (6MWD), from baseline to 6-months following the randomization date between the two study groups.

  2. Part 1 Efficacy Endpoint - Change in the health status from baseline to 6 months as assessed by the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ CSS). [ Time Frame: 6 months ]
    Demonstrate that CCM therapy improves health status in subjects with symptomatic heart failure with LVEF ≥40% and ≤60%. Compare the changes in health status, as measured by the KCCQ CSS, from baseline to 6-months following the randomization date between the two study groups.

  3. Part 1 Safety Endpoint - The incidence of Optimizer device- or procedure-related complications within the first 12 months after implant [ Time Frame: 12 months ]
    Compare the composite incidence of Optimizer device-related and procedure-related SAEs (complications) for available data collected from implant to 12 months after the Optimizer implantation procedure to a performance goal of 75% free of complications.

  4. Part 2 Endpoint - The hierarchical composite of mortality, morbidity, and health status outcomes (KCCQ CSS). [ Time Frame: 18 months ]
    Demonstrate that CCM therapy improves a composite endpoint of cardiovascular mortality at 18-months, heart failure hospitalizations at 18-months, urgent heart failure visits requiring IV diuretics at 18-months and the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ CSS) at 12-months. Comparison of a hierarchical composite endpoint between the two study groups will be based on the Finkelstein-Schoenfeld global rank method.



Information from the National Library of Medicine

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Ages Eligible for Study:   21 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Signed and dated informed consent form;
  2. Male or non-pregnant female, 21 years or older;
  3. Diagnosed with symptomatic heart failure;
  4. LVEF ≥40 and ≤60% (as assessed by echo core lab);
  5. Heart failure hospitalization within 12 months prior to study consent OR Urgent heart failure visit requiring IV therapy during the 6 months prior to study consent;
  6. Elevated NT-proBNP levels, >200 pg/ml for subjects without atrial tachyarrhythmia (AT) or >600 pg/ml for subjects in AT OR Elevated BNP levels, >75 pg/ml for subjects without AT or >225 pg/ml for subjects in AT;

6) Subjects must be on a stable, scheduled oral loop diuretic treatment (not only PRN) for at least 30 days prior to study consent, unless documented allergy.

Exclusion Criteria:

  1. Resting heart rate <50 or >110 bpm;
  2. Resting systolic blood pressure <100 or ≥160 mmHg;
  3. BMI greater than 40
  4. Any moderate or severe valvular stenotic disease or any severe valvular regurgitation;
  5. Mechanical tricuspid valve;
  6. Complex congenital heart disease;
  7. Exercise tolerance limited by a condition other than heart failure that, in the opinion of the investigator, contributes significantly to the primary symptoms of shortness of breath and/or exercise intolerance;
  8. Unable to walk at least 100 meters or walks more than 450 meters during a 6MWT;
  9. A KCCQ CCS score higher than 85;
  10. Hypertrophic, infiltrative/restrictive or inflammatory cardiomyopathy;
  11. Unstable angina pectoris within 30 days prior to study consent;
  12. Acute, decompensated heart failure requiring IV therapy or ultrafiltration within 30 days prior to consent, in the hospital or an outpatient setting;
  13. Receiving cardiac resynchronization therapy (CRT);
  14. Scheduled for a cardiac surgery or a percutaneous cardiac intervention (PCI) or have undergone cardiac surgery within 90 days or a PCI procedure within 30 days prior to study consent;
  15. Myocardial infarction within 90 days prior to study consent;
  16. Prior heart transplant or ventricular assist device;
  17. Planning to become pregnant during the study;
  18. Dialysis (permanent) or GFR <20 ml/min/1.73m2;
  19. Participating in another investigational study;
  20. Currently undergoing active chemotherapeutic and/or radiation treatment for cancer or has a history of chemotherapy during the 2-year period prior to study consent;
  21. Expected lifespan of less than 18 months from time of study consent;

Information from the National Library of Medicine

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): NCT05064709


Contacts
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Contact: Maria Fernanda Villarreal, MD 8453592389 aimhigher@impulsedynamics.com

Locations
Show Show 60 study locations
Sponsors and Collaborators
Impulse Dynamics
Investigators
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Principal Investigator: Javed Butler, MD, MPH, MBA Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
Principal Investigator: Oussama Wazni, MD, MBA Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
Publications:
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Responsible Party: Impulse Dynamics
ClinicalTrials.gov Identifier: NCT05064709    
Other Study ID Numbers: CA_CP_340
First Posted: October 1, 2021    Key Record Dates
Last Update Posted: January 26, 2023
Last Verified: May 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Keywords provided by Impulse Dynamics:
HFpEF
Heart failure
CCM
CCM therapy
cardiac contractility modulation
symptomatic heart failure
left ventricular ejection fraction
LVEF
Optimizer
Optimizer Smart Mini
Quality of Life
Additional relevant MeSH terms:
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Heart Failure
Heart Failure, Diastolic
Heart Diseases
Cardiovascular Diseases