Effects of Sildenafil on Pulmonary Arterial Pressure in Patients With Heart Failure With Preserved Ejection Fraction ( HFpEF) and Pulmonary Hypertension
试验速览
- 阶段
- 3 期
- 状态
- 已完成
- 入组人数
- 52
- 试验地点
- 1
- 主要终点
- Mean Pulmonary Artery Pressure Measured by Right Heart Catheterization
研究概览
简要总结
Aim of the study is to investigate whether Sildenafil treatment results in a reduction of pulmonary artery pressure without decrease of cardiac output (CO) and in improvement of exercise capacity in patients with heart failure with preserved ejection fraction (HFpEF) with pulmonary hypertension ( PH).
详细描述
Rationale: Treatment of diastolic left heart failure is a challenging task. Compared to systolic left heart failure the level of evidence for known medical treatment regiments is low. Sildenafil, a phosphodiesterase 5 (PDE 5) inhibitor and effective therapy for pulmonary arterial hypertension acts as a selective pulmonary vasodilator by inhibiting the impaired nitric oxide (NO) pathway. Reducing the pulmonary vascular resistance would be the primary target by treatment of diastolic left heart failure with PH. But clinical and hemodynamical studies to evaluate the role of Sildenafil in diastolic heart failure, also called heart failure with preserved ejection fraction (HFpEF) with secondary pulmonary hypertension are lacking. Our hypothesis is that Sildenafil decreases pulmonary artery pressure in patients with HFpEF and pulmonary hypertension.
Objective: To investigate whether Sildenafil treatment results in a hemodynamic improvement and in an improvement of exercise capacity in these patients.
Study design: single-center, prospective, randomized, placebo controlled study. Study population: 52 patients with HFpEF and PH Intervention : One group receives three times daily 20 mg Sildenafil for 2 weeks followed by three times daily 60 mg Sildenafil for 10 weeks. The other group receives three times daily 20 mg of Placebo, followed by 3 times daily 60 mg placebo.
Main study parameters/endpoints:
Primary objectives
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •>18 years
- •Written inform consent
- •PH secondary to diastolic left heart failure defined as
- •PAP mean >25 mmHg
- •Wedge mean >15 mmHg
- •Normal systolic left ventricular (LV) function on echo/nuclear imaging (left ventricular ejection fraction (LVEF) > or =45%)
- •New York Heart Association class (NYHA) II-IV despite heart failure therapy
排除标准
- •Severe noncardiac limitation to exercise (as severe chronic obstructive pulmonary disease)
- •Other cause of PH besides diastolic heart failure
- •Coronary ischemia or recent myocardial infarction (<6 months)
- •Hypotension ( <90/50 mmHg)
- •Ongoing nitrate therapy
- •Ongoing therapy with citochrome P450 3A4 ( CYP3A4) inhibitors (ketoconazole, erythromycin, cimetidine, clarithromycin, itraconazole, voriconazole and protease inhibitors) or CYP3A4 inductors(carbamacepine, phenytoin, phenobarbital, rifampicin, Sint Janskruid ). Furthermore patients will be informed not to drink grapefruit juice while on study medication because of the known impact of grape fruit on pharmacokinetics of Sildenafil.
- •Ongoing therapy with alpha -inhibitors
- •Significant mitral or aortic valve dysfunction
- •Severe liver dysfunction
- •Pregnancy
- •Unable to read and comprehend Dutch language
研究组 & 干预措施
Sildenafil
Sildenafil orally 3 times 20mg for 2 weeks , followed by 3 times 60 mg for 10 weeks
干预措施: Sildenafil (Drug)
Placebo
placebo orally 3 times 20mg tablets, followed by 3 times 60 mg for 10 weeks
干预措施: Placebo (Drug)
结局指标
主要结局
Mean Pulmonary Artery Pressure Measured by Right Heart Catheterization
时间窗: baseline and 12 weeks
change of mean pulmonary artery pressure between baseline and 12 weeks measured by heart catheterisation
次要结局
- VO2max(baseline and 12 weeks)
- Wedge Pressure Measured Invasively by Right Heart Catheterization(baseline and 12 weeks)
- Cardiac Output Measured Invasively by Right Heart Catheterization(baseline and 12 weeks)
研究者
E.S. Hoendermis
MD, PhD
University Medical Center Groningen