Interatrial Shunt Device (IASD) Treatment in Symptomatic Heart Failure With Reduced Left Ventricular Ejection Fraction (HFrEF) Alleviates Elevated Myocardial Left Ventricular Pressures, Improves Myocardial Mitochondrial Function and Promotes Regional and Global Myocardial Recovery
Overview
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- Heinrich-Heine University, Duesseldorf
- Enrollment
- 15
- Locations
- 1
- Primary Endpoint
- Reverse LV remodeling
Overview
Brief Summary
This prospective, single-center post-market-follow-up study aims to fill knowledge gaps by combining advanced cardiac MRI/MRS with systemic mitochondrial assays and exercise testing to characterize the energetic and functional impact of IASD therapy in HFrEF patients.
Detailed Description
All patients receive standard of care percutaneous implantation of the interatrial Ventura shunt according to the instructions for use. Cardiac function, volumes, pressures, and energy efficiency will be determined by state-of-the-art clinical multiparametric cMRI and spectroscopy (MRS) at baseline, 3-months, and 12-months follow-up. Systemic mitochondrial respiratory function will be determined by established Oroboros and Seahorse protocols.
Post-procedural assessments include:
- Cardiac Imaging: Multiparametric cardiac MRI (cMRI) and Phosphorus-31 Magnetic Resonance Spectroscopy (³¹P-MRS) at rest and during cycle ergometry to evaluate ventricular volumes, pressures, and myocardial energy efficiency.
- Functional Testing: Cardiopulmonary exercise testing (CPET) to quantify functional capacity via VO2 max and standardized symptom assessment in the heart failure unit.
- Laboratory & Biomarkers: Blood sampling for systemic mitochondrial respiratory function (PBMC respirometry via Oroboros® and Seahorse® protocols) and serum metabolomic testing.
- Clinical Follow-up: NYHA classification, quality of life assessment using the Kansas City Cardiomyopathy Questionnaire (KCCQ), and standard-of-care echocardiography.
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Other
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Ischemic or non-ischemic cardiomyopathy with LVEF ≤ 40%
- •Patient is eligible and scheduled to receive the Ventura IASD as per the current IFU.
- •Symptoms: NYHA Class III
- •Stability: Chronic heart failure for ≥ 6 months on stable, and at least 3 months on guideline-directed medical therapy (GDMT)
- •Biomarkers: NTproBNP ≥ 1,200 pg/ml
- •Age 18 years or older
- •Subject has signed informed consent form and is willing and able to attend all follow-up visits and is physically capable of performing all tests.
Exclusion Criteria
- •Hemodynamics: Resting SBP \< 90 or \> 160 mmHg
- •Severe PH (PASP \>70 mmHg, PVR \> 4 Wood Units)
- •Anatomy/Structure:
- •intracardiac thrombus
- •Severe RV dysfunction (TAPSE \<12 mm or RVFAC ≤25%)
- •LVEDD \> 8 cm
- •Significant ASD or PFO
- •Valvular Disease:
- •Severe, untreated mitral stenosis or aortic stenosis or regurgitation
- •Mitral repair device \<3 months prior to enrollment
Arms & Interventions
IASD therapy in HFrEF
All patients receive standard of care percutaneous implantation of the interatrial Ventura shunt according to the instructions for use.
Intervention: cardiac MRI (Other)
IASD therapy in HFrEF
All patients receive standard of care percutaneous implantation of the interatrial Ventura shunt according to the instructions for use.
Intervention: Functional Testing (Other)
Outcomes
Primary Outcomes
Reverse LV remodeling
Time Frame: Baseline to 12 months
The primary endpoint is to achieve reverse remodeling detected by gold standard cMRI, comparing left-ventricular end-diastolic volume (LVEDV).
Secondary Outcomes
- Myocardial Energy metabolism(Baseline to 12 months)