RECOVER-HF Pilot Study - Randomized, Single-Center, Double-blinded Study of Synchronized Diaphragmatic Stimulation (SDS) for Improvement of Symptomatic Reduced Ejection Fraction Heart Failure
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 35
- 试验地点
- 4
- 主要终点
- Change in LVESV
研究概览
简要总结
The RECOVER HF pilot is a feasibility study for evaluating a randomized, doubled-blinded study design to determine the benefits and risks of chronically delivering Synchronized Diaphragmatic Stimulation (SDS) in Heart Failure patients on GDMT with NYHA II/III, EF<=40% and QRSd,=130ms.
详细描述
Symptomatic Diaphragmatic Stimulation (SDS) is a novel approach designed to improve cardiac function, symptoms, and, ultimately, outcomes for patients who are symptomatic for heart failure.
Elevated intracardiac pressures are the hallmark of heart failure (HF) and a key pathological driver of disease progression and limited exertional capacity. The degree of cardiac pressure elevation is determined by preload, afterload, and pericardial restraint. The pericardium restrains the heart, and the degree of restraint is determined by the pericardial structure itself and the intrathoracic pressure. This aspect of HF pathophysiology is among the fundamental drivers behind the SDS therapy concept. SDS induces a temporal modulation of intrathoracic pressure with a resultant reduction in pericardial restraint, leading to improved cardiac filling and reduced afterload. When applied at the right time in the cardiac cycle, SDS can improve cardiac filling, cardiovascular pressure conditions, and systolic cardiac performance.
Encouraged by the results of the VisONE HF study pilot (NCT03484780), SDS shall now be further valuated in a randomized controlled trial (RCT) pilot. This RCT pilot has three objectives: two semi-acute items (15-30 days) verification of sensing function using the modified input filters and improved usability based on increased automaticity of the user-interface; and one chronic result (6 months) to reproduce similar efficacy endpoints. The herein described study is a pilot trial for a larger RCT trial.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Treatment
- 盲法
- Triple (Participant, Care Provider, Investigator)
盲法说明
Investigator blinded to device programming, therapy imperceptible to patient
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
- •NYHA classes II/III on optimal Guideline Directed Medical Therapy
- •QRS duration ≤ 130 ms
- •LVEF < 40%
- •Willing and able to comply with protocol requirements, including attending all required visits
- •Wiling to participate in the study and able to sign an informed consent form
排除标准
- •Baseline 6-minute walk test > 500 meters or < 200 meters
- •NT-proBNP< 250 if on loop diuretics, or NT-proBNP < 500 if not on loop diuretics
- •Supine resting heart rate > 140 bpm
- •Systolic blood pressure < 80 mmHg or > 170 mmHg
- •Serum creatinine > 2.5 mg/dL
- •Serum hepatic function 3x ULN
- •Unstable angina, AMI, CABG, PTCA, CVA/TIA, persistent AF, NSVT or DCCV within 3 months
- •Intermittent IV inotropic drug treatment
- •Arrhythmias present during screening (profound ectopy, bradycardia, profound prevalence of ectopy, NSVT, VF, AF*, SVT or AFLT) - * see enrollment exception allowing for 10 patients in AF for a separate subgroup analysis
- •Reversible non-ischemic cardiomyopathy
- •Primary valvular disease
- •Severe primary pulmonary disease, including pulmonary arterial hypertension. PAP sys >70 mmHg at rest
- •Severe COPD, other respiratory or lung diseases where FEV < 50%
- •Pericardial disease
- •Diabetic neuropathy
- •Existing diaphragmatic stimulation for respiration assist
- •LVAD or other mechanical cardiac assist devices
- •Contraindications to laparoscopic access to the diaphragm, as determined by the implanting physician
- •Known intra-abdominal pathology which could increase the risk of laparoscopic access to the diaphragm.
- •Previous open laparotomy within 1 year
- •Previous thoracic or abdominal organ transplant
- •Drug induced immuno-suppression
- •Body mass index > 40
- •Enrollment in a concurrent investigation / clinical study
- •Having a life expectancy of <1 year due to any condition
- •Pregnant or planning a pregnancy during the study period
研究组 & 干预措施
Therapy
SDS system implanted and Therapy On for 6 months post randomization
干预措施: Synchronized Diaphragmatic Stimulation (Device)
Control
SDS system implanted and Therapy Off for 6 months post randomization
干预措施: Synchronized Diaphragmatic Stimulation (Device)
结局指标
主要结局
Change in LVESV
时间窗: 6 months
Change from baseline in left ventricular end systolic volume (LVESV) post-randomization between the control group and the therapy group.
Freedom from VisONE device-related and procedure-related Major Adverse Respiratory and Cardiovascular Events (MARCE) after the index implantation procedure
时间窗: 12 months
The following Major Respiratory and Cardiovascular Events will be analyzed for their rate and severity and association with the implantable device or procedure: 1. CV Death 2. Stroke 3. Cardiac Arrest 4. Interaction with cardiac rhythm device requiring permanent termination of SDS therapy 5. Acute Heart Failure Decompensation 6. Infection requiring device/lead explant 7. Diaphragmatic dysfunction leading to a clinically significant reduction is respiratory function 8. Inadequate SDS therapy delivery requiring surgical intervention 9. Injury to abdominal organs requiring surgical intervention 10. Pneumothorax 11. Hemothorax 12. Peritonitis
次要结局
- Change in 6MHW distance(6 months)
- Change in MLWHF overall score(6 months)