CMR to Assess Fibrosis in Cardiomyopathy Using Eplerenone

The recruitment status of this study is unknown because the information has not been verified recently.
Verified December 2008 by Royal Brompton & Harefield NHS Foundation Trust.
Recruitment status was  Recruiting
Sponsor:
Information provided by:
Royal Brompton & Harefield NHS Foundation Trust
ClinicalTrials.gov Identifier:
NCT00401856
First received: November 20, 2006
Last updated: December 10, 2008
Last verified: December 2008
  Purpose

The aim of this study is to determine if therapy with the aldosterone antagonist, Eplerenone, is associated with improved remodeling of the left ventricle in patients with cardiomyopathy. We will determine if any benefit to cardiac remodeling is associated with improved clinical outcomes, including improved exercise capacity and reduced incidence of major adverse cardiac events such as death, hospitalization for heart-failure, serious heart rhythm disturbances and transplantation.

The null hypothesis is that therapy with Eplerenone over 12 months is associated with an improvement in cardiopulmonary exercise capacity and furthermore that treatment is associated with improved clinical outcomes.

In order to test this hypothesis we will study stable patients on optimal drug therapy with documented cardiomyopathy using a trial design where therapy will be randomized, double-blinded and placebo-controlled. This will reduce the likelihood of any 'researcher bias'. Patients will be recruited from the Heart-failure Service at the Royal Brompton Hospital.


Condition Intervention Phase
Cardiomyopathy
Drug: Eplerenone
Drug: Placebo
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: A Randomised, Double-Blinded, Placebo-Controlled Trial Using Cardiovascular Magnetic Resonance (CMR) Scanning to Assess Remodelling and Regression of Fibrosis in Cardiomyopathy With Eplerenone

Resource links provided by NLM:


Further study details as provided by Royal Brompton & Harefield NHS Foundation Trust:

Primary Outcome Measures:
  • Improvement in MVO2 [ Time Frame: 6 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Reduction in major adverse cardiovascular events [ Time Frame: 6 months ] [ Designated as safety issue: No ]

Estimated Enrollment: 140
Study Start Date: December 2007
Estimated Study Completion Date: July 2010
Estimated Primary Completion Date: December 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
This arm will receive eplerenone
Drug: Eplerenone
50mg oral route
Placebo Comparator: 2
This group will receive the placebo
Drug: Placebo
Placebo is identical to eplerenone but the active ingredient is absent

Detailed Description:

Our aim is to recruit 140 patients (based on statistical power calculation in). These patients will be recruited from the cardiology clinics at The Royal Brompton Hospital as well as from a database of patients who have previously undergone imaging.

The study will be a double-blinded, placebo-controlled randomized study. The recruited patients would have had an established diagnosis of cardiomyopathy as documented by the history, examination and characteristic echocardiographic + ECG findings. The patients would also have had a CMR scan demonstrating late gadolinium hyperenhancement previously. These patients will have been established on maximally tolerated doses of standard drugs used in the treatment of cardiomyopathy (including ACE inhibitors and beta blockers as appropriate) and the doses of these drugs would have remained unchanged in the 2 months preceding enrollment to the trial. Patients would be randomized to receive a maximal dose of 50mg eplerenone or placebo. The study dose of Eplerenone to be used will be initially 25mg once daily (one tablet). After 4 weeks, provided it has been well tolerated with no problems the dose will be increased to the usual maintenance dose of 50mg once daily (two tablets). For patients receiving placebo, the number of tablets received will match the Eplerenone group at the same time points.

Baseline tests will include CMR evaluation of ventricular function using a magnetic field strength of 1.5 Tesla (T). The initial scan will assess ventricular size and function and LV mass. Blood tests will be taken prior to the scan (at the time of intravenous cannulation) for urea and electrolytes, liver function, cytokines, and collagen markers. In addition, echocardiograms, 24 hour Holter monitors will be fitted and metabolic exercise tests (MVO2) will be performed as part of the cardiac assessment at baseline, 6 and 12 months.

The findings of the initial scans and tests will be correlated with base line parameters and also prospectively compared with the occurrence of events over 6 and 12 month time periods. During the follow up period all events including death, cardiac arrest, cardiac transplantation, arrhythmic events, implantation of implantable cardiac defibrillators/biventricular pacemakers, NYHA classification, escalation of treatment and hospitalization will be recorded. There will be regular clinical reviews at 1 week, 2 weeks, 4 weeks and then at 3, 6, 9 and 12 months during the study period at which point blood tests will be taken including a check of renal function to look for evidence of hyperkalaemia and renal failure which may be a result of treatment with eplerenone. Other reported adverse effects and any withdrawals from the trial as a direct result of these effects will also be recorded. After the treatment/placebo has been stopped we will contact all patients within one week by telephone to ensure that there has been no deterioration in symptoms and will review all patients within four weeks for a post-treatment follow up visit to monitor their blood-pressure, kidney function and ensure that there has been no evidence of problems.

Patients will also be asked to complete a Minnesota Living with Heart Failure (MLWHF) Questionnaire at baseline visit and again during the 6 and 12 month visits.

It is hoped that the study will reveal that patients with cardiomyopathy who are treated with eplerenone will have evidence of regression of fibrosis with a concomitant improvement in diastolic function as demonstrated by CMR scanning, as well as in clinical outcomes by Holter and metabolic exercise testing and markers of collagen turnover.

  Eligibility

Ages Eligible for Study:   16 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Stable patients with an established diagnosis of cardiomyopathy as assessed by history, examination and typical ECG/Echo findings who are on maximally tolerated doses of appropriate drugs with no changes being made to the prescription in the 2 months preceding the start of the trial.

Exclusion Criteria:

  • Patients already established on treatment with an aldosterone antagonist
  • Patients with contraindications to eplerenone (hyperkalaemia, renal failure)
  • Critically ill patients requiring respiratory and/or circulatory support
  • Pacemaker or ICD
  • Implanted ferromagnetic cerebrovascular clips
  • Pregnant women (precautionary only)
  • Intolerance of confined spaces
  • Inability to lie supine for 60 minutes
  • Unwilling or unable to give written informed consent
  • Atrial fibrillation or ventricular bigemini.
  • Any contraindication to CMR.
  • Recent MI
  • HCM patients who have received surgical/alcohol ablation treatment
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00401856

Contacts
Contact: Sanjay Prasad, MD MRCP 020 7351 8812 s.prasad@rbht.nhs.uk

Locations
United Kingdom
Royal Brompton & Harefield NHS Trust Recruiting
London, United Kingdom, SW3 6NP
Contact: Sanjay Prasad, MD, MRCP         
Sub-Investigator: Dudley Pennell, MD FRCP FESC         
Sub-Investigator: Rory O'Hanlon, MRCPI         
Sub-Investigator: Martin Cowie, MD, MSc FRCP         
Sponsors and Collaborators
Royal Brompton & Harefield NHS Foundation Trust
Investigators
Principal Investigator: Sanjay Prasad, MD, MRCP Royal Brompton & Harefield NHS Foundation Trust
  More Information

No publications provided

Responsible Party: Wendy Butcher, Royal Brompton & Harefield NHS Trust
ClinicalTrials.gov Identifier: NCT00401856     History of Changes
Other Study ID Numbers: 2004CD006B, Eudract 2004-002494-23
Study First Received: November 20, 2006
Last Updated: December 10, 2008
Health Authority: United Kingdom: National Health Service

Keywords provided by Royal Brompton & Harefield NHS Foundation Trust:
Cardiomyopathy
Fibrosis
Magnetic-Resonance
Eplerenone

Additional relevant MeSH terms:
Fibrosis
Cardiomyopathies
Pathologic Processes
Heart Diseases
Cardiovascular Diseases
Eplerenone
Mineralocorticoid Receptor Antagonists
Hormone Antagonists
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Pharmacologic Actions
Diuretics, Potassium Sparing
Diuretics
Natriuretic Agents
Cardiovascular Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on October 19, 2014