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Heart Failure and a Preserved Ejection Fraction

This study has been completed.
Sponsor:
Information provided by:
Mayo Clinic
ClinicalTrials.gov Identifier:
NCT00586833
First received: December 21, 2007
Last updated: October 13, 2010
Last verified: October 2010

December 21, 2007
October 13, 2010
April 2007
June 2009   (final data collection date for primary outcome measure)
Contrast resting and exercise-induced changes in vascular stiffness, endothelial function, and afterload in patients with HFpEF to age-matched controls. [ Time Frame: Throughout single visit. ] [ Designated as safety issue: No ]
Same as current
Complete list of historical versions of study NCT00586833 on ClinicalTrials.gov Archive Site
  • Determine how baseline and exercise-induced changes in the vascular parameters measured are related to LV systolic and diastolic functional reserve, cardiac output response, metabolic exercise performance, and changes in pulmonary cap [ Time Frame: Throughout single visit ] [ Designated as safety issue: No ]
  • Determine if vascular and ventricular stiffness properties measured in specific aim 1 are associated with abnormal neurohormonal responses to exercise. [ Time Frame: Immediately pre and post exercise ] [ Designated as safety issue: No ]
Same as current
Not Provided
Not Provided
 
Heart Failure and a Preserved Ejection Fraction
The Role of Vascular Dysfunction in Limiting Cardiovascular Reserve in Patients With Heart Failure and a Preserved Ejection Fraction

This will be a cross sectional study comparing patients with HFpEF and age-matched, non-HF controls recruited from the community. This design will allow for determination of biologically relevant differences in baseline ventricular and vascular function, and importantly, differences in the ability to augment ventricular and vascular function dynamically during exercise stress, when symptoms of HF typically are first noted. The endpoint of exercise-reserve function is novel and has been little examined in the existing HFpEF literature.

Congestive heart failure (HF) is the leading cause of hospitalization among older Americans.1 Approximately half of affected patients have apparently normal systolic function (HF with preserved ejection fraction, HFpEF).2-4 In contrast to HF with low EF, there are no proven treatments for HFpEF, due largely to a lack of mechanistic understanding.4 HFpEF patients are typically older, hypertensive and female,2,3 and each of these characteristics is associated with vascular stiffening and dysfunction.5-7 Diastolic abnormalities may contribute to symptoms of exertional intolerance3,8, but non-cardiac limitations have recently been shown to be equally important.9-11 Patients with HFpEF display impaired decreases in mean vascular resistance in response to exercise, significantly limiting performance,9 yet this represents only one component of ventricular afterload. With aging and particularly in HFpEF, pulsatile load due to vascular stiffening and increased wave reflections becomes more magnified.6,12 The latter can be quantified by pulse wave velocity, arterial compliance and carotid augmentation index. These can be determined noninvasively, and while they have been shown to be abnormal in HFpEF patients at rest10,11, little is known about changes in each during exercise stress, or how this might modulate ventricular performance. Recent evidence indicates that endothelial and autonomic dysfunction are present in HFpEF9, but it is not known how these abnormalities might limit ventricular-vascular function with exercise. The primary objective of this proposal is to compare resting and exercise-induced changes in vascular function in patients with HFpEF and age-matched controls, to determine how these factors may affect exercise performance and cardiovascular reserve function.

Specific Aim 1. Contrast resting and exercise-induced changes in vascular stiffness, endothelial function, and afterload in patients with HFpEF to age-matched controls. Net, mean, and late components of afterload will be assessed by arterial elastance (Ea), systemic vascular resistance (SVR), and central augmentation index (AI). Vascular stiffness will be quantified by pulse wave velocity and total arterial compliance. Stiffness and afterload are dynamically modulated by endothelial and autonomic function, and these responses will be assessed by finger volume plethysmography. Parameters will be measured at rest, during upright cycle ergometry, and immediately post exercise by noninvasive blood pressure, tonometry and comprehensive echo-Doppler examination with tissue Doppler echo (TDE).

Specific Aim 2. Determine how baseline and exercise-induced changes in the vascular parameters measured in specific aim 1 are related to LV systolic and diastolic functional reserve, cardiac output response, metabolic exercise performance, and changes in pulmonary capillary blood volume. LV systolic and diastolic function will be assessed by echo-Doppler and TDE parameters at rest and immediately after peak exercise. Cardiac output response will be determined by the product of echo-Doppler stroke volume and heart rate. Exercise performance will quantified by expired gas analysis. Pulmonary blood volume will be estimated based upon the ratio of diffusion capacity of nitric oxide and carbon monoxide, obtained both at rest and immediately post exercise. Regression analyses will then be performed using the measured components of afterload and vascular stiffness as the independent variable and each of the above parameters as dependent output variables to delineate the role of vascular stiffening on exercise performance, reserve and ventricular-vascular coupling.

Specific Aim 3. Determine if vascular and ventricular stiffness properties measured in specific aim 1 are associated with abnormal neurohormonal responses to exercise. Blood samples will be obtained from HFpEF subjects and controls prior to and immediately after peak exercise to contrast exercise-induced changes in B-type natriuretic peptide levels and cyclic guanosine monophosphate levels.

Observational
Observational Model: Case Control
Time Perspective: Cross-Sectional
Not Provided
Retention:   Samples With DNA
Description:

Blood is drawn to evaluate BNP and cGMP pre and post exercise.

Non-Probability Sample

HFpEF Cases will be recruited from the community. Subjects will be largely drawn from an existing Mayo database examining all incident cases of HF in Olmsted County.3 There are currently >350 pre-identified subjects with HFpEF from this study who may be eligible, which will greatly enrich the recruiting process.

Control Subjects will be recruited from the community. Control subjects will be matched for age and gender to HFpEF subjects, but will have no history of HF hospitalization or significant exertional dyspnea suggestive of "preclinical" HF.

Heart Failure
Procedure: O2 consumption max bike test
Single visit exercise study
Other Names:
  • Standard metabolic stress testing.
  • Pulmonary Capillary Blood Volume.
  • Plasma and Serum Neurohormone levels.
  • Ventricular data determined from echo-Doppler.
  • Vascular data obtained using a radial tonometry device
  • 1
    No CHF/HTN Never diagnosed with CHF and undergoing current treatment for HTN
    Intervention: Procedure: O2 consumption max bike test
  • 2
    CHF with HFpEF HFpEF Cases will be recruited from the community. Subjects will be largely drawn from an existing Mayo database examining all incident cases of HF in Olmsted County.
    Intervention: Procedure: O2 consumption max bike test
  • 3 Healthy normal adults
    No identifiable cardiac issues at time of exercise.
    Intervention: Procedure: O2 consumption max bike test
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
51
June 2009
June 2009   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Consultation by a cardiologist for HF in the past 1 year
  • (HF rigorously defined by the modified Framingham criteria9),
  • able to exercise on a treadmill

Exclusion Criteria:

  • decompensated HF; significant valvular disease; infiltrative, restrictive, or hypertrophic cardiomyopathy; cor pulmonale or significant pulmonary limitation; unstable coronary disease; atrial fibrillation; pregnancy; inability to exercise or suspend vasoactive medicines for at least 24 hours
Both
18 Years and older
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00586833
07-001301, CHF
No
Barry A. Borlaug, MD, Mayo Clinic
Mayo Clinic
Not Provided
Principal Investigator: Barry A. Borlaug, MD Mayo Clinic
Mayo Clinic
October 2010

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP