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A Phase II Trial to Assess Hemodynamic Effects of Istaroxime in Pts With Worsening HF and Reduced LV Systolic Function (HORIZON-HF)

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ClinicalTrials.gov Identifier: NCT00616161
Recruitment Status : Completed
First Posted : February 15, 2008
Last Update Posted : February 15, 2008
MDS Pharma Services
Information provided by:
sigma-tau i.f.r. S.p.A.

Brief Summary:
The purpose of this study is to determine the minimum effective dose of Istaroxime, in patients requiring hospitalization for deterioration of chronic heart failure and left ventricular systolic dysfunction. This goal will be reached by comparing the hemodynamic effect of three different doses of the drug versus placebo. Efficacy will be measured as a change in Pulmonary Capillary Wedge Pressure from pre-infusion to the last assessment at six hours intravenous infusion.Secondary objectives will be to evaluate safety, tolerability and efficacy on other main hemodynamic parameters, echocardiographic and echo-doppler measurements, plus preliminary pharmacokinetics of the drug.

Condition or disease Intervention/treatment Phase
Heart Failure Drug: Istaroxime Drug: Placebo Phase 2

Detailed Description:

Congestive heart failure is one of the most common cardiovascular conditions and it is presently reaching epidemic proportions. The prevalence of chronic heart failure has risen specifically as a result of the increased longevity and longer survival after myocardial infarction. In 2003, over one million hospitalization with a primary diagnosis of heart failure occurred in the United States of America, and a similar number has been reported in Europe, too. At present, approximately 5 million Americans are estimated to suffer of this syndrome and the number is expected to continue to increase with the increase and aging of the population. Despite advances in treatment, the mortality remains high in U.S.A. as in Europe, with nearly three hundred thousands patients dying of CHF as the primary or contributory cause each year.

The total number of hospital admissions approaches 3 million yearly when HF is listed as a primary or secondary diagnosis. Although these patients have a relatively low mortality during the hospitalization (less than 4%), the readmission rates within 60 days of discharge range from 20 to 30% and mortality within 60 days of discharge is 5 - 10%.

The primary aim of acute treatment of worsening CHF is to alleviate the symptoms of congestion and edema, improve the hemodynamic profile, and preserve renal function without causing myocardial injury. Improved hemodynamics usually results in relief of primary symptoms like dyspnea and edema and in a consequent improved sense of wellbeing and mental status. The improvement in hemodynamics may persist after the pharmacological interventions used in the acute phase are withdrawn.

The need in this setting is to decrease the filling pressures (RA pressure and PCWP), increase cardiac output, without increasing the heart rate and inducing/worsening atrial or ventricular arrhythmias. In addition, the agent should improve diastolic function, modulate the exaggerated neurohormonal responses to CHF and preserve/protect the viable but non contractile myocardium (e.g.: the hibernated myocardium). The agent should also facilitate the earlier start of life-saving therapies (e.g. beta - blockers).Pre-clinical data on Istaroxime show that this drug increases contractility without increasing heart rate and oxygen consumption; furthermore it is improving diastolic dysfunction and it not causing vasodilatation.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 120 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase II Study to Assess the Hemodynamic Effects of Istaroxime, a Novel Lusinotropic Agent, in Patients Hospitalized With Worsening Heart Failure and a Reduced Left Ventricular Systolic Function
Study Start Date : August 2006
Actual Primary Completion Date : July 2007
Actual Study Completion Date : August 2007

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Heart Failure

Arm Intervention/treatment
Experimental: 1
Istaroxime dose of 0.5 microgram/kg body weight/minute of iv infusion for six ours
Drug: Istaroxime
0.5 microgram/kg/min IV for 6 hours
Other Name: PST2744

Experimental: 2
Istaroxime dose of 1.0 microgram/kg body weight/minute of iv infusion for six ours
Drug: Istaroxime
1.0 microgram/kg/min IV for 6 hours
Other Name: PST2744

Experimental: 3
Istaroxime dose of 1.5 microgram/kg body weight/minute of iv infusion for six ours
Drug: Istaroxime
1.5 microgram/kg/min IV for 6 hours
Other Name: PST2744

Placebo Comparator: 4
Placebo iv infusion for six ours
Drug: Placebo
Other Name: placebo of PST2744

Primary Outcome Measures :
  1. To determine the minimum effective dose of ISTAROXIME by comparing the hemodynamic effect of 3 different doses of the drug versus placebo. Efficacy will be measured as a change in PCWP from right heart catheterization. [ Time Frame: 6 hours drug infusion ]

Secondary Outcome Measures :
  1. safety, tolerability and efficacy on blood pressure, heart rate, cardiac index, stroke work index, right atrial pressure, systemic and pulmonary vascular resistances, Echocardiographic and Doppler parameters, neurohormonal parameters and renal function. [ Time Frame: 6 and 24 hours after start of infusion ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Signing of a written informed consent form.
  • Male or female patients aged between 18 and 85 years.
  • Negative pregnancy test at screening, for women of childbearing potential.
  • Body weight less or equal to 100 kg.
  • Blood pressure not more than SAP=150 or DAP=90 mmHg.
  • Heart rate in the range of 60-110 bpm
  • Adequate Echo window available.
  • Hospital admission to a monitored bed with a primary diagnosis of worsening of heart failure and LV Ejection Fraction less or equal to 35% documented by 2D-Echocardiogram, or radionuclide angiography or LV angiogram within 6 months prior to screening or at hospitalization.
  • the clinical condition of the patient are stabilized within 48 hours from hospitalization and do not require continuous iv drug treatments
  • no need for additional new oral treatments or any intravenous treatment administration over the following 8 hours is foreseen

Randomisation period inclusion criteria:

  • Any residual sign of heart failure (e.g.: Jugular Venous Distension, and/or Rales and/or Peripheral Oedema) associated with a PCWP more or equal to 20 mmHg,
  • The last three consecutive determinations of PCWP, obtained during the stabilization period, have to be in a maximum range of variability of 10%.

Exclusion Criteria:

  • Ongoing treatment with oral or intravenous inotropes and/or inodilators.
  • Patient treated with digoxin within the last week, can be randomised if the plasma concentration of digoxin are tested before randomisation and its value will be less than 0.5 ng/ml.
  • Intermittent inotropes administration within 2 weeks.
  • Symptoms of Heart Failure at randomization e.g.: dyspnoea
  • Systolic blood pressure < 90 mmHg.
  • Atrial fibrillation within 2 weeks.
  • Left Ventricular Bundle Branch Block
  • Cardiogenic shock or mechanical ventilation.
  • Creatinine level > 3.0 mg/dl or requiring dialysis treatment.
  • Left ventricular failure primarily from uncorrected obstructive valvular disease, hypertrophic obstructive cardiomyopathy, restrictive/obstructive cardiomyopathy, uncorrected thyroid disease, known acute myocarditis, known amyloid cardiomyopathy.
  • Artificial heart valve.
  • Electrical device implanted (ICD, CRT)
  • Evidence of acute coronary syndrome within 3 months.
  • History of stroke or transient ischemic attack in the 6 months prior to screening.
  • History of sustained ventricular tachycardia.
  • Coronary by-pass grafting or PTCA within the last 30 days
  • INR > 1.5.
  • Status post successful cardiac resuscitation.
  • Serum K < 3.5 mEq/l or > 5.3 mEq/l just prior to treatment.
  • ALT, AST > 3 times the upper normal limit just prior to treatment.
  • Hemoglobin < 10 g/dl (either gender) just prior to treatment.
  • Other clinically significant laboratory or medical conditions, which in the opinion of the Investigator make the patient unsuitable for evaluation in the study.
  • Anticipated survival of less than 2 months for concomitant diseases.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00616161

Sponsors and Collaborators
sigma-tau i.f.r. S.p.A.
MDS Pharma Services
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Study Chair: Mihai Gheorghiade, MD FACC Northwestern University Feinberg School of Medicine - Chicago
Principal Investigator: Witold Ruzyllo, MD National Institute of Cardiology, Department of Coronary Artery Disease - Warsaw - POLAND
Principal Investigator: Cezar Macarie, MD Insitutul de Boli Cardiovasculare C.C. Iliescu Bucuresti, Bucharest - ROMANIA
Principal Investigator: Dimitrios Th Kremastinos, MD Second Cardiology Department, Athens University Medical School, University Hospital Attikon, Athens - GREECE
Principal Investigator: Serban I Bubenek-Turconi, MD First Anaesth. & Intensive Care Dept., CC Iliescu Heart Disease Institute, Bucharest - ROMANIA
Principal Investigator: Maria Dorobantu, MD Emergency Hospital "Loreasca", Bucharest - ROMANIA
Principal Investigator: Jerzy Korewicki, MD Institute of Cardiology, Warsaw, Poland
Principal Investigator: Jaroslaw Drodz, MD Hospital bieganskieko , Dept of Cardiology, Lodz - POLAND
Principal Investigator: Piotr Ponikowski, MD Iv Military Hospital, Wroclaw, POLAND
Principal Investigator: John N Nanas, MD PhD Alexandra University Hospital, Athens - GREECE

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Mihai Gheorghiade, MD, FACC Professor of Medicine and Surgery, Associate Chief, Division of Cardiology, Northwestern University, Feinberg School of Medicine - 201 E. Huron - Chicago IL
ClinicalTrials.gov Identifier: NCT00616161    
Other Study ID Numbers: PST2744-DM-04-012
First Posted: February 15, 2008    Key Record Dates
Last Update Posted: February 15, 2008
Last Verified: February 2008
Keywords provided by sigma-tau i.f.r. S.p.A.:
Acute Heart Failure
Lusitropic agents
Additional relevant MeSH terms:
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Heart Failure
Heart Diseases
Cardiovascular Diseases