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Significance of Regional Ventriculo-arterial Coupling in Patients With Chronic Heart Failure (VACHF)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01156207
Recruitment Status : Unknown
Verified June 2010 by Taipei Veterans General Hospital, Taiwan.
Recruitment status was:  Not yet recruiting
First Posted : July 2, 2010
Last Update Posted : July 2, 2010
National Science Council, Taiwan
Information provided by:
Taipei Veterans General Hospital, Taiwan

Brief Summary:

Heart failure is a major health problem worldwide. Optimal treatment of this disabling and fatal condition may require functional characterization of the failed left ventricle (LV) and its interaction with the arterial system. Part of the physiological significance of the ventriculo-arterial coupling has been studied experimentally and clinically using the framework of the ratio of effective arterial elastance (Ea) to end-systolic elastance (Ees), with limited clinical applications.

From central ascending aorta to terminal arterioles, every segment of the arterial tree contributes to the arterial loads that interact and impact LV performance in both systole and diastole, leads to atrial and ventricular remodeling and hypertrophy, and results in the development of heart failure. On the other hand, the ventricular systole is a complex coordination of multi-directional myocardial fibers involving longitudinal contraction, circumferential shortening, radial thickening, twist, and torsion, the so-called LV deformations.

The purposes of the present study are to investigate the relationship between different components of hemodynamic load or arterial abnormalities and different components of LV myocardial deformations or regional LV function, the modulating effects of endothelial progenitor cells (EPCs) on the ventriculo-arterial coupling, and the therapeutic effects of aliskiren on the components of hemodynamic load and LV myocardial deformations and their couplings. The investigators will also investigate whether the ventriculo-arterial coupling, EPCs, and add-on therapy of aliskiren predict cardiovascular outcomes.

Condition or disease Intervention/treatment Phase
Heart Failure Drug: Aliskiren Phase 4

Detailed Description:
In the proposed 3-year project, we hypothesize that the different components of arterial load are coupled with different components of LV function. The regional ventriculo-arterial couplings may be important in the pathogenesis of heart failure and ventricular remodeling, and in the prediction of future cardiovascular events. Therapies targeting these may play a role in the prevention and treatment of heart failure. Therefore, we will study at least 120 patients with chronic heart failure (NYHA Class II-IV) who will randomly receive a direct renin inhibitor, aliskiren, or a placebo for 6 months on top of standard therapy.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 120 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: Significance of Regional Ventriculo-arterial Coupling in Patients With Chronic Heart Failure: Effects of Endothelial Progenitor Cells and a Direct Renin Inhibitor
Study Start Date : July 2010
Estimated Primary Completion Date : July 2013

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Heart Failure
Drug Information available for: Aliskiren

Arm Intervention/treatment
Experimental: Aliskiren Drug: Aliskiren
300mg Aliskiren qd for 6 month

Placebo Comparator: placebo Drug: Aliskiren
300mg Aliskiren qd for 6 month

Primary Outcome Measures :
  1. LV systolic function, the global longitudinal strain [ Time Frame: 1 year ]
    During 1-year treatment, ventricular systolic functions would be measured by using speckle tracking and presented as global longitudinal, circumferential, and radial strain at baseline and at the end of study. The changes of strain would be compared between 2 study groups.

Secondary Outcome Measures :
  1. plasma NT-proBNP level [ Time Frame: 1 year ]
    After 1 year, plasma NT-proBNP will be re-checked. The differences between on-treatment and baseline NT-proBNP levels will be compared between 2 groups.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 90 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Outpatients ≥ 18 years of age, male or female. Female patients must be either post-menopausal for one year, surgically sterile, or using effective contraceptive methods such as oral contraceptives, barrier method with spermicide or an intrauterine device.
  2. Patients with a diagnosis of chronic heart failure (NYHA Class II-IV) and reduced systolic function: LVEF ≤ 45% at Visit 1 (local measurement, measured within the past 6 months assessed by echocardiogram, MUGA, CT scan, MRI or ventricular angiography).
  3. NT-pro BNP ≥ 600pg/ml (BNP ≥ 150 pg/ml) at Visit 1 or NT-pro BNP ≥ 450 pg/mL (BNP (≥ 100 pg/ml) and a hospitalization for HF within last 12 months
  4. Patients must be on a stable dose of either an ACE inhibitor or an ARB for at least 4 weeks prior to Visit 1.
  5. Patients must be treated with a beta blocker, unless contraindicated or not tolerated, at a stable dose for at least 4 weeks prior to Visit 1.
  6. Patients with documented sinus rhythm at Visit 1. -

Exclusion Criteria:

  1. History of hypersensitivity to any of the study drugs.
  2. Patients who require treatment with both ACEI and ARB.
  3. Current acute decompensated HF (exacerbation of chronic HF manifested by signs & symptoms that may require IV therapy).
  4. Symptomatic hypotension and/or less than 100 mmHg at the time of screening or less than 90 mmHg at the time of randomization.
  5. eGFR < 30 ml/min/1.73m2 as measured by the MDRD formula at Visit 1 (screening) , or a > 25% decrease after 14 days of active run-in period.
  6. Serum potassium > 5.0 mmol/L at screening (Visit 1).
  7. Acute coronary syndrome, stroke, transient ischemic attack, cardiac, carotid or major vascular surgery, percutaneous coronary intervention (PCI) or carotid angioplasty, within the past 3 months prior to visit 1.
  8. Coronary or carotid artery disease likely to require surgical or percutaneous intervention within the 6 months after Visit 1.
  9. Patients with active or unstable bronchospasm or asthma (patients must be on stable regimen of respiratory medications for 1 month prior to Visit 1).
  10. Right heart failure due to severe pulmonary disease.
  11. Diagnosis of peripartum or chemotherapy induced cardiomyopathy within the 12 months prior to visit 1.
  12. Patients with a history of heart transplant or who are on a transplant list or with left ventricular assistance device (LVAD device).
  13. Documented ventricular arrhythmia with syncopal episodes within past 3 months, prior to visit 1, that is untreated.
  14. Symptomatic bradycardia or second or third degree heart block without a pacemaker.
  15. Implantation of a CRT (cardiac resynchronization therapy) device within the prior 3 months from visit 1 or intent to implant a CRT device.
  16. Presence of hemodynamically significant mitral and/or aortic valve disease, except mitral regurgitation secondary to left ventricular dilatation.
  17. Presence of other hemodynamically significant obstructive lesions of left ventricular outflow tract, including aortic and sub-aortic stenosis.
  18. Severe primary pulmonary, renal or hepatic disease.
  19. Presence of any other disease with a life expectancy of < 1 year.
  20. Chronic long-term requirement for NSAIDs (high dose) or COX2 inhibitors, with the exception of aspirin at doses used for CV prophylaxis (≤325 mg o.d.).
  21. Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of study drugs
  22. Subjects get pregnant or will be pregnant within 6 months.

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 identifier (NCT number): NCT01156207

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National Taiwan University Hospital Not yet recruiting
Taipei, Taiwan
Principal Investigator: Liang-Yu Lin         
Taipei Veterans General Hospital Not yet recruiting
Taipei, Taiwan
Principal Investigator: Chen-Huan Chen, MD         
Sponsors and Collaborators
Taipei Veterans General Hospital, Taiwan
National Science Council, Taiwan

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Responsible Party: National Taiwan University Hospital Identifier: NCT01156207     History of Changes
Other Study ID Numbers: NSC20110101
201003020MB ( Other Grant/Funding Number: NSC )
First Posted: July 2, 2010    Key Record Dates
Last Update Posted: July 2, 2010
Last Verified: June 2010

Keywords provided by Taipei Veterans General Hospital, Taiwan:
To establish the coupling between components of arterial load ( and components of LV myocardial deformations at baseline and 6 months after randomization.
To establish the role of EPCs on modulation of the components of arterial load and LV myocardial deformations and their coupling.

Additional relevant MeSH terms:
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Heart Failure
Heart Diseases
Cardiovascular Diseases