Pulmonary Artery Denervation for Treatment of Pulmonary Arterial Hypertension (DENERV'AP)
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|ClinicalTrials.gov Identifier: NCT02525926|
Recruitment Status : Terminated (Refusal of CPP to extend the period of inclusion)
First Posted : August 18, 2015
Last Update Posted : January 30, 2019
Pulmonary hypertension is a rare condition that leads to right ventricular dysfunction and premature death. Only modest improvements of outcomes have been observed with the current available advanced specific drug therapy. Pulmonary hypertension advanced therapy is also expensive and leads to frequent adverse effects, sometimes serious. Results from a pilot study, the first-in-man experience of pulmonary artery denervation, demonstrated a clinical improvement in 13 patients with severe pulmonary hypertension despite optimal medical management. However this single non-randomized study requires confirmation.
The investigators propose a prospective multi-center, randomized, single-blinded trial. Its main objective will be to assess, in patients with uncontrolled pulmonary hypertension despite optimal medical management, the efficacy of pulmonary artery denervation in reducing mean pulmonary artery pressure (mPAP) at six months, compared to continued medical treatment following a simulated (sham) procedure.
The principal evaluation criteria will be the mPAP change (in mm Hg) as measured by right heart catheterization.
The study will run for 18 months and it will be necessary to recruit 50 patients.
All adult patients (with the exception of pregnant women and individuals unable to receive an appropriate information and to give their free and informed consent) with uncontrolled pulmonary arterial hypertension despite optimal medical management will be invited to participate, in the absence of any exclusion criteria.
The investigators will also measure changes in clinical, biological, echocardiographic and hemodynamic prognostic markers in both groups.
|Condition or disease||Intervention/treatment||Phase|
|Pulmonary Arterial Hypertension||Procedure: denervation Procedure: sham procedure||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||1 participants|
|Intervention Model:||Parallel Assignment|
|Official Title:||Pulmonary Artery Denervation for Treatment of Pulmonary Arterial Hypertension|
|Actual Study Start Date :||January 2016|
|Actual Primary Completion Date :||March 2017|
|Actual Study Completion Date :||March 2018|
The examination proceeds under rigorous aseptic technique. Femoral, jugular or brachial venous access will be performed. A flexible catheter is first introduced across a 7-Fr venous introducer, and passed through the right heart chambers toward the origin of the pulmonary arteries. The pressures in the right heart chambers and the pulmonary artery will be measured. At the end of the examination, the catheter is removed, a dressing is applied and the venous puncture is compressed by hand.
|Sham Comparator: control group||
Procedure: sham procedure
Right heart catheterism is mandatory in PAH patients care (for diagnosis and during follow-up) and will serve as a " sham " procedure. A usually performed and after a venous punction, cardiac outpout and pulmonary artery pressures will be recorded.
Acoustically isolated headphones will be given to patients during the procedure in order to assure simple-blind during the study.
- Mean pulmonary artery pressure (in mmHg) measured during right heart catheterization [ Time Frame: at 6 month ]
- Mean pulmonary artery pressure (in mmHg) from the initial procedure [ Time Frame: at 3 month ]
- Pulmonary vascular resistance (in Wood units) measured during right cardiac catheterization. [ Time Frame: at 6 month ]
- Clinical parameters: NYHA class [ Time Frame: at 6 month ]
- Clinical parameters: Borg dyspnea rating scale [ Time Frame: at 6 month ]
- Clinical parameters: 6-minute walk test (distance walked in meters), [ Time Frame: at 6 month ]
- Clinical parameters: oxygen dependence (quantity of oxygen in L/min), [ Time Frame: at 6 month ]
- Clinical parameters: ECG with supra ventricular arrhythmia. [ Time Frame: at 6 month ]
- Biological parameters: levels of Brain Natriuretic Peptide (pg/ml) in non-fasting morning samples. [ Time Frame: at 6 month ]
- Biological parameters: levels of troponin Ic (ng/ml) in non-fasting morning samples. [ Time Frame: at 6 month ]
- Echocardiographic parameters of right ventricular function [ Time Frame: at 6 month ]
- Right ventricular diameter at admission (mm) in 4-chamber view
- Right ventricular systolic function: tricuspid annular plane systolic excursion (TAPSE) (mm), peak S-wave velocity at the lateral tricuspid ring (cm/s), Right ventricular fractional area change (%), acceleration (m/s2) and peak isovolumic contraction (cm/s), pulmonary systolic time velocity integral (cm), longitudinal deformation of right ventricular free wall using speckle-tracking imaging (%)
- Right ventricular adaptation: right ventricular Tei-index and presence of pericardial effusion
- Other hemodynamic parameters obtained by right cardiac catheterization [ Time Frame: at 6 month ]
- Cardiac index/output using thermodilution (L/min/m2)
- Right atrial pressure (mmHg)
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): NCT02525926
|CHU de Grenoble|
|Grenoble, France, 38700|
|Marseille, France, 13354|
|CHU de Nice|
|Nice, France, 06000|
|CHU de Toulouse|
|Toulouse, France, 31059|
|¨Paris, France, 75015|