Heart Failure Clinical Trial
The Effect of Inflammation in Heart Failure
Summary
Background:
Heart failure is a serious health condition. Researchers believe inflammation plays a role. They want to see if adding an additional heart drug to a person s treatment can help treat heart failure with preserved ejection fraction (HFpEF).
Objective:
To learn if chronic inflammation is high in heart failure and if taking dapagliflozin along with the standard of care medicines for 6 months will reduce inflammation and improve heart function in people with HFpEF.
Eligibility:
People aged 18 and older who have heart failure and qualify for dapagliflozin therapy. Healthy adult volunteers are also needed.
Design:
Participants will be screened with:
Medical history
Physical exam
Heart function tests
X-ray scans of the heart and blood vessels. They may receive medicines to slow their heart rate or make their heart blood vessels bigger. An intravenous (IV) catheter will be placed in their arm to inject contrast.
Blood and urine tests
Participants will have up to 3 study visits. Some screening tests will be repeated.
Participants will take one tablet of the study drug daily for 6 months.
-Participants will have an imaging scan of their heart and blood vessels. They will receive a contrast and stress medicine through an IV to view blood supply.
Participants will have a stress test that measures exercise ability. They will wear sticky pads on their chest, a blood pressure cuff, and a mask. They will also have a 6-Minute Walk Test.
Participants will complete questionnaires about their symptoms and their health.
Participants may be on the study for up to 6 months. They will have a follow-up phone call 1 month after treatment ends.
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Full Description
Study Description:
Heart failure (HF) remains a significant public health burden. Unlike heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF) currently does not have any effective therapies, suggesting incomplete understanding of the underlying mechanisms of the syndrome. Chronic inflammation has been postulated to be one of the central mechanisms in HFpEF pathogenesis. In this pilot study to be conducted at the NIH Clinical Center, we propose to examine the role of the NLRP3 inflammasome- IL-1 pathway in HFpEF and evaluate whether treatment using the sodium glucose co-transport 2 (SGLT2) inhibitor dapagliflozin can attenuate NLRP3 inflammasome activation.
Objectives:
To test the hypothesis that macrophage NLRP3 inflammasomeactivation is upregulated in subjects with HFpEF compared to healthy controls and that NLRP3 inflammasome activation will be attenuated by dapagliflozin therapy
To test the hypothesis that pro-inflammatory signatures in peripheral blood mononuclear cells (PBMCs) will be increased in HFpEF compared to healthy controls and that they will be attenuated by dapagliflozin therapy
To test the hypothesis that macrophage NLRP3 inflammasome activation associates with perturbances in myocardial perfusion, structure, and function and that attenuation of NLRP3 inflammasome activation with dapagliflozin therapy will associate with improvement in myocardial perfusion, myocardial structure, and function
To test the hypothesis that NLRP3 inflammasome activation is inversely associated with maximum oxygen consumption (VO2max), exercise functional status, and symptoms in HFpEF and that attenuation of NLRP3 inflammasome activation with dapagliflozin therapy will associate with improvement in VO2max, exercise functional status, and symptoms.
Endpoints:
Primary outcome will be:
-IL-1 beta, a measure of NLRP3 inflammasome activation, from macrophages in subjects with HFpEF compared to healthy controls.
Secondary outcomes will be:
Delineation of the differences in PBMC gene expression profiles measured by RNA sequencing and in immunophenotyping signatures measured by flow cytometry in subjects with HFpEF compared to healthy controls. The effect of dapagliflozin on these immunological profiles will also be determined in the HFpEF study subjects.
Myocardial perfusion (on CMR), left ventricular mass (on CMR), diastolic function (on echocardiogram), myocardial mechanics (on echocardiogram and CMR), myocardial edema and inflammation, and interstitial fibrosis (on CMR) in subjects with HFpEF compared to healthy controls and in response to dapagliflozin therapy.
Exploratory outcomes will be:
- VO2max, symptoms and exercise functional status in HFpEF compared to healthy controls and in response to dapagliflozin therapy.
Eligibility Criteria
INCLUSION CRITERIA
Subjects of both genders will be considered for inclusion in this study. There will be no racial, ethnic, or gender discrimination.
Affected Subjects:
18years of age or older
Diagnosed with HFpEF clinically confirmed by licensed physician or advanced practitioner
Signs and symptoms of HFpEF
LVEF >= 50% on echocardiography from screening visit
Left ventricular hypertrophy (interventricular septal thickness (Bullet) 1cm) or enlarged left atrial volume ( (Bullet)34ml/m2) on echocardiography from screening visit
NT-proBNP > 300pg/mL
Healthy Controls:
Females and males 18 years of age or older
EXCLUSION CRITERIA:
Affected Subjects:
Pregnant or lactating women
Acute coronary syndrome, cardiac surgery or percutaneous coronary intervention within past 6 months
Atrial fibrillation
Coronary artery disease with >= 50% stenosis in the left main, left anterior descending artery, left circumflex artery, or right coronary artery on CCTA from screening visit
Infiltrative cardiomyopathy by diagnosis or imaging
-> Moderate valvular stenosis on screening echocardiography
Diagnosis of an inflammatory disease (including psoriasis, psoriatic arthritis, rheumatoid arthritis, lupus, inflammatory bowel disease, HIV)
Currently taking an SGLT2 inhibitor
Estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73m^2 body surface area according to the Modification of Diet in Renal Disease criteria
Subjects with a contraindication to MRI scanning will not receive the CMR assessment.
These contraindications include subjects with the following devices:
i. Central nervous system aneurysm clips
ii. Implanted neural stimulator
iii. Implanted cardiac pacemaker or defibrillator
iv. Cochlear implant
v. Ocular foreign body (e.g. metal shavings)
vi. Implanted Insulin pump
vii. Metal shrapnel or bullet
History of seizures or taking anti-epileptic medications
History of serious hypersensitivity to dapagliflozin
History of diabetic ketoacidosis
Inability to provide informed consent
Healthy Controls:
History of HF
Acute coronary syndrome, cardiac surgery or percutaneous coronary intervention within past 6 months
Coronary artery disease with >= 50% stenosis in the left main, left anterior descending artery, left circumflex artery, or right coronary artery on CCTA
Diagnosis of an inflammatory disease (including psoriasis, psoriatic arthritis, rheumatoid arthritis, lupus, inflammatory bowel disease, HIV)
Estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73m^2 body surface area according to the Modification of Diet in Renal Disease criteria
Pregnant women and lactating women
Subjects with a contraindication to MRI scanning will not receive the CMR assessment.
These contraindications include subjects with the following devices:
viii. Central nervous system aneurysm clips
ix. Implanted neural stimulator
x. Implanted cardiac pacemaker or defibrillator
xi. Cochlear implant
xii. Ocular foreign body (e.g. metal shavings)
xiii. Implanted Insulin pump
xiv. Metal shrapnel or bullet
History of seizures or taking anti-epileptic medications
Inability to provide informed consent
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There is 1 Location for this study
Bethesda Maryland, 20892, United States
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